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Anderson JG, Jabson Tree JM, Flatt JD, Smith JL, Morgan KH, Beebe LH, Rose KM. Use of Digital Health Resources by Sexual and Gender Minority Caregivers of Older Adults: Findings From the 2020 Caregiving in the U.S. Survey. J Fam Nurs 2024; 30:68-80. [PMID: 38098262 DOI: 10.1177/10748407231218000] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
We applied Andersen's Behavioral Model of Health Services Use to investigate the health needs and use of digital health resources among sexual and/or gender minority (SGM) caregivers. Data were from the Caregiving in the U.S. 2020 survey. Regression analyses were used to describe associations between predisposing, enabling, and need factors and usage of digital health resources. SGM caregivers provided more hours of care per week, reported higher levels of care intensity, and reported higher physical, emotional, and financial strain compared with non-SGM caregivers. Regression analyses indicated SGM status was a significant predictor of overall use of digital health resources. Younger caregivers, racial minority caregivers, those providing higher levels of care, and those reporting a poorer health status were more likely to use digital health resources. Digital health resources may be useful tools for SGM caregivers of older adults. More research is needed to investigate the reasons SGM caregivers use these resources.
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Liu H, Lou VWQ, Xu S. Randomized controlled trials on promoting self-care behaviors among informal caregivers of older patients: a systematic review and meta-analysis. BMC Geriatr 2024; 24:86. [PMID: 38263091 PMCID: PMC10804633 DOI: 10.1186/s12877-023-04614-6] [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: 05/03/2023] [Accepted: 12/17/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Informal caregivers of older patients often neglect their self-care, despite the mental and physical health effects of caregiving. Randomized controlled trials (RCTs) on self-care interventions for informal caregivers are lacking, making it difficult to determine effective strategies. This systematic review explored the definition and categories of self-care RCTs for informal caregivers and a meta-analysis was conducted to determine the effectiveness of these interventions. METHODS Seven databases (Scopus, Web of Science, MEDLINE, PubMed, ProQuest, CINAHL, and Embase) were searched for articles in English reporting on self-care intervention outcomes for informal caregivers of patients aged 60 years or older. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. Subgroup, sensitivity, and publication bias analyses were conducted. RESULTS Eighteen studies were included in the systematic review, of which fifteen studies were included in the meta-analysis. RCTs lacked a clear definition of self-care, mainly focused on promoting physical and mental health and individual capacity, and neglected disease prevention. The interventions focused on self-management for health and individual agency, with less attention on health literacy, decision-making capacity, self-monitoring for health status, and linkage to the health system. Meta-analysis results showed that RCTs had a small effect on reducing anxiety (SMD = -0.142, 95% CI [-0.302, 0.017], p = .081) but a significant effect on reducing depression (SMD = -0.214, 95% CI [-0.353, -0.076], p = .002). Country and type of caregiver significantly contributed to the effect of reducing caregivers' depression in subgroup analysis. CONCLUSIONS Studies on caregiver-centered self-care interventions are limited, resulting in a lack of a clear definition and comprehensive intervention. RCTs indicated a small effect on informal caregivers' mental health, and interventions should consider both mental and physical health. More evidence is needed on the effectiveness of self-care interventions for informal caregivers' anxiety and physical health.
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Affiliation(s)
- Huanran Liu
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
- Sau Po Centre On Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Vivian W Q Lou
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China.
- Sau Po Centre On Ageing, The University of Hong Kong, Hong Kong SAR, China.
| | - Shicheng Xu
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
- Sau Po Centre On Ageing, The University of Hong Kong, Hong Kong SAR, China
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Martin JT, Anderson JR, Chapman KR, Kayani N, Drost J, Spitznagel MB. Predicting Caregiver Communications in a Geriatric Clinic. J Geriatr Psychiatry Neurol 2024; 37:39-48. [PMID: 37539781 DOI: 10.1177/08919887231195223] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The current study evaluated the use of a machine learning model to determine benefit of medical record variables in predicting geriatric clinic communication requirements. Patient behavioral symptoms and global cognition, medical information, and caregiver intake assessments were extracted from 557 patient records. Two independent raters reviewed the subsequent 12 months for documented (1) incoming caregiver contacts, (2) outgoing clinic contacts, and (3) clinic communications. Random forest models' average explained variance in training sets for incoming, outgoing, and clinic communications were 7.42%, 3.65%, and 6.23%, respectively. Permutation importances revealed the strongest predictors across outcomes were patient neuropsychiatric symptoms, global cognition, and body mass, caregiver burden, and age (caregiver and patient). Average explained variance in out-of-sample test sets for incoming, outgoing, clinic communications were 6.17%, 2.78%, and 4.28%, respectively. Findings suggest patient neuropsychiatric symptoms, caregiver burden, caregiver and patient age, patient body mass index, and global cognition may be useful predictors of communication requirements for patient care in a geriatric clinic. Future studies should consider additional caregiver variables, such as personality characteristics, and explore modifiable factors longitudinally.
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Affiliation(s)
- John T Martin
- Department of Psychological Sciences, Kent State University, OH, USA
| | - Jason R Anderson
- Department of Psychological Sciences, Kent State University, OH, USA
| | - Kimberly R Chapman
- Department of Psychological Sciences, Kent State University, OH, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, RI, USA
| | - Natalie Kayani
- Division of Geriatric Medicine, Summa Health System, Akron, OH, USA
| | - Jennifer Drost
- Division of Geriatric Medicine, Summa Health System, Akron, OH, USA
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Brewster GS, Higgins M, McPhillips MV, Bonds Johnson K, Epps F, Yeager KA, Bliwise DL, Hepburn K. The Effect of Tele-Savvy on Sleep Quality and Insomnia in Caregivers of Persons Living with Dementia. Clin Interv Aging 2023; 18:2117-2127. [PMID: 38111602 PMCID: PMC10726954 DOI: 10.2147/cia.s425741] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Sleep disturbance is prevalent in caregivers of persons living with dementia (PLwD). Tele-Savvy, a 7-week virtual psychoeducational intervention, enhances caregivers' competence and self-care, and reduces depression. While not explicitly designed to do so, Tele-Savvy can potentially improve caregivers' disturbed sleep. The present study aimed to examine the longitudinal effects of Tele-Savvy on caregivers' sleep quality and insomnia. Methods This was a secondary data analysis of a 3-arm randomized control trial [Tele-Savvy (active treatment), Healthy Living (attention control), and usual care (waitlist control)]. Multilevel mixed modeling with intent-to-treat principles tested for group, time, and group-by-time effects. Effect sizes were estimated for all changes from baseline to the initial 6-month post-intervention point. Following completion of the 6-month post-randomization delay, we examined combined outcomes for Tele-Savvy. Results Participants (n=137; mean age 64.7 years) were predominantly female (68.6%) and White (68.6%). We found no initial group-by-time effects for the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). For the combined Tele-Savvy group, there was a statistically significant improvement in ISI scores across time (p=0.050). The combined Tele-Savvy effect size for PSQI was d=0.126 and ISI was d=0.310. Discussion Tele-Savvy resulted in a significant long-term reduction in insomnia symptoms in this sample of caregivers of PLwD and demonstrated a positive trend for improvement in their sleep quality. Since sleep disturbance is so prevalent among caregivers of PLwD, the inclusion of sleep health education into psychoeducation caregiver interventions may yield even better outcomes for caregivers.
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Affiliation(s)
- Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donald L Bliwise
- Division of Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Agyapomah R, Boateng EA, Amankwaa I, Dzomeku VM, Peprah LO. "She is My Work": Caregiving for Older Adults With Hypertension and Diabetes Mellitus. Clin Nurs Res 2023; 32:886-894. [PMID: 37060299 DOI: 10.1177/10547738231165886] [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: 04/16/2023]
Abstract
To explore the lived experiences of informal caregivers of older adults with hypertension and/or diabetes mellitus in Kumasi, Ghana. A qualitative research approach was used to conduct the study using informal caregivers of older adults with hypertension and/or diabetes mellitus at a teaching hospital in Ghana. In all, 20 participants were purposively sampled, interviewed, and data were analyzed using thematic analysis. Three main themes emerged: "Experience with care demands," "Coping with care demands," and "Motivation for caregiving." Older adults with hypertension and/or diabetes mellitus had needs that placed a burden on informal caregivers' work life, health, and social life. Informal caregivers of older adults with hypertension and/or diabetes mellitus are under strain. Caregiving is a difficult task, requiring a lot of time, effort, attention, and devotion. Nurses should plan the care of older adults with hypertension and/or diabetes mellitus in collaboration with their informal caregivers.
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Affiliation(s)
| | - Edward Appiah Boateng
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Alemi Y, Loughman B, Uriyo M. Distributed Caregiving for Cognitively Impaired Individuals: A Case Report. Cureus 2023; 15:e34677. [PMID: 36909032 PMCID: PMC9994040 DOI: 10.7759/cureus.34677] [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] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Many caregivers of people with cognitive impairment spend a significant amount of their time helping patients with instrumental daily functions. Distributed caregiving is an innovative model designed to reduce an individual caregiver's time burden and increase the likelihood of continued independent living for the patient. Echo Show and Google Home platforms were used to enable the participation of remote family members in caregiving, specifically the socialization and entertainment of a person with cognitive impairment. Caregiver interviews, review of medical records, and case study analysis were used to measure caregiver burden, after distributing some components of caregiving to distant family members with human-in-the-loop artificial intelligence. This case explores the use of Alexa, Echo Show, and other commercial technologies in the management of a patient with cognitive impairment. The human-in-the-loop system introduced in this case study is a creative, accessible, low-cost, and sustainable way to potentially reduce caregiver burden and improve patient outcomes with targeted intervention. Targeted distributed caregiving reduced time spent in caregiving, reduced caregiver guilt and frustration, improved patient's compliance with requests for behavior changes (e.g., voiding before leaving the house), and improved the relationship between the caregiver and the person with cognitive impairment. This case study demonstrates how distributed caregiving, including human-in-the-loop artificial intelligence, can lead to better use of technology in reducing the social isolation of persons with cognitive impairment and in reducing caregiver burden.
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Affiliation(s)
- Yara Alemi
- Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Maria Uriyo
- Health Administration and Policy, George Mason University, Fairfax, USA
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Zhang J, Wang J, Liu H, Wu C. Association of dementia comorbidities with caregivers' physical, psychological, social, and financial burden. BMC Geriatr 2023; 23:60. [PMID: 36721085 PMCID: PMC9890694 DOI: 10.1186/s12877-023-03774-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Informal caregivers of older adults with dementia may experience substantial burdens during their caregiving process, especially when caring for older adults with other comorbid conditions. This study evaluated whether and how comorbidity burden for persons with dementia (PWD) was associated with caregivers' physical, psychological, social, and financial burden as well as caregiving gain. METHODS Data were from 1,065 community-dwelling older adults living with dementia and their primary caregivers in the National Health and Aging Trends Study and the National Study of Caregiving. PWD's comorbidity burden was measured by the count of chronic conditions and the pattern of comorbidity identified by the latent class analysis (LCA). We considered four domains of caregiving burden-physical, psychological, social, and financial burden. We used linear regressions to identify the unadjusted and adjusted associations between PWD's comorbidity burden and caregiving burden and gain. RESULTS Of 1,065 PWD, 13.5% had 0-1 and 24.9% had 5 or more number of comorbid chronic conditions, respectively. After multivariable adjustment, an additional chronic condition is associated with an 0.11- and 0.36-point increase in caregivers' physical and psychological burden, respectively. Caregivers of PWD with 5 or more chronic conditions had a 0.64- and 2.22-point higher score of physical and psychological burden, respectively, than those caring for PWD with 0 or 1 comorbid condition. LCA divided PWD into two classes, a high comorbidity class (69.0%) and a low comorbidity class (31.0%). Caregivers of PWD in the high comorbidity burden class had a 0.46-point higher score of physical caregiving burden than those in the low comorbidity burden class. No significant association was found between care recipients' comorbidity burden and their caregivers' social and financial burden or caregiving gain. CONCLUSIONS The comorbidity burden of PWD was associated with their caregivers' physical and psychological caregiving burden. Relevant interventions to manage the comorbid conditions of people living with dementia and support their caregivers are crucial to improving their physical health and psychological wellbeing.
