Caregiving burden and its determinants in Polish caregivers of stroke survivors

Depressive Symptoms and Its Associated Factors Among Primary Caregivers of Stroke Survivors at Amhara Regional State Tertiary Hospitals: Multicenter Study

Background

Stroke is one of the leading causes of severe disability and functional limitation, which are reasons for being dependent on their family for daily activities and participation in social affairs. After discharge from the hospital, most stroke survivors require physical, psychosocial, and financial support from caregivers at home, which is one of the most stressful events for families. The stroke survivors and their caregivers may influence each other during the caregiving process and social life. The stroke survivor's disability and depressive symptoms affect the quality of life of the survivor and their caregivers. Therefore, the purpose of this study was to assess the prevalence and associated factors of depression among caregivers of stroke survivors.

Methods

An institution-based, cross-sectional study was conducted in Amhara regional state tertiary hospitals. A systematic random sampling technique was employed to select 424 participants. The data were collected using an interviewer-administered and chart-reviewed structured questionnaire. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression. Univariable and multivariable logistic regression analyses were performed to identify factors associated with depression. Adjusting the odds ratio with the corresponding 95% confidence interval and variables with a P-value < 0.05 was considered significantly associated with depression.

Results

The overall prevalence of depressive symptoms was 65.6% (95% CI: 60.8-69.8). Being female, older than 40, having no formal education, having a low family monthly income, being the son or daughter, and spending more than six hours per day were associated with depression.

Conclusion

We found that depression was prevalent among primary caregivers of stroke survivors. To reduce the risk of developing depression, policymakers should fully recognize the role of caregivers in caring for stroke patients. More attention should be given to caregivers who are female, elderly, have a low income, are sons or daughters, and spend a long time caring per day.

The mediating role of anxiety in feelings of stigma and quality of life of post-epidemic hemiplegic patients with cerebral hemorrhage

OBJECTIVE

To analyze factors influencing the sense of shame, anxiety and quality of life of hemiplegic patients after cerebral hemorrhage and to verify the intermediary role of anxiety in the post-epidemic period.

METHODS

240 hemiplegic patients with cerebral hemorrhage were enrolled from a third class a hospital in Hubei Province and interrogated by questionnaire and convenience sampling method.

RESULTS

Some ICH patients demonstrated problems related to sense of shame, anxiety, and poor quality of life. Sense of shame was positively related to anxiety and shame and anxiety were negatively related to the quality of life. Multivariate regression analysis indicated that age, educational level, occupational status, per capita monthly income, medical payment method, disease duration, sense of shame and anxiety influenced quality of life and together explained 55.8% of the variability. Anxiety mediated prediction of illness and shame on quality of life and the mediating effect accounted for 55.6% of the total effect.

CONCLUSION

The current study examined correlations between anxiety, stigma and quality of life while testing the hypothesis that anxiety mediated the quality of life. Anxiety was related to quality of life. As such, treatment of anxiety may present an opportunity to improve quality of life after ICH.

Predictors of psychological distress and sleep deprivation in caregivers of stroke survivors

BACKGROUND

Caregivers for stroke survivors (CSS) suffer from long hours of care, limited support, and financial difficulties, which often affect their mental health.

OBJECTIVES

This study sought to determine the factors affecting psychological distress and sleep duration among CSS.

METHODS

We analyzed cross-sectional data from the 2013 Comprehensive Survey of the Living Conditions for Stroke Survivors and CSS. Linked data from 841 pairs of stroke survivors and CSS were extracted. Kessler's Psychological Distress scale (K6) was used to evaluate psychological distress. CSS who slept less than 5 hours per day were classified as having short sleep duration. Factors predictive of psychological distress and short sleep duration were evaluated using multivariable logistic regression analysis with the forward selection method.

RESULTS

The mean (SD) age of the CSS was 65.4 (12.5) years. A total of 5.6% of these caregivers presented with serious psychological distress, and 12.0% were sleep deprived. Serious psychological distress was associated with not having someone to consult with, having subjective symptoms within a few days, and having short sleep duration, while having their own houses reduced the risk of serious psychological distress. Furthermore, short sleep duration was associated with stroke survivors in long-term care levels 4 or 5, not having someone to consult with, participation in sponge baths as part of nursing care activities, and having serious psychological distress.

CONCLUSIONS

This nationwide survey identified several risk factors for psychological stress and sleep deprivation among CSS and suggests the need for multidimensional approaches to reduce their distress.

The effectiveness of self-management interventions with action-taking components in improving health-related outcomes for adult stroke survivors: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aims to synthesise the evidence of the effectiveness of self-management interventions with action-taking components in improving self-efficacy, health-related quality of life, basic and instrumental activities of daily living, and depression for adult stroke survivors.

MATERIALS AND METHODS

Nine electronic databases were searched for relevant studies, including grey literature and ongoing studies. Randomised controlled trials targeting adult stroke survivors comparing health-related outcomes of patients receiving self-management interventions with action-taking components to usual care, placebo, or no-treatment were included. Screening, data extraction, and methodological quality assessment were conducted by two reviewers. Meta-analyses were performed. Overall quality of evidence was assessed using the GRADE tool.

RESULTS

A total of seventeen studies were included. Meta-analyses showed that the intervention may result in a slight increase in self-efficacy (SMD = 0.29, 95% CI [0.07-0.52], p = 0.010, I² = 47%) and basic activities of daily living (SMD = 0.31, 95% CI [0.16-0.46], p < 0.001, I² = 0%), but not for the other outcomes.

