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Chokphukhiao C, Tun WST, Masa S, Chaiayuth S, Loeiyood J, Pongskul C, Patramanon R. Revolutionizing elderly care: Building a healthier aging society through innovative long-term care systems and assessing the long-term care acceptance model. Geriatr Gerontol Int 2024; 24:477-485. [PMID: 38584313 DOI: 10.1111/ggi.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/25/2023] [Accepted: 02/24/2024] [Indexed: 04/09/2024]
Abstract
AIM With a growing elderly population, the demand for caregivers is increasing in Khon Kaen, Thailand, with approximately 17 000 elderly residents. This growing number of older people and a shortage of caregivers could overload the healthcare system. METHODS The present study involved 129 healthcare volunteers (caregivers for questionnaires study) and the collection of health data from 290 elderly residents from northeastern Thailand. After training, the volunteers assessed its usefulness through questionnaires. Tool reliability and statistical hypotheses were tested using stratified regression analysis (hierarchical regression) and multiple regression. RESULTS The relative mean scores of perceived usefulness, perceived ease of use, attitude toward usage and behavioral intention to use technology were 4.51, 4.29, 4.44 and 4.41, respectively. In addition, perceived usefulness and user attitudes positively affected volunteers' willingness to use the system. CONCLUSION The study was developed from the awareness of enhancing community quality and ecosystem through a long-term care system application. Analyzing external factors can enhance technology's future effectiveness. Geriatr Gerontol Int 2024; 24: 477-485.
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Affiliation(s)
- Chaturapron Chokphukhiao
- Information Technology International Program, College of Computing, Khon Kaen University, Khon Kaen, Thailand
- Center of Excellence in Digital Innovation, Faculty of Education, Khon Kaen University, Khon Kaen, Thailand
- Khon Kaen University Phenom Center, Khon Kaen University, Khon Kaen, Thailand
| | - Wonn Shweyi Thet Tun
- Department of Chemistry, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand
| | - Sakaowrat Masa
- Khon Kaen University Phenom Center, Khon Kaen University, Khon Kaen, Thailand
| | - Somporn Chaiayuth
- Division of Public Health and Environment Service, Office of Public Health and Environment, Khon Kaen Municipality, Khon Kaen, Thailand
| | - Jugsun Loeiyood
- Division of Information and Communication Technology, Khon Kaen Provincial Health Office, Khon Kaen, Thailand
| | - Cholatip Pongskul
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Rina Patramanon
- Khon Kaen University Phenom Center, Khon Kaen University, Khon Kaen, Thailand
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Sung P, Lim-Soh J, Malhotra R. Informal Caregiver Social Network Types and Mental Health: The Mediating Role of Psychological Resilience. J Aging Soc Policy 2024:1-16. [PMID: 38424034 DOI: 10.1080/08959420.2024.2319535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 11/13/2023] [Indexed: 03/02/2024]
Abstract
Little is known about whether and why social networks protect mental health among informal caregivers. This study examined the association between informal caregiver social network types and depressive symptoms and the mediatory mechanism of psychological resilience. Latent class analysis, applied to cross-sectional data on 278 Singaporean caregivers, identified four social network types: restricted (42%), friend (16%), family (21%), and diverse (21%). Path analysis showed that the diverse social network type, compared to the restricted social network type, was associated with a lower level of depressive symptoms, and psychological resilience fully mediated this association. Interventions should help caregivers to maintain social networks with their family and friends.
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Affiliation(s)
- Pildoo Sung
- Department of Sociology, Hong Kong Baptist University, Hong Kong, China
| | - Jeremy Lim-Soh
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Rahul Malhotra
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Teng B, Rosbergen ICM, Gomersall SR, Hatton A, Brauer SG. Barriers to and Facilitators of Adherence to Prescribed Home Exercise in Older Adults at Risk of Falling in Singapore: A Qualitative Study. J Aging Phys Act 2023; 31:48-58. [PMID: 35649516 DOI: 10.1123/japa.2021-0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 02/03/2023]
Abstract
Adherence to prescribed exercise poses significant challenges for older adults despite proven benefits. The aim of this exploratory descriptive qualitative study was to explore the perceived barriers to and facilitators of prescribed home exercise adherence in community-dwelling adults 65 years and older. Three focus groups with 17 older adults (Mage ± SD = 77 ± 5.12) living in Singapore were conducted. Inductive thematic analysis revealed that "the level of motivation" of individuals constantly influenced their exercise adherence (core theme). The level of motivation appeared to be a fluid concept and changed due to interactions with two subthemes: (a) individual factors (exercise needs to be tailored to the individual) and (b) environmental factors (i.e., support is essential). Hence, these factors must be considered when designing strategies to enhance exercise adherence in this vulnerable population. Strategies must be informed by the culturally unique context, in this case, a developed country with a multiethnic urban Asian population.
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Sung P, May-Ling Lee J, Chan A. Lonely in a Crowd: Social Isolation Profiles and Caregiver Burden Among Family Caregivers of Community-Dwelling Older Adults With Cognitive Impairment. J Aging Health 2022; 35:419-429. [PMID: 36330754 DOI: 10.1177/08982643221137939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives This study identified distinct social isolation profiles among caregivers, each formed by varied combinations of social disconnectedness and loneliness, and examined if and how the profiles were associated with caregiver burden. Methods Latent class analysis and multivariable regression were applied to data from 266 caregivers of community-dwelling older Singaporeans with cognitive impairment. Results Two caregiver social isolation profiles were identified: strongly connected, not lonely (86%), and moderately connected, lonely (14%). Moderately connected and lonely caregivers tended to perceive a higher level of burden than strongly connected and not lonely caregivers. Moderately connected and lonely caregivers were also more likely to be burdened by their care recipients’ poor health than their connected and not lonely counterparts. Discussion Caregivers who feel “lonely in a crowd” are vulnerable to caregiving stress and burden. Tailored interventions, such as cognitive behavioral therapy, are needed to reduce the loneliness of moderately connected caregivers.
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Affiliation(s)
- Pildoo Sung
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - June May-Ling Lee
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Angelique Chan
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Ho KHM, Cheung DSK, Lee PH, Lam SC, Kwan RYC. Co-living with migrant domestic workers is associated with a lower level of loneliness among community-dwelling older adults: A cross-sectional study. Health Soc Care Community 2022; 30:e1123-e1133. [PMID: 34288198 DOI: 10.1111/hsc.13520] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/02/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
Loneliness (inclusive social loneliness and emotional loneliness) of older adults is a prominent public health issue internationally. Factors consistently associated with loneliness are age, gender, education, living arrangements, social network, and functional status. Intergenerational co-living with spouse and adult children is important for the exchange of social, emotional, practical, and financial support provided to older adults. Co-living with migrant domestic workers (MDWs) to care for older adults became an emergent phenomenon internationally, particularly in Asian countries. According to the convoy model of social relations, the effect of co-living with MDWs on older adults' loneliness is unknown. This study examined (1) the prevalence of loneliness among community-dwelling older adults; and (2) the association between co-living with MDWs and older adult loneliness. Using the Chinese version of the 6-item De Jong Gierveld Loneliness Scale on loneliness, 380 older adults were interviewed at busy points in Hong Kong, including subway stations. 35.3% of older adults experienced moderate-to-severe loneliness. Linear regression was performed to examine the association between co-living with MDWs and loneliness. The results showed that co-living with MDWs was significantly associated with lower levels of overall loneliness (β = -0.636; p = .022) and emotional loneliness (β = -0.298, p = .039), but not for social loneliness (β = -0.337, p = .084). While MDWs could be an attachment figure for older adults, they might not be effective in promoting the social integration of older adults. There is a need to investigate the barriers of social integration faced by older adults co-living with MDWs.