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Affiliation(s)
- Jingyi Zhang
- grid.254880.30000 0001 2179 2404Dartmouth College, Hanover, NH USA
| | - Jing Wang
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China
| | - Hua Liu
- grid.452273.50000 0004 4914 577XDepartment of Neurosurgery, The Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Chenkai Wu
- grid.448631.c0000 0004 5903 2808Global Health Research Center, Duke Kunshan University, Kunshan, China
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Sehar U, Rawat P, Choudhury M, Boles A, Culberson J, Khan H, Malhotra K, Basu T, Reddy PH. Comprehensive Understanding of Hispanic Caregivers: Focus on Innovative Methods and Validations. J Alzheimers Dis Rep 2022. [DOI: 10.3233/adr-220094] [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: 12/31/2022] Open
Abstract
Alzheimer’s disease (AD) and Alzheimer’s disease-related disorders (ADRD) are late-onset, age-related progressive neurodegenerative disorders, characterized by memory loss and multiple cognitive impairments. Current research indicates that Hispanic Americans are at an increased risk for AD/ADRD and other chronic conditions such as diabetes, obesity, hypertension, and kidney disease, and given their rapid growth in numbers, this may contribute to a greater incidence of these disorders. This is particularly true for the state of Texas, where Hispanics are the largest group of ethnic minorities. Currently, AD/ADRD patients are taken care by family caregivers, which puts a tremendous burden on family caregivers who are usually older themselves. The management of disease and providing necessary/timely support for patients with AD/ADRD is a challenging task. Family caregivers support these individuals in completing basic physical needs, maintaining a safe living environment, and providing necessary planning for healthcare needs and end-of-life decisions for the remainder of the patient’s lifetime. Family caregivers are mostly over 50 years of age and provide all-day care for individuals with AD/ADRD, while also managing their health. This takes a significant toll on the caregiver’s own physiological, mental, behavioral, and social health, in addition to low economic status. The purpose of our article is to assess the status of Hispanic caregivers. We also focused on effective interventions for family caregivers of persons with AD/ADRD involving both educational and psychotherapeutic components, and a group format further enhances effectiveness. Our article discusses innovative methods and validations to support Hispanic family caregivers in rural West Texas.
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Affiliation(s)
- Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Moumita Choudhury
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - John Culberson
- Department of Family Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Hafiz Khan
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Keya Malhotra
- Hendrick Health System, Grace Clinic, Lubbock, TX, USA
| | - Tanisha Basu
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Hendrick Health System, Grace Clinic, Lubbock, TX, USA
- Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Lee M, Williams IC. Predictive factors on caregiver burden in caregivers of individuals with cognitive impairment. International Journal of Care Coordination 2022. [DOI: 10.1177/20534345221148281] [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: 12/29/2022]
Abstract
Introduction Informal caregivers, mostly family members or friends, have often been required to engage in medical/nursing tasks and to navigate complex healthcare systems. It is unclear whether those activities impact caregiver burden. Therefore, the purpose of this study was to examine predictive factors of caregiver burden in consideration of healthcare-related factors (caregivers’ perception of performing medical/nursing tasks, care coordination, and number of hospitalizations). Methods Secondary analysis of cross-sectional survey data taken from the Caregiving in the U.S. 2015 was conducted. Data were collected by the National Alliance for Caregiving and the American Association of Retired Persons (AARP). Self-identified caregivers (n = 304) who provided care for individuals with cognitive impairment (ICI), and who were living in the community were participants in the study. Results The overall model explained 38.4% of the variance in caregiver burden (F = 20.48, p < 0.001). When examining each factor, perceived difficulty in medical/nursing tasks (β = 0.38, p < 0.001) was the most influential factor, followed by caregivers’ physical health (β = −0.27, p < 0.001), income (β = −0.13, p = 0.01), and level of the care coordination (β = 0.12, p = 0.02). Discussion Although caregivers’ involvement in healthcare-related activities for ICI is necessary, this involvement has a considerable impact on caregiver burden. Healthcare providers should be cognizant of caregiver burden related to healthcare-related activities. Moreover, researchers should develop interventions and community services to decrease caregivers’ difficulty in performing their roles.
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Affiliation(s)
- Mijung Lee
- Korea Armed Forces Nursing Academy, Korea
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10
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Bakker EM, Witkamp FE, Luu KLN, van Dongen SI, Raijmakers NJH, van Roij J, van der Heide A, Rietjens JAC. Caregiver activation of relatives of patients with advanced cancer. Eur J Cancer Care (Engl) 2022; 31:e13656. [PMID: 35841207 PMCID: PMC9788340 DOI: 10.1111/ecc.13656] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/22/2021] [Revised: 05/03/2022] [Accepted: 06/21/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Relatives of patients with advanced cancer often have many caring responsibilities. Not everyone may have sufficient knowledge, skills, and confidence-also known as caregiver activation-to provide such care. We assessed caregiver activation in relatives and its association with their personal characteristics and their own well-being. METHODS A cross-sectional study among relatives of patients with advanced cancer. Measures included caregiver activation (C-PAM), resilience, personal self-care, caregiver burden, depressive symptoms, quality of life, and social well-being. The C-PAM distinguishes four levels of activation, ranging from poor (level 1) to adequate (level 4). Bivariate and multivariable regression analyses were performed. RESULTS Two hundred fifty-four relatives were included; 32% had level 1 activation, 30% level 2, 27% level 3 and 11% level 4. Higher levels of caregiver activation were found among partners, those who provided more hours of informal care, were more resilient, and scored higher on personal self-care. Higher caregiver activation was associated with lower caregiver burden, less depressive symptoms, and better social well-being. CONCLUSION In our study, the majority of relatives seem insufficiently prepared to provide care for their loved one. Supporting them in gaining knowledge, skills, and confidence to provide such care may improve their own well-being.
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Affiliation(s)
- Evi Marit Bakker
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Frederika Erica Witkamp
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands,Research Centre Innovations in CareRotterdam University of Applied SciencesRotterdamThe Netherlands
| | - Khanh Linh Nancy Luu
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Sophie Irene van Dongen
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Natasja Johanna Helena Raijmakers
- Netherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands,Netherlands Association for Palliative Care (PZNL)UtrechtThe Netherlands
| | - Janneke van Roij
- Netherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands,Netherlands Association for Palliative Care (PZNL)UtrechtThe Netherlands,CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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Schara H, Johnson T, Brungardt A, Marcus AM, Cassidy J, Shanbhag P, Plys E, Lum HD. Living With Dementia: Care Partner Needs and Outcomes of a Dementia Support Program in Primary Care. Gerontol Geriatr Med 2022; 8:23337214221129466. [PMID: 36275412 PMCID: PMC9583199 DOI: 10.1177/23337214221129466] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
To address the need for collaborative approaches to managing dementia in primary care, we implemented the Living with Dementia (LWD) program in a geriatric primary care clinic. This study evaluated the impact of short (≤6 months) and longer-term (7+ months) participation in LWD on care partner outcomes (i.e., self-efficacy, depression, and burden) using t-tests and examined dementia support topics discussed with care partners through the intervention using deductive content analysis. Across 20 months analyzed, 57 dyads participated in the LWD program. Short and longer-term LWD participation indicated a significant increase in self-efficacy with small effect sizes; no changes were observed in depression or burden. Dementia support topics most frequently discussed with care partners focused on care partner well-being, behavior management, and offering referrals. This early evaluation suggests a collaborative care program integrated into primary care can address needs related to caring for persons with dementia and may improve care partner self-efficacy.
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Affiliation(s)
- Hannah Schara
- University of Colorado School of
Medicine, Aurora, USA
| | | | | | | | | | | | - Evan Plys
- University of Colorado School of
Medicine, Aurora, USA
| | - Hillary D. Lum
- University of Colorado School of
Medicine, Aurora, USA,Hillary D. Lum, MD, PhD, Division of
Geriatric Medicine, Department of Medicine, University of Colorado School of
Medicine, 12631 East 17th Avenue, Mailstop B179, Aurora, CO 80045, USA.
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Yous ML, Ploeg J, Kaasalainen S, McAiney C, Fisher K. Feasibility, acceptability, and preliminary effectiveness of the adapted Namaste Care program delivered by caregivers of community-dwelling older persons with moderate to advanced dementia: a mixed methods feasibility study. BMC Geriatr 2022; 22:797. [PMID: 36229789 PMCID: PMC9559259 DOI: 10.1186/s12877-022-03483-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Caregivers have considerable responsibilities in supporting persons in advanced stages of dementia, however they receive little education. Namaste Care is a multisensory program originally designed to be delivered by healthcare providers in long-term care homes for persons with advanced dementia. The program has not yet been adapted and evaluated for use by caregivers of persons with moderate to advanced dementia living at home. The purpose of this feasibility study is to determine the feasibility, acceptability and preliminary effectiveness of the adapted Namaste Care program for use by caregivers of community-dwelling older persons with moderate to advanced dementia. METHODS This feasibility study, with a one-group before-after design and interviews, was part of a larger study using a multiphase mixed methods design. A total of 12 caregivers delivered the program over three months. Caregivers completed questionnaires on caregiver quality of life, perceptions of caregiving, self-efficacy, and burden at baseline and 3-month follow-up. Caregivers participated in interviews at the 3-month follow-up to explore acceptability and perceived benefit. Descriptive statistics and paired t-tests were used to analyze quantitative data. A secondary analysis used multiple imputation to explore the impact of missing data. Experiential thematic analysis was used in analyzing qualitative data. RESULTS The adapted Namaste Care program was judged to be feasible, given that all caregivers used it at least twice a week over the 3-month period. The retention rate of caregivers was 83% (10 of 12). Caregivers perceived that the program was practical, enhanced the wellbeing of persons with dementia, and brought them closer in their relationships with persons with dementia. There were no statistically significant changes for quality of life, perceptions of caregiving, self-efficacy, or burden outcomes. Multiple imputation results revealed promising findings for an improvement in caregiver wellbeing related to quality of life. CONCLUSIONS The adapted Namaste Care program for use by caregivers of community-dwelling older persons with moderate to advanced dementia was feasible and acceptable. The program has the potential to enhance the quality of life and other outcomes of caregivers, however there is a need to conduct a larger trial that is adequately powered to detect these effects.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- School of Public Health Sciences, Schlegel Research Chair in Dementia, Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Kathryn Fisher
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON L8S 4K1 Canada
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Williamson HJ, Begay AB, Dunn DJ, Bacon R, Remiker M, Garcia YE, McCarthy MJ, Baldwin JA. "We Live on an Island": Perspectives on Rural Family Caregivers for Adults with Alzheimer's Disease and Related Dementias in the United States. Qual Rep 2022; 27:2343-2358. [PMID: 36425903 PMCID: PMC9682982 DOI: 10.46743/2160-3715/2022.5193] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
As the United States' aging population grows, there will be increased prevalence of individuals living with Alzheimer's Disease and related dementias (ADRD), who largely rely on the support of their family caregivers. Family caregivers residing in rural areas face additional challenges with managing caregiving responsibilities and navigating support services. The purpose of this multilevel phenomenological qualitative study was to explore the assets, unique needs, and resources of rural-residing ADRD caregivers from the caregiver, provider, and policy influencers' perspectives. The study took place between 2019 through 2021 in northern Arizona, a largely rural and geographically vast area home to caregivers from diverse backgrounds. Twenty-seven caregivers to a loved one with ADRD participated in focus groups. Twelve health and social services providers and twelve policy influencers, those involved in leadership positions for aging programs or advocacy groups, completed individual interviews. Caregivers demonstrate many assets which contribute to their ability to manage and cope with their caregiving role. However, caregivers face a series of issues related to their caregiving role and need early and ongoing education regarding ADRD. There is a lack of resources available in rural areas, in particular providers, making it challenging to obtain needed resources necessary to support their loved one with ADRD. Furthermore, there is a need for more providers trained in working with aging adults and those experiencing ADRD, and a need for more culturally relevant resources.