CONCLUSIONS

Self-management interventions with action-taking components may result in a slight improvement in self-efficacy and rehabilitation of basic activities of daily living. Future research should investigate which core self-management skill, or combination of them, is most effective in improving short-term and long-term outcomes.IMPLICATIONS FOR REHABILITATIONStroke can be a chronic condition as approximately half of stroke survivors suffer from permanent disabilities.Self-management interventions are one form of rehabilitation programmes available to stroke survivors.Self-management interventions with action-taking components may result in a slight increase in patient self-efficacy and carrying out basic activities of daily living compared to usual care given.

Huntington's Disease Progression and Caregiver Burden

Huntington's disease (HD) is a neurodegenerative, progressive disorder conditioned by a mutation in the HTT gene. Its progression is dependent on the causative mutation extension. Caregivers of individuals affected by HD, most often patients' relatives, are burdened with the care. This study aims to assess the caregivers' burden cross-sectionally and longitudinally and look for biological and clinical patients-related burdening factors. In total, 144 caregiver-patient pairs observed annually for up to 8 years were included in the study. In all of the patients, demographic data were collected, Unified Huntington&apos;s Disease Rating Scale (UHDRS) assessments were conducted, and disease burden (DB) was calculated when caregivers were assessed in Caregiver Burden Inventory (CBI). Caregivers' burden measured in CBI at the first visit reached 18.7 ± 18.4 scores. Longitudinal observation showed no evidence for any discrepancy between clinical progression measured in UHDRS, nor biological progression measured in DB and the caregivers' burden progression measured in CBI. Caregivers were burdened mostly by patients' dependence and a discrepancy between reality and life expectations. This study indicates factors to be addressed to reduce caregivers' burden. Strict relation between caregivers' burden and biological and clinical progression denies conception of overloaded with care tasks or adaptation to the burden.

Experiences of family caregivers 3-months after stroke: results of the prospective trans-regional network for stroke intervention with telemedicine registry (TRANSIT-Stroke)

Background

Long-term support of stroke patients living at home is often delivered by family caregivers (FC). We identified characteristics of stroke patients being associated with receiving care by a FC 3-months (3 M) after stroke, assessed positive and negative experiences and individual burden of FC caring for stroke patients and determined factors associated with caregiving experiences and burden of FC 3 M after stroke.

Methods

Data were collected within TRANSIT-Stroke, a regional telemedical stroke-network comprising 12 hospitals in Germany. Patients with stroke/TIA providing informed consent were followed up 3 M after the index event. The postal patient-questionnaire was accompanied by an anonymous questionnaire for FC comprising information on positive and negative experiences of FC as well as on burden of caregiving operationalized by the Caregiver Reaction Assessment and a self-rated burden-scale, respectively. Multivariable logistic and linear regression analyses were performed.

Results

Between 01/2016 and 06/2019, 3532 patients provided baseline and 3 M-follow-up- data and 1044 FC responded to questionnaires regarding positive and negative caregiving experiences and caregiving burden. 74.4% of FC were older than 55 years, 70.1% were women and 67.5% were spouses. Older age, diabetes and lower Barthel-Index in patients were significantly associated with a higher probability of receiving care by a FC at 3 M. Positive experiences of FC comprised the importance (81.5%) and the privilege (70.0%) of caring for their relative; negative experiences of FC included financial difficulties associated with caregiving (20.4%). Median overall self-rated burden was 30 (IQR: 0–50; range 0–100). Older age of stroke patients was associated with a lower caregiver burden, whereas younger age of FC led to higher burden. More than half of the stroke patients in whom a FC questionnaire was completed did self-report that they are not being cared by a FC. This stroke patient group tended to be younger, more often male with less severe stroke and less comorbidities who lived more often with a partner.

Conclusions

The majority of caregivers wanted to care for their relatives but experienced burden at the same time. Elderly patients, patients with a lower Barthel Index at discharge and diabetes are at higher risk of needing care by a family caregiver.

Trial registration

The study was registered at “German Clinical Trial Register”: DRKS00011696. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011696

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02919-6.

Development and Psychometric Properties of the Caregiver Burden Scale in Polish Caregivers of Stroke Patients

Purpose

Most stroke patients require long-term care of their family members. Excessive care burden entails several negative consequences; therefore, the severity of the burden should be periodically assessed. For this purpose, valid multidimensional measures are needed. Our study, which is a part of a larger research project, aims to translate and evaluate the psychometric properties of the Polish Caregiver Burden Scale (CBS) in relation to construct validity and internal consistency in caregivers of the patients after stroke.

Patients and Methods

The sample of this cross-sectional observational study consisted of 366 informal caregivers to consecutive first-ever stroke survivors. The five-factor Polish CBS and the Hospital Anxiety and Depression Scale (HADS) were administered during the home visits at three to six months after patients’ hospitalisation. Exploratory (EFA), confirmatory (CFA) factor analyses and a net analysis were performed to investigate the internal structure and a factorial construct validity of the CBS. Correlation analyses between the CBS and the HADS were carried out to examine convergent validity. Cronbach’s alpha and item-total correlation were applied to assess internal consistency.

Results

Three out of five factors identified by EFA were similar to the original indices of the CBS, while the remaining two deviated from the original structure of the CBS. The CFA five-factor model represented an acceptable fit (confirmatory fit index, CFI = 0.96, root mean square error, RMSEA = 0.04) but only after a modification. All subscale scores of the CBS were positively correlated with the HADS, supporting the convergent validity. Cronbach’s alpha coefficients for the overall scale (0.92) and all subscales (0.72–0.87) except one (0.69) and item-total correlation results indicated good internal consistency.

Conclusion

The Polish version of the CBS showed acceptable internal consistency and good convergent validity. Factorial validity and structural integrity were partially supported. The interrelationships between the CBS subdomains, their partial mutual contamination, and the scale’s non-orthogonal structure should be considered when interpreting the results of further studies using this version of the scale.

