Health-related quality of life in caregivers of community-dwelling individuals with disabilities or chronic conditions. A gender-differentiated analysis in a cross-sectional study

Family-based interventions in improving caregivers' psychological-related outcomes: A systematic literature review

ObjectivesThis review aims to identify the content of family-based interventions that are commonly used for primary caregivers of people diagnosed with chronic illness. In addition, the psychological-related outcome measures of the FAMIs will be examined.MethodsPRISMA was adopted for the review process. We searched CINAHL, Scopus, and Web of Science databases for studies that implemented a family-based intervention for family caregivers of patients with chronic illness. We reviewed articles published between January 2000 and January 2021. Two independent reviewers, multiple researcher triangulation, and peer review were employed to ensure the validity and reliability of the data.ResultsWe included 11 studies in this systematic literature review. In total, seven themes emerged under the content of family-based intervention consisting of family elements, skills, information, activities, positive psychology, recovery, and roles and responsibility. The psychological related outcome measures of the intervention include recovery, patient care management, skills improvement, emotional management, family relationships, and self-functioning.DiscussionThe aspect of family functioning may help the family caregivers to empower themselves and build up their inner strength to face unexpected situations. The results highlighted the importance of the involvement of the experts in family therapy in helping family caregivers. Cultural implications were also highlighted.

Deterioration of health-related quality of life: the hidden health burden of informal caregiving

Informal caregiving is physically and mentally demanding and may lead to poor health and impaired well-being. We aim to check the effects of informal caregiving on health-related quality of life (HRQoL). We utilised longitudinal data from the most recent sixteen waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. We measured HRQoL through the physical component summary (PCS), the mental component summary (MCS), the short-form six-dimension (SF-6D) utility index, and the eight dimensions of the SF-36 health survey. The primary exposure variable is informal caregiving. The variable was categorised into not a caregiver, lighter (< 5 hours [h]/week), moderate (5-19 h/week), and intensive (≥ 20 h/week) caregiving based on the hours of providing informal care per week. We have found that informal caregiving negatively affects HRQoL. We found that moderate (β = -0.0035, standard error [SE] = 0.0012) and intensive caregiving (β = -0.0074, SE = 0.0020) reduced SF-6D utility value. We also found that lighter (β = -0.29, SE = 0.07), moderate (β = -0.55, SE = 0.12), and intensive (β = -1.53, SE = 0.19) caregiving lowered MCS scores. Moreover, our results revealed that lighter, moderate and intensive caregiving decreases the scores of mental health-related dimensions (e.g., role emotional, social functioning, and mental health) of the SF-36 health survey. Our study findings have significant policy implications for improving the HRQoL and well-being of caregivers. To effectively support the health and well-being of informal carers, it is crucial to implement strategies that address their diverse needs, including supporting work-life balance, providing financial assistance and social security measures, ensuring access to community-based services, providing access to relevant information and training, and offering respite care options.

Caregivers' Perceived Threat Of Sickle Cell Disease Complications And Its Association With Hydroxyurea Use Among Children With Sickle Cell Disease In Dar Es Salaam, Tanzania

Purpose

Tanzania is the fifth country with the highest sickle cell disease (SCD) prevalence globally. Although hydroxyurea (HU) is available, only 25% of persons with SCD are reported to use it in Tanzania. Perceived disease threat is associated with medication usage in patients with chronic diseases. We assessed the factors associated with caregivers' perceived threat of SCD complications and its relationship with HU use among children with SCD in Dar-es-Salaam.

Methods

We conducted a cross-sectional hospital-based study from May to August 2023. We enrolled 374 caregivers of health-insured children with SCD from 4 public SCD clinics. We adapted the modified original and revised Champion's Health Belief Model Scales to derive perceived threat scores. We used Mann-Whitney and Kruskal-Wallis tests to compare the outcomes across sociodemographic characteristics and regression analysis for factors associated with perceived SCD threat.

Results

The median score (InterQuartile Range) for perceived threat of SCD complications was 559 (175, 598). Sixty-one percent of caregivers had a high SCD perceived threat. The caregivers of under-five children had 141 lower median SCD threat scores than those of children aged 13-17 years, p-value < 0.001. Participants from Regional Referral Hospitals (RRH) had lower median threat scores compared to participants attending Muhimbili National Hospital (MNH), 177 for Amana RRH, 325 Temeke RRH, 585 MNH Mloganzila, and 557 MNH Upanga, p-value <0.001. Children of caregivers with high perceived SCD threat were 3.4 times more likely to use HU compared to those with low SCD threat perception (Incidence Rate Ratio 3.4, 95% CI: 2.7-4.5).

Conclusion

The perceived threat of SCD predicts the likelihood of SCD patients using HU in Dar-es-Salaam, Tanzania. We recommend health education to caregivers aiming to improve their SCD threat perception and thus improve the use of HU among children with SCD in similar settings.