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Affiliation(s)
- Heather J Williamson
- works at Northern Arizona University's Center for Health Equity Research and in the Department of Occupational Therapy, Flagstaff, Arizona, USA
| | - Andria B Begay
- works at Northern Arizona University's Center for Health Equity Research, Flagstaff, Arizona, USA
| | - Dorothy J Dunn
- works at the University of Massachusetts Dartmouth in the Department of Community Nursing and Health Sciences, Dartmouth, Massachusetts, USA
| | - Rachel Bacon
- works at the Center for Mind and Culture, Boston, Massachusetts, USA
| | - Mark Remiker
- works in Northern Arizona University's Center for Health Equity Research, Flagstaff, Arizona, USA
| | - Yolanda E Garcia
- works in Northern Arizona University's Department of Educational Psychology Flagstaff, Arizona, USA
| | - Michael J McCarthy
- works in Northern Arizona University's Department of Social Work, Flagstaff, Arizona, USA
| | - Julie A Baldwin
- works in Northern Arizona University's Center for Health Equity Research, Flagstaff, Arizona, USA
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Pignatiello GA, Martin R, Kraus N, Gutierrez A, Cusick R, Hickman RL. Sleep Interventions for Informal Caregivers of Persons with Dementia: A Systematic Review. West J Nurs Res 2022; 44:886-898. [PMID: 34085889 PMCID: PMC9887937 DOI: 10.1177/01939459211019033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 02/03/2023]
Abstract
We conducted a systematic review on the state of the science related to sleep interventions for informal caregivers of persons with Alzheimer's disease or related dementia (ADRD). This review included English-written, peer-reviewed articles that studied the effect of an intervention on sleep health outcomes for informal caregivers of persons with ADRD. Our search yielded 15 articles that met our a priori inclusion criteria. We categorized interventions into four categories: environmental, physical, cognitive, and collaborative. Intervention effects were heterogeneous, with most yielding nonsignificant sleep health effects. There is a need for theoretically sound and robust sleep health interventions for informal caregiver samples. Future research in this area could benefit from the use of more controlled, pragmatic, and adaptive research designs, and the use of objective measures that conceptually represent the multiple domains of sleep health to enhance intervention quality.
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Affiliation(s)
- Grant A. Pignatiello
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Richard Martin
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Noa Kraus
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Armando Gutierrez
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Rebecca Cusick
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Ronald L. Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Dessy A, Zhao AJ, Kyaw K, Vieira D, Salinas J. Non-Pharmacologic Interventions for Hispanic Caregivers of Persons with Dementia: Systematic Review and Meta-Analysis. J Alzheimers Dis 2022; 89:769-788. [PMID: 35938246 DOI: 10.3233/jad-220005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: As the Hispanic/Latino (HL) population grows, so too does the need for HL family caregivers for persons with dementia. HL caregivers tend to have less education, lower health literacy, and lower income, each uniquely compounding burden. Research is needed to appropriately tailor interventions for this population. Objective: A systematic review and meta-analysis was conducted to 1) provide an updated review of non-pharmacologic intervention studies for HL dementia caregivers, 2) characterize promising interventions, and 3) highlight opportunities for future research. Methods: Databases were searched for articles evaluating non-pharmacologic interventions for HL dementia caregivers. Studies were excluded if target populations did not include HLs or if no intervention was delivered. Data were extracted and random effects meta-analysis was performed on two primary outcomes: caregiver depression and burden. Effect sizes were calculated as pre- and post-intervention standardized mean differences (SMD), and further depression subgroup meta-analysis was performed. Other secondary outcome measures (e.g., perceived social support, caregiver knowledge, anxiety) were evaluated qualitatively. Results: Twenty-three studies were identified. Most included multiple components pertaining to psychosocial support, caregiver education, and community resource facilitation. Many studies were successful in improving caregiver outcomes, though intervention design varied. Meta-analysis revealed minimal to moderate heterogeneity and small effect size in improving depressive symptoms (SMD = –0.31, 95% CI –0.46 to –0.16; I2 = 50.16%) and burden (SMD = –0.28, 95% CI –0.37 to –0.18; I2 = 11.06%). Conclusion: Although intervention components varied, many reported outcome improvements. Future studies may benefit from targeting physical health, addressing sociocultural and economic contexts of caregivers, and leveraging technology.
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Affiliation(s)
- Alexa Dessy
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Amanda J. Zhao
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kay Kyaw
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Dorice Vieira
- New York University Health Sciences Library, New York University Grossman School of Medicine, New York, NY, USA
| | - Joel Salinas
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
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He J, Wang J, Zhong H, Guan C. The Effectiveness of Multi-Component Interventions on the Positive and Negative Aspects of Well-Being among Informal Caregivers of People with Dementia: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19:ijerph19126973. [PMID: 35742220 PMCID: PMC9222573 DOI: 10.3390/ijerph19126973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
The present review aims to examine whether multi-component interventions for informal caregivers of people with dementia are effective on positive and negative aspects of caregiver well-being. Eleven databases were searched from inception to 8 March 2021. Only randomized controlled trials reporting the effectiveness of multi-component intervention on positive and negative aspects of caregiver well-being were eligible. Endnote X7 (Thomson ResearchSoft, Stanford, CA, USA) was used for study selection and version 5.1.0 of Cochrane Collaboration’s tool (Cochrane, London, UK) was applied for quality assessment. Review Manager (Revman) Version 5.3 (Cochrane, London, UK) was used for the meta-analysis, and if statistical synthesis was inappropriate, only narrative analysis was performed. A total of 31 RCTs with 3939 participants were included. Meta-analyses showed small to moderate effects on subjective well-being, depression, and burden of caregivers, and a moderate to high effect on caregiver anxiety. Due to insufficient data and vast heterogeneity, meta-analysis was not performed for other outcomes, such as resilience, competence, and empathy. This review suggests that individualized multi-component interventions for caregivers may be one of the ways to promote their well-being. Further research is needed to explore the impact of rigorously designed and personalized multi-component interventions on informal caregivers, especially on more positive indicators, as well as its long-term effects and sustainability.
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Affiliation(s)
- Jinjie He
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
| | - Jing Wang
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
- Correspondence: ; Tel.: +86-29-8265-7015
| | - Hongmei Zhong
- Department of Nursing, School of Medicine, Shihezi University, Shihezi 832002, China;
| | - Chengguo Guan
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
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Ejem D, Atkins GC, Perkins M, Morhardt DJ, Williams IC, Cothran FA, Epps F, Scott C, Mittelman M, Clay OJ. Stressors and Acceptability of Services Among Black Caregivers of Persons With Memory Problems. J Gerontol Nurs 2022; 48:13-18. [PMID: 35648582 DOI: 10.3928/00989134-20220505-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to identify stressors of Black family caregivers (FCGs) of persons with memory problems (PWMPs), services of interest, and barriers to use of these services. Black FCGs were recruited from the Alzheimer's family program at the University of Alabama at Birmingham and affiliated geriatric clinics, media sources, and word-of-mouth referrals. Of 38 Black FCGs interviewed, 26 (68%) were female, 18 (47%) were employed, and 21 (55%) were adult children. Average age of FCGs was 52.11 years. Mean scores for the AD8 Dementia Screening Scale (mean = 13.95, SD = 2.17) and Clinical Dementia Scale Sum of Boxes (mean = 7.29, SD = 0.87) were higher than clinical cutoffs. The most common stressors for Black FCGs were PWMPs' inability to remember who they were, managing care recipients' financial affairs, and managing PWMPs' comorbid conditions. FCGs were most interested in educational material regarding treatment and diagnosis (55.3%), caring for people with dementia (52.6%), understanding dementia (52.6%), and financial/legal services (52.6%). FCGs stated that transportation difficulties and the need for a relief person were barriers to use of services. Results suggest that Black FCGs may be more likely to participate in interventions that include virtual conferencing modalities. [Journal of Gerontological Nursing, 48(6), 13-18.].
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18
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Cooper CJ, Owen PJ, Sprajcer M, Crowther ME, Craige EA, Ferguson SA, Gupta CC, Gibson R, Vincent GE. Interventions to improve sleep in caregivers: a systematic review and meta-analysis. Sleep Med Rev 2022; 64:101658. [DOI: 10.1016/j.smrv.2022.101658] [Citation(s) in RCA: 1] [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: 02/16/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 01/01/2023]
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Vila-Castelar C, Fox-Fuller JT, Guzmán-Vélez E, Schoemaker D, Quiroz YT. A cultural approach to dementia - insights from US Latino and other minoritized groups. Nat Rev Neurol 2022; 18:307-314. [PMID: 35260817 PMCID: PMC9113534 DOI: 10.1038/s41582-022-00630-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/14/2022]
Abstract
Alzheimer disease and related dementias present considerable challenges to health-care and medical systems worldwide. In the USA, older Black and Latino individuals are more likely than older white individuals to have Alzheimer disease and related dementias. In this Perspective, we leverage our experience and expertise with older US Latino groups to review and discuss the need to integrate cultural factors into dementia research and care. We examine the importance of considering the effects of cultural factors on clinical presentation and diagnosis, dementia risk, clinical research and recruitment, and caregiving practices, with a focus on minoritized groups in the USA. We highlight critical gaps in the literature to stimulate future research aimed at improving the prevention and early detection of Alzheimer disease and related dementias and developing novel treatments and interventions across ethnoracially diverse populations. In addition, we briefly discuss some of our own initiatives to promote research and clinical care among Latino populations living in the USA.
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Affiliation(s)
- Clara Vila-Castelar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua T Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Edmarie Guzmán-Vélez
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dorothee Schoemaker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yakeel T Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Cothran FA, Chang E, Beckett L, Bidwell JT, Price CA, Gallagher-Thompson D. A Landscape of Subjective and Objective Stress in African-American Dementia Family Caregivers. West J Nurs Res 2022; 44:239-249. [PMID: 34865588 PMCID: PMC8908689 DOI: 10.1177/01939459211062956] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/15/2022]
Abstract
Stress is a significant part of daily life, and systemic social inequities, such as racism and discrimination, are well-established contributors of chronic stress for African Americans. Added exposure to the stress of caregiving may exacerbate adverse health outcomes. This secondary analysis describes subjective and objective stress in African American family caregivers, and relationships of subjective and objective stress to health outcomes. Baseline data from 142 African American dementia family caregivers from the "Great Village" study were described using means and frequencies; regression models and Pearson's correlation were used to examine associations between demographics, social determinants of health, and health outcomes. Mixed models were used to examine change and change variation in cortisol. Most caregivers had moderate degrees of stress. Stress was associated with sleep disruption and depressive symptoms, and discrimination appeared to be an independent contributor to depressive symptoms. This work provides a foundation for interpreting subjective and objective indicators of stress to tailor existing multicomponent interventions.