Factors associated with social support for family members who care for stroke survivors

Introduction

Vascular strokes are a primary cause of long-term disability for adults, with many social consequences for the patient, the family and healthcare systems worldwide.

Aim

To investigate the relation between patients' and caregivers' characteristics, as well as burden and depression, and the social support received by carers for stroke victims in Greece.

Method

Patients and caregivers were recruited from community settings in the Attica region of Greece, using purposive sampling. They completed a set of questionnaires during face-to-face interviews. Correlational and multiple regression analyses were performed to identify factors associated with caregivers' perceptions of social support.

Results

In total, 109 dyads of patients and their respective caregivers were recruited. The patients' mean age was 69.3 years, while caregivers' mean age was 58.0 years; 51.4% of patients were males, whereas 67.9% of the caregivers were females. The majority of both patients and caregivers were married, with an annual family income less than €10,000. The level of perceived social support was significantly associated with patients' or caregivers' annual family income, caregivers' working status and the daily caring hours (p < 0.01). Greater perceived support was significantly associated with a lower care burden BCOS (r = 0.29, p < 0.01) and female gender (p = 0.023), but not with the patient's functional level nor with depression (p > 0.05).

Decompressive Craniectomy for Hemispheric Infarction in a Low-Income Population

BACKGROUND

Stroke is a worldwide leading cause of mortality and disability, and there are substantial economic costs for poststroke care. Disadvantaged populations show increased incidence, severity, and unfavorable outcomes. This study aimed to report the survival, functional outcome, and caregiver satisfaction of low-income patients diagnosed with a large hemispheric infarction (LHI) who underwent decompressive craniectomy (DC).

METHODS

A retrospective analysis was conducted in consecutive adult patients with an LHI who underwent DC at a single center between October 2015 and September 2019. Demographic, clinical, and radiologic data were reviewed. The primary outcomes were 1-year survival and favorable functional outcome.

RESULTS

Forty-nine patients were included; those <60 years of age showed a higher proportion of favorable functional outcomes (76% vs. 33%; P = 0.031) but similar survival (52% vs. 56%; P = 0.645) than older patients, respectively. Performing the craniectomy in <48 hours from stroke onset compared with ≥48 hours showed no statistically significant differences in survival (59% vs. 46%; P = 0.352) and favorable functional outcomes (56% vs. 70%; P = 0.683), respectively. In retrospective thinking, 79% of caregivers would decide to perform the surgery again.

CONCLUSIONS

Age group and time from stroke onset to craniectomy were not associated with survival; notwithstanding, a higher proportion of patients <60 years of age were associated with a favorable functional outcome compared with older patients. Additionally, if given the option, most caregivers would decide to perform the surgery again, independently of the grade of disability of the patient.

Effects of different rehabilitation provision systems on functional recovery in patients with subacute stroke

INTRODUCTION

The extent of rehabilitation is a key element in promoting functional recovery in patients with stroke. However, the type of rehabilitation therapy that should be provided to improve functional outcomes remains unclear.

OBJECTIVE

This study aimed to compare the effects of three different rehabilitation provision systems, namely conventional rehabilitation therapy, conventional rehabilitation therapy plus physical therapy (PT) on weekends, and conventional rehabilitation therapy plus PT and occupational therapy (OT) on weekends, on functional recovery in patients with subacute stroke.

DESIGN

Retrospective observational cohort study.

SETTING

Convalescence Rehabilitation Hospital.

PATIENTS

Three hundred and one patients with subacute stroke (mean age, 69.7 ± 12.8 years).

INTERVENTIONS

Patients were classified into three groups according to rehabilitation therapy they received: a conventional group (only weekdays PT and OT; n = 70), an additional PT group (additional PT on weekends; n = 119), and an additional PT + OT group (additional PT and OT on weekends; n = 112).

MAIN OUTCOME MEASURE

Functional Independence Measure (FIM) effectiveness was calculated as (discharge FIM - admission FIM/maximum FIM - admission FIM) × 100. A multivariate general linear model was used to assess the difference in FIM effectiveness among the groups.

RESULTS

The mean FIM effectiveness in the conventional, additional PT, and additional PT + OT groups were 39.3 ± 30.1, 43.4 ± 33.2, and 54.3 ± 29.1, respectively. The multivariate analysis revealed a significant difference in FIM effectiveness among the three groups (P = 0.036), and the η_p ² was 0.02, indicating a small effect. The additional PT + OT group showed significantly greater improvements in FIM effectiveness than the conventional group (mean difference = 8.78, SE = 3.58, 95% confidence interval: 0.17-17.39).

CONCLUSIONS

This study showed that the additional PT + OT group had better functional recovery than did the conventional group. This indicates that increasing the amount of both PT and OT can promote post-stroke functional recovery. This article is protected by copyright. All rights reserved.

The Effects of Patients' and Caregivers' Characteristics on the Burden of Families Caring for Stroke Survivors

Background: Vascular strokes are the leading cause of long-term disability for adults. They impose high levels of burden on the patient, the family, and national healthcare systems worldwide. This study aimed to assess the effects of patients’ and caregivers’ characteristics on the perceptions of burden in families caring for a loved one living with stroke in Greece. Methods: Using purposive sampling, 109 dyads of patients and their respective caregivers were recruited from the Attica region. Patients completed a questionnaire that included personal characteristics and the Barthel Index, while caregivers completed a set of questionnaires—personal characteristics, revised Bakas Caregiving Outcomes Scale (BCOS), Personal Resource Questionnaire (PRQ 2000), and Center for Epidemiological Studies-Depression (CES-D). Results: Caregiving burden was linked to both patients’ and caregivers’ characteristics. A patient’s educational level, the number of family members living in the same house, the existence of equipment and facilities in the house, and the duration of provided care were associated with perception of greater burden. Regarding caregivers’ characteristics, those in good health had a significantly lower perception of burden. Higher PRQ 2000 scores were significantly associated with higher BCOS scores (less burden), and higher CES-D scores were significantly associated with lower BCOS scores (more burden). Conclusion: Caring for a loved one affected by stroke places a considerable burden on the caregiver. Systematic assessment and intervention strategies can help to identify caregivers at risk so that suitably targeted assistance may be provided.