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Affiliation(s)
- Ken Hok Man Ho
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Paul Hong Lee
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Simon Ching Lam
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Rick Yiu Cho Kwan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Yuan Q, Zhang Y, Samari E, Jeyagurunathan A, Tan GTH, Devi F, Wang P, Magadi H, Goveas R, Ng LL, Subramaniam M. The impact of having foreign domestic workers on informal caregivers of persons with dementia - findings from a multi-method research in Singapore. BMC Geriatr 2022; 22:305. [PMID: 35395748 PMCID: PMC8993210 DOI: 10.1186/s12877-022-03002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background Informal caregivers of persons with dementia (PWDs) sometimes engage foreign domestic workers (FDWs) to support their caregiving journey. However, there has not been much research to establish if this is really beneficial. The current study aims to investigate whether engaging FDWs specifically for caregiving of PWDs truly moderates caregiver stress and to explore caregivers’ experiences of engaging FDWs. Methods A multi-method study design with a quantitative and qualitative sub-study was adopted. For the quantitative sub-study, 282 informal caregivers of PWDs were recruited. Propensity score matching analysis was used. For the qualitative sub-study, 15 informal caregivers with FDWs were interviewed. Inductive thematic analysis was conducted. Results The quantitative sub-study confirmed that engaging FDWs did moderate the depressive symptoms of informal dementia caregivers (marginal effect = -3.35, p = 0.0497). However, such support did not affect their caregiving burden, self-efficacy, and perceived positive aspects of caregiving. The qualitative sub-study suggested that engaging FDWs is an ambivalent experience, which entails both support and challenges. Conclusions The current study confirmed previous research findings, that engaging FDWs moderated depressive symptoms among caregivers of PWDs, and it could be through their physical support such as in daily caregiving activities. Policy-makers may consider providing more subsidies to caregivers caring for PWDs with mobility issues to hire FDWs. They may also consider providing training to FDWs on dementia caregiving skills and improving the intake of such training as this might be helpful for both FDWs and caregivers during this journey.
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Affiliation(s)
- Qi Yuan
- Research Division, Institute of Mental Health, Buangkok Green, Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Buangkok Green, Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Buangkok Green, Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green, Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Gregory Tee Hng Tan
- School of Social Sciences, Singapore Management University, Singapore, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, Buangkok Green, Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Buangkok Green, Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Harish Magadi
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Richard Goveas
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Department of Psychological Medicine, Changi General Hospital, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green, Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
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Ang KW, Koh YLE, Wang XF, Yusoff AM, Tan AM, Poh XYC, Zhang N, Tan NC. Pilot cross-sectional study of foreign domestic workers supporting the basic healthcare needs of older persons in the community. BMJ Open 2022; 12:e051877. [PMID: 35351699 PMCID: PMC8961118 DOI: 10.1136/bmjopen-2021-051877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This pilot study aimed to determine the proportions, level of knowledge, anxiety and confidence of foreign domestic workers (FDWs) who were involved in supporting the healthcare needs of older persons with long-term non-communicable diseases. DESIGN The pilot study used a cross-sectional and descriptive design.FDWs who accompanied the older adults attending a primary healthcare setting in Singapore. 100 eligible FDWs' demographic data, knowledge and confidence level of caregiving in food preparation, medication supervision, exercise, blood pressure (BP), blood glucose (BG) monitoring and anxiety level assessed by the Generalised Anxiety Disorder-7 scale were recorded. Descriptive statistics were performed and presented. Items on confidence were regrouped into two groups of 'very' versus 'no/a little/moderate'. Knowledge scores and caregiving tasks were assessed with items on confidence using Mann-Whitney U test and χ2 test, respectively. RESULTS The FDWs were from Indonesia (60%), Philippines (23%) and Myanmar (14%). Their mean age was 33 years with an average of 5.8 years working experience; 62% self-reported previous caregiver training for elderly. The mean age of care-recipients was 81 years. Knowledge of FDWs on BP and BG monitoring was low (<50% answered correctly). Among the 55 FDWs who were required to perform BP monitoring, 45.5% lack confidence. Similarly, 40% of the 30 FDWs were not confident in performing BG monitoring. Those with very high confidence levels had higher knowledge on BP and BG monitoring. Of those who were involved in medication supervision (n=86), 36% lacked confidence. The majority of the FDWs (96%) were not affected by anxiety in managing these healthcare tasks for older persons. CONCLUSION More than half of the FDWs supported healthcare needs of older persons but they had inadequate knowledge and lacked confidence in performing the healthcare-related tasks.
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Affiliation(s)
- Kim Wai Ang
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Academic Clinical Programme, Singapore
| | | | | | | | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Academic Clinical Programme, Singapore
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Wang Y, Tyagi S, Hoenig H, Lee KE, Venketasubramanian N, Menon E, De Silva DA, Yap P, Tan BY, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Ning C, Cheong A, Koh GCH. Burden of informal care in stroke survivors and its determinants: a prospective observational study in an Asian setting. BMC Public Health 2021; 21:1945. [PMID: 34702247 PMCID: PMC8547090 DOI: 10.1186/s12889-021-11991-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informal caregiving is an integral part of post-stroke recovery with strenuous caregiving demands often resulting in caregiving burden, threatening sustainability of caregiving and potentially impacting stroke survivor's outcomes. Our study aimed to examine and quantify objective and subjective informal care burden after stroke; and to explore the factors associated with informal care burden in Singapore. METHODS Stroke patients and their informal caregivers were recruited from all five tertiary hospitals in Singapore from December 2010 to September 2013. Informal care comprised of assistance provided by informal caregivers with any of the activities of daily living. Informal care burden was measured by patients' likelihood of requiring informal care, hours of informal care required, and informal caregivers' Zarit's Burden Score. We examined informal care burden at 3-months and 12-months post-stroke. Generalized linear regressions were applied with control variables including patients' and informal caregivers' demographic characteristics, arrangement of informal care, and patients' health status including stroke severity (measured using National Institute of Health Stroke Scale), functional status (measured using Modified Rankin Scale), self-reported depression, and common comorbidities. RESULTS Three hundred and five patients and 263 patients were examined at 3-months and 12-months. Around 35% were female and 60% were Chinese. Sixty three percent and 49% of the patients required informal care at 3-months and 12-months point, respectively. Among those who required informal care, average hours required per week were 64.3 h at 3-months and 76.6 h at 12-months point. Patients with higher functional dependency were more likely to require informal care at both time points, and required more hours of informal care at 3-months point. Female informal caregivers and those caring for patients with higher functional dependency reported higher Zarit's Burden. While informal caregivers who worked full-time reported higher burden, those caring for married stroke patients reported lower burden at 3-months point. Informal caregivers who co-cared with foreign domestic workers, i.e.: stay-in migrant female waged domestic workers, reported lower burden. CONCLUSIONS Informal care burden remains high up to 12-months post-stroke. Factors such as functional dependency, stroke severity, informal caregiver gender and co-caring with foreign domestic workers were associated with informal care burden.