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Affiliation(s)
- Fawn A. Cothran
- Family Caregiving Institute at the Betty Irene Moore School of Nursing; University of California, Davis
| | - Emily Chang
- Department of Statistics; Department of Public Health Sciences, University of California, Davis
| | - Laurel Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis
| | - Julie T. Bidwell
- Family Caregiving Institute at the Betty Irene Moore School of Nursing; University of California, Davis
| | - Candice A. Price
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis
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21
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Thomson MD, Wilson-Genderson M, Siminoff LA. The presence of a secondary caregiver differentiates primary cancer caregiver well-being. Support Care Cancer 2022; 30:1597-605. [PMID: 34546455 DOI: 10.1007/s00520-021-06544-8] [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: 04/15/2021] [Accepted: 09/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Informal caregivers play a fundamental role in the care of hematological cancer patients, but less is known about how secondary caregivers are involved. We assessed the presence or absence of a secondary caregiver, the types of caregiving activities performed by primary and secondary caregivers, and examined whether the presence of a secondary caregiver was associated with primary caregiver characteristics and well-being over time. METHODS A case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Multilevel models were developed to examine the associations between the presence of a secondary caregiver and the primary caregivers' well-being. RESULTS Most (64.9%) primary caregivers reported having secondary caregivers. Multilevel models showed primary caregivers without help had higher baseline mental and physical health, but experienced deteriorating physical health over time, compared to supported primary caregivers. Supported primary caregivers reported improvements in mental health over time that was associated with improvements in physical health. CONCLUSIONS Primary caregivers in good physical and mental health at the beginning of their caregiving journey but who have the least assistance from others may be at greatest risk for detrimental physical health effects long term. Attention to the arrangement of caregiving roles (i.e., who provides what care) over time is needed to ensure that caregivers remain healthy and well supported.
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22
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Abstract
African American Alzheimer's disease and related dementia (ADRD) family caregivers are understudied in intervention research with discrepant evidence existing on their mental and physical health outcomes. The stress toll of ADRD caregiving, coupled with the well-documented health disparities for African Americans, place these caregivers at higher risk for morbidity and mortality.Objectives: The purpose of this study was to explore African American ADRD family caregivers' perceptions of caregiving and self-care.Design: Qualitative descriptive study based on individual, one-time, semi-structured interviews from a purposeful sample of current/former African American ADRD community-dwelling family caregivers. Participants agreed to either face-to-face or telephonic interviews between 60 and 90 minutes in length.Results: Twenty-one caregiver interviews were conducted with primarily adult children (mean age = 62.61 (SD = 12.88); 81% completed college; 57% women). Content analysis yielded three major themes: Stressors, Resources, and Coping. The results demonstrate a complex interaction of sociocultural and environmental stressors and perceptions of resources that influence the coping strategies adopted by caregivers to navigate their caregiving experience.Conclusions: These findings suggest a broadened perspective to further inform the development and testing of interventions to address the health outcomes and caregiving needs of African American ADRD caregivers.
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Affiliation(s)
- Fawn A Cothran
- Department of Adult Health and Gerontological Nursing, College of Nursing, Chicago, IL, USA
| | - Olimpia Paun
- Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Shaila Strayhorn
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Lisa L Barnes
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Chicago, IL, USA
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23
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Song MJ, Kim JH. Family Caregivers of People with Dementia Have Poor Sleep Quality: A Nationwide Population-Based Study. Int J Environ Res Public Health 2021; 18:ijerph182413079. [PMID: 34948685 PMCID: PMC8702002 DOI: 10.3390/ijerph182413079] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022]
Abstract
Previous studies have documented cognitive impairments, psychological stress, and depressive symptoms in family caregivers of people with dementia (PWD), which could be attributed to their sleep disturbances. Notwithstanding the increasing recognition of poor sleep quality and sleep disturbances in family caregivers of PWD, their association has not been tested yet using population-representative samples. We conducted a retrospective, cross-sectional study using population-based data from the 2018 Korean Community Health Survey. Sociodemographic, mental health-related, and physical health-related variables as well as sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) were compared between 2537 cohabitating caregivers of PWD, 8864 noncohabitating caregivers of PWD, and 190,278 non-caregivers. Two sets of multivariable logistic regressions were conducted to examine the associations between dementia caregiving and poor sleep quality in cohabitating and noncohabitating caregivers versus noncaregivers. Both cohabitating and noncohabitating caregivers had higher global PSQI scores and higher prevalence of poor sleep quality (PSQI score > 5) than did noncaregivers. Multivariable logistic regressions adjusted for potential confounders revealed that cohabitating caregivers (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.15-1.38) and noncohabitating caregivers (OR 1.15, CI 1.10-1.21) were significantly associated with poor sleep quality. Our results showed that both cohabitating and noncohabitating caregivers of PWD experienced overall poorer sleep quality compared to noncaregivers, indicating the deleterious effect of dementia caregiving on sleep quality, regardless of living arrangements. Given the high prevalence of poor sleep quality in family caregivers of PWD and the increasing awareness of the serious health consequences of poor-quality sleep, physicians should consider active sleep interventions to promote health and wellbeing not only for the dementia patients but also for family caregivers.
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Affiliation(s)
- Min Ji Song
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea;
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
- Correspondence: ; Tel.: +82-2-2626-3171
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Hu M, Ma C, Sadarangani T, Wu B. Social-behavioral interventions for Asian and Hispanic American dementia caregivers: An integrative review. Aging and Health Research 2021. [DOI: 10.1016/j.ahr.2021.100027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sikora Kessler A, Mock G, Hendricks D, Robbins L, Kaur H, Potter JF, Burgio LD. Translating the REACH OUT dementia caregiver intervention into a primary care setting: a pilot study. Aging Ment Health 2021; 25:1483-1492. [PMID: 33258686 DOI: 10.1080/13607863.2020.1850638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The current study translated the Resources for Enhancing Alzheimer's Caregiver Health: Offering Useful Treatments (REACH OUT), a skills-building stress and burden intervention, for the primary care setting and pilot the resulting intervention. METHODS The 16-week intervention consisted of a combination of clinic-based group and one-on-one sessions offered within a medical home, geriatrics clinic. A quasi-experimental pre- and post-test study design without a control group tested the resulting intervention. Semi-structured qualitative exit interviews evaluated program satisfaction. RESULTS Twenty-five caregivers participated in one of four intervention groups; 21 caregivers completed the intervention (attended at least five of six group sessions). Caregiver burden on standardized assessments was significantly reduced between pre- and post-intervention, specifically for physical/emotional strain and caregiving uncertainty. Significant reductions were found in the frequency of reported disruptive behaviors; increased caregiver confidence in handling behavior problem frequency, depressive symptoms, disruptive behaviors, and memory-related problems; and decreased bother with respect to behavioral problem frequency and care recipient depression. Program satisfaction was high. CONCLUSION This work suggests that the REACH OUT program can be successfully modified for use within a primary-care medical home setting.
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Affiliation(s)
- Asia Sikora Kessler
- College of Public Health, Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA.,QualityMetric Incorporated, LLC, Johnston, Rhode Island, USA
| | - Gabrielle Mock
- Brown University, Department of Medicine, Providence, Rhode Island, USA
| | - Diane Hendricks
- Department of Internal Medicine, Division of Geriatrics, Gerontology, and Palliative Medicine, University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska, USA
| | - Laura Robbins
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Harpriya Kaur
- College of Public Health, Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jane F Potter
- Department of Internal Medicine, Division of Geriatrics, Gerontology, and Palliative Medicine, University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska, USA
| | - Louis D Burgio
- The University of Alabama and Burgio Geriatric Consulting, Tuscaloosa, Alabama, USA
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Abstract
BACKGROUND AND OBJECTIVES Dementia is becoming increasingly prevalent and family caregivers have been providing most of the care for persons with dementia. This caregiving is a mentally and physically demanding task. "The Berlin Inventory of Caregiver Stress-Dementia" (BICS-D) is a theory driven, multidimensional assessment which was developed as part of the Longitudinal Dementia Caregiver Stress Study (LEANDER). RESEARCH DESIGN AND METHODS The inventory consists of 25 subscales with a total of 121 items. Analyses of the psychometric properties of the inventory were based on responses from 594 caregivers. RESULTS Factor analyses confirm the multidimensionality of the inventory. The reliabilities of the subscales (Cronbach's α) are between .72 and .95. Validity and sensitivity of the inventory were also confirmed. Differing patterns of burden could be demonstrated for different relatives (partners, children, and daughters-in-law) as well as for different degrees of severity of dementia. DISCUSSION AND IMPLICATIONS The scores derived for the instrument have support for reliability and validity, and sensitivity to change. It is suitable for the differential measurement of burden experienced by different subgroups of caregivers as well as for the evaluation of interventions. The different subscales of the battery can also be used separately, depending on the study's objectives.
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Affiliation(s)
- Anna Schlomann
- Department of Special Education and Rehabilitation Science, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Claudia Schacke
- Soziale Gerontologie, Katholische Hochschule für Sozialwesen Berlin, Berlin, Germany
| | - Bernhard Leipold
- Department of Psychology, Bundeswehr University, Munich, Germany
| | - Susanne Zank
- Department of Special Education and Rehabilitation Science, Faculty of Human Sciences, University of Cologne, Cologne, Germany
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27
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Ahn S, Esquivel JH, Davis EM, Logan JG, Chung ML. Cardiovascular Disease Incidence and Risk in Family Caregivers of Adults With Chronic Conditions: A Systematic Review. J Cardiovasc Nurs 2021. [PMID: 33938535 DOI: 10.1097/JCN.0000000000000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Family caregivers experience psychological distress or physical strain that may lead to an increased risk of cardiovascular disease (CVD) morbidity and mortality. OBJECTIVE This systematic review aimed to describe the current evidence and gaps in the literature on measures used to assess CVD outcomes in family caregivers, the association of caregiving with CVD incidence/risk outcomes, and associated factors in family caregivers of patients with chronic disease. METHODS Medline, PubMed, CINAHL, Web of Science, and Google Scholar were searched for English-language, peer-reviewed studies published from 2008 to 2020 that examined CVD incidence and risk among family caregivers of adults with chronic conditions. RESULTS Forty-one studies were included in this review. The measures used to assess CVD risk were categorized into biochemical, subclinical markers, components of metabolic syndrome, and global risk scores. Compared with noncaregivers, caregivers were more likely to have higher CVD incidence rates and objectively measured risk. Cardiovascular disease risks were also increased by their caregiving experience, including hours/duration of caregiving, caregivers' poor sleep status, psychological symptoms, poor engagement in physical/leisure activities, and care recipient's disease severity. CONCLUSIONS Although there were limited longitudinal studies in caregivers of patients with diverse health conditions, we found evidence that caregivers are at high risk of CVD. Further research for various caregiver groups using robust methods of measuring CVD risk is needed. Caregiver factors should be considered in developing interventions aimed at reducing CVD risk for caregivers.
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Fernández-Puerta L, Prados G, Jiménez-Mejías E. Interventions that Improve Sleep in Caregivers of Adult Care-Recipients: A Systematic Review. West J Nurs Res 2021; 44:180-199. [PMID: 33686882 DOI: 10.1177/0193945921995477] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/16/2022]
Abstract
The purpose of the present review was to compile and analyze all interventions aimed at improving the sleep-rest pattern of adult caregivers. A database search was performed in PubMed, Embase, Scopus, CINAHL and PsycINFO. Twenty-four papers published between 1998 and 2020 met the inclusion criteria. Informal caregivers can benefit from various types of sleep interventions, including (a) cognitive-behavioral sleep interventions (CBIs), (b) caregiver health interventions (CHIs), and (c) exercise programs. Other types of interventions such as acupressure, back massage, reflexology, music, and heart rate variability biofeedback sessions may have beneficial effects on the sleep of caregivers. Yet, studies on this topic are heterogeneous and often have considerable methodological shortcomings. Few clinical trials have explored sleep problems as a dyadic caregiver-patient relationship. It is necessary to conduct new clinical trials to determine the viability and level of evidence of the various strategies aimed at improving sleep of informal caregivers.
