Caring for a Relative with Dementia: Determinants and Gender Differences of Caregiver Burden in the Rural Setting

A Skill-Based multimodal intervention for dementia caregivers: impact on burden and anxiety

BACKGROUND

Dementia is a global health challenge affecting both patients and their caregivers, with family members often bearing the primary caregiving burden. In Egypt, where research on caregiver mental health is limited, interventions addressing caregiver burden and anxiety is critical.

AIM

To determine the effect of a psychoeducation and skill-based multimodal intervention on caregiver burden and anxiety.

METHODS

A randomized controlled trial (RCT) involving 84 family caregivers. Participants were assigned to either the intervention group (n = 42), which received structured psychoeducation and skill-based training over six biweekly sessions, or the control group (n = 42), which received routine outpatient care. Caregiver burden and anxiety were assessed using the Zarit Burden Interview (ZBI) and the Generalized Anxiety Disorder Scale (GAD-7). Behavioral and psychological symptoms of dementia were evaluated using the Neuropsychiatric Inventory Questionnaire (NPI-Q).

RESULTS

The sample consisted predominantly of women (79% in the intervention group, 69% in the control group), with daughters forming the largest caregiver subgroup (66.6% and 52.4%, respectively). The mean age of caregivers was 39.2 ± 4.2 years. After three months, caregivers in the intervention group exhibited a significant reduction in burden (ZBI median score: 24 vs. 34, p < 0.0001) and anxiety (GAD-7 mean score: 6.15 vs. 9.4, p < 0.0001) compared to the control group, however, NPI-Q scores remained unchanged.

CONCLUSION

A structured psychoeducation and skill-based intervention significantly reduces caregiver burden and anxiety. Implementing such programs in Egypt could improve the well-being of caregivers and individuals with dementia.

Relationship between anxiety and fatigue in dementia family caregivers: hope as a mediator

BACKGROUND

This study investigated the mediating role of hope in the relationship between anxiety and fatigue in family caregivers of individuals with dementia.

METHODS

A cross-sectional design was employed, with data collected from 84 family members caring for a patient with dementia in Tzu Chi Hospital in eastern Taiwan. Instruments were the Herth Hope Index, fatigue, and anxiety scales.

RESULTS

The findings revealed a significant negative correlation between fatigue and hope (r = -.431, p <.01), a significant positive correlation between fatigue and anxiety (r =.584, p <.01), and a significant negative correlation between hope and anxiety (r = -.364, p <.01). Furthermore, the results indicated that anxiety indirectly predicted fatigue through hope. Hope was a mediating variable between anxiety and fatigue, accounting for 15.6% of the mediating effect.

CONCLUSIONS

Prioritizing the physical and mental health of family caregivers of individuals with dementia by fostering hope can help alleviate their caregiving fatigue and enhance their overall well-being.

Geographical location as a determinant of caregiver burden: a rural-urban analysis of the informal caregiving, health, and healthcare survey in Ghana

BACKGROUND

The caregiving scholarship widely acknowledges informal caregivers' contributions to maintaining older adults' health and well-being. However, informal caregivers encounter economic, physical, social, financial and psychological challenges when caring for older adults. The caregiving literature has shown variations in caregiving intensity and motivation between rural and urban informal caregivers of older adults. This situation is likely to result in rural-urban disparities in caregiver burden. However, the literature on predictors of caregiver burden is more focused on demographic, socio-economic, caregiving and health-related factors with very little attention to geographical dynamics. For this reason, the effects of demographic, socio-economic, caregiving, and health-related factors on the variations in caregiver burden between rural and urban informal caregivers of older adults are yet to be known in the sub-Saharan African context, including Ghana. Notably, the impact of geographical location on caregiver burden is mainly missing in the informal caregiving literature in Ghana. Situated within the stress process model, we determine the association between geographical location and caregiver burden among informal caregivers of older adults in Ghana.

METHODS

This study employed data from a large cross-sectional survey on informal caregiving, health, and healthcare among caregivers of older adults aged 50 years or above (N = 1,853) in Ghana. We selected the World Health Organization Impact of Caregiving Scale to measure caregiver burden. Generalized multivariable linear regression models were employed to determine the association between geographical location and caregiver burden among informal caregivers of older adults. We reported beta values and standard errors with significance levels of 0.05 or less.