Caregiver burden and coping strategies in caregivers of older patients with stroke

Background

Coping strategies play a key role in modulating the physical and psychological burden on caregivers of stroke patients. The present study aimed to determine the relationship between the severity of burden of care and coping strategies amongst a sample of Iranian caregivers of older stroke patients. It also aimed to examine the differences of coping strategies used by male and female caregivers.

Methods

A total of 110 caregivers of older patients who previously had a stroke participated in this descriptive and cross-sectional study. The Zarit Burden Interview and Lazarus coping strategies questionnaires were used for data collection. Questionnaires were completed by the caregivers, who were selected using convenience sampling. The collected data were analyzed using Pearson's correlations and independent t-tests.

Results

The mean age of participants was 32.09 ± 8.70 years. The majority of the caregivers sampled reported mild to moderate (n = 74, 67.3%) burden. The most commonly used coping strategies reported were positive reappraisal and seeking social support. Results of the independent t-test showed that male caregivers used the positive reappraisal strategy (t(110) = 2.76; p = 0.007) and accepting responsibility (t(110) = 2.26; p = 0.026) significantly more than female caregivers. Pearson’s correlations showed a significant positive correlation between caregiver burden and emotional-focused strategies, including escaping (r = 0.245, p = 0.010) and distancing (r = 0.204, p = 0.032).

Conclusions

Caregivers with higher burden of care used more negative coping strategies, such as escape-avoidance and distancing. In order to encourage caregivers to utilize effective coping skills, appropriate programs should be designed and implemented to support caregivers. Use of effective coping skills to reduce the level of personal burden can improve caregiver physical health and psychological well-being.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00556-z.

Influence of Spiritual Coping and Social Support on the Mental Health and Quality of Life of the Saudi Informal Caregivers of Patients with Stroke

The research explored the influence of spiritual coping and social support on mental health and quality of life (QOL) of informal caregivers of stroke survivors in Saudi Arabia. The respondents were frequently using religious coping strategies than existential coping strategies. The respondents received higher support from significant others and lowest support from friends. The majority of the respondents had mild to moderate depression, while more than one-third had mild to severe anxiety. Psychological health received the highest QOL, while physical health received the poorest QOL. Spiritual coping and social support significantly influenced the informal caregivers' mental health and QOL.

Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis

There is increasing evidence that subjective caregiver burden is an important determinant of clinically significant anxiety in family carers. This meta-analysis aims to synthesise this evidence and investigate the relationship between subjective caregiver burden and anxiety symptoms in informal caregivers. We searched PubMed, CINAHL and PsycINFO up to January 2020. Combined estimates were obtained using a random-effects model. After screening of 4,312 articles, 74 studies (with 75 independent samples) were included. There was a large, positive association between subjective caregiver burden and anxiety symptoms (r = 0.51; 95% CI = 0.47, 0.54; I2 = 0.0%). No differences were found in subgroup analyses by type of study design (cross-sectional vs. longitudinal), sampling, control of confounders or care-recipient characteristics. Subjective caregiver burden is an important risk factor for anxiety in informal caregivers. Targeting subjective caregiver burden could be beneficial in preventing clinically significant anxiety for the increasing number of family carers worldwide.

The impact of wheelchair propulsion based physical activity on functional recovery in stroke rehabilitation: a multicenter observational study

PURPOSE

We aimed to evaluate the relationship between the daily wheelchair self-propulsion distance and functional recovery in subacute stroke survivors.

METHODS

Seventy-four patients with stroke were prospectively recruited from four convalescent rehabilitation hospitals. All participants were unable to walk independently and required manual wheelchairs for locomotion on admission. The daily wheelchair self-propulsion distance was measured using a cycle computer that was connected to a touch switch to exclude the assistance-propulsion distance. The outcome measures were represented as the relative gain of the Functional Independence Measure (FIM) effectiveness during hospitalization. Moreover, a better functional recovery was defined as a FIM effectiveness > 50%. Participants were categorized into three groups according to tertiles of the average daily wheelchair self-propulsion distance: lowest tertile (T1, ≤0.59 km/day); middle tertile (T2, 0.60-1.23 km/day); and highest tertile (T3, ≥1.24 km/day).

RESULTS

Multivariate logistic regression analysis adjusted for baseline characteristics showed that the T2 and T3 groups had a significant association with better FIM effectiveness, and their odds ratios (95% confidence interval, p) were 7.26 (1.13-45.85, p = .038), and 10.19 (1.15-91.75, p = .035), respectively.

CONCLUSIONS

The daily wheelchair self-propulsion distance was significantly associated with functional recovery in subacute stroke survivors.IMPLICATIONS FOR REHABILITATIONNon-ambulatory stroke survivors can obtain extra independent physical activity by using wheelchair self-propulsion, when they do not have someone to assist them with walking.This multicenter observational study revealed that the self-propulsion distance of a manual-wheelchair was significantly associated with functional recovery in subacute stroke survivors.

Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian hospitals

Purpose

This study aimed to evaluate the psychometric properties of the Indonesian version of the Care Dependency Scale (CDS) among stroke survivors.