Time for Care: Male and Female Voices Based on Their Caregiving Experiences

Background/Objectives: To understand the lived experiences of the informal caregivers of people with chronic noncommunicable diseases and their interpretations of the significance of that care. The perspectives of men and women interacting with people in a situation of chronicity are examined. Methods: This qualitative, phenomenological, hermeneutic study was based on Van Manen's comprehensive and interpretative vision. Criterion-oriented non-probability random sampling was used. In-depth interviews were used to collect the information. Twenty informal caregivers participated in the study. Results: The following five themes emerged: transformation of the caregiver's world; uncertainty of care; tireless guardianship and unwavering devotion; isolation and emotional exhaustion; and imbalance between caring for others and the self. Conclusions: The experience of informal caregivers reveals that both men and women face significant challenges, albeit from gender-differentiated perspectives and experiences. Men and women elaborate different meanings of caregiving, reflecting their gender roles and expectations. Therefore, an inclusive and equitable approach that recognizes and addresses these gender differences is essential in order to improve the support and quality of life for all informal caregivers, respecting and valuing their unique voices and experiences. An inclusive and equitable approach that recognizes gender intersections is required to improve support and the quality of life for informal caregivers.

Parental emotions in families of children and adolescents with and without autism spectrum disorder

This study assessed the influence of sociodemographic conditions, oral hygiene habits, and the socio-psychological need for orthodontic treatment on the emotions of caregivers of children with and without autism spectrum disorder (ASD). We conducted a comparative cross-sectional study with families of individuals aged 6 to 14 years at a reference center for neurodevelopmental disorders and two dental school clinics in northeastern Brazil. Caregiver emotions were assessed using the 'Parental Emotions' domain of the Family Impact Scale (FIS). We analyzed sociodemographic variables, oral hygiene habits, and sociopsychological need for orthodontic treatment using the esthetic component of the Index of Orthodontic Treatment Need (IOTN). We used descriptive and hierarchical Poisson regression analyses with robust variance (α = 5%). The study included 144 families evenly distributed across the groups. The caregiver group with ASD demonstrated a higher total score for parental emotions (p < 0.001). Factors associated with this factor included caregiver responsible for brushing (PR = 1.34; 95%CI: 1.12-1.59), mandatory need for orthodontic treatment (PR = 1.25; 95%CI: 1.07-1.46), and caregivers' education up to 8 years (PR = 1.45; 95%CI: 1.02-2.07). Caregivers with lower income showed a lower prevalence of parental emotions (PR = 0.57; 95%CI: 0.35-0.93). Caregivers of children with ASD exhibited a higher emotional burden. Factors associated with parental emotions included responsibility for tooth brushing attributed to caregivers, sociopsychological need for orthodontic treatment, and family income.

Mood states and well-being of spouses of fibromyalgia patients: a systematic review and meta-analysis

Background

We carried out a systematic review of the medical literature on potential effects of caregiving on the health and well being of spouses of Fibromyalgia (FM) patients and pooled the results in a meta-analysis.

Methods

The review is comprised of original studies that examined the mood states and well-being of husbands/wives, or long-term intimate partners, of FM patients. The authors searched the PubMed, Scopus, APA PsycNet and Web of Science databases using the key words "fibromyalgia and spouses," "fibromyalgia and partners," and "fibromyalgia and husbands." Of 570 papers that were initially identified using the search words, 18 papers were considered eligible. We used the Joanna Briggs Institute Critical Appraisal Checklist (JBICAC) and Critical Appraisal Skills Program (CASP) tools to assess the risk of bias in the analytical cross-sectional and qualitative studies, respectively.

Results

The overall score in mood states was significantly higher among spouses of FM patients than among spouses of individuals without FM (SMD [95% CI] = 0.52 [0.30; 0.74]). The strongest evidence was found for depression, SMD [95% CI] = 0.68 [0.33; 1.03]. The overall standardized score of quality of life was significantly lower among spouses of FM patients, SMD [95% CI] = -0.59 [-0.79; -0.38], with significant differences in physical function and role, emotional role, and mental health subscales.

Limitation

Limitation of this review is the scant number of studies that addressed several health domains, which made it impossible to carry out meta-analyses in these domains.

Conclusion

Spouses of FM patients show the emotional and physical consequences of caregiving, and impaired quality of life. Addressing these problems can prevent deterioration of their health and improve their quality of life.