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Affiliation(s)
| | - Germán Prados
- Department of Nursing, School of Health Sciences, University of Granada, Granada, Spain
| | - Eladio Jiménez-Mejías
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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Abstract
IMPORTANCE Caregiver strain has been shown to be associated with adverse effects on caregivers' health, particularly among those with cardiovascular disease. Less is known about the association of caregiver strain with health behaviors among caregivers with diabetes, a disease that requires a high degree of self-care. OBJECTIVE To examine the association between caregiver strain and diabetes self-care among caregivers with diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted between July 13, 2018, and June 25, 2020, using data on 795 US caregivers aged 45 years or older with self-reported diabetes from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which comprised 30 239 Black and White adults 45 years or older throughout the US enrolled from January 2003 to October 2007. EXPOSURES Caregiver strain, assessed by self-report in response to the question, "How much of a mental or emotional strain is it to provide this care?" Response options were no strain, some strain, or a lot of (high) strain. MAIN OUTCOMES AND MEASURES Diabetes self-care, which was assessed across 4 domains (Mediterranean diet adherence, physical activity, smoking status, and medication adherence), and a composite self-care score summing performance across these domains. The association between caregiver strain and diabetes self-care was examined with multivariable Poisson regression adjusting for demographic, clinical, physical and mental functioning, and caregiving covariates. RESULTS Among the 795 caregivers with diabetes included in the study, the mean (SD) age was 63.7 (8.6) years, 469 (59.0%) were women, and 452 (56.9%) were Black individuals. Overall, 146 caregivers (18.4%) reported high caregiver strain. In unadjusted models, high caregiver strain was associated with less physical activity (prevalence ratio [PR], 0.66; 95% CI, 0.45-0.97), low medication adherence (PR, 0.80; 95% CI, 0.68-0.94), and worse self-care (PR, 0.65; 95% CI, 0.44-0.98). In adjusted models, the association between some and high caregiving strain with low medication adherence remained significant (adjusted PR: some strain, 0.88 [95% CI, 0.78-0.99]; high strain, 0.83 [95% CI, 0.69-0.99]). CONCLUSIONS AND RELEVANCE In this cohort study of US adult caregivers with diabetes, a high level of strain was associated with low medication adherence. Increased awareness of the prevalence of caregiver strain and potential ramifications on caregivers' self-care appears to be warranted among health care professionals and caregivers.
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Affiliation(s)
- Alexandra King
- New York Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - Ronald Adelman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - David L. Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Hinton L, Nguyen H, Nguyen HT, Harvey DJ, Nichols L, Martindale‐Adams J, Nguyen BT, Nguyen BTT, Nguyen AN, Nguyen CH, Nguyen TTH, Nguyen TL, Nguyen ATP, Nguyen NB, Tiet QQ, Nguyen TA, Nguyen PQ, Nguyen TA, Pham T. Advancing family dementia caregiver interventions in low- and middle-income countries: A pilot cluster randomized controlled trial of Resources for Advancing Alzheimer's Caregiver Health in Vietnam (REACH VN). Alzheimers Dement (N Y) 2021; 6:e12063. [PMID: 33532542 PMCID: PMC7825546 DOI: 10.1002/trc2.12063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Low- and middle-income countries have rapidly increasing numbers of people with dementia, yet little evidence on family caregiving interventions. We tested the preliminary efficacy and feasibility of a family caregiving intervention in northern Vietnam. METHODS Nine clusters comprising 60 family caregivers were randomized to a culturally adapted version of a four- to six-session, multicomponent intervention delivered in-home over 2 to 3 months, or enhanced control. Eligible caregivers were ≥18 years of age and scored ≥6 on the Zarit Burden Inventory (ZBI). RESULTS Fifty-one caregivers (85%) completed the study. Using analysis of covariance with 3-month assessment as the outcome and baseline assessment as a covariate, intervention group caregivers had an average ZBI (primary outcome) score 1.2 standard deviation (SD) lower (P = .02) and Patient Health Questionnaire-4 (psychological distress) score 0.7 SD lower (P = .03) than controls. DISCUSSION In the first study of its kind in Vietnam, a culturally adapted, manualized, family caregiver intervention was both efficacious and feasible.
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Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | - Huong Nguyen
- Department of Religious StudiesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Hung Trong Nguyen
- Vietnam National Geriatric HospitalHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | - Danielle J Harvey
- Department of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | - Linda Nichols
- Caregiver CenterVeterans Affairs Medical CenterMemphisTennesseeUSA
- Department of Preventive MedicineUniversity of Tennessee Health Sciences CenterMemphisTennesseeUSA
| | - Jennifer Martindale‐Adams
- Caregiver CenterVeterans Affairs Medical CenterMemphisTennesseeUSA
- Department of Preventive MedicineUniversity of Tennessee Health Sciences CenterMemphisTennesseeUSA
| | | | | | | | | | | | | | | | | | - Quyen Q. Tiet
- California School of Professional Psychology at Alliant International UniversitySan FranciscoCaliforniaUSA
| | | | | | - Trung Anh Nguyen
- Vietnam National Geriatric HospitalHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | - Thang Pham
- Vietnam National Geriatric HospitalHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
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Spillman BC, Freedman VA, Kasper JD, Wolff JL. Change Over Time in Caregiving Networks for Older Adults With and Without Dementia. J Gerontol B Psychol Sci Soc Sci 2020; 75:1563-1572. [PMID: 31102533 PMCID: PMC7424285 DOI: 10.1093/geronb/gbz065] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 10/02/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We provide national estimates of caregiving networks for older adults with and without dementia and examine how these networks develop over time. Most prior research has focused on primary caregivers and rarely on change over time. METHOD We identify a cohort of older adults continuously followed in the National Health and Aging Trends Study between 2011 and 2015 and receiving help from family members or unpaid caregivers in 2015 (n = 1,288). We examine differences by dementia status in network size, types of assistance and task sharing, and composition-differentiating between "specialist" and "generalist" caregivers helping in one versus multiple activity domains. Multinomial regression is used to estimate change over time in network task sharing and composition. RESULTS In 2015, older adults with dementia had larger caregiving networks involving more task sharing than those without dementia and more often relied on generalist caregivers, especially the subset assisting with medical, household, and mobility or self-care activities. Uniformly greater reliance over time on these more intensely engaged generalist caregivers chiefly accounts for larger dementia networks. DISCUSSION Findings lend support to the need for caregiver training on managing multiple task domains and-for dementia caregivers in particular-task-sharing skills. More generally, the design of new approaches to better support older adults and their caregivers should consider the complexity, heterogeneity, and change over time in caregiving networks.
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Affiliation(s)
| | - Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Judith D Kasper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Ross A, Perez A, Wehrlen L, Lee LJ, Yang L, Cox R, Bevans M, Ding A, Wiener L, Wallen GR. Factors influencing loneliness in cancer caregivers: A longitudinal study. Psychooncology 2020; 29:1794-1801. [PMID: 32672866 DOI: 10.1002/pon.5477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/01/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe levels of loneliness in cancer caregivers over a 6 month time period, and to examine factors that influence changes in loneliness in caregivers over time. METHODS Prospective, repeated measures design was utilized to examine levels of loneliness and factors that influence loneliness in 129 family caregivers of individuals undergoing cancer treatment at three time points over a 6 month period. Measures included: PROMIS global health and sleep disturbance; NIH Toolbox loneliness, self-efficacy and perceived stress; Family Care Inventory mutuality scale; and Caregiver Reaction Assessment. RESULTS Approximately one third (30.2%, n = 39) of the caregivers had high levels of loneliness, and levels of loneliness did not change over the three time points (P = .985). For any given time point, caregivers who were not married (P = .008), not working (P = .027), with worse mental health (P = .015), more perceived-stress (P < .0001), and more caregiver burden (P = .003) reported higher levels of loneliness. CONCLUSION This study provides guidance for clinicians attempting to identify at-risk caregivers by confirming the findings of previous research that caregivers with higher burden, stress and in poor mental health are at increased risk for loneliness. This study provides preliminary evidence that continuing to work during the caregiving trajectory may be beneficial to caregivers by reducing levels of loneliness. Future research is needed to confirm these findings and to examine novel interventions to reduce loneliness in cancer caregivers.
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Affiliation(s)
- Alyson Ross
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Avery Perez
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Leslie Wehrlen
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Lena J Lee
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Li Yang
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Robert Cox
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Margaret Bevans
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Alice Ding
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Lori Wiener
- National Cancer Institute Center for Cancer Research Pediatric Oncology Branch, Bethesda, Maryland, USA
| | - Gwenyth R Wallen
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
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Bernstein A, Merrilees J, Dulaney S, Harrison KL, Chiong W, Ong P, Heunis J, Choi J, Walker R, Feuer JE, Lee K, Dohan D, Bonasera SJ, Miller BL, Possin KL. Using care navigation to address caregiver burden in dementia: A qualitative case study analysis. Alzheimers Dement (N Y) 2020; 6:e12010. [PMID: 32377557 PMCID: PMC7201177 DOI: 10.1002/trc2.12010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/11/2019] [Accepted: 12/26/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Many caregivers of people with dementia experience burden and resulting health effects due to the intensive nature of caregiving. Phone- and web-based care navigation is an innovative model of care that may be useful in addressing caregiver burden in dementia. METHODS Qualitative methods (interviews, focus groups, and case study analysis) were used to identify care navigator approaches used to address caregiver burden in dementia as part of a dementia care navigation program. RESULTS Care navigators targeted caregiver burden by focusing on strategies to reduce caregiver guilt and frustration, manage patient-related behavior, address caregiver depression, and improve the relationship between the caregiver and person with dementia. The case studies presented demonstrate the ways that care navigators identified patient and caregiver needs and tailored their approaches to meet the specific social, cultural, economic, and geographic contexts of the dyads with which they worked. DISCUSSION Findings provide insights into strategies used to address caregiver burden through care navigation. Care navigators who speak the same language as the caregivers with whom they work and who have an in-depth understanding of the symptoms of different dementia syndromes may be particularly effective.
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Affiliation(s)
- Alissa Bernstein
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCalifornia
- Department of NeurologyGlobal Brain Health InstituteUniversity of CaliforniaSan FranciscoCalifornia
- Department of AnthropologyHistoryand Social MedicineUniversity of CaliforniaSan FranciscoCalifornia
| | - Jennifer Merrilees
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
| | - Sarah Dulaney
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
| | - Krista L. Harrison
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCalifornia
| | - Winston Chiong
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
| | - Paulina Ong
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
| | - Julia Heunis
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
| | - Jeff Choi
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
| | - Reilly Walker
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
| | - Julie E. Feuer
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
| | - Kirby Lee
- Department of Clinical PharmacyUniversity of CaliforniaSan FranciscoCalifornia
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCalifornia
| | - Stephen J. Bonasera
- Division of GeriatricsDepartment of Internal MedicineHome Instead Center for Successful AgingOmahaNebraska
| | - Bruce L. Miller
- Department of NeurologyGlobal Brain Health InstituteUniversity of CaliforniaSan FranciscoCalifornia
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
| | - Katherine L. Possin
- Department of NeurologyGlobal Brain Health InstituteUniversity of CaliforniaSan FranciscoCalifornia
- Department of NeurologyMemory and Aging CenterUniversity of CaliforniaSan FranciscoCalifornia
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Gaugler JE, Statz TL, Birkeland RW, Louwagie KW, Peterson CM, Zmora R, Emery A, McCarron HR, Hepburn K, Whitlatch CJ, Mittelman MS, Roth DL. The ResidentialCare Transition Module: a single-blinded randomized controlled evaluation of a telehealth support intervention for family caregivers of persons with dementia living in residential long-term care. BMC Geriatr 2020; 20:133. [PMID: 32293314 PMCID: PMC7158110 DOI: 10.1186/s12877-020-01542-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 11/29/2019] [Accepted: 03/29/2020] [Indexed: 11/22/2022] Open
Abstract
Background Families do not fully disengage from care responsibilities following relatives’ admissions to residential long-term (RLTC) care settings such as nursing homes. Caregiver stress, depression, or other key outcomes remain stable or sometimes increase following a relative’s RLTC entry. Some interventions have attempted to increase family involvement after institutionalization, but few rigorous studies have demonstrated whether these interventions are effective in helping families navigate the potential emotional and psychological upheaval presented by relatives’ transitions to RLTC environments. The Residential Care Transition Module (RCTM) provides six formal sessions of consultation (one-to-one and family sessions) over a 4-month period to family caregivers who have admitted a relative to a RLTC setting. Methods In this embedded mixed methods randomized controlled evaluation, family members who have admitted a cognitively impaired relative to a RLTC setting are randomly assigned to the RCTM (n = 120) or a usual care control condition (n = 120). Primary outcomes include reductions in family members’ primary subjective stress and negative mental health outcomes; secondary role strains; and residential care stress. The mixed methods design will allow for an analysis of intervention action mechanisms by “embedding” qualitative components (up to 30 semi-structured interviews) at the conclusion of the 12-month evaluation. Discussion This evaluation will fill an important clinical and research gap by evaluating a psychosocial intervention designed for families following RLTC admission that determines whether and how the RCTM can help families better navigate the emotional and psychological challenges of residential care transitions. Trial registration ClinicalTrials.gov (NCT02915939, prospectively registered).