Methods

The study was undertaken in four hospitals. We analysed datasets obtained from 109 stroke survivors on inpatient wards and in outpatient clinics, who were rated by nurses to determine the CDS reliability coefficients. The Cronbach's α and Cohen's kappa coefficients were applied. Concurrent validity was conducted for the data on care dependency, which werecollected from 49 of these 109 participants on inpatient wards by nurses using the CDS and the Barthel Index. A Spearman's rank correlation analysis was conducted to measure the association between the CDS and the Barthel Index results.

Results

An analysis of the results of the CDS tested on the inpatient ward and in the outpatient clinic revealed a high level of internal consistency. The reliability analysis yielded the same Cronbach's α coefficient of 0.98 for both the inpatient and outpatient data. A significant, moderate correlation was observed between the CDS and Barthel Index results.

Conclusion

The CDS can be recommended for use as a tool for the assessment and evaluation of stroke survivors who are receiving acute or long-term care.

The effect of family-centered empowerment program on the family caregiver burden and the activities of daily living of Iranian patients with stroke: a randomized controlled trial study

Dependence of stroke survivors regarding the ability to perform activities of daily living imposes a burden on family caregivers. The study evaluated the effect of the family-centered empowerment program on the ability of Iranian patients with stroke to perform activities of daily living, as well as on family caregiver burden. In this randomized controlled trial study, a total of 90 pairs of patients with stroke and their family caregivers was selected and randomly assigned to the intervention or control groups. Patients and their family caregivers participated in four family-centered empowerment program sessions over four consecutive days while the patient was hospitalized. The difference in the ability of patients with stroke in the intervention and control groups to perform activities of daily living was not significant 2 weeks after the intervention. However, the ability of patients with stroke in the intervention group to perform activities of daily living increased significantly 2 months after the intervention compared with the control group: 66 ± 35.95 and 51.31 ± 36.28, respectively (p = 0.047). Two weeks after the intervention, the family caregiver burden significantly decreased in the intervention group (29.55 ± 15.38) compared with the control group (38.77 ± 18.53 and p = 0.012). The burden in the intervention group also decreased 2 months after the intervention compared with the control group: 22.95 ± 15.68 and 36.11 ± 18.88, respectively (p < 0.001). Nurses can use the family-centered empowerment program to improve the quality of life of patients with stroke, and to reduce the burden of family caregivers.

Emotional Burden and Perceived Social Support in Male Partners of Women with Cancer

Background: The aim of this study was to describe the correlations between the psychosocial burden on male caregivers and their perception of social support, as well as distress, anxiety, and depression among their partners in the first six months after a cancer diagnosis. Methods: A cross-sectional, longitudinal and observational study was conducted on a group of 61 couples, with the use of Zarit Burden Interview (ZBI), Caregiver Burden Scale (CBS), Berlín Social Support Scales (BSSS), Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT). Statistical analysis was performed using Statistica v.13. Results: A strong positive correlation between the ZBI and CBS, as well as between support-seeking and the emotional involvement of male partners, was documented. The negative correlation between the lack of instrumental support and a much greater burden on caregivers, in emotional, social, and family life was documented. The level of distress, anxiety, and depression, as well as family problems reported by female patients, were positively correlated with the male caregiver′s burden. A demographic analysis showed significant relationships between the number of offspring and the negative health indicators of patients and their partners. Implications: The obtained results encourage deeper reflection on the need to improve the availability of instrumental support for male caregivers and support for families with an oncological ill parent in caring for minor children, and to maintain the social activity of the caregiver.

Caregiver Burden and Related Factors Among Caregivers of Patients with Myotonic Dystrophy Type 1

BACKGROUND

Multi-systemic symptoms of varying severity in myotonic dystrophy type 1 (DM1) may pose difficulties in caregiving. However, the factors which affect their care burden are yet to be sufficiently understood.

OBJECTIVE

We investigated care burden and its correlates among caregivers of patients with DM1.

METHODS

General demographic information was obtained from patients with DM1, as well as Barthel index (ADL), body mass index, and genetic information. Patients completed SF-36v2 (health-related quality of life), CES-D (depressive symptoms), and ESS (daytime sleepiness) questionnaires. Caregivers reported their perception of patient's status through these questionnaires, and completed Zarit Caregiver Burden Interview (ZBI). Correlation analysis of these variables were performed, and regression analysis was utilized to assess the relationship between caregiver burden and other variables.

RESULTS

Forty-three patient-caregiver dyads participated. Mean ZBI score was 20.7±17.4, and 32.6% reported a significant care burden. ZBI correlated with caregiver-reported CES-D, but not with patient-reported CES-D. Both patient-reported and caregiver-reported physical QoL of patients correlated with patient ADL. Multiple regression analysis revealed that the combination of caregiver-reported CES-D, caregiver-reported mental QoL, and genetic characteristics predicted caregiver burden.

CONCLUSIONS

Caregiver burden was felt although patients were relatively well-functioning. Patients' and caregivers' assessment of patients' physical condition were similar. However, they did not agree on the evaluation of the patients' psychological state. Cognitive characteristic of the patients and the caregivers' perception of the patients' state may have affected the results. Future DM1 care strategies need to work on improvement of patient-caregiver communication and provide support for the caregiver's psychological health.

An analysis of the costs of treating aged patients in a large clinical hospital in Poland under the pressure of recent demographic trends

INTRODUCTION

The aging of modern societies increases the general healthcare burden due to the growing demand for inpatient services, which lack adequate financing.

MATERIAL AND METHODS

Data concerning the costs of 312,250 hospitalizations at University Clinical Hospital in Wrocław, Poland in the years 2012-2015 were analyzed according to the age of the patients: below 65 years and 65 years and older, with subgroups (65-74, 75-84 and 85 years and older).