RESULTS

The results showed that rural informal caregivers of older adults significantly have a decreased caregiver burden compared to urban informal caregivers (β = -1.64; SE = 0.41). Also, participants across all the self-rated health categories (poor/very poor: β = 12.63; SE = 1.65; fair: β = 9.56; SE = 1.07; good: β = 11.00; SE = 0.61, very good: β = 7.03; SE = 0.49) have a significantly increased caregiver burden for the full sample and for both rural (poor/very poor: β = 13.88; SE = 2.4; fair: β = 6.11; SE = 1.62; good: β = 9.97; SE = 0.96, very good: β = 6.06; SE = 0.71) and urban (poor/very poor: β = 11.86; SE = 2.25; fair: β = 12.33; SE = 1.42; good: β = 11.80; SE = 0.79, very good: β = 7.90; SE = 0.67) participants. This study further revealed that participants with no financial support needs reported a decreased caregiver burden compared to those with financial support needs for the full sample (β = -2.92, p-value < 0.01) and for both rural (β = -3.20; p-value < 0.01) and urban (β =-2.70; p-value < 0.01) participants.

CONCLUSION

The findings from this study underscore geographical location differences in caregiver burden among informal caregivers of older adults in Ghana. Given these findings, the need to consider geographical location variations in providing welfare and health support programs to lessen caregiver burden among informal caregivers of older adults is welcomed. In line with the stress process model, such welfare and health programs should consider background, context, and stressor factors that contribute to variations in caregiver burden between rural and urban informal caregivers of older adults in Ghana and other sub-Saharan African countries.

Evaluation of loneliness and its associated factors in caregivers of patients with dementia: a cross-sectional study

Objective

To identify the levels of loneliness and the factors associated with the prevalence of loneliness in caregivers of patients with dementia.

Methods

An observational cross-sectional study was conducted, including unpaid caregivers of patients with dementia who were receiving home care in Bogotá, Colombia. The prevalence of loneliness was estimated using the UCLA Loneliness Scale. Participants were also assessed regarding their satisfaction with providing care and whether they felt they received the necessary emotional support from family and friends. The association between loneliness and the patient's clinical variables, as well as the sociodemographic characteristics of the caregiver, was evaluated by calculating the odds ratio (OR) between the groups.

Results

A total of 52 caregivers of patients with dementia were included. Severe loneliness was present in 5.77% of caregivers, while 26.92% experienced moderate loneliness. All caregivers reported feeling satisfied with providing care to their relatives, and 71% felt that their family or friends provided the emotional support they required. Loneliness was more common among caregivers of patients with total functional dependence (OR: 4.061, p= 0.0278). Conversely, the perception of receiving emotional support from family and friends was identified as a potential protective factor against loneliness (OR: 0.184, p= 0.0104).

Conclusions

The prevalence of loneliness in this study is lower than that reported in previous studies. All caregivers reported satisfaction in providing care; most perceived adequate emotional support from family and friends. These factors could be contributing to the lower prevalence of loneliness observed.

Family Caregiving of Patients With Heart Failure and Vascular Dementia in Rural Appalachia: A Mixed-Methods Study

INTRODUCTION

Vascular dementia and heart failure (HF) are common co-existing conditions among adult populations. Each condition requires extensive home caregiving from family caregivers, especially those in rural Appalachia. This study aimed to assess caregivers' burden and their physical and mental health status, as well as explore their experiences and needs.

METHODS

This study used an exploratory mixed-methods design combining quantitative and qualitative research (N = 20 caregivers). We collected data using questionnaires, short-answered interviews, and focus group discussions. The multivariable generalized linear model (GLiM) was used to analyze quantitative data; content analysis was used for qualitative data.

RESULTS

The average age of family caregivers was 64.95 years. The generalized linear model showed that the caregiving burden was associated with caregivers' depression/anxiety (r = 0.68, P < .001) and their number of dementia caregiving years (r = 0.54, P < .05). Caregivers' poor physical health status was associated with better preparedness for HF and dementia home caregiving (r = 0.52, P < .05) and male caregivers (r = -0.46, P < .01). Caregivers' mental health status was associated with depression/anxiety (r = -0.80, P < .001). The qualitative data identified key caregiving themes: emotional impact and physical demands of caregiving, lack of help in rural areas, dealing with multiple disease progression, and relationship changes with their loved ones.

CONCLUSION

Caregiving burden was associated with caregivers' home care responsibilities and the need for support. Nurse-led home caregiving preparedness interventions tailored for family caregivers of patients with HF and dementia in rural areas are recommended.

Burden of Care, Depression, and Anxiety Among Family Caregivers of People With Dementia

BACKGROUND

There are many challenges that entail caring for an individual with dementia, affecting not only the individual with the condition but also their caregivers. This can lead to increased burden, frustration, and depression among those taking care of them. A research gap exists concerning the care of people with dementia in Egypt, particularly regarding the mental health of caregivers. Limited studies have been conducted in Egypt, particularly focusing on the mental health of caregivers. This lack highlights the need to understand the prevalence and impact of caregiver burden in this population.

OBJECTIVES

The research aimed to evaluate the burden of dementia, levels of depression, and anxiety among family caregivers of individuals with dementia.