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Affiliation(s)
- Joseph E Gaugler
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA.
| | - Tamara L Statz
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Robyn W Birkeland
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Katie W Louwagie
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Colleen M Peterson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Zmora
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ann Emery
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Hayley R McCarron
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | | | - Mary S Mittelman
- Department of Psychiatry, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
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Abstract
Objective: To examine the relationship between care recipient (person with Alzheimer's disease) ability to perform daily tasks and caregivers' (CG) perceived burden and depression, guided by the caregiver identity theory. We also examine the mediating effect of CG abilities to meet their basic needs.Methods: This study utilizes the baseline data of the REACH II study. Spearman's rho (ρ) was used to test for relationships between burden, reported depression, and each ADLs and IADLs. To further explore the relationship between burden and each ADLs and IADLs, structural equation modeling was conducted using Mplus 8.0.Results: Reported CG total scores indicated increased perceived CG burden with greater number of assisted daily activities. CG depression scores were significantly predicted by reported burden scores and caregiver's ability to pay for basic needs. Importantly, 34.6% of variation in CG reported depressions scores were explained by reported burden scores. A multivariate regression model with reported burden scores, controlling for caregiver's ability to pay for basic needs, explained 36.6% of the variance in CG depression scores. Burden scores and CG ability to pay for basic needs significantly predicted depression scores. Results from the three models indicated that CG burden fully mediated the relationship between daily living skill scores and CG depression.Conclusion: Our study findings suggest the need to more closely examine the link between AD caregiving, financial instability, and mental health and bolster support for policies and programs that offer tangible supports and services to offset the costs of informal AD CG.
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Affiliation(s)
- Vivian J Miller
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Michael O Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Noelle Fields
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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Teahan Á, Lafferty A, McAuliffe E, Phelan A, O’Sullivan L, O’Shea D, Nicholson E, Fealy G. Psychosocial Interventions for Family Carers of People With Dementia: A Systematic Review and Meta-Analysis. J Aging Health 2020; 32:1198-1213. [DOI: 10.1177/0898264319899793] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective:This study aimed to review and synthesize findings of the effectiveness of psychosocial interventions aimed at improving outcomes for family carers of people with dementia. Method: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the following databases: Cochrane, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Excerpta Medica Database (EMBASE), and Applied Social Sciences Index and Abstracts (ASSIA). RevMan 5 software was used to conduct meta-analysis and subgroup analysis using a random-effects model. Results: The search yielded 22 high-quality intervention articles that were suitable for further meta-analysis. Meta-analysis revealed that psychosocial interventions have a small to moderate significant effect on carer burden (standardized mean difference [SMD] = −0.34, confidence interval [CI] = [−0.59, −0.09]), depression (SMD = −0.36, CI = [−0.60, −0.13]), and general health (SMD = 0.34, CI = [0.18, 0.51]). Discussion: Psychosocial interventions had a positive impact on carer outcomes; however, these results should be interpreted with caution, given the significant level of heterogeneity in study designs. Future research could examine contextual and implementation mechanisms underlying psychosocial interventions to develop effective support systems for family carers of people with dementia.
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Affiliation(s)
- Áine Teahan
- National University of Ireland Galway, Ireland
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Kim G, Allen RS, Wang SY, Park S, Perkins EA, Parmelee P. The Relation Between Multiple Informal Caregiving Roles and Subjective Physical and Mental Health Status Among Older Adults: Do Racial/Ethnic Differences Exist? Gerontologist 2020; 59:499-508. [PMID: 29373738 DOI: 10.1093/geront/gnx196] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 01/18/2017] [Accepted: 11/14/2017] [Indexed: 01/21/2023] Open
Abstract
PURPOSE OF THE STUDY The present study examined whether race/ethnicity moderated the relation between type of caregiving role (none, one, or multiple care recipients) and subjective physical and mental health among older adults. DESIGN AND METHODS The sample was drawn from the 2009 California Health Interview Survey. Racially/ethnically diverse adults aged 55 and older (n = 24,241) were categorized into 3 groups by caregiving roles: noncaregivers (n = 18,626; referent), caregivers with a single caregiving role (n = 4,023), and caregivers with multiple caregiving roles (n = 1,772). A 2-way analysis of covariance was conducted to test main and interaction effects. RESULTS After adjustment for covariates, noncaregivers reported significantly worse self-rated health and lower psychological distress than caregivers with any type of role. The interaction between race/ethnicity and caregiving roles was significant only for self-rated health (p < .05). Blacks with multiple caregiving roles had poorer self-rated health than those with a single caregiving role and better self-rated health than noncaregivers, whereas other racial/ethnic groups with multiple caregiving roles had better self-rated health compared to both noncaregivers and those with a single caregiving role. Our sensitivity analysis showed that controlling caregiving-related variables present only among caregivers eliminated the differences in self-rated health between the two types of caregivers. IMPLICATIONS Findings suggest that caregivers report better self-rated health than noncaregivers and that the relation of multiple caregiving roles with self-rated health differs by race/ethnicity, with blacks differing from other racial/ethnic groups. This implies that caregivers experience gain, or are selected into the role of caregiving by virtue of having good health.
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Affiliation(s)
- Giyeon Kim
- Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Rebecca S Allen
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa.,Department of Psychology, The University of Alabama, Tuscaloosa
| | - Sylvia Y Wang
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Soohyun Park
- Department of Psychology, The University of Alabama, Tuscaloosa
| | | | - Patricia Parmelee
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa.,Department of Psychology, The University of Alabama, Tuscaloosa
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Stoia DCM, Ștefănuț A, Moldovan R, Hogea L, Giurgi-Oncu C, Bredicean C. Effectiveness of Family Stress-Relief Interventions for Patients with Dementia: A Systematic Evaluation of Literature. Neuropsychiatr Dis Treat 2020; 16:629-635. [PMID: 32184602 PMCID: PMC7061436 DOI: 10.2147/ndt.s241150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/30/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to evaluate the effectiveness of stress-relief interventions for family members of patients with dementia. DATA SOURCE This analysis includes peer-reviewed articles published between 1989 and 2019, selected from online databases. The introduced keywords were: stress reduction, dementia, or Alzheimer's; program, therapy, intervention, or technique; caregivers. FOR THE SELECTION OF STUDIES We utilized the following inclusion criteria: (1) studies with experimental or quasi-experimental design; (2) study samples that include adult caregivers, who take care of other family members diagnosed with various types of dementia; (3) testing one or more types of psychological inferences presented in the study has been conducted to reduce the stress of patients with dementia; (4) studies written in English and subjected to a peer-review process. RESULTS Stress-reduction interventions for patients with dementia appear to have had a statistically significant effect in most of the identified studies. CONCLUSION On a qualitative level, the results show the effectiveness of both pre-test and follow-up interventions, but these results are to be regarded cautiously, considering the heterogeneity of the evaluation tools used and the small number of studies included.
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Affiliation(s)
| | - Adelina Ștefănuț
- Department of Psychology, West University of Timișoara, Timișoara, Romania
| | - Romina Moldovan
- "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Lavinia Hogea
- Discipline of Psychology, Department of Neuroscience, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Cătălina Giurgi-Oncu
- Discipline of Psychiatry, Department of Neuroscience, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Cristina Bredicean
- Discipline of Psychiatry, Department of Neuroscience, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
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Hansen BR, Hodgson NA, Budhathoki C, Gitlin LN. Caregiver Reactions to Aggressive Behaviors in Persons With Dementia in a Diverse, Community-Dwelling Sample. J Appl Gerontol 2020; 39:50-61. [PMID: 29457520 PMCID: PMC5824433 DOI: 10.1177/0733464818756999] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 11/16/2022] Open
Abstract
Purpose: To describe caregiver challenges with and confidence managing three aggressive behavior types in persons with dementia: verbal aggression, destroying property, and threatening to hurt others. Design and Method: Secondary analysis of baseline data from the 2001-2004 Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) initiative. Results: One or more aggressive behaviors within 1 week were reported by more than a third of caregivers, with most expressing upset but fewer expressing confidence managing the behaviors. Caregiver distress and confidence differed by race/ethnicity in response to verbal aggression, with more White/Caucasian caregivers expressing upset than Hispanic/Latinos or Black/African Americans. Fewer Hispanic/Latinos expressed confidence managing verbal aggression, compared with White/Caucasians or Black/African Americans. Discussion: Aggressive behaviors challenge caregivers, with reactions varying by behavior type and race/ethnicity. Cultural and contextual factors suggest the need to tailor interventions, especially skill-building interventions that increase confidence managing aggressive behaviors while decreasing upset.
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Affiliation(s)
- Bryan R. Hansen
- Assistant Professor, Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, Maryland 21205, Office: 410-614-4820
| | - Nancy A. Hodgson
- Associate Professor, University of Pennsylvania School of Nursing
| | | | - Laura N. Gitlin
- Distinguished Professor, Director, Center for Innovative Care in Aging, Johns Hopkins School of Nursing
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Possin KL, Merrilees JJ, Dulaney S, Bonasera SJ, Chiong W, Lee K, Hooper SM, Allen IE, Braley T, Bernstein A, Rosa TD, Harrison K, Begert-Hellings H, Kornak J, Kahn JG, Naasan G, Lanata S, Clark AM, Chodos A, Gearhart R, Ritchie C, Miller BL. Effect of Collaborative Dementia Care via Telephone and Internet on Quality of Life, Caregiver Well-being, and Health Care Use: The Care Ecosystem Randomized Clinical Trial. JAMA Intern Med 2019; 179:1658-1667. [PMID: 31566651 PMCID: PMC6777227 DOI: 10.1001/jamainternmed.2019.4101] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering care from centralized hubs across broad geographic areas to caregivers and persons with dementia (PWDs) independently of their health system affiliations. OBJECTIVE To determine whether the Care Ecosystem is effective in improving outcomes important to PWDs, their caregivers, and payers beyond those achieved with usual care. DESIGN, SETTING, AND PARTICIPANTS A single-blind, randomized clinical trial with a pragmatic design was conducted among PWDs and their caregivers. Each PWD-caregiver dyad was enrolled for 12 months between March 20, 2015, and February 28, 2017. Data were collected until March 5, 2018. Study interventions and assessments were administered over the telephone and internet by clinical and research teams in San Francisco, California, and Omaha, Nebraska. Of 2585 referred or volunteer PWD-caregiver dyads in California, Iowa, or Nebraska, 780 met eligibility criteria and were enrolled. A total of 512 PWD-caregiver dyads were randomized to receive care through the Care Ecosystem and 268 dyads to receive usual care. All eligible PWDs had a dementia diagnosis; were enrolled or eligible for enrollment in Medicare or Medicaid; and spoke English, Spanish, or Cantonese. Analyses were intention-to-treat. INTERVENTION Telephone-based collaborative dementia care was delivered by a trained care team navigator, who provided education, support and care coordination with a team of dementia specialists (advanced practice nurse, social worker, and pharmacist). MAIN OUTCOMES AND MEASURES Primary outcome measure: Quality of Life in Alzheimer's Disease based on caregiver's rating of 13 aspects of PWD's well-being (including physical health, energy level, mood, living situation, memory, relationships, and finances) on a 4-point scale (poor to excellent). Secondary outcomes: frequencies of PWDs' use of emergency department, hospitalization, and ambulance services; caregiver depression (score on 9-Item Patient Health Questionnaire; higher scores indicate more severe depression); and caregiver burden (score on 12-Item Zarit Burden Interview; higher scores indicate more severe caregiver burden). RESULTS The 780 PWDs (56.3% female; mean [SD] age, 78.1 [9.9] years) and 780 caregivers (70.9% female; mean [SD] age, 64.7 [12.0] years) lived in California (n = 452), Nebraska (n = 284), or Iowa (n = 44). Of 780 dyads, 655 were still active at 12 months, and 571 completed the 12-month survey. Compared with usual care, the Care Ecosystem improved PWD quality of life (B, 0.53; 95% CI, 0.25-1.30; P = .04), reduced emergency department visits (B, -0.14; 95% CI, -0.29 to -0.01; P = .04), and decreased caregiver depression (B, -1.14; 95% CI, -2.15 to -0.13; P = .03) and caregiver burden (B, -1.90; 95% CI, -3.89 to -0.08; P = .046). CONCLUSIONS AND RELEVANCE Effective care management for dementia can be delivered from centralized hubs to supplement usual care and mitigate the growing societal and economic burdens of dementia. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02213458.