RESULTS

The mean length of stay (LOS) differed significantly for patients below 65 years and for patients 65 years old or older (3.5 vs. 4.7 person-days); over the 4 years covered by our data, these increased by 0.4 person-days, mostly among patients 85 years and older (by 0.7 person-days). The mean direct cost of hospitalization differed significantly for patients below 65 years and those 65 years or older (PLN 4,907.12 vs. PLN 6,357.15). The mean cost of laboratory tests and radiologic diagnostics was significantly higher among those in the 65+ group, and the difference had a rising trend. The differences between age groups in cost-related hospitalization characteristics and direct hospitalization costs that have been suggested by the medical literature have also been confirmed in Poland.

CONCLUSIONS

The mean hospitalization costs of patients aged 65 years and older in Poland are higher than for younger patients due to longer LOS and more complex and expensive treatment, especially laboratory and radiologic diagnostics, which is increasingly common in the oldest age groups. This demands an urgent systemic solution, especially in terms of adjusted financing of elderly patients' hospital treatment.

Measures used to assess impact of providing care among informal caregivers of persons with stroke, spinal cord injury, or amputation: a systematic review

PURPOSE

(1) To identify measures used to evaluate the impact of caregiving among caregivers of persons with stroke, spinal cord injury, and amputation; and (2) to systematically evaluate their clinimetric properties reported in validation studies.

MATERIALS AND METHODS

Two separate systematic reviews (Embase, PsycINFO, CINAHL, Pubmed/Medline) were conducted. COSMIN guidelines were used to assess clinimetric properties and methodological quality of studies.

RESULTS

(1) 154 studies published between 2008 and May 2019 were included, in which 48 measures were used, mostly describing negative impact. Thirty measures were used only once and not further described. (2) In general, structural validity, internal consistency, and hypothesis testing were often investigated. Reliability, cross-cultural and criterion validity to a lesser extent, and scale development and content validity were rarely described. Tests of measurement error and responsiveness were exceptional. Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire.

CONCLUSIONS

There is a wide variety of impact of caregiving measures. The present study provided a detailed overview of what is known about clinimetric characteristics of 18 different measures repeatedly used in research. The overview provides clinicians a guidance of appropriate measure selection.

PROSPERO REGISTRATION

CRD42018094796IMPLICATIONS FOR REHABILITATIONClinicians should be aware that information about measure development and clinimetric properties for most measures used to assess impact of informal caregiving is incomplete.Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire.This overview of clinimetric properties provides clinicians guidance for selection of an appropriate measure.

Determinants of quality of life in patients with hemorrhagic stroke: A path analysis

Identifying the determinants of health-related quality of life (HRQOL) improved assessment and decision-making in clinical practice. A few studies have focused on the determinants of HRQOL and their interrelationships in patients with hemorrhagic stroke. The aim of this study was to identify the factors contributing to HRQOL and exam their interrelationships.A total of 202 patients with hemorrhagic stroke who were discharged from the neurological unit participated in this study. Stroke-specific quality of life was used to assess HRQOL. The Hamilton Rating Scale for Anxiety, the Hamilton Rating Scale for Depression, the Scandinavian Stroke Scale and the Barthel Index were collected as potential predictors as well as social-demographic data. A path analysis was used to explore the potential interrelationships between various factors based on the International Classification of Functioning model.The final model reasonably fitted the data. The activities of daily living, neurological function and anxiety had direct effects on quality of life. Age, comorbidities, hemorrhage type, financial status, anxiety, and neurological function also had indirect influences on quality of life. All these factors explained 82.0% of all variance in quality of life.HRQOL in patients with stroke can be predicted by anxiety, neurological function, activities of daily living and other personal and environmental factors. These identified predictors and their interrelationships may assist clinical professions focusing their assessments and developing strategies for modifiable factors to improve HRQOL.

Determinants of care efficiency in a group of Polish parents raising children with different developmental disorders: a cross-sectional study

Objectives: Care efficiency of family can be determined by many factors such as mental and physical health status of family members and their socioeconomic situation. Raising children with disabilities is a burdening and stressful situation for their caregivers. This article examines determinants of care efficiency in a group of Polish parents raising children with developmental disorders. Methods: The cross-sectional study was conducted in 9 Polish schools for disabled children located in Cracow. Questionnaire that included the Caregiver Burden Scale and the Scale Efficiency of Care was completed by 213 mothers and 30 fathers. During the data analysis parametric tests (e.g. ANOVA) and nonparametric tests (e.g. a Mann-Whitney U test, Kruskal-Wallis test) were used. Results: Parents' care efficiency and burden of care were on an average level. Sociodemographic variables such as gender, age, place of residence, education and family structure were not related to the care efficiency. The relationship with housing and material conditions of the respondents was shown. The statistical analysis showed the relationship between the level of parents' care efficiency and all subscales of Caregiver Burden Scale. Parents who demonstrated a higher level of care efficiency experienced lower level of burden in areas such as General Strain, Isolation, Disappointment, Emotional Involvement and Environment. Conclusions : Disability of a child reduces caring potential of a family. Parents experience more physical and mental fatigue, which aggravates their disappointment. It is important to make precise diagnosis of parents' care problems and implement an individualized program to help a family.

Sense of coherence, burden and mental health in caregiving: A systematic review and meta-analysis

BACKGROUND

Informal caregiving is associated with a number of negative effects on carers' physical and psychological well-being. The salutogenic theory argues that sense of coherence (SOC) is an important factor in psychological adjustment to stress. The main aim of this study was to systematically review current evidence on the association between SOC, burden and mental health outcomes in informal carers.

