Psychosocial Correlates of the Experience of Caregiving Among Caregivers of Patients With Schizophrenia

BACKGROUND

Family caregivers provide essential support to their loved ones with schizophrenia with profound outcomes for themselves. The caregiver burden fails to consider the entire caregiving experience, which also incorporates positive aspects of caring. Many potentially significant variables are associated with this.

AIM

To examine the correlates of the experience of caregiving in caregivers of patients with schizophrenia. The specific objectives were to examine the socio-demographic variables of the patients and caregivers, clinical variables of the patient, caregivers' knowledge of illness, caregivers' perspectives of family functioning, caregiver coping, their social support, psychological distress, quality of life, and their spirituality, religiosity and personal beliefs and the associations of these variables with the caregivers' experience of caregiving.

METHODS

This cross-sectional observational study was conducted between August 2018 and January 2021 at All India Institute of Medical Sciences, New Delhi, India. One hundred and fifty-eight dyads of patients with schizophrenia and their family caregivers were recruited using purposive sampling. Experience of Caregiving Inventory was used to evaluate the caregiving experience. The caregivers were also assessed on socio-demographics, knowledge of illness, family functioning, coping, social support, general mental health, quality of life, and spiritual, religious, and personal beliefs. Patient socio-demographics and clinical variables were also assessed.

RESULTS

A negative experience of caregiving was reported by caregivers of patients who had higher positive or negative symptoms of schizophrenia. Impaired Communication, Roles, Affective Responsiveness, Affective Involvement, and General Functioning aspects of family functioning were associated with a negative experience of caregiving. Denial/blame and seeking social support as coping were also associated with a negative experience of caregiving. A negative experience of caregiving was significantly positively correlated with greater psychological distress and poorer quality of life. Greater inner peace was associated with a less negative experience of caregiving. Spiritual strength was associated with a more positive experience of caregiving. Knowledge of mental illness and caregiver social support were not significantly associated with the experience of caregiving.

CONCLUSION

Experience of caregiving is a relevant construct, the understanding of which can help inform caregiver-directed interventions in the future. Specifically, family-based interventions, which include ameliorating patient symptomatology, improving the family environment, strengthening caregivers' coping strategies, attending to caregiver distress, and encouraging spirituality among caregivers, may lead to a less negative and more positive experience of caregiving; and a better quality of life for caregivers.

Mitigating Caregiver Distress in South Western Ontario: Perspectives on Role, Community, and Care

The former South West Local Health Integration Network (SW LHIN) of Ontario, which is in a predominantly rural region, regularly reports the lowest rates of caregiver distress in the province. Caregivers from rural communities regularly face challenges related to the access, applicability, and availability of supports and services, This qualitative case study describes perspectives of caregiving from the region, and explores how role construction and expectations of caregivers might both mitigate distress and influence service support use. Thematic analysis identified five themes: anticipated care, gendered caring, service support assumptions, confidence in community, and the "line in the sand": care decisions for evolving needs. Using the lens of caregiver identity theory, the findings suggest that these caregivers conceptualize identity as an extension of their primary role, to include caregiving obligations and responsibilities. We also noted a steadfast confidence in community and perceived service support assumptions across the region, with no notable rural-urban divide.

A mixed-methods study to inform development of a caregiver-specific problem list for cancer distress screening

OBJECTIVE

Oncology guidelines for distress management recommend use of the single-item distress thermometer (DT) and accompanying Problem List (PL) to identify patients with high distress levels and their potential sources of distress. However, oncology practices have yet to establish standardized protocols to screen and triage caregivers with high distress levels. With an eye toward integrating caregiver-centered support services into cancer care, this mixed-methods study sought to assess caregiver distress and challenges that may contribute to their distress.

METHODS

Nineteen caregivers of metastatic breast cancer patients (60% female, 47% ethnic/racial minority) completed an interview and a survey comprised of the DT, the original 39-item PL, and five additional caregiver-specific PL items.

RESULTS

Caregivers reported moderate distress levels and more than half exceeded the National Comprehensive Cancer Network (NCCN) cut-off, denoting significant distress. There was no association between caregiver distress and the number of items endorsed on the original PL. Qualitative analysis identified nine problem domains as areas of caregiver unmet need needs (i.e., practical challenges, caregiving responsibilities, social/relationship issues, caregiver and patient emotional well-being, caregiver and patient physical well-being, spiritual well-being, and communication). Two of the problem domains (caregiving responsibilities and communication) were not captured in any way by the original PL.