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Affiliation(s)
- Katherine L Possin
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco.,Global Brain Health Institute, University of California, San Francisco
| | - Jennifer J Merrilees
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Sarah Dulaney
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Stephen J Bonasera
- Home Instead Center for Successful Aging, Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Kirby Lee
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Sarah M Hooper
- UCSF/UC Consortium on Law, Science & Health Policy, UC Hastings College of the Law, San Francisco
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Tamara Braley
- Home Instead Center for Successful Aging, Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Alissa Bernstein
- Global Brain Health Institute, University of California, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Talita D Rosa
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco.,Global Brain Health Institute, University of California, San Francisco
| | - Krista Harrison
- Global Brain Health Institute, University of California, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.,Division of Geriatrics, University of California, San Francisco
| | - Hailey Begert-Hellings
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - James G Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Georges Naasan
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Serggio Lanata
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Amy M Clark
- Home Instead Center for Successful Aging, Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha.,Department of Social Work, Nebraska Wesleyan University, Lincoln
| | - Anna Chodos
- Division of Geriatrics, University of California, San Francisco
| | - Rosalie Gearhart
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Christine Ritchie
- Division of Geriatrics, University of California, San Francisco.,Center for Research on Aging, San Francisco Campus for Jewish Living, San Francisco, California
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
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Abramsohn EM, Jerome J, Paradise K, Kostas T, Spacht WA, Lindau ST. Community resource referral needs among African American dementia caregivers in an urban community: a qualitative study. BMC Geriatr 2019; 19:311. [PMID: 31727000 PMCID: PMC6857299 DOI: 10.1186/s12877-019-1341-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 06/27/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND African American caregivers of community-residing persons with dementia are mostly unpaid and have high rates of unmet basic and health needs. The National Alzheimer's Project Act (NAPA) mandates improved coordination of care for persons with dementia and calls for special attention to racial populations at higher risk for Alzheimer's Disease or related dementias (ADRD) to decrease health disparities. The purpose of this study is to describe the perceptions of African American caregivers of people with dementia about community resources needed to support caregiving as well as their own self-care. METHODS Using a qualitative study design, in-depth, semi-structured qualitative interviews were conducted with caregivers (N = 13) at an urban geriatric clinic to elicit community resource needs, barriers to and facilitators of resource use and how to optimize clinical referrals to community resources. Caregivers were shown a community resource referral list ("HealtheRx") developed for people with dementia and were queried to elicit relevance, gaps and insights to inform delivery of this information in the healthcare setting. Data were iteratively coded and analyzed using directed content analysis. Results represent key themes. RESULTS Most caregivers were women (n = 10, 77%) and offspring (n = 8, 62%) of the person with dementia. Community resource needs of these caregivers included social, entertainment, personal self-care and hospice services. Main barriers to resource use were the inability to leave the person with dementia unsupervised and the care recipient's disinterest in participating in their own self-care. Facilitators of resource use included shared caregiving responsibility and learning about resources from trusted sources. To optimize clinical referrals to resources, caregivers wanted specific eligibility criteria and an indicator of dementia care capability. CONCLUSIONS African American caregivers in this study identified ways in which community resource referrals by clinicians can be improved to meet their caregiving and self-care needs.
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Affiliation(s)
- Emily M Abramsohn
- Department of Obstetrics and Gynecology, The University of Chicago, 5841 S Maryland Ave., MC2050, Chicago, IL, 60637, USA.
| | - Jessica Jerome
- Department of Health Sciences, DePaul University, Chicago, USA
| | - Kelsey Paradise
- Department of Obstetrics and Gynecology, The University of Chicago, 5841 S Maryland Ave., MC2050, Chicago, IL, 60637, USA
| | - Tia Kostas
- Department of Medicine, Section of Geriatrics & Palliative Medicine, The University of Chicago, Chicago, USA
| | | | - Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, Chicago, USA
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Hinton L, Tran D, Nguyen TN, Ho J, Gitlin L. Interventions to support family caregivers of people living with dementia in high, middle and low-income countries in Asia: a scoping review. BMJ Glob Health 2019; 4:e001830. [PMID: 31798992 PMCID: PMC6861057 DOI: 10.1136/bmjgh-2019-001830] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Despite increasing numbers of persons living with Alzheimer's disease and Alzheimer's-related dementias (AD/ADRD) in Asia, particularly in low-income countries (LIC) and middle-income countries (MIC), surprisingly little is known about the current state of the evidence for family caregiver interventions. The objectives of this scoping review were to: (1) describe the evidence for efficacy of family dementia-caregiver psychosocial interventions in Asian countries, (2) compare evidence across LIC, MIC, and high-income countries (HIC), and (3) characterise cultural adaptions to interventions developed outside Asia. METHODS The inclusion criteria included: (1) conducted in Asia (2) included an intervention delivered to a family caregiver of a person living with AD/ADRD, (3) reported quantitative outcomes for the family caregiver and (4) published in a peer-reviewed journal with full text available in English. RESULTS Thirty intervention trials were identified meeting inclusion criteria and all reported statistically significant (p<0.05) improvement in one or more caregiver outcomes. Interventions usually included multiple components. The most frequently reported outcomes (ie, by ≥20% of studies) were caregiver depression, burden, quality of life and self-efficacy. Overall, 26 (87%) of the studies were conducted in HIC in Asia, primarily in Hong Kong SAR-China and Taiwan, and only 4 (13%) in LIC and MIC in Asia. Seven studies (23%) used interventions developed in USA and several described cultural adaptations. CONCLUSION This scoping review found substantial evidence, particularly from high-income Asian countries, that a wide range of interventions improve AD/ADRD family caregiver outcomes. However, critical knowledge gaps exist, particularly for LIC and MIC in Asia, where the number of persons with dementia is numerically largest and projected to increase dramatically in coming decades. The field could also benefit from more detailed descriptions of the process and types of cultural adaptations to interventions.
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Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - Duyen Tran
- University of California Davis, Davis, California, USA
| | | | - Janis Ho
- Touro University California, Vallejo, California, USA
| | - Laura Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Fields NL, Xu L, Richardson VE, Parekh R, Ivey D, Calhoun M. Utilizing the Senior Companion Program as a platform for a culturally informed caregiver intervention: Results from a mixed methods pilot study. Dementia (London) 2019; 20:161-187. [PMID: 31488021 DOI: 10.1177/1471301219871192] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
To address the need for accessible, affordable, and sustainable Alzheimer's disease and related dementia caregiver interventions with minority populations, we developed the Senior Companion Program Plus, a three-phase pilot study that used a mixed methods experimental design. The intent was to determine if participation in a lay provider, peer-led psychoeducational intervention designed for African American Alzheimer's disease and related dementia caregivers (N = 16) improved caregiver burden and/or stress, coping skills, and social support. Focus groups with Senior Companions informed the intervention design. Quantitative results indicated that caregivers experienced improvement in their overall level of social support and well-being in meeting basic needs. Qualitative findings suggested that caregivers experienced improvement in their knowledge about the disease, experienced increased coping with Alzheimer's disease and related dementia caregiving, and reported benefits of using a lay provider model. Overall, the data suggest that the Senior Companion Program Plus is a promising intervention for African American Alzheimer's disease and related dementia caregivers.
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Affiliation(s)
| | - Ling Xu
- The University of Texas at Arlington, TX, USA
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Abstract
Objective: This study used qualitative methods to understand how to further alleviate symptoms of depression and caregiver burden and address the needs of non-responders following a course of Resources for Enhancing Alzheimer's Caregiver Health in VA (REACH VA). Methods: Semi-structured interviews with caregivers and interventionists post-treatment were coded for themes related to ways to address the needs of non-responder caregivers. Results: The following suggestions recurred among non-responder caregivers and interventionists: (1) tailor skills and psychoeducation material to caregiver's needs; (2) provide greater overall support within the realm of caregiving; (3) explore and process caregiver's emotions around caregiving experience and grief; (4) address interpersonal difficulties and barriers to asking for help; (5) spend more time practicing skills to aid in implementing them at home. Conclusions: For many non-responders, a longer-term treatment targeting caregivers' emotional processing, interpersonal skills, social connection, acquisition and implementation of skills is indicated.
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Affiliation(s)
- Nicole Nehrig
- a VA Harbor Healthcare System-Manhattan Campus , New York , NY , USA.,b Department of Psychiatry , New York University , New York , NY , USA
| | - Cory K Chen
- a VA Harbor Healthcare System-Manhattan Campus , New York , NY , USA.,b Department of Psychiatry , New York University , New York , NY , USA
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Abstract
IMPORTANCE In the United States, 16 million family caregivers provide long-term care for patients with dementia. Although one's physical, mental, and cognitive health depends on sleep, many caregivers experience chronic stress, and stress is typically associated with worse sleep quantity and quality. OBJECTIVE To quantify the extent, nature, and treatability of sleep problems in dementia caregivers. DATA SOURCES PubMed and Scopus databases were systematically searched for articles published through June 2018 using the following keywords: caregiver or spouse or caretaker AND sleep or circadian AND dementia or Alzheimer. Backward citation tracking was performed, and corresponding authors were contacted for additional data to conduct meta-analyses and pooled analyses. STUDY SELECTION Two reviewers independently screened 805 studies to identify those that reported sleep duration or sleep quality in caregivers of patients with dementia. DATA EXTRACTION AND SYNTHESIS Following the PRISMA guidelines, 2 reviewers independently extracted data from all studies and conducted National Heart, Lung, and Blood Institute study quality assessments. Meta-analyses with random-effects models were performed to evaluate sleep duration, sleep quality, and sleep interventions in dementia caregivers. MAIN OUTCOMES AND MEASURES Sleep quality and total sleep time were measured by polysomnography, actigraphy, and self-report. RESULTS Thirty-five studies were analyzed with data from 3268 caregivers (pooled mean age [SD of sample means], 63.48 [5.99] years; 76.7% female) were analyzed. Relative to age-matched control noncaregiver adults, caregivers had lower sleep durations akin to losing 2.42 to 3.50 hours each week (Hedges g = -0.29; 95% CI, -0.48 to -0.09; P = .01). Sleep quality was significantly lower in caregivers (Hedges g = -0.66; 95% CI, -0.89 to -0.42; P < .001), but caregivers who underwent sleep intervention trials had better sleep quality than caregivers who did not receive a sleep intervention (Hedges g = 0.35; 95% CI, 0.20-0.49; P < .001). CONCLUSIONS AND RELEVANCE Sleep debt is known to have cumulative associations with physical, mental, and cognitive health; therefore, poor sleep quality in dementia caregivers should be recognized and addressed. Although the caregiving role is stressful and cognitively demanding by its nature, better sleep quality was observed in caregivers who received low-cost behavioral interventions.