METHOD

A systematic search was carried out up to September 2017 in the following databases: PubMed, CINAHL (EBSCO), PsychInfo (OVID) and Scopus. Studies were included if they evaluated the relationship between sense of coherence and subjective caregiver burden and/or mental health outcomes, specifically symptoms of depression and anxiety. Meta-analyses were performed and subgroup analyses were carried out to explore if methodological factors influenced findings.

RESULTS

Thirty-five studies were included in the meta-analysis, which provided 40 independent samples with 22 independent comparisons for subjective caregiver burden, 26 for symptoms of depression and 7 for symptoms of anxiety. Higher levels of SOC were associated with lower levels of subjective caregiver burden and better mental health outcomes. Publication bias did not change the estimate of the effect.

LIMITATIONS

Most of the studies included in this review were cross-sectional.

CONCLUSIONS

Findings suggest that SOC is an important determinant of carer well-being and may protect carers from high levels of psychological distress and caregiver burden.

Determinants of caregiver burden of patients with haemorrhagic stroke in China

AIM

The aim of this study was to assess the caregiver burden over time of patients with haemorrhagic stroke and the determinants of this.

BACKGROUND

Identification of the predictors for caregiver burden can be used to improve the outcomes of stroke survivors and caregivers. Few studies focus on the caregiver burden of patients with haemorrhagic stroke and how this changes over time.

DESIGN

This was a prospective longitudinal study.

METHODS

A convenience sample of 202 stroke survivor/caregiver pairs were recruited in the neurosurgery unit from March 2015 to March 2016. The participants were assessed at three different times by face to face or telephone interview. Caregiver burden was assessed using the Bakas Caregiver Outcomes Scale. Sociodemographic data and other characteristics of the pairs were also collected. Multiple linear regression was performed to identify the determinants.

RESULTS

Caregiver burden decreased from T1 to T3 significantly. The physical function, depression of stroke survivors, and self-rated burden of caregivers were the most important determinants for overall caregiver burden. The factors identified explained 41.6% to 67.4% of overall burden.

CONCLUSION

Caregiver burden decreased over time, affected by factors from patients and caregivers. More professional caregivers are needed to support informal carers.

Relationship between the anxiety/depression and care burden of the major caregiver of stroke patients

To investigate the anxiety/depression of caregivers of stroke patients.This study used a cross-sectional survey design and convenience sampling.Totally, 117 caregivers of stroke patients were enrolled. Data were collected from questionnaires. Hamilton anxiety scale, Hamilton depression scale, and Zarit caregiver burden interview were performed. Multiple linear regression and correlation analysis were used.The anxiety score, depression score and total burden score of 117 stroke caregivers were 16.56 ± 8.02, 18.63 ± 9.39, and 25.88 ± 10.35, respectively. Anxiety symptoms, mild to moderate depressive symptoms, and severe depressive symptoms were found in 43.9%, 26.5%, and 27.4% of the caregivers, respectively. Daily care time and medical payment method were influencing factors for anxiety and depression (P < .05). Both anxiety and depression were positively correlated with total care burden score (P < .01).Anxiety and depression are common in the caregivers of stroke patients and are closely related to care burdens. In this regard, appropriate home care guidance, psychological counseling and social support should be provided to the caregivers to reduce their physical and mental burden.

A Meta-analytic Study of Predictors for Informal Caregiver Burden in Patients With Stroke

BACKGROUND

Several studies have reported on predictors for caregiver burden in patients with stroke, but the magnitude of the impact of these variables remains unclear. The aim of the study was to determine the magnitude of relationship between each predictor and caregiver burden.

METHODS

Articles related to this filed were search in PUBMED, MEDLINE and Cochrane Library electronic database from the upset to May 2018. Of the 812 articles identified, 22 were included in the final analysis (3025 patients and 2887 caregivers). Weighted correlation coefficient (r-index) was computed as effect size for each predictor.

RESULTS

Of predictor variables of patients, the activity of daily living and anxiety had moderate to large effect sizes; gender, neurological function and depression had the small to moderate effect sizes. Of caregivers' predictors, depression, anxiety, and sense of coherence had large effect sizes; gender, daughter in law, physical health and employment status had small to moderate effect sizes.

CONCLUSIONS

The most powerful predictors of caregiver burden using meta-analysis were identified to direct future research and evidence-based practice.

Benefit finding for Chinese family caregivers of community-dwelling stroke survivors: A cross-sectional study

AIMS AND OBJECTIVES

To identify whether benefit finding is a mediator or moderator in the relationship between caregiver burden and psychological well-being (anxiety and depression) in Chinese family caregivers of community-dwelling stroke survivors.

BACKGROUND

Family caregivers not only bear a heavy burden, a high level of anxiety and depression, but also experience benefit finding (positive effects result from stressful events). However, the relationships among benefit finding, caregiver burden and psychological well-being in Chinese family caregivers are not well known.

DESIGN

This study was a cross-sectional correlational design.

METHODS

Caregivers (n = 145) of stroke survivors were recruited from two communities in Zhengzhou, China. Data were collected by face-to-face interviews with structured questionnaires, examining caregiver burden, benefit finding and psychological well-being of caregivers. A hierarchical regression analysis explored whether caregiver burden and benefit finding were associated with anxiety and depression of caregivers. The moderator role of benefit finding was examined by testing the significance of the interaction between caregiver burden and benefit finding. A mediational model was used to test benefit finding as a mediator between caregiver burden and psychological well-being of caregivers using process in spss 21.0.

RESULTS

Caregiver burden and benefit finding were significantly associated with both anxiety and depression of caregivers. Benefit finding did not portray a moderating role, but portrayed the mediator role in the relationship between caregiver burden, anxiety and depression in caregivers.