CONCLUSION

With further research and development, the identified domains could serve as the basis for a caregiver-specific PL to facilitate triage and referral when incorporated as part of routine distress screening.

Developing a psychoeducational programme for caregivers of people with intellectual disability

Background

In the Western Cape, South Africa, a significant number of individuals with intellectual disabilities are cared for by caregivers who receive little or no compensation, education or support. Despite the unique challenges faced by these caregivers, no psychoeducational programmes have been implemented for this particular population.

Objectives

The study aimed to examine the factors contributing to caregiver distress and develop a solution in the form of a psychoeducational programme for caregivers.

Methods

A mixed-methods research approach was employed. The qualitative phase involved exploratory research to gather fundamental information and gain new insights into caregiver distress. The quantitative phase utilised a 'one-group pre-test, post-test design' with a Likert-scale questionnaire to enable meaningful interpretations and comparisons of the psychoeducational programme's impact and value. The paired t-test was employed to determine significant differences between pre-test and post-test results.

Results

The statistical findings demonstrated a significant increase in knowledge, with 99% of respondents indicating a positive impact in reducing caregiver distress and 85% feeling better equipped to care for individuals with intellectual disabilities.

Conclusion

The psychoeducational programme developed in this study had a positive effect on reducing caregiver distress.

Contribution

This knowledge provides valuable insights for healthcare professionals in designing relevant intervention programmes, offering support and providing resources not only for individuals with intellectual disabilities but also for their caregivers.

The role of maladaptive personality in behavioural and psychological symptoms in dementia

BACKGROUND

Although research demonstrated a significant link between premorbid normative personality traits and the severity of behavioural and psychological symptoms in dementia (BPSD) and associated emotional distress of the caregiver, little is known about the relationship of BPSD symptoms and associated distress with maladaptive traits.

METHOD

Informants (N = 182) of Dutch nursing home residents with dementia aged 65+, completed the Neuropsychiatric Inventory Questionnaire to assess the severity of BPSD and associated emotional distress. Premorbid maladaptive personality traits were evaluated using informant versions of a brief version of the Personality Inventory for Diagnostic and Statistical manual of Mental Disorders-5 (PID-5-BF), and two age-specific personality measures, the Informant Personality Questionnaire (HAP), and Gerontological Personality disorder Scale. Relationships between premorbid personality and BPSD were investigated with correlational and ordinal regression analyses.

RESULTS

BPSD severity and distress were associated with medium sized correlations to Negative Affectivity, Antagonism and indications of personality disorder presence. The emotional distress also correlated with a medium effect with Detachment. Higher scores on maladaptive personality traits increased the odds of higher BPSD severity and distress.

CONCLUSION

Results found with age-specific personality measures were in line with results found with other measures of (mal)adaptive traits. Several maladaptive personality traits had a significant relationship with the BPSD severity and associated emotional distress. We therefore encourage to implement personality assessment within BPSD treatment strategies. This way care becomes more person-focused and more tailored to the specific needs of patients and caregivers.

Effect of the COVID-19 Pandemic on the Self-Perceived Change of Caregivers' Burden in Providing Care for People With Dementia

Objectives: To explore how the COVID-19 pandemic affects caregiver (CG) burden, the quality of care provided to people with dementia (PwD) and their perceived changes between before and during the pandemic. Methods: A cross-sectional study surveyed primary CGs about burden and self-perceived change in multidimensional domains and compared these before and during the pandemic. Results: About 135 primary CGs of PwD were enrolled at Siriraj Hospital's Geriatric Clinic in Thailand and assessed using various online platforms. About 13.8% of CGs had a "mild to moderate" burden. The NPI-Q score and level of functional capacity of the PwD declined during the COVID-19 pandemic (p-value .001 and .001, respectively). The CG-associated factors that related to a higher CG burden were younger age (mean age of 54.2 years old), female (76.3%), and high educational level (80.7%). Conflict between CG and PwD was associated with an increase in CG burden (p-value .004; 95% CI [1.19, 6.12]). Regarding the COVID-19-related factors, there was no association between CG burden and the PwD's characteristics or COVID-19-related concerns. Conclusions: The COVID-19 pandemic was associated with a higher CG burden. Identifying the related factors in an unusual situation may help reduce the CG burden and improve the care of PwD.