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Affiliation(s)
- Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Centre, 508 Fulton St, Durham, NC, 27705, USA
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Mount Elizabeth, #11-14/15, Mount Elizabeth Medical Centre, Singapore, 228510, Singapore
| | - Narayanaswamy Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, 585 North Bridge Rd, Level 9 Raffles Specialist Centre, Singapore, 188770, Singapore
| | - Edward Menon
- St. Andrew's Community Hospital, 8 Simei Street 3, Singapore, 529895, Singapore
| | - Deidre Anne De Silva
- National Neuroscience Institute, Singapore General Hospital campus, 11 Jln Tan Tock Seng, Level 1, Singapore, 308433, Singapore
| | - Philip Yap
- Dept of Geriatric Medicine, Khoo Teck Puat Hospital, 90 Central Yishun, Singapore, 768828, Singapore
| | - Boon Yeow Tan
- St. Luke's Hospital, 2 Street 11 Bukit Batok, Singapore, 659674, Singapore
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Level 1, Singapore, 308433, Singapore
| | - Yan Hoon Ang
- Dept of Geriatric Medicine, Khoo Teck Puat Hospital, 90 Central Yishun, Singapore, 768828, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Level 1, Singapore, 308433, Singapore
| | - Reshma A Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital campus, 11 Jln Tan Tock Seng, Level 1, Singapore, 308433, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
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Basnyat I, Chang L. Tensions in support for family caregivers of people with dementia in Singapore: A qualitative study. Dementia (London) 2021; 20:2278-2293. [PMID: 33913355 DOI: 10.1177/1471301221990567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family members as informal caregivers are considered the first line of support for people with dementia across the world. In Singapore, caregiving expectations revolve around the cultural expectations of providing care in the home environment. However, studies in Singapore have identified a lack of family support for primary caregivers. Family support has been discussed in the literature as the provision of care for people with dementia, and rarely as a resource for family caregivers. METHOD To understand family support among primary caregivers in Singapore, 24 semi-structured interviews were conducted. Thematic analysis found four themes: excuses for lack of physical support for the caregiver, tensions between cultural expectations of caregiving and the provision of support, unmet emotional support, and lack of awareness of dementia and caregiving needs. FINDINGS Caregivers rationalized and forgave the absence of physical support but were frustrated when the lack of support impacted people with dementia. This was seen as a lack of fulfilling cultural obligations of caring for elderly parents. The caregivers also felt frustrated with the lack of emotional support provided to them, but these were unspoken between the caregiver and the family members. Insufficient and unhelpful support giving was exacerbated with the perception of family members' limited understanding of the demands of caregiving. CONCLUSION The findings offer four practical suggestions to address unmet support needs. First, public education is needed to enhance general knowledge about the symptoms and progression of dementia. Second, help is needed to address miscommunication about support within the family. Third, the development of guidebooks is needed to help family caregivers communicate with family members about their various support needs. Fourth, the relationship between cultural expectation and caregiving must be understood within the context of modernity and urbanism.
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Affiliation(s)
- Iccha Basnyat
- School of Communication Studies, 3745James Madison University, VA, USA
| | - Leanne Chang
- Department of Communication Studies, 26679Hong Kong Baptist University, Kowloon, Hong Kong
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Ng YM, Tilse C, Wilson J. Managing social support needs in older age for childless Malaysians living in poverty. Australas J Ageing 2021; 40:e301-e307. [PMID: 33783946 DOI: 10.1111/ajag.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore how older people manage social support needs when they are childless and living in poverty in the Malaysian context where social policy emphasises family as the primary provider of social support. METHODS Semi-structured interviews were completed with a purposive sample of 34 childless and older Malaysians living in poverty in Kuala Lumpur, Malaysia. A thematic content analysis focused on their reports of managing social support needs. RESULTS Key strategies were using existing resources, developing new networks and adjusting expectations. Agency played a vital role in avoiding institutional care. CONCLUSIONS This paper adds to research on childlessness in older age in varied policy and cultural contexts. It challenges assumptions about families providing social support and argues for policies to recognise older people as an individual unit rather than as part of a family to prolong independent living in the community.
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Affiliation(s)
- Yin Mei Ng
- Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Malaysia
| | - Cheryl Tilse
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Jill Wilson
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Muyskens K. Will Confucian Values Help or Hinder the Crisis of Elder Care in Modern Singapore? Asian Bioeth Rev 2020; 12:117-34. [PMID: 33717333 DOI: 10.1007/s41649-020-00123-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022] Open
Abstract
The unique mix of modern Western and traditional Confucian values in Singapore presents young people with contradictory views on duties to aging parents. It remains to be seen whether the changing demands of modern life will result in new generations giving up Confucian family ethics or whether the Confucian dynamic will find a way to adapt to the new pressures. It is the opinion of this author that the Confucian family structure has mixed potential for the growing crisis of elder care. Alone, both Confucian traditions and typical Western institutional approaches toward elder care fall short of what is necessary for intergenerational social justice, yet a hybrid of the two has great potential for the growing aging crisis. To demonstrate this, I first give a brief account of the history of filial piety in Confucianism as well as the social environment from which it originated. Then I turn my attention to the present issues of an aging population and elder care that face much of the developed world in the twenty-first century. Finally, I show how adherence to Confucian filial traditions can both help to address many of these issues and how it can potentially leave unjust gaps in elder care. Ultimately, I conclude that the crisis of elder care may be best dealt with through a hybrid of Confucian values and Western approaches.
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Barrenetxea J, Yang Y, Markides KS, Pan A, Koh W, Feng Q. Social support and health among older adults – the Singapore Chinese Health Study. Ageing and Society. [DOI: 10.1017/s0144686x20001944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract
While having social support can contribute to better health, those in poor health may be limited in their capacity to receive social support. We studied the health factors associated with social support among community-dwelling older adults in Singapore. We used data from the third follow-up interviews (2014–2016) of 16,943 participants of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese. Participants were interviewed at a mean age of 73 years (range 61–96 years) using the Duke Social Support Scale (DUSOCS). We first applied ordinary least squares regression to DUSOCS scores and found that those with instrumental limitations, poor self-rated health, cognitive impairment and depression had lower social support scores. We then applied latent class analysis to DUSOCS answer patterns and revealed four groups of older adults based on the source and amount of social support. Among them, compared to the ‘overall supported’ group (17%) with the highest social support scores and broad support from family members and non-family individuals, the ‘family restricted’ (50%) group had the lowest social support scores and only received support from children. Health factors associated with being ‘family restricted’ were instrumental limitations (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.19–1.49), poor self-rated health (OR = 1.40, 95% CI = 1.28–1.53), cognitive impairment (OR = 1.19, 95% CI = 1.04–1.37) and depression (OR = 2.50, 95% CI = 2.22–2.82). We found that while older adults in poor health have lower social support scores, they were more likely to receive a lot of support from children. Our results showed that lower social support scores among Singaporean older adults in poor health may not indicate lack of social support, but rather that social support is restricted in scope and intensified around children. These results may apply to other Asian societies where family plays a central role in elder-care.
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Abstract
INTRODUCTION Families increasingly employ foreign domestic workers (FDWs) to care for older loved ones. Caregiver burden reflects FDWs' difficulty adapting to work demands. We test hypothesized associations between burden and six personal characteristics: children, marriage, education, Chinese proficiency, eldercare experience, and non-eldercare experience. METHOD In total, 299 Indonesian FDWs in Taiwan completed the Zarit Burden Interview. Exploratory factor analysis identified the dimensions of burden. Multiple and multinomial regressions related the variables to overall burden, burden dimensions, and burden severity. RESULTS Four dimensions were found: personal strain, role strain, dependency, and guilt. Children were negatively associated with burden, role strain, dependency, and guilt. Chinese proficiency was negatively associated with severity and guilt. Eldercare experience was positively associated with severity and personal strain. Marriage was non-monotonically related to severity. CONCLUSION Caregivers whose earnings benefit their children may be more likely to thrive in Taiwan. Language training may boost caregiver performance and host family satisfaction.
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Huang J, Chau PH, Choi EPH, Wu B, Lou VWQ. The Patterns of Caregiving Activities for Family Caregivers of Older Adults in Hong Kong: An Exploratory Latent Class Analysis. J Gerontol B Psychol Sci Soc Sci 2020; 76:1605-1616. [PMID: 33211887 DOI: 10.1093/geronb/gbaa203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study identified the classes (i.e., patterns) of caregivers' activities, based on their engagements in caregiving activities, and explored the characteristics and the caregiver burden of these classes. METHODS This study was a secondary analysis of a cross-sectional survey on the profiles of family caregivers of older adults in Hong Kong. A latent class analysis approach was adopted to classify family caregivers (N = 932) according to their routine involvements in 17 daily caregiving activities: 6 activities of daily living (ADLs) and 8 instrumental activities of daily living activities (IADLs) in addition to emotional support, decision making, and financial support. Multinomial logistic regression and multiple linear regression illuminated the characteristics of the classes and compared their levels of caregiver burden. RESULTS The family caregivers fell into 5 classes: All-Round Care (High Demand, 19.5%), All-Round Care (Moderate Demand, 8.2%), Predominant IADLs Care (High Demand, 23.8%), Predominant IADLs Care (Moderate Demand, 32.5%), and Minimal ADLs and IADLs Care (Low Demand, 16.0%). These classes exhibited different characteristics in terms of care recipients' cognitive statuses and caregiver backgrounds. The levels of caregiver burden differed across classes; the All-Round Care (High Demand) class experienced the highest levels of caregiver burden. DISCUSSION This study contributes to existing scholarship by turning away from a predefined category of care tasks to explore the patterns of caregiving activities. By identifying caregiving activity patterns and understanding their associated characteristics and caregiver burden, prioritizing and targeting caregiver support interventions better is possible.
