Changes in Health Outcomes among Older Husband Caregivers: A One-Year Longitudinal Study

Potential Harmful Behavior Toward Older Family Members: Applying a Double-ABCX Model to Examine Problematic Family Caregiving

Grounded in Lin and Giles' communication model of elder abuse and neglect and McCubbin and Patterson's double-ABCX model of family stress, this study examined whether caregiver self-efficacy and perceptions of positive caregiving outcomes predicted caregivers' lowered tendency to engage in potential harmful behaviors (PHB) toward care receiver directly or indirectly through lowered reports of care receivers' problem behaviors and negative coping strategy (i.e., communication neglect coupled with expressed anger). These expectations were tested through structural equation modeling of survey responses of 339 family caregivers in the U.S. Model results identified "negative coping strategy" as a strong mediating variable for the effects of reports of care receivers' problem behaviors on PHB. A serial mediation path from higher caregiver self-efficacy to lowered reports of care receivers' problem behavior, to reduced use of "negative coping strategy" and finally to reduced PHB was significant. Perceptions of positive caregiving outcomes did not yield similar results.

Influence of spousal caregiving and living arrangement on depression among husband caregivers in rural China

OBJECTIVES

With sociodemographic changes, men are increasingly taking responsibility for spousal caregiving. Previous studies have described gender differences in the psychological outcomes of caregiving; however, few have focused exclusively on husband caregivers. This study investigates the influence of starting spousal caregiving on the psychological well-being of older husbands in rural areas and examines whether living arrangements can moderate this relationship.

METHODS

A total of 1,167 baseline non-caregiver husbands aged 60 and above in rural areas were taken from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS). The generalized estimating equation (GEE) was employed to examine the effects of spousal caregiving transitions and living arrangement changes on depressive symptoms over four years.

RESULTS

Compared with rural husbands who remained non-caregivers, those transitioning into activities of daily living (ADL) caregiving reported higher depressive symptoms at follow-up (B = 1.67, p < 0.05). Moreover, the increase in depressive symptoms when transitioning into ADL caregiving was significantly lower among participants who changed from living with spouse alone to living with spouse and other family members together (B = - 5.37, p < 0.05).

CONCLUSION

There was an association between transitioning into ADL caregiving and an elevated level of depression over four years among older husbands, which could be alleviated by living with family members. Co-residence with family members could serve as a natural support resource, buffering adverse mental health outcomes when older husbands start a demanding caregiving role.

Family caregiving of older Chinese people with dementia: testing a model

BACKGROUND

The process of taking care of older people with dementia at home is complex and influenced by cultural factors, necessitating a better understanding of the interrelationships of factors within the context of culture.

OBJECTIVES

The aim of this study was to test the proposed Dementia Caregiving Model, specifying how caregiving appraisal, coping, perceived social support, and familism influence the impact of caregiving stressors on the psychological health of caregivers.

METHODS

A cross-sectional correlational design with a convenience sample (n = 96) from three outpatient clinics of hospitals in China was used. Questionnaires were utilized to measure the variables in the model. Path analysis was used to assess model fit and paths.

RESULTS

The original proposed model did not fit the data, butminor modifications produced a very good model fit (χ(10, n = 96) = 8.14, p = .62; goodness-of-fit index = .98, comparative fit index = 1.00, and root mean square error of approximation < .001). Care recipients' behavioral problems had direct and indirect negative effects on caregivers' psychological health. Perceived social support had direct and indirect positive effects on caregivers' psychological health. Familism had indirect positive effects on caregivers' psychological health in relation with caregiving satisfaction and coping. Caregiving appraisal and coping were mediators in the model.

CONCLUSIONS

The model findings lend support that caregivers' cognitive appraisal and coping explain some observed individual differences in stress response and outcomes. The findings broaden understanding of the effects of familism on caregivers' psychological health. In the future, programs should include interventions for caregivers, as well as interventions for care recipients.

A psycho-educational intervention focused on communication for caregivers of a family member in the early stage of Alzheimer’s disease: Results of an experimental study

A psycho-educational intervention focused on communication was conceived for caregivers of family members in the early stage of Alzheimer’s disease (i.e., persons with dementia), and tested on five proximal outcome variables: caregiver knowledge, perceptions of communication difficulties and degree of perceived disturbance related to these difficulties, self-efficacy and skills. Guided by a theoretical framework that encompassed geragogy, the McGill model of nursing and self-efficacy theory, the intervention was evaluated via an experimental design with pre-post tests. Fifty family caregivers were randomly assigned to an experimental group (intervention program), or to a control group (information flier on communication and memory). Statistically significant effects were found on four dependent variables: caregiver knowledge, degree of disturbance related to communication difficulties, self-efficacy and skills. No significant effects were observed in regard to the perceived presence of communication difficulties. This communication program serves as a useful tool to prepare caregivers for their new role.

Challenges associated with transition to caregiver role following diagnostic disclosure of Alzheimer disease: a descriptive study

BACKGROUND

The prevalence of Alzheimer's disease is rising. The large number of new cases identified each year means that many new families will set upon a long trajectory of caring for a relative with dementia. Diagnostic disclosure of Alzheimer's disease marks the official transition to the caregiver role, yet this early period of the caregiver career have rarely been studied.

OBJECTIVES

Based on Meleis's theoretical framework for role transition, the objectives of this study were to document the characteristics of the caregiving context during the transition to the caregiver role following diagnostic disclosure of Alzheimer's disease and to compare these characteristics by caregiver gender and kinship tie to the relative.

DESIGN SETTINGS AND PARTICIPANTS

A descriptive design was used. Data were collected using standardized measures selected in accordance with the role transition theoretical framework. The sample recruited in Quebec (Canada) cognition clinics comprised 122 caregivers of an elderly relative diagnosed with Alzheimer's disease in the past nine months.

RESULTS

Findings reveal the context of care to be marked by several challenges for caregivers. The majority of caregivers receives little informal support, has poor knowledge of available formal services, and has difficulty planning ahead for the relative's future care needs. Caregivers themselves report a lack of preparedness to provide care. Compared with men caregivers, women seem to have more problems controlling disturbing thoughts about their new caregiver role and to experience more family conflicts and psychological distress. Compared with offspring caregivers, spouse caregivers are less able to respond to the relative's disruptive behaviors, make less use of problem-solving strategies, and report fewer family conflicts.

CONCLUSIONS

The challenges faced by caregivers during the transition to the caregiver role are sensitive to nursing interventions. Pro-active interventions from the outset of the caregiving career, such as early assessment of caregiver needs for support and of caregiver preparedness to provide care as well as early psycho-educational interventions, are essential to foster positive caregiver responses to the challenges of their new role.

Advocating for a parent with dementia in a long-term care facility: the process experienced by daughters

Daughter caregivers of elders with dementia become their parents' advocates over time. This role takes on even greater importance when one or both parents are placed in a long-term care facility. This article presents the results of a qualitative study aimed at explaining how this advocacy role evolves following institutionalization. In-depth interviews were conducted with daughters (N = 14) of an institutionalized parent with dementia and selected using a theoretical sampling procedure. Data analysis using grounded theory revealed three interrelated processes that explain role transformation of the daughters: integration in the care setting, evaluation of quality of care, and development of trust. Implications for involving daughters as care partners in long-term care settings are offered.