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Affiliation(s)
- Chenlu Gao
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas
| | | | - Michael K. Scullin
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas
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Nehrig N, Shifrin M, Abraham K, Chen CK. The Benefits and Limitations of a Behavioral Intervention for Caregivers of Dementia Patients: A Qualitative Study. Cognitive and Behavioral Practice 2019. [DOI: 10.1016/j.cbpra.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Corry M, Neenan K, Brabyn S, Sheaf G, Smith V. Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses. Cochrane Database Syst Rev 2019; 5:CD012533. [PMID: 31087641 PMCID: PMC6516056 DOI: 10.1002/14651858.cd012533.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Many caregivers, however, find themselves in a caring role for which they are ill prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical location. OBJECTIVES The objective of this review was to evaluate the effectiveness of telephone support interventions, delivered by healthcare professionals, when compared to usual care or non-telephone-based support interventions for providing education and psychosocial support for informal caregivers of people with acute and chronic diagnosed illnesses, and to evaluate the cost-effectiveness of telephone interventions in this population. SEARCH METHODS We searched the following databases from inception to 16 November 2018: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ProQuest Dissertations and Theses A&I; and CINAHL Complete. We also searched 11 caregiver-specific websites, three conference links, and two clinical trial registries. SELECTION CRITERIA We included randomised controlled trials (RCTs) (including cluster-RCTs) and quasi-RCTs. We excluded cross-over trials because of the high risk of carry-over effects from one intervention to another. DATA COLLECTION AND ANALYSIS Two authors independently screened citations against the review's inclusion criteria, extracted data, and assessed the included studies using the Cochrane 'Risk of bias' tool. The review's prespecified primary (quality of life and burden) and secondary outcomes (skill acquisition, psychological health, knowledge, health status and well-being, family functioning, satisfaction, and economic outcomes), where reported, were assessed at the end of intervention delivery and at short-term (≤ 3 months), medium-term (> 3 to ≤ 6 months) and longer-term time points (> 6 to 12 months) following the intervention. Where possible, meta-analyses were conducted, otherwise results were reported narratively. MAIN RESULTS We included 21 randomised studies involving 1,690 caregivers; 19 studies compared telephone support interventions and usual care, of which 18 contributed data to the analyses. Two studies compared telephone and non-telephone professional support interventions. Caregiver ages ranged from 19 years to 87 years across studies. The majority of participants were female (> 70.53%), with two trials including females only. Most caregivers were family members, educated beyond secondary or high school level or had the equivalent in years of education. All caregivers were based in the community. Overall risk of bias was high for most studies.The results demonstrated that there is probably little or no difference between telephone support interventions and usual care for the primary outcome of quality of life at the end of intervention (SMD -0.02, 95% CI -0.24 to 0.19, 4 studies, 364 caregivers) (moderate-certainty evidence) or burden at the end of intervention (SMD -0.11, 95% CI -0.30 to 0.07, 9 studies, 788 caregivers) (low-certainty evidence). For one study where quality of life at the end of intervention was reported narratively, the findings indicated that a telephone support intervention may result in slightly higher quality of life, compared with usual care. Two further studies on caregiver burden were reported narratively; one reported that telephone support interventions may decrease burden, the other reported no change in the intervention group, compared with usual care.We are uncertain about the effects of telephone support interventions on caregiver depression at the end of intervention (SMD -0.37, 95% CI -0.70 to -0.05, 9 studies, 792 caregivers) due to very low-certainty evidence for this outcome. Depression was reported narratively for three studies. One reported that the intervention may reduce caregiver depression at the end of intervention, but this effect was not sustained at short-term follow-up. The other two studies reported there may be little or no difference between telephone support and usual care for depression at the end of intervention. Six studies measured satisfaction with the intervention but did not report comparative data. All six reported high satisfaction scores with the intervention. No adverse events, including suicide or suicide ideation, were measured or reported by any of the included studies.Our analysis indicated that caregiver anxiety may be slightly reduced (MD -6.0, 95% CI -11.68 to -0.32, 1 study, 61 caregivers) and preparedness to care slightly improved (SMD 0.37, 95% CI 0.09 to 0.64, 2 studies, 208 caregivers) at the end of intervention, following telephone-only support interventions compared to usual care. Findings indicated there may be little or no difference between telephone support interventions and usual care for all of the following outcomes at the end of intervention: problem-solving, social activity, caregiver competence, coping, stress, knowledge, physical health, self-efficacy, family functioning, and satisfaction with supports (practical or social). There may also be little or no effect of telephone support interventions for quality of life and burden at short-term follow-up or for burden and depression at medium-term follow-up.Litttle or no difference was found between groups for any of the reported outcomes in studies comparing telephone and non-telephone professional support interventions. We are uncertain as to the effects of telephone support interventions compared to non-telephone support interventions for caregiver burden and depression at the end of intervention. No study reported on quality of life or satisfaction with the intervention and no adverse events were reported or noted in the two studies reporting on this comparison. AUTHORS' CONCLUSIONS Although our review indicated slight benefit may exist for telephone support interventions on some outcomes (e.g. anxiety and preparedness to care at the end of intervention), for most outcomes, including the primary outcomes, telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care. The findings of the review were mainly based on studies with overall high risk of bias, and few participants. Further high-quality trials, with larger sample sizes are required.
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Affiliation(s)
- Margarita Corry
- Trinity College DublinSchool of Nursing and MidwiferyDublinIreland
| | - Kathleen Neenan
- Trinity College DublinSchool of Nursing and MidwiferyDublinIreland
| | - Sally Brabyn
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO10 5DD
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
| | - Valerie Smith
- Trinity College DublinSchool of Nursing and MidwiferyDublinIreland
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Yoo R, Yeom J, Kim GH, Park HK, Kang Y, Hwang J, Choi SH, Na HR, Cho SJ, Yu KH, Kim DH, Lee JH, Jeong JH. A Multicenter, Randomized Clinical Trial to Assess the Efficacy of a Therapeutic Intervention Program for Caregivers of People with Dementia. J Clin Neurol 2019; 15:235-242. [PMID: 30938110 PMCID: PMC6444149 DOI: 10.3988/jcn.2019.15.2.235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/20/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Caregivers experience tremendous social, financial, physical, and psychological burdens in caring for people with dementia. This study aimed to determine the efficacy of a multicomponent therapeutic intervention program for the caregivers of people with dementia (CGPWD) through a multicenter clinical trial: the intervention program-caregivers of people with dementia study. METHODS The 38 caregivers of dementia patients at 8 sites were randomized into 2 groups: treatment (n=19) and control (n=19). The treatment group received the intervention program for 8-10 weeks, including one group session for dementia education and three individual sessions (on cognitive behavioral therapy, coping with stress, and stress management) and single targeted training for daily activities. The Korean version of the Zarit Burden Interview (ZBI-K) and the Geriatric Depression Scale (GDS) were evaluated at pre- and postintervention as primary efficacy measures. RESULTS The treatment group displayed significant improvements in scores on the ZBI-K and GDS. The ZBI-K score at postintervention was significantly reduced in the treatment group compared to that in the control group [6.2-point decrease vs. 3.7-point increase, t(37)=-2.9, p<0.01]. There was a significant difference in the GDS score between the treatment and control groups [2.2-point decrease vs. 1.3-point increase, t(18)=2.5, p<0.05]. CONCLUSIONS The findings of this study imply that a multicomponent therapeutic intervention program is effective in reducing the burden experienced by and depression among CGPWD. Further research is warranted to investigate the long-term effects of the intervention program for CGPWD.
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Affiliation(s)
- Rayoung Yoo
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jiyoung Yeom
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Geon Ha Kim
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Kyung Park
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yeonwook Kang
- Department of Psychology, Hallym University, Chuncheon, Korea.,Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jihye Hwang
- Department of Neurology, Keimyung University College of Medicine, Dongsan Medical Center, Daegu, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Hae Ri Na
- Department of Neurology, Bobath Memorial Hospital, Seongnam, Korea
| | - Soo Jin Cho
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Kyung Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Do Hoon Kim
- Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jae Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
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Abstract
The purpose of this study was to examine the associations between three indicators of social support and self-rated health among caregivers of people with dementia, and whether caregiving burden mediated such associations. Data from the Resources for Enhancing Alzheimer's Caregiver Health II (REACH II; N = 637) was used and multivariate analyses were conducted to test the mediation effects of caregiving burden by PROCESS for v3.2.03. The results revealed that three indicators of social support (received support, social network, and negative interactions) were all significantly associated with self-rated health. Findings also showed that caregiving burden acted as a mediator mechanism through which the associations between social network and self-rated health, negative interactions and self-rated health occurred. Results suggest that there is a need for more comprehensive caregiving assessments as well as multicomponent interventions that include improving and expanding social networks for caregivers of people with dementia. Findings also highlight the importance of minimizing interpersonal conflicts with others and providing more multicomponent programs aimed at reducing caregiving burden.
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Affiliation(s)
- Mihua Xian
- College of Humanity & Law, Huazhong Agricultural University, Wuhan, China
| | - Ling Xu
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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von Känel R, Mausbach BT, Dimsdale JE, Ziegler MG, Mills PJ, Allison MA, Patterson TL, Ancoli-Israel S, Grant I. Refining caregiver vulnerability for clinical practice: determinants of self-rated health in spousal dementia caregivers. BMC Geriatr 2019; 19:18. [PMID: 30669980 PMCID: PMC6343283 DOI: 10.1186/s12877-019-1033-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caregivers of a family member with a chronic disability or illness such as dementia are at increased risk for chronic disease. There are many factors that contribute to dementia caregiver vulnerability and these factors can be challenging to assess in clinical settings. Self-rated health (SRH) is an independent measure of survival and physical health in the elderly. As an inclusive measure of health, SRH has been proposed as a reliable way to assess a patient's general health in primary care. Therefore, we sought to identify determinants of poor/fair SRH versus categories of at least good SRH in informal caregivers. METHODS In a cross-sectional study, we examined 134 elderly (≥55 years) providing in-home care for a spouse with dementia who rated their own health with a single-item question: "In general, would you say your health is excellent, very good, good, fair or poor?". In a multivariable model, we compared caregivers with poor/fair SRH to those with good, very good, or excellent SRH on demographics, health characteristics (health behaviors, physical health indicators, psychosocial factors) and caregiving-specific stress (a composite index/total of four caregiving-specific stressors: years of caregiving, dementia severity, care recipient functional impairment and perceived caregiver burden). RESULTS Compared with caregivers who rated their own health as either good (31.3%), very good (38.8%) or excellent (14.2%), caregivers with poor/fair SRH (15.7%) were more likely to have lower physical function and total greater caregiving-specific stress. More years of caregiving, severe dementia and care recipient functional impairment, but not perceived caregiver burden, were also more likely among caregivers with poor/fair SRH. Additionally, high negative affect and low positive affect were more likely in caregivers with poor/fair vs. good or excellent and very good or excellent SRH, respectively. CONCLUSIONS Caregivers with poor/fair SRH were characterized by higher levels of medical comorbidity, low physical function, high negative, but low positive affect and longer duration of caregiving, as well as more severe dementia and greater functional impairment of the care recipient. These findings suggest that caregivers need to be more closely evaluated and targeted for preventive interventions in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT02317523 .
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, CH-8091 Zurich, Switzerland
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
| | - Brent T. Mausbach
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
| | - Joel E. Dimsdale
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
| | - Michael G. Ziegler
- Department of Medicine, University of California San Diego, La Jolla, California USA
| | - Paul J. Mills
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California USA
| | - Matthew A. Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California USA
| | - Thomas L. Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
- Department of Medicine, University of California San Diego, La Jolla, California USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
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