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Affiliation(s)
- Jing Huang
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Pui Hing Chau
- School of Nursing and Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | | | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York City
| | - Vivian W Q Lou
- Department of Social Work and Social Administration and Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
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Nan Y, Feng T, Hu Y, Qi X. Understanding Aging Policies in China: A Bibliometric Analysis of Policy Documents, 1978-2019. Int J Environ Res Public Health 2020; 17:E5956. [PMID: 32824512 PMCID: PMC7459736 DOI: 10.3390/ijerph17165956] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 12/31/2022]
Abstract
Aging poses a big challenge in all aspects of social governance in China. A coherent and focused aging policy response that spans multiple sectors of government has been undertaken to achieve the goal of "Healthy Aging". From an historical perspective, this paper uses a bibliometric analysis method to probe into the evolution of Chinese aging policies from 1978 to 2019, and the roles of core government agencies in policy-making. We obtained 226 Chinese aging policies from the PKULaw Database and the websites of the government departments. Co-word analyses and network analyses were applied in mapping the topics of aging policies and collaboration among the agencies. Gephi software was used to visualize the most frequently used keywords and their network graphs. Findings are as follows. Firstly, the development of the aging policy system in China has undergone two phases, from focusing on basic security to emphasizing the rights and health of the elderly. Secondly, the network structure of aging policy-making departments presents a distinct edge-core layer. More and more government agencies have become involved in the formulation of aging policies. But collaboration among the agencies is insufficient. Thirdly, pilot promotion is the main tool for implementing aging policies.
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Affiliation(s)
| | - Tieying Feng
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an 710049, China; (Y.N.); (Y.H.); (X.Q.)
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Ho EQY, Hong SI, Thang LL, Ong PH, Koh GCH. Falls Among Asians Living in Small Apartments Designed for Older Adults in Singapore. Journal of Aging and Environment 2020. [DOI: 10.1080/02763893.2019.1627265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Elaine Qiao-Ying Ho
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Song-Iee Hong
- Department of Social Welfare, Dongguk University, Seoul, South Korea
| | - Leng Leng Thang
- Department of Japanese Studies, National University of Singapore, Singapore, Singapore
| | - Peck Hoon Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Law W, Kwok TCY. Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study. Int J Geriatr Psychiatry 2019; 34:1765-1775. [PMID: 31390090 DOI: 10.1002/gps.5191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/05/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objectives of this study are to explore the feasibility of a multicomponent intervention programme and to evaluate its impacts on behavioural and psychological symptoms of dementia (BPSD) and psychological health of caregivers. METHODS Fifty-six community-dwelling people with dementia (PWD) and knee osteoarthritis (OA) and their caregivers were recruited and randomized into the intervention group (IG) or comparison group (CG). Each participant in both groups received an individual physiotherapy session (personalized home exercises and care education) and underwent 8 weeks of a 1-hour-structured group exercise session weekly at a day care centre. They were instructed to follow the prescribed home exercise. The IG received a multicomponent programme, combining knee OA-specific therapeutic exercise with self-management support, while the CG attended the routine group exercise programme. The attendance rate and reasons for non-attendance were recorded for evaluating the feasibility. The Chinese versions of the Revised Scale for Caregiving Self-Efficacy (RSCSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) were measured at the baseline and postintervention. RESULTS Fifty-four dyads completed the programme with high attendance rate (94.4%). Compared with the CG, caregivers in the IG significantly improved in three domains of RSCSE scores (P ≤ .005) and caregivers' distress (P = .004) after the intervention. However, no effects were observed in terms of BPSD severity in PWD. No adverse events or falls were reported. CONCLUSION This multicomponent programme is feasible and safe for dementia caregivers and older people with mild-to-moderate dementia and knee OA. The programme has beneficial effects on caregiving self-efficacy and distress of dementia caregivers.
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Affiliation(s)
- Waiyan Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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Ho KHM, Chiang VCL, Leung D, Cheung DSK. A feminist phenomenology on the emotional labor and morality of live-in migrant care workers caring for older people in the community. BMC Geriatr 2019; 19:314. [PMID: 31744456 PMCID: PMC6862863 DOI: 10.1186/s12877-019-1352-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Global societal changes, such as increasing longevity and a shortage of family caregivers, have given rise to a popular worldwide trend of employing live-in migrant care workers (MCWs) to provide homecare for older people. However, the emotional labor and morality inherent in their interactions with older people are largely unknown. The aim of the present study is to understand the corporeal experiences of live-in migrant care workers in the delivery of emotional labor as seen in their interactions with older people by: (1) describing the ways by which they manage emotional displays with older people; and (2) exploring their morality as enacted through emotional labor. Methods We performed a secondary analysis drawing on feminist phenomenology to thematically analyze data from interviews with 11 female MCWs. Follow-up interviews were conducted with 10 participants. The participants had two to 15 years of experience in caring for older people in their homes in Hong Kong. Results Performing emotional labor by suppressing and inducing emotions is morally demanding for live-in MCWs, who experience socio-culturally oppressive relationships. However, developing genuine emotions in their relationships with older people prompted the MCWs to protect the interests of older people. Through demonstrating both fake and genuine emotions, emotional labor was a tactic that live-in MCWs demonstrated to interact morally with older people. Conclusions Emotional labor allowed live-in MCWs to avoid conflict with older people, and to further protect their own welfare and that of others. This study highlights the significance of empowering live-in MCWs by training them in ways that will help them to adapt to working conditions where they will encounter diverse customs and older people who will develop an increasing dependence on them. Thus, there is a need to develop culturally appropriate interventions to empower live-in MCWs to deliver emotional labor in a moral manner.
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Affiliation(s)
- Ken H M Ho
- School of Nursing, Tung Wah College, 31 Wiley Road, Kowloon, Hong Kong SAR
| | - Vico C L Chiang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR.
| | - Doris Leung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Daphne S K Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
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Kim JH, Jung SH, Yang SY, Choi HJ. Job security and workaholism among non-permanent workers: The moderating influences of corporate culture. Journal of Psychology in Africa 2019. [DOI: 10.1080/14330237.2019.1667148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Joon-ho Kim
- Department of Business Administration, Sejong University, Seoul, South Korea
| | - Seung-hye Jung
- School of Dance, Kyung Hee University, Seoul, South Korea
| | - Soo-yun Yang
- Department of Cultural Contents, Korea University Graduate School, Seoul, South Korea
| | - Hyun-ju Choi
- Department of Cultural & Arts Management, Sangmyung University, Chungcheongnam-do, South Korea
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Abstract
Falls, the leading cause of injury and death among older people, can have a significant psychosocial impact on carers. Carers play a crucial role in caring for older persons at home and in fall prevention. This review, which included 15 studies, aimed to identify carers' concern about older people falling and its impact. We identified that most carers had concerns about repeated falls in older people, unknown consequences of falls and care recipients' non-adherence to fall prevention advice. These concerns, in turn, affect carers' physical and psychological health, lifestyle, caregiving burden and use of fall prevention strategies. This paper highlights the importance of recognising carers' fall concern so as to identify carers' needs and awareness of fall prevention in older people living at home. Greater insight into carers' fall concern could facilitate the implementation of new strategies to manage older people's fall risk as well as improve carers' well-being.