METHODS

A cross-sectional study was conducted at a geriatric unit clinic of a psychiatric hospital in Cairo University, Egypt. Caregiver burden, anxiety, and depression were assessed using questionnaires. These questionnaires included the Zarit Burden Interview (ZBI), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), together with demographic data on the patients and caregivers.

RESULTS

The majority of the 141 participants (73% (n = 103)) were female, mostly daughters, with an average age of 40 years. Approximately 50% (n = 71) of the subjects exhibited mild to moderate burden, whereas 30% (n = 43) showed moderate to severe burden. About 31% (n = 44) of the subjects exhibited symptoms of moderate depression, whereas 9% (n = 13) had symptoms of severe depression. Furthermore, almost 43% (n = 60) of caregivers exhibited a moderate level of anxiety. Furthermore, a significant association was seen between caregiver burden and the presence of anxiety and depression.

CONCLUSION

This study showed a substantial burden in providing care, elevated levels of despair, and anxiety among caregivers of PWD. The findings highlight how important it is to develop targeted therapies and support systems in order to lessen the load on caregivers, advance their mental health, and improve overall care for both caregivers and their patients in Egypt. Policy-makers should prioritize investing in dementia-related support systems and services to empower caregivers and improve the quality of life for both caregivers and their patients.

A mixed method study exploring gender differences in dementia caregiving

Few studies have investigated the experience of male carers of people with dementia and fewer specifically examined whether male and female carers of people with dementia differ in their approach to the caring role. As such, this research set-out to investigate whether male carers of people with dementia approach the caring role differently to female carers. Data from 167 survey participants (24 males and 143 females) were analysed using a mixed research methodology. Participants' demographics and scores on standardised burden and coping scales were analysed using linear regression. Participants' written responses to open-ended questions were analysed using thematic analysis anchored in theories of hegemonic masculinity. No significant gender differences were identified in carers' coping strategies or self-reported carer burden. However, qualitative analysis revealed strong thematic gender differences like: gendered barriers to help-seeking; gendered service preference; gendered considerations about residential care; gendered expression of burden; and themes of the absent son and exhausted daughter. This research identified that male carers of people with dementia approach help-seeking differently to female carers, typically focusing on addressing functional tasks and refraining from showing emotions, this despite reporting similar carer burden. Rapport building with male carers should start with conversations around functional issues rather than assessing the emotional impact of the caring role. The findings reinforce the need for more qualitative research into the unmet needs of male carers of people with dementia, to inform the design of male-friendly interventions which could facilitate timely access to services by male carers.

Caring load and family caregivers' burden in China: the mediating effects of social support and social exclusion

Objective

Caring for older adults with disabilities is a source of stress for family caregivers, and the lack of social support and the pressure of social exclusion might aggravate family caregiver burden. This study aimed to examine the association between caring load and family caregivers' burden, as well as the mediating effects of social support and social exclusion.

Methods

Data used in this study was derived from the nationally representative database of the aged population in China, and 3,125 households with disabled old adults and their home-bound caregivers were eventually selected for this analysis. Regression methods and mediation analysis methods were employed in this study.

Results

The results indicated that there was a significant positive association between caring load and the caregiver burden, and specifically, social support intensity (rather than social support breadth) and passive social exclusion (rather than active social exclusion) played partial mediating effects. Furthermore, the contributions of mediating effects of social support intensity and passive social exclusion were 13-15 and 27-29%, respectively, and the total contribution of mediating effects was about 35-38%.

Conclusion

Family caregivers' burden should be paid more attention to in the large population with rapidly aging speed like China, and more guidance services as well as support should be provided to family caregivers. In addition, it is crucial to focus on the community's social support and social exclusion in public policy innovation.

Burden in caregivers of primary care patients with dementia: influence of neuropsychiatric symptoms according to disease stage (NeDEM project)

BACKGROUND

Caregiver burden is related to personal factors and patient characteristics and is greater when neuropsychiatric symptoms (NPSs) are present.

OBJECTIVE

Estimate the prevalence of burden among caregivers of dementia patients and its association with NPSs and identify NPSs causing greater caregiver distress according to dementia stage.

METHODS

A cross-sectional observational study in caregivers of noninstitutionalized dementia patients was conducted. Caregiver variables were sociodemographic, time of care, NPS-associated distress based on the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D) and burden based on the Zarit Burden Interview (ZBI). Patient variables were time since disease onset, Global Deterioration Scale (GDS) disease stage, functional assessment and NPS presence and intensity according to the Neuropsychiatric Inventory (NPI). The mean ZBI score, prevalence of burden and NPI-D score with 95% CIs at each dementia stage were estimated. Factors associated with burden were identified by multivariate analysis.