Family Caregivers' Experiences during the COVID-19 Pandemic: Qualitative Study

Background: The COVID-19 pandemic imposed lockdown measures that affected caregiving. Understanding caregivers' context provides reveals their adaptive strategies to continue caring in this situation of uncertainty and isolation. Objective: To better understand the caregiving experiences of caregivers looking after dependent individuals living in the community during the pandemic. Design: Qualitative research, phenomenological approach. Setting: Primary healthcare centers in Madrid region (Spain). Participants: 21 family caregivers. Methods: Purposive and theoretical sampling was used to recruit caregivers across nurses from primary healthcare centers. Participants were interviewed using a semi-structured interview guide to explore the caring experience. Interview transcripts were evaluated using thematic analysis. Results: The findings were categorized into two themes: "Caregivers during lockdown-providing care in a time of adversity" and "Caregiving toward normality". The sub-themes identified were the re-structuring of before-care services and the introduction of new care approaches, managing the dependent person's health problems, looking after oneself, and dealing with adversity. To adapt to the new normal, strategies were put in place designed to recover confidence and trust, reincorporate assistance, and reconnect with others. Conclusions: Care intensified during the pandemic. Caregivers took on the task without assistance, focusing on preventing contagion and protecting themselves to be able to continue giving care.

Global Research on Care-Related Burden and Quality of Life of Informal Caregivers for Older Adults: A Bibliometric Analysis

As global populations continue to undergo demographic aging, the role of caregivers in providing essential support and assistance to older adults has become increasingly prominent. This demographic shift has led to a growing reliance on informal caregivers, often family members, who take on the responsibilities of caring for older adults. This not only affects immediate family dynamics but also holds broader implications for societal sustainability. The primary objective of this bibliometric analysis is to comprehensively examine the worldwide research output related to the quality of life and caregiver burden among individuals providing care to older adults. By understanding the worldwide research output related to caregivers and their quality of life and burden, we can assess the long-term sustainability of caregiving practices. We retrieved studies with titles containing the terms “caregivers”, “burden”, “quality of life”, and “aged” from the Web of Science (WOS) database. The collected publications were then subjected to analysis using the “bibliometric” package in the R programming environment. A total of 44 publications from 2006–2023 were included in the analysis. Spain emerged as the leading contributor in terms of the number of publications, accounting for 21.9%, followed by the USA at 16.5% and China at 13.6%. The most prolific institution was Kaohsiung Medical University, Taiwan, responsible for 25% of the publications. Among the authors, Cura-Gonzalez I.D. had the highest number of articles, contributing four publications, or 9.1% of the total output. An analysis of co-occurring keywords revealed that the predominant focus of the research revolved around caregiver burden, quality of life, health, care, stress, and impact, reflecting enduring areas of interest within this field. This bibliometric analysis may serve as a tool to provide insights into the current state of research on caregiver burden and quality of life among those caring for older adults. The results of this study can contribute to the assessment of research strategies and the encouragement of global cooperation in the field of care for older adults. By considering the multidimensional nature of caregiving challenges and promoting international cooperation, strides can be made towards sustainable caregiving practices that ensure the wellbeing of both caregivers and the aging population, thus safeguarding the sustainability of healthcare systems worldwide.

Examining the relationship between health literacy and quality of life: evidence from older people admitted to the hospital

INTRODUCTION

Literacy has become an increasingly serious problem, especially as it relates to health care. In this regard, health literacy (HL), as a cognitive skill, has proven to be an influential factor to improve of the quality of life (QOL). This study aimed to examine the level of HL and its relationship with the QOL of older people at the time of discharge from the hospital in the south of Iran.

METHODS

This descriptive-analytical cross-sectional study included 300 older people admitted and treated in 10 teaching-therapeutic hospitals affiliated with the Shiraz University of Medical Sciences in 2021. The standard Health Literacy for Iranian Adults (HELIA) questionnaire and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) were used to collect the required data. Data were analyzed with SPSS software version 23 software using descriptive and inferential statistics, Pearson's correlation coefficient, T-test, ANOVA, and multiple linear regression at p = 0.05.

RESULTS

The mean scores of Hl and QOL for older people were 48.22 ± 9.63 (out of 100) and 61.59 ± 12.43 (out of 120), respectively. Moreover, there was a significant direct correlation between the participants' HL and their QOL (r=0.388, p<0.001). All dimensions of HL, including comprehension (β=0.461, p<0.001), decision-making and behavior (β=0.434, p<0.001), access (β=0.397, p<0.001), reading skill (β=0.362, p=0.002), and assessment (β=0.278, p=0.004), were significant relationship with QOL. A statistically significant difference was revealed between the mean scores of HL regarding the participants' gender (p=0.04) and level of education (p=0.001). Furthermore, the mean scores of QOL were significantly different with regard to older people's gender (p=0.02), marital status (p=0.03), level of education (p=0.002), and income (p=0.01).

CONCLUSION

The findings revealed the participants' inadequate HL and average QOL. Considering the relationship of HL with QOL, it is recommended to develop comprehensive programs and effective interventions to develop HL skills and subsequently improve QOL among older people.