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Affiliation(s)
| | - Anthony Paul O'Brien
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Amanda Wilson
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
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22
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Chan EY, Phang KN, Glass GF, Lim WS. Crossing, Trudging and Settling: A phenomenological inquiry into lived experience of Asian family caregivers of older persons with dementia. Geriatr Nurs 2019; 40:502-509. [PMID: 30979516 DOI: 10.1016/j.gerinurse.2019.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/18/2022]
Abstract
Throughout Asian societies, family members often adopt the role of caregiving for older persons, providing essential care for loved ones with dementia. To date, there has been limited insight into the lived experience and meaning ascribed to the journey of these caregivers. This descriptive phenomenological study aims to explore the lived experience of Asian family caregivers of persons with dementia. Semi-structured face-to-face interviews were conducted with 16 family members caring for aged persons with dementia. Interviews were audio-recorded and data analysed using Colaizzi's technique. Analysis revealed the essential structure of a caregiver's journey with three major transitions, namely: (1) Crossing the threshold from ordinary world into caregiving world, (2) Trudging on the road of trials and obstacles, and (3) Settling into a new normalcy. Understanding the lived experience of Asian caregivers can help clinicians in targeting relevant support and information, and prepare new caregivers for the demands of their role.
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Affiliation(s)
- Ee-Yuee Chan
- Nursing Service, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng, Singapore, Singapore; Alice Lee Centre of Nursing Studies, National University of Singapore, Singapore, Singapore.
| | - Koh Ni Phang
- Nursing Service, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng, Singapore, Singapore
| | | | - Wee-Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatric and Active Aging, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Lo SF, Chang LJ, Hayter M, O Yang AC. An Exploration of Factors Related to Quality of Life in Indonesian Care Workers in Home-Based Care Settings. J Nurs Res 2019; 27:e47. [PMID: 30830034 DOI: 10.1097/JNR.0000000000000314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Indonesians constituted 79% of foreign care workers for long-term care in Taiwan in 2015. Therefore, it is crucial to explore the effect of work stress and quality of life (QoL) on this population. PURPOSE This study aims to explore stress levels, social support requirements, and perceived QoL among Indonesian care workers (ICWs) who work in home care settings. METHODS A cross-sectional design was used. Data were collected between 2014 and 2016 from a convenience sample of ICWs working in eastern Taiwan using a self-administered questionnaire that comprised the Stress Perception Scale (SPS), Social Support Scale (SSS), and World Health Organization Quality of Life-Brief scale. One hundred fifty-seven valid questionnaires were collected. The response rate was 80.51%. Data were analyzed using descriptive statistics, one-way analysis of variance, Pearson's correlation coefficient, and multiple regression analysis. RESULTS The results found that the average SPS of the sample was 70.50, with low QoL scores and requirements for more social support. In addition, significant and positive correlations were found between QoL and SPS, SSS, duration of patient care, and hours of care per week. Stepwise regression analysis showed that the most predictive variables for QoL were time spent caring, preservice training, psychological stress, and emotional support, which together accounted for 60.9% of the total variance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE This study facilitated understanding of the stress on ICWs and the impact of social support on their QoL. The findings suggest that new immigrants in Taiwan should be introduced to foreign care workers or nursing attendants. Moreover, long-term-care-related teachers should work with home care institutions or agencies to develop a teaching model for innovative care skills to relieve the perceived stress of ICWs.
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Affiliation(s)
- Philip A. Rozario
- School of Social Work, Adelphi University School of Social Work, Garden City, New York, USA
| | - Song-Iee Hong
- Department of Buddhist Social Welfare, Dongguk University, Korea, Seoul, South Korea
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Ang SGM, O'Brien AP, Wilson A. Fall concern about older persons shifts to carers as changing health policy focuses on family, home-based care. Singapore Med J 2018; 59:9-11. [PMID: 29376188 DOI: 10.11622/smedj.2018005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With the Singaporean population ageing at an exponential rate, home carers are increasingly becoming essential partners in fall prevention and care delivery for older persons living at home and in the community. Singapore, like other Asian countries, regards the family as the main support structure for the older person, and national policies have been implemented to support this cultural expectation. Family carers experience similar concerns as older persons with regard to fall risk, and identifying and addressing these concerns can potentially lower fall risk and improve fall prevention for older persons. It is timely to remind ourselves - as concern about falls in older persons begins to shift to carers - to incorporate the influence of Asian cultural values and unique family dynamics of outsourcing family caregiving, in the management of older persons' fall risk in the community.
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Affiliation(s)
- Seng Giap Marcus Ang
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Anthony Paul O'Brien
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Amanda Wilson
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Australia
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Tam WJ, Koh GC, Legido-Quigley H, Ha NHL, Yap PLK. "I Can't Do This Alone": a study on foreign domestic workers providing long-term care for frail seniors at home. Int Psychogeriatr 2018; 30:1269-77. [PMID: 29151397 DOI: 10.1017/S1041610217002459] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED ABSTRACTBackground:Foreign domestic workers (FDWs) play an important role in long-term caregiving of seniors at home. However, how FDWs cope with the caregiving demands, the dynamic interaction between familial and FDW caregivers and its impact on care recipients remain largely un-explored. Existing caregiver interventions mainly target familial caregivers; little assistance is available for FDW caregivers. This study explores FDWs' challenges, coping strategies, and the support they need in caring for seniors. METHODS FDWs were recruited from a geriatric ward and outpatient clinic of a tertiary hospital in Singapore. Qualitative in-depth interviews were conducted with 25 FDWs caring for frail seniors and five healthcare staff. Interviews were transcribed and analyzed using thematic analysis. RESULTS FDWs were from Indonesia, Philippines, and Myanmar. Nineteen cared for seniors with dementia (SWDs). We derived six subthemes, clustered into three salient themes: two described social support to FDWs by the senior's family members, two described their coping strategies, and two described their job satisfaction. Those who cared for SWDs faced more difficulties. We derived two family models of care: FDW-centered family dynamics, where family members rely on FDWs to perform most duties, causing poor impact on seniors' well-being and team-based family dynamics, where family members and FDWs share the caregiving burden, resulting in better impact on seniors' well-being. CONCLUSION FDWs face significant challenges in eldercare. Improving FDWs' access to training courses in eldercare, providing them with more emotional support, engaging employers to create healthy caregiving spaces at home, and improving access to senior care services can be helpful.
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Heng JL, Fan E, Chan EY. Caregiving experiences, coping strategies and needs of foreign domestic workers caring for older people. J Clin Nurs 2018; 28:458-468. [DOI: 10.1111/jocn.14619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Juit Lin Heng
- National University of Singapore; Singapore Singapore
| | - Emilia Fan
- Tan Tock Seng Hospital; Singapore Singapore
| | - Ee-Yuee Chan
- National University of Singapore; Singapore Singapore
- Tan Tock Seng Hospital; Singapore Singapore
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Abstract
UNLABELLED ABSTRACTBackground:Although foreign domestic workers (FDWs) play a significant role in caring for frail seniors in Singapore and are vulnerable to caregiving burden, there has been little research conducted hitherto. We explored caregiver burden and its determinants in this study. METHODS FDWs (N = 221, Mage = 32.3, SD = 6.23) recruited from a hospital geriatric unit completed the Zarit Burden Interview (ZBI) administered in English, Bahasa Melayu, or Burmese. Univariate and multivariate regression were employed to investigate factors influencing caregiving burden in FDWs. RESULTS Majority were Indonesians (60.0%), married (57.5%) with children (62.4%), with secondary-level education (59.7%), and providing care for >1 year (79.9%). Importantly, 25.1% reported physical health problems and 23.1% encountered language difficulties with employers. Univariate analysis revealed three significant factors associated with caregiving burden: nationality (p < 0.001), lack of privacy (p = 0.029), and caring for persons with dementia (PWD) (p = 0.001). On multivariate regression, FDWs who cared for PWD were 5.47 times (p = 0.013) more likely to experience burden, while FDWs who encountered language difficulties were 5.46 times (p = 0.030) more likely to experience burden. Filipinos FDWs were 9.73 times more likely to express burden (p < 0.001) compared to their Indonesian and Burmese counterparts. CONCLUSION The study highlights caregiver burden in FDWs and potential ways to alleviate it by empowering FDWs with dementia-specific caregiving skills, providing language training opportunities, and supporting particular FDW ethnic groups with more emotional and practical help.