CONCLUSION

This study provides the preliminary evidence to nurses that intervention focus on benefit finding may help improve the psychological well-being of caregivers.

RELEVANCE TO CLINICAL PRACTICE

This study offers nurses rational for assessing caregiver's negative emotions and benefit finding. By targeting benefit finding, the nurse may guide caregivers in benefit identification and implement interventions to reduce anxiety, depression and caregiver burden.

Roles of Changing Physical Function and Caregiver Burden on Quality of Life in Stroke: A Longitudinal Dyadic Analysis

BACKGROUND AND PURPOSE

The purpose of this study was to examine changes in stroke survivor and caregiver quality of life (QOL) and to determine whether changes in survivor physical functioning and caregiver burden (ie, the impact of the physical, psychological, and social demands of caregiving) influence changes in QOL.

METHODS

Longitudinal design with 226 stroke survivor-caregiver dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed over 12 months. We measured survivor physical functioning, caregiver burden, and QOL (physical, psychological, social, and environmental) in both survivor and caregiver. Multilevel modeling was used to control for the interdependence of the data.

RESULTS

Survivors (50% male sex) and caregivers (66% female sex) were 70.8 (SD=11.9) and 52.4 (SD=13.1) years old, respectively. Over the 12 months, stroke survivor's physical (γ=1.59; P<0.001) and psychological (γ=0.86; P<0.05) QOL significantly improved; social and environmental QOL did not P>0.05. Caregiver QOL, on average, did not significantly change over time P>0.05. Improvements in survivor physical functioning were associated with increases in survivor and caregiver physical and psychological QOL and survivor environmental QOL. Decreases in caregiver burden were significantly associated with improvements in caregiver physical, psychological, and environmental QOL but not with survivor QOL.

CONCLUSIONS

QOL of stroke survivors and caregivers covaries and is greatly impacted by the physical function changes of the survivor. Dyadic approaches to stroke rehabilitation that acknowledge the interdependence of dyads are needed.

Caregiver burden and emotional problems in partners of stroke patients at two months and one year post-stroke: Determinants and prediction

OBJECTIVES

(a) To determine levels of and factors explaining partners' burden, anxiety and depressive symptoms at two months post-stroke, (b) to predict partners' burden, anxiety and depressive symptoms at one year post-stroke based on patient and partner characteristics available at two months post-stroke.

METHODS

Prospective cohort study. Partners of stroke patients (N=183) were included. Main outcome measures were the Caregiver Strain Index and the Hospital Anxiety and Depression Scale.

RESULTS

Many partners experienced high burden, anxiety and depressive symptoms. At two months post-stroke, these outcomes were associated with the partner variables: age, relationship satisfaction, pro-active coping, self-efficacy, everyday social support, burden, anxiety and depressive symptoms; and the patient variables: stroke severity and depressive symptoms. Partner outcomes at one year post-stroke were mainly predicted by the level of these outcomes at two months post-stroke.

CONCLUSIONS

Partner outcomes at two months post-stroke predict to a large degree partner outcomes at one year post-stroke.

PRACTICE IMPLICATIONS

Measuring partners' burden and anxiety and depressive symptoms in the post-acute phase is recommended to trace partners at risk of long-term burden and emotional problems.

Burden and Cognitive Appraisal of Stroke Survivors' Informal Caregivers: An Assessment of Depression Model With Mediating and Moderating Effects

This study proposes and evaluates a model of depression that concerns the role of burden and cognitive appraisal as mediators or moderators of outcomes among stroke survivor caregivers. A total of 105 informal caregivers of stroke survivor completed the self-report measures of Caregiver Burden Inventory, Center for Epidemiologic Studies Depression Scale, and Cognitive Impact of Appraisal Scale. The Glasgow Coma Scale and Barthel Index were used by the researcher to examine the physical functional status of the survivor. Partial least squares (PLS) path modeling was used to estimate the parameters of a depression model that included mediating or moderating effects. The model shows that burden and impact of cognitive appraisal have a significant direct and indirect impact on depression, while survivor physical functional status does not have a direct impact. The model also demonstrates that burden and impact of cognitive appraisal separately play a mediating role between survivor physical functional status and caregiver depression. In addition, cognitive appraisal has a moderating influence on the relationship between burden and depression. Overall, survivor physical functional status, burden, and cognitive appraisal were the predictors of caregiver depression, explaining 47.1% of the variance. This study has shown that burden and cognitive appraisal are mediators that more fully explain the relationship between patient severity and caregiver depression.

Burden in caregivers of long-term stroke survivors: Prevalence and determinants at 6 months and 5 years after stroke

OBJECTIVES

To assess the prevalence of considerable burden among caregivers of stroke survivors at 6 months (Time 1) and 5 years after stroke (Time 2), to analyse changes in burden severity over time and to identify factors associated with the burden.

METHODS

Eighty eight patient/caregiver pairs were assessed. Caregiver burden was measured with the Caregiver Burden Scale. Socio-demographic, stroke-related and psychological characteristics were analysed as potential determinants of the burden. Exact multiple logistic regression was used to identify the predictive factors.

RESULTS

Considerable burden was reported by 44% of the caregivers at Time 1 and 30% at Time 2. The burden was independently associated with caregivers' sense of coherence and amount of time spent caregiving at Time 1, and with caregivers' anxiety at Time 2.

CONCLUSIONS

A significant proportion of the caregivers experienced considerable burden in the post-acute and chronic phases of stroke, although this proportion declined over time. Several characteristics were associated with the increased burden at different time points. All the independent predictors related to aspects of the carers.

PRACTICE IMPLICATIONS

Programmes including education about coping strategies and time management, as well as respite care provision, could be beneficial and might help to reduce the burden of caregiving.