RESULTS

Of the 125 caregivers included, 77.6% were women, with a mean age of 60.7 (± 14.3) years; 78.4% (95%CI: 71.0; 86.0) experienced burden. The mean ZBI score was 12.3 (95%CI: 11.6; 12.9) and increased according to NPS number (p = 0.042). The NPSs causing the most burden were disinhibition (93.5%), irritability (87.3%) and agitation (86.1%). Agitation, apathy, and sleep disorders were the NPSs generating the greatest overall caregiver distress; depression (max NPI-D 1.9), hyperactivity (max NPI-D 2.1), and psychosis symptoms (max NPI-D 1.6) generated the greatest distress at stage GDS 3, stages GDS 4-5, and stages GDS 6-7, respectively. The NPI score (OR = 1.0, 95%CI 1.0; 1.1), intensity of irritability (OR = 1.2, 95%CI 1.0; 1.6), disinhibition (OR = 2.6, 95%CI 1.1; 5.8) and hyperactivity subsyndrome (OR = 1.1, 95%CI 1.0; 1.2) were associated with caregiver burden. Other associated factors were female gender (OR = 6.0, 95%CI 1.6; 22.8), ≥ 8 h daily care (OR = 5.6, 95%CI 1.4; 22.8), working outside the home (OR = 7.6, 95%CI 1.8; 31.8), living with the patient (OR = 4.5, 95%CI 1.1; 19.6), kinship (OR = 5.4, 95%CI 1.0; 28.2) and lower patient education (OR = 8.3, 95%CI 2.3; 30.3).

CONCLUSIONS

The burden on caregivers of dementia patients is high and associated with NPS presence and intensity. Disinhibition and irritability caused the highest burden. Depression, hyperactivity and psychosis produce more distress in mild, mild-moderate and severe dementia, respectively.

Jordanian Community People's Knowledge of and Attitudes Toward Dementia

Introduction

Limited research exists on the knowledge and attitudes of Jordanian community residents toward people with dementia (PwD). As the prevalence of dementia is anticipated to increase, there is a critical need for informed knowledge and positive attitudes toward dementia in the Jordanian community.

Objectives

This study aimed to evaluate people's knowledge of and attitudes toward PwD and identify the predictors of dementia knowledge and attitudes.

Methods

The study employed a cross-sectional research design and utilized a self-administered questionnaire as the primary data collection method. The study employed the Alzheimer's Disease Knowledge Scale (ADKS) to evaluate the knowledge of the participants, and the Dementia Attitudes Scale (DAS) was utilized to assess their attitudes in the Jordanian community. Multiple regression analysis was performed to find relevant factors influencing knowledge of and attitude toward dementia.

Results

The study's 346 participants revealed limited knowledge about dementia, with an average ADKS score of 17.21 out of 30. However, participants showed a positive attitude toward dementia, as evidenced by a mean DAS score of 88 out of 140. Statistical analysis demonstrated significantly higher knowledge scores among employed individuals (P < .05), while females exhibited significantly higher attitude scores (P < .05). Participants with experience in geriatric clinical practice, dementia education or training, informal caregiving experience, and a desire to learn more about dementia also exhibited significantly higher knowledge and attitude scores (P < .05).

Conclusion

The study offers preliminary insights into the knowledge and attitudes toward dementia in the Jordanian population. The findings underscore the importance of continuing education and training to increase knowledge and understanding of dementia. Improving dementia care and support in Jordan requires enhancing knowledge and attitudes toward dementia. The study findings were presented to policymakers, with recommendations for strategic planning and the development of awareness programs. Future research can build upon these findings and promote evidence-based practices in dementia care and community awareness programs.

Primary and Secondary Caregivers of People with Dementia (PwD): Differential Patterns and Implications for Psychological Support

Very little attention has been paid to identifying the differential characteristics of primary and secondary dementia caregivers. The aims of this study were: to determine whether differences exist between primary and secondary caregivers of people with dementia (PwD) and to explore the profile of primary and secondary caregivers reporting symptoms of anxiety and/or depression. The participants were 146 caregivers of PwD, 73 primary caregivers and 73 secondary caregivers. The results revealed different patterns for each type of caregiver. Primary caregivers showed a more negative profile in terms of poorer self-rated health and higher levels of anxiety and depression: 61.6% of primary and 42.5% of secondary caregivers reported symptoms of anxiety, and 24.7% and 11% reported depression, respectively. The frequency of problem behavior, subjective burden, health, and the comorbidity between anxiety and depression were associated with depression and anxiety among primary caregivers, whereas gender (being a woman), subjective burden, health, and the comorbidity between anxiety and depression were associated among secondary caregivers. These findings may help to guide professionals in targeting psychological support programs and customizing the strategies and skills that need to be provided in accordance with the type of caregiver in question: primary or secondary. The practical implications of the findings are discussed.