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Abstract
The well-being of informal caregivers in the familial context is increasingly recognized as a critical area of concern affecting the care of older family members. This paper focuses on the dynamics of family caregiving for older members from the work-life perspective, contextualised in the highly developed and rapidly ageing society that is Singapore. Drawing from qualitative research on 30 adult family caregivers and 15 live-in foreign domestic workers (FDWs), the main themes identified from the qualitative interviews were: 1) Stresses and dilemmas faced by family caregivers; 2) Filial responsibility in the caring for one's parents; 3) Coping with work and caregiving - FDWs in family caregiving; 4) Coping with extra help - hiring of FDWs and challenges. This study highlights the complexities when paid and unpaid family care is juxtaposed in the family household. The findings point to the need for improvement in policies, training and support for caregivers.
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Tyagi S, Lim DSY, Ho WHH, Koh YQ, Cai V, Koh GCH, Legido-Quigley H. Acceptance of Tele-Rehabilitation by Stroke Patients: Perceived Barriers and Facilitators. Arch Phys Med Rehabil 2018; 99:2472-2477.e2. [PMID: 29902469 DOI: 10.1016/j.apmr.2018.04.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To explore the perceived barriers and facilitators of tele-rehabilitation (TR) by stroke patients, caregivers and rehabilitation therapists in an Asian setting. DESIGN Qualitative study involving semi-structured in-depth interviews and focus group discussions. SETTING General community. PARTICIPANTS Participants (N=37) including stroke patients, their caregivers, and tele-therapists selected by purposive sampling. INTERVENTIONS Singapore Tele-technology Aided Rehabilitation in Stroke trial. MAIN OUTCOME MEASURES Perceived barriers and facilitators for TR uptake, as reported by patients, their caregivers, and tele-therapists. RESULTS Thematic analysis was used to inductively identify the following themes: facilitators identified by patients were affordability and accessibility; by tele-therapists, was filling a service gap and common to both was unexpected benefits such as detection of uncontrolled hypertension. Barriers identified by patients were equipment setup-related difficulties and limited scope of exercises; barriers identified by tele-therapists were patient assessments, interface problems and limited scope of exercises; and common to both were connectivity barriers. Patient characteristics like age, stroke severity, caregiver support, and cultural influence modified patient perceptions and choice of rehabilitation. CONCLUSIONS Patient attributes and context are significant determinants in adoption and compliance of stroke patients to technology driven interventions like TR. Policy recommendations from our work are inclusion of introductory videos in TR programs, provision of technical support to older patients, longer FaceTime sessions as re-enforcement for severely disabled stroke patients, and training of tele-therapists in assessment methods suitable for virtual platforms.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Daniel S Y Lim
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System
| | - Wilbert H H Ho
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System
| | - Yun Qing Koh
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System
| | - Vincent Cai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System.
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; London School of Hygiene and Tropical Medicine, United Kingdom
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Ho KHM, Chiang VCL, Leung D, Ku BHB. When Foreign Domestic Helpers Care for and About Older People in Their Homes: I Am a Maid or a Friend. Glob Qual Nurs Res 2018; 5:2333393617753906. [PMID: 29404382 PMCID: PMC5791470 DOI: 10.1177/2333393617753906] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/16/2022] Open
Abstract
We examine the lived experiences of foreign domestic helpers (FDH) working with community-dwelling older people in Hong Kong. Unstructured interviews were conducted with 11 female FDHs, and thematically analyzed. The theme inescapable functioning commodity represented the embodied commodification of FDHs to be functional for older people in home care. Another theme, destined reciprocity of companionship, highlighted the FDHs' capacity to commit to home care and be concerned about older people. The waxing and waning of the possibilities of commodified companionship indicated the intermittent capacity of FDHs to find meaning in their care, in which performative nature for functional purposes and emotional engagement took turns to be the foci in migrant home care. This study addresses the transition of FDHs from task-oriented relation to companions of older people through care work. Discussion draws on the development of a kin-like relationship between FDHs and older people with emotional reciprocity grounded in moral values.
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Affiliation(s)
| | | | - Doris Leung
- The Hong Kong Polytechnic University, Hong Kong
| | - Ben H B Ku
- The Hong Kong Polytechnic University, Hong Kong
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Anjara SG, Nellums LB, Bonetto C, Van Bortel T. Stress, health and quality of life of female migrant domestic workers in Singapore: a cross-sectional study. BMC Womens Health 2017; 17:98. [PMID: 29017558 PMCID: PMC5634837 DOI: 10.1186/s12905-017-0442-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a global increase in migrant workers. In Singapore, there are over 230,000 migrant domestic workers (MDWs). Female MDWs may experience high levels of stress and social isolation, which may negatively impact on their health and quality of life. There have also been documented cases of abuse and exploitation. However, there is a lack of empirical research with this population. This study aimed to investigate factors impacting on the health and quality of life of female MDWs in Singapore, including socio-demographic and job related characteristics, stress, social isolation, and working management style. METHODS A cross-sectional survey was carried out with 182 female MDWs in Singapore. The survey examined health and quality of life (WHOQoL-Bréf), social connectedness (the Friendship Scale), and preferred and experienced working management style (the Theory X and Theory Y Questionnaire). Descriptive analyses were carried out in addition to ANOVA, t-tests, and chi-square tests, followed by a multivariate analysis using linear regression. RESULTS Participants were found to have good overall quality of life and satisfaction with health. Age and working experience were found to be significantly (p < 0.05) associated with overall quality of life and three domains (psychological, social, and environmental health). Agreement between experienced and preferred working management style was also found to be associated with higher quality of life scores (with the exception of the social relationships domain). Though women reported relatively good overall quality of life, more than half of participants reported feeling stressed. In addition, nearly 20% of participants reported being isolated or very isolated. Stress was identified to be associated with isolation. In the multivariate analysis, stress was found to contribute to worse quality of life in all domains except social relationships, after adjusting for confounders. Social connectedness was positively associated with all domains of quality of life, and agreement of working management style was positively associated with physical health, psychological health and environmental quality of life. CONCLUSIONS The findings serve as an evidence-base pointing to the need for policies aimed at decreasing stress and social isolation among female MDWs in order to improve their health and quality of life.
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Affiliation(s)
- S. G. Anjara
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | - L. B. Nellums
- Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, 8th Floor Commonwealth Building, Hammersmith Hospital, Du Cane Road, London, W12 0NN UK
| | - C. Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - T. Van Bortel
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Institute for Health and Human Development, University of East London, Stratford Campus, Suite 250, University House, The Green, Water Lane, London, E15 4LZ UK
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Penkunas MJ, Eom KY, Chan AW. Classification trees for identifying non-use of community-based long-term care services among older adults. Health Policy 2017; 121:1093-9. [DOI: 10.1016/j.healthpol.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 05/06/2017] [Accepted: 05/15/2017] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE This study examined the moderating effect of domestic helpers on distress of offspring caring for parents with cognitive impairments and with or without behavioural problems. METHOD This secondary analysis of data involved 5086 Hong Kong Chinese adults aged 60 or older applying for public long-term care services from 2010 to 2012. All variables were measured using the mandatory Hong Kong version of the Minimum Data Set-Home Care 2.0. RESULTS Regarding taking care of parents with cognitive impairments, 10.7% of offspring primary caregivers were aided by domestic helpers, 55.54% reported distress, and 75.70% lived with their parents. Assistance from domestic helpers reduced offspring caregiver distress if the offspring provided psychological support to parents (ratio of OR = 0.655, p < .05) and were not living with parents (ratio of OR = 1.183, p < .01). CONCLUSION These findings might suggest: a) the positive effects of audience on psychological responses to stress; b) caregiving is usually less stressful for informal caregivers not residing with care recipients. Conversely, having a domestic helper could add to caregiving distress if offspring caregivers live with their parents, most likely because offspring may witness difficulties that domestic helpers face in providing dementia care.