Interrupting Biases in the Experience and Management of Pain Nurses can help address challenges faced by racially and ethnically diverse patients and caregivers

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series provide practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Booker, S.Q., et al. Interrupting Biases in the Experience and Management of Pain. Am J Nurs 2022; 122(9): 48-54.

Does caring for others affect our mental health? Evidence from the COVID-19 pandemic

Despite a growing literature about the mental health effects of COVID-19, less is known about the psychological costs of providing informal care during the pandemic. We examined longitudinal data from the UK's Understanding Society Survey, including eight COVID surveys, to estimate fixed effects difference-in-differences models combined with matching, to explore the causal effects of COVID-19 among informal carers. While matching accounts for selection on observables into caregiving, multiple period difference-in-differences specifications allow investigation of heterogeneous mental health effects of COVID-19 by timing and duration of informal care. The estimates suggest that while mental health fluctuated following the imposition of social restrictions, informal carers who started caregiving during the pandemic show the largest mental health deterioration, especially during lockdowns. Policies to mitigate the psychological burden of caregiving might be more effective if targeted at those starting to provide care for the first time.

Competencia del cuidar y sobrecarga del cuidador de la persona con enfermedad crónica hospitalizada

Objetivo: Describir la competencia del cuidar y su asociación con la sobrecarga del cuidador familiar de la persona con enfermedad crónica. Método: Estudio cuantitativo descriptivo, transversal, muestreo por conveniencia. Se aplicó la ficha de caracterización de la díada, Instrumento CUIDAR y Zarit. 102 cuidadores de personas con enfermedades crónicas en las áreas hospitalarias, que cumplían los criterios de inclusión. Resultados: Predominan las mujeres como cuidadores, nivel de escolaridad bajo, sobrecarga en un 56,8%, alto nivel de competencia para cuidar 68,6%. Relación estadísticamente significativa con la variable sobrecarga y la calificación global de la competencia CUIDAR así como con sus dimensiones: Conocimiento, Unicidad, Anticipación. Conclusión: La competencia de cuidar se asocia con la sobrecarga del cuidador de personas con enfermedad crónica no transmisible. Por lo tanto, Enfermería tiene la responsabilidad de identificar las necesidades del cuidador e intervenirlas para contribuir en la transición hacia el rol de cuidador en el egreso del paciente al hogar. 

Advantages and Limitations in the Evaluation of the Neurological and Functional Deficit in Patients with Spinal Cord Injuries

(1) Background: Vertebro-medullary trauma (VMT) causes osteo-articular injuries in a varied anatomical lesion associated with multiple clinical manifestations and therapeutic indications. The neurological evaluation of patients who have suffered a spinal cord injury (SCI) is costly in testing the motor and sensory function. To standardize the assessment, several scales are used that measure the neurological deficit in order to guide subsequent treatment according to complete or incomplete SCI. The aim of this study is to identify and present the relevant tools for assessing SCI. (2) Methods: Relevant SCI studies were used for a fact-finding investigation from a rational and critical perspective of this field of research. The relationship between clinical tools and those with a psychosocial component was assessed based on studies reported in the literature. (3) Results: SCI severity scales have been proposed throughout to be able to estimate the functional prognosis of victims of these traumatic events. These tools can be divided into scales for assessing the neurological deficit due to trauma, and functional scales that assess the ability to perform daily activities, self-care, etc. (4) Conclusions: The closest scale to the need for standardization and the most accurate assessment of neurological deficits secondary to SCI is ASIA/IMSOP.

Depression Associated with Caregiver Quality of Life in Post-COVID-19 Patients in Two Regions of Peru

Due to COVID-19, the workload experienced by caregivers has increased markedly which has led them to experience fatigue, anxiety and depression. This study aims to determine the relationship between quality of life and depression in caregivers of post-COVID-19 patients in two regions of Peru. In a cross-sectional analytical study, the sample was non-probabilistic and by snowball, and consisted of 730 caregivers, to whom the questionnaires "Modified Betty Ferell Quality of Life" and the "Beck Depression Inventory" were applied. It was determined that being a male caregiver (OR: 2.119; 95% CI: 1.332-3.369) was associated with a good quality of life. On the other hand, caregivers who had children (OR: 0.391; 95% CI: 0.227-0.675), were vaccinated against COVID-19 (OR: 0.432; 95% CI: 0.250-0.744), were immediate family members (OR: 0.298; 95% CI: 0.117-0.761) and had high depression (OR: 0.189; 95% CI: 0.073-0.490) were associated with poor quality of life. The results of this study allow us to conclude the association between depression and poor quality of life in caregivers of these patients so it is necessary to monitor the mental health of caregivers, and to develop adaptation strategies to pandemic conditions.