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Affiliation(s)
- Alice M L Chong
- a Department of Applied Social Sciences , City University of Hong Kong , Kowloon , Hong Kong
| | - Chi Wai Kwan
- b Department of Statistics and Actuarial Science , University of Hong Kong , Hong Kong City , Hong Kong
| | - Vivian W Q Lou
- c Department of Social Work and Social Administration , University of Hong Kong , Hong Kong City.,d Sau Po Centre on Aging , University of Hong Kong , Hong Kong City , Hong Kong
| | - Iris Chi
- e School of Social Work , University of Southern California , Los Angeles , CA , USA
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Basnyat I, Chang L. Examining Live-In Foreign Domestic Helpers as a Coping Resource for Family Caregivers of People With Dementia in Singapore. Health Commun 2017; 32:1171-1179. [PMID: 27710130 DOI: 10.1080/10410236.2016.1220346] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In Singapore, the responsibility of caring for persons with dementia falls on family members who cope with a long-term caregiver burden, depending on available support resources. Hiring foreign domestic workers to alleviate caregiver burden becomes a prevalent coping strategy that caregivers adopt. This strategy allows caregivers to provide home care as part of fulfilling family obligations while managing the caregiver burden. This study aimed to investigate primary caregivers' relationship with hired support and its impact on coping with caregiver burden. Twenty in-depth interviews were conducted with primary caregivers who hired live-in domestic helpers to take care of their family members with dementia. The findings revealed that caregivers perceived the normative obligations to provide home care to family members with dementia. They sought support from domestic helpers to cope with physical and mental burnout, disruption of normal routines, and avoidance of financial strain. A mutual-support relationship was built between caregivers and domestic helpers through trust and interdependence. The presence of domestic helpers as a coping resource reveals the positive outcomes of problem-, emotional-, and diversion-focused coping. This study illustrates that coping strategies are employed in different ways depending on the needs of caregivers, access to infrastructure, cultural expectations, and available resources.
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Affiliation(s)
- Iccha Basnyat
- a Department of Communications and New Media , National University of Singapore
| | - Leanne Chang
- a Department of Communications and New Media , National University of Singapore
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Woo LL, Thompson CL, Magadi H. Monetary cost of family caregiving for people with dementia in Singapore. Arch Gerontol Geriatr 2017; 71:59-65. [DOI: 10.1016/j.archger.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 03/09/2017] [Accepted: 03/17/2017] [Indexed: 12/01/2022]
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Kodate N, Timonen V. Bringing the Family in through the Back Door: the Stealthy Expansion of Family Care in Asian and European Long-Term Care Policy. J Cross Cult Gerontol 2017; 32:291-301. [DOI: 10.1007/s10823-017-9325-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
PURPOSE To identify environmental factors associated with participation and gain an in-depth understanding of relationships between environmental factors and participation among people with spinal cord injury. METHOD Six focus groups (n= 30) with individuals with spinal cord injury were conducted. Two independent coders thematically analyzed the transcribed data. RESULTS Twenty environmental factors were identified, all of which were classified into eight categories: built environment; natural environment; assistive technology; transportation; information and technology access; economics; social support and social attitudes; and systems, services and policies. While all factors had direct impacts on individuals' participation outcomes, factors within the categories of societal attitudes, policies and economics also affected participation through affecting other environmental factors. Some factors together also showed cumulative or countering effects on participation. Accordingly, a conceptual model of the relationships between environmental factors and participation was constructed. CONCLUSIONS This study highlighted key environmental factors and their impacts on participation of people with spinal cord injury. The findings support previous research findings but also suggest that different factors may have different levels of impact on participation. Based on our findings, rehabilitation practitioners and policymakers can prioritize intervention plans to optimize the environment for people with spinal cord injury and improve their societal participation. Implications for rehabilitation Environmental factors are critical contributors to participation among people with spinal cord injury (SCI) and need to be addressed in rehabilitation programs. Factors with broader impacts on participation, such as societal attitudes and policies, should be treated as priorities in intervention plans aimed at improving participation among people with SCI. Rehabilitation practitioners should not only consider how the community supports people with SCI but also consider how rehabilitation programs change the community.
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Affiliation(s)
- Feng-Hang Chang
- a Graduate Institute of Injury Prevention and Control , College of Public Health, Taipei Medical University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan
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Ong PH, Tai BC, Wong WP, Wee LE, Chen C, Cheong A, Fong NP, Chan KM, Tan BY, Menon E, Lee KK, Ee CH, Petrella R, Thind A, Koh GCH. Caregivers: Do They Make a Difference to Patient Recovery in Subacute Stroke? Arch Phys Med Rehabil 2017; 98:2009-2020. [PMID: 28363700 DOI: 10.1016/j.apmr.2017.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the relationship between caregiver nature and availability, and rehabilitation outcomes in subacute stroke. DESIGN Retrospective cohort study. SETTING Four community rehabilitation hospitals. PARTICIPANTS Patients with subacute, first-time stroke (N=4042; 48.5% men; mean age ± SD, 70.12±10.4y; 51.5% women; mean age ± SD, 72.54 ±10.0y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Rehabilitation effectiveness, defined as the percentage of potential improvement eventually achieved with rehabilitation; and rehabilitation efficiency, defined as the rate of functional improvement during rehabilitation. RESULTS In our cohort, 96.7% had available caregiver(s), of which 42.0% were primarily supported by foreign domestic workers (FDWs), 25.9% by spouses, 19.3% by first-degree relatives, 7.8% by other relatives, and 5.1% by other caregivers. Using quantile regression, we found that having a caregiver was independently associated with rehabilitation efficiency (β=-3.83; 95% confidence interval [CI], -6.99 to -0.66; P=.018). The relationship between caregiver availability and rehabilitation effectiveness was modified by patient sex in that the negative association was significantly greater in men (β=-22.81; 95% CI, -32.70 to -12.94; P<.001) than women (β=-5.64; 95% CI, -14.72 to 3.44; P=.223). Having a FDW as a caregiver compared with a spousal caregiver was negatively associated with rehabilitation effectiveness (β=-3.95; 95% CI, -6.94 to -0.95; P=.01) and rehabilitation efficiency (β=-1.83; 95% CI, -3.14 to -0.53; P=.006). The number of potential caregivers was only significantly associated with rehabilitation effectiveness at the bivariate level (P=.006). CONCLUSIONS Caregiver identity, and possibly availability, appears to negatively affect rehabilitation outcomes in subacute stroke. A better understanding of these relationships has potential implications on clinical practice and policy directions.
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Affiliation(s)
- Peck-Hoon Ong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | | | - Liang En Wee
- Singhealth Internal Medicine Residency, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Ngan Phoon Fong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | | | | | | | - Kok Keng Lee
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | | | - Robert Petrella
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada
| | - Amardeep Thind
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
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Koh CY, Wee K, Goh C, Yeoh BS. Cultural mediation through vernacularization: framing rights claims through the day-off campaign for migrant domestic workers in Singapore. Int Migr 2017. [DOI: 10.1111/imig.12332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Day care services for patients with dementia (PWD) are generally under-utilized worldwide despite evidence of positive outcomes, such as improved behavioral, psychological, and cognitive functioning for patients, and reduced caregiver burden. This study sought to gain an in-depth understanding of the reasons for non-utilization of day care services in Singapore using qualitative methodology. METHODS A purposive sample of 16 caregivers of PWD who had never attended day care services participated in semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Data analysis was based on an Interpretative Phenomenological Analysis framework. FINDINGS Caregivers recognized the importance of engagement for PWD, yet were constrained by patients' refusal to attend day care, which caregivers attributed to the patients' negative beliefs about day care and fear of abandonment by their families. Caregivers also raised concerns about service delivery issues, the suitability of activities at day care, and their perceptions of the patients' ability to integrate into the setting. Non-utilization was also related to caregivers' low perceived need due to the availability of alternative care arrangements (e.g. having a domestic helper and adequate family support). CONCLUSIONS Caregivers generally understand the value of day care but several factors tip the balance in favor of non-use. These include culturally bound caregiving values and perceptions, and inadequacies in service delivery. Negative perceptions about services highlight the need to enhance the image and standards of day care and increase awareness of the benefits of day care for PWD beyond its custodial role.
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Abstract
BACKGROUND The need to follow a multidisciplinary strategy in chronic obstructive pulmonary disease (COPD) management and rehabilitation in community settings in Greece raises significant questions, given the severe austerity measures being imposed at present. The aim of this study was to investigate the clinical profile of patients with COPD along with the care provided in rural community settings in Greece. METHODS Two primary health care centers and 200 newly diagnosed patients over a 12-month period were involved in the study. A self-assessment questionnaire, including questions about smoking habits, the presence of comorbidities and chronic respiratory symptoms, as well as the COPD Assessment Test were used. Spirometry was performed with a dry spirometer. Obstructive spirometry was defined as forced expiratory volume in 1 second/forced vital capacity ratio <0.7, according to Global Initiative for Chronic Obstructive Lung Disease guidelines. RESULTS Males comprised 70% of the sample, with cough and sputum being the prominent signs. Regarding COPD staging, 68.5% were classified in stages I/II. Arterial hypertension and coronary heart disease were the most common comorbidities. Current smokers accounted for 88.5%, while 88% were heavy drinkers. A general practitioner made the diagnosis in 68.5% of the cases, among which offspring and spouses provided home care in 38% and 8% of the cases, respectively, while an informal caregiver other than a relative was reported in 34% of the cases. No caregiver (self-care) was reported in 20% of the cases. All patients of stage III and IV had a COPD Assessment Test score >10. CONCLUSION Patients with COPD dwelling in the community exhibit an overall mild-to-moderate type of COPD. General practitioner is in charge of COPD management. Informal caregiving is the major type of home care, with nonfamily members playing a significant role. The patients' profile permits limited optimism about their future perspective and urges for immediate action at primary care level.
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Affiliation(s)
| | | | - Zoe Daniil
- Pulmonary Medicine Department, University Hospital of Larissa
| | - Chryssa Hatzoglou
- Physiology Department, Medical School, University of Thessaly, Larissa, Greece
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Ong P, Koh GC. Caregiver Factors in Stroke: Are They the Missing Piece of the Puzzle? Arch Phys Med Rehabil 2016; 97:1223-5. [DOI: 10.1016/j.apmr.2016.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/21/2022]
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Penkunas MJ, Chan AWM, Wong CH, de Korne DF, Tan SM, Wong SF. The Role of a Multicomponent Home-Health Intervention in Reducing Caregiver Stress in Singapore: A Qualitative Study. J Gerontol B Psychol Sci Soc Sci 2016; 73:314-325. [DOI: 10.1093/geronb/gbw008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/16/2016] [Indexed: 11/14/2022] Open
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Abstract
ABSTRACTAs in many developed countries, foreign care-givers have made up a short-term labour force to help shoulder the responsibilities of older adult care in Taiwan since 1992. This study uses the dual labour market and the occupational segregation theoretical frameworks and a mixed-method approach to examine whether foreign care-givers are supplementary or have replaced Taiwanese care-givers in Taiwan's long-term care (LTC) industry, and to understand better the status of care workers and their influx into the secondary labour market. As of 2012, 189,373 foreign workers joined the care services, compared to 7,079 Taiwanese, indicating they are no longer supplementary. The gap between the dual care system and workforce regulation has resulted in occupation segregation, and the secondary care labour market has been divided into ‘institutional’ and ‘home’ spheres, segregating care-givers into three levels: all Taiwanese care-givers, foreign institutional care-givers, and foreign home care-givers, the latter being the cheapest, most obedient and most adaptable LTC products. This case exhibits the ‘particularistic’ associations between nationality and care-givers’ workplace, which should be abolished. Only by squarely facing the changes and impacts caused by importing workers into the secondary labour market can one propose concrete, effective LTC labour plans and retention policies.
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Chong AML, Kwan CW, Chi I, Lou VWQ, Leung AYM. Domestic Helpers as Moderators of Spousal Caregiver Distress. J Gerontol B Psychol Sci Soc Sci 2014; 69:966-72. [DOI: 10.1093/geronb/gbu034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chon Y. An exploratory qualitative study on relationships between older people and home care workers in South Korea: the view from family carers and service providers. Ageing and Society 2015; 35:629-52. [DOI: 10.1017/s0144686x13000950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
ABSTRACTAlthough the proportion of older people using home care services has significantly increased in East Asian countries, the issue of the relationships between older people and home care workers in the East Asian context has received scant attention from scholars. This exploratory qualitative study aims to explore these relationships under the new Korean long-term care insurance system. Semi-structured in-depth interviews were conducted with 22 family carers and private-sector home care service providers (home care workers and provider managers). The findings show that while the majority of family carers interviewed reported that their relationships were good, the majority of service providers' responses were more negative. Service providers stated that they experienced a number of difficulties that affected their relationships with older clients, including excessive demands or sexual harassment by the older people in their care, exposure to unsafe working environments, and poor treatment in terms of pay and conditions. The findings suggest that stable and good relationships between home care workers and their clients have not been secured in Korea's long-term care system.
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Khoo SA, Chen TY, Ang YH, Yap P. The impact of neuropsychiatric symptoms on caregiver distress and quality of life in persons with dementia in an Asian tertiary hospital memory clinic. Int Psychogeriatr 2013; 25:1991-9. [PMID: 24230964 DOI: 10.1017/S1041610213001518] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study aims to determine the prevalence, profile, and severity of neuropsychiatric symptoms (NPS) across the dementia continuum and their relative impact on caregiver distress and quality of life (QoL) in persons with dementia (PWD). METHOD Six hundred and sixty-seven PWD and their family caregivers presented to a memory clinic in a tertiary hospital across a 60-month period. Clinicians determined the dementia diagnosis and severity using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and the Clinical Dementia Rating scale, respectively. The Neuropsychiatric Inventory Questionnaire was administered to assess NPS in PWD and the corresponding distress experienced by the caregiver. QoL for PWD (PWD-QoL) was assessed by the Quality of Life-Alzheimer's Disease scale. RESULTS Ninety-six percent of PWD presented with at least one NPS, 18% experiencing mild, 31% moderate, and 47% severe symptoms, respectively. While agitation (63.1%), apathy (61.8%), depression (55.5%), and irritability (55.5%) were the most common NPS; disinhibition (35.2%), hallucination (25.5%), and elation (14.2%) were the least common. NPS increased generally but differentially as dementia progressed and significantly predicted caregiver distress (ηp 2 = 0.732, p < 0.0001) and PWD-QoL (ηp 2 = 0.066, p < 0.0001). Factor analysis revealed two NPS clusters, disruptive and affective; the former exerting greater impact on caregiver distress and the latter on PWD-QoL. CONCLUSION The results show a high prevalence of NPS which increase caregiver distress and negatively impact PWD-QoL. The differential profile of NPS across the dementia stages warrants stage-specific interventions and due consideration in resource planning and service design for PWD and their caregivers.
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