A Race to the End: Family Caregivers' Experience of Medical Assistance in Dying (MAiD)-a Qualitative Study

BACKGROUND

The June 2016 legalization of medical assistance in dying (MAiD) provided an added layer of choice to end-of-life care in Canada. Family caregivers play an important role in patient end-of-life decision-making. They may experience unique psychological burden or distress associated with their role. However, we know little about the caregiver experience associated with patient MAiD requests and the nature of psychosocial supports caregivers require before, during, and following MAiD intervention.

OBJECTIVE

The objective of this study is to better understand the caregiver experience of MAiD within the Canadian legal landscape following Bill C-14.

DESIGN

Caregiver experience was examined based on qualitative, semi-structured interviews.

PARTICIPANTS

A total of 22 caregivers of patients who had requested MAiD were interviewed.

APPROACH

Transcripts were recorded, transcribed, and analyzed based on grounded theory methodology.

KEY RESULTS

The caregiver experience of MAiD within the legal framework was found to be understood as a "race to the end," with the ultimate goal of creating an ideal dying experience for the patient while balancing a threat to capacity that would undermine their access to MAiD. Caregivers can be described within the overarching framework as either co-runners or onlookers. Sources of caregiver distress were linked to these roles.

CONCLUSIONS

The "race to the end" theoretical model contributes new knowledge and understanding that can inform the development of tailored support services for caregivers, the impact of legislative changes on this population, and future research examining decision-making near end of life and the caregiver experience.

Caregiver distress: A mixed methods evaluation of the mental health burden of caring for children with bladder exstrophy

INTRODUCTION

Caring for children with bladder exstrophy-epispadias complex (BEEC) exacts a long-term emotional toll on caregivers. Previous studies leave a gap in understanding the impact that caring for a child with BEEC has on caregivers in low- and middle-income countries (LMIC). We hypothesize that families and caregivers experience psychological distress that has long gone unaddressed.

MATERIALS AND METHODS

From 2018 to 2020, researchers conducted a multi-method evaluation of caregiver distress with participants recruited as part of the annual International Bladder Exstrophy Collaboration based in Ahmedabad, Gujarat, India. In 2018, pilot data was collected through cognitive interviews. In 2019, researchers conducted structured interviews predicated on themes from the previous year, which subsequently prompted formal mental health screenings in 2020. Caregivers who reported suicidal thoughts were immediately referred for intervention.

RESULTS

In 2018, caregivers described the primary source of stigma arose from their village (n = 9, 26.5%). Caregivers also identified long-term concerns (n = 18, 52.9%), including future fertility and marital prospects, as sources of anxiety. In 2019, caregivers substantiated preliminary findings with the primary source of anticipated (n = 9, 31%) and experienced (n = 19, 65.5%) stigma again stemming from their communities. Both cohorts identified the collaboration as a positive source of support (n = 23, 36.5%). In 2020, caregivers stated decreased emotional wellbeing as number of subsequent repairs increased (n = 54, 75%, p = 0.002). Caregivers of children who underwent initial surgery within 5 years of screening reported higher anxiety (n = 46, 63.8%) and this was exacerbated as the number of subsequent repairs increased (p = 0.043).

CONCLUSION

Complex, long-term course of care, including additional surgeries, significantly impacts caregiver distress in the LMIC setting. Screening for caregivers of children with complex congenital anomalies, like BEEC, should be an essential element of any comprehensive effort to alleviate the global burden of disease.

Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes

OBJECTIVES

To investigate differences in behavioral and psychological symptoms of dementia (BPSD) and caregiver distress caused between older adults with dementia living in the community and in nursing homes.

DESIGN

A comparative cross-sectional study.

SETTING AND PARTICIPANTS

Participants were recruited from outpatient clinics of a tertiary psychiatric hospital and dementia units of a nursing home in Guangzhou, China.

METHODS

Neuropsychiatric Inventory was used to assess symptoms and caregiver distress. Dementia severity was determined using the Clinical Dementia Rating.

RESULTS

This study included 157 community and 112 nursing home residents with dementia. Clinically significant symptoms (item score ≥ 4) were found in 88.5% of the former and 75% of the latter. Caregivers of 79.6% of the former and 26.8% of the latter reported that at least one of these caused them moderate-to-severe distress (distress score ≥ 3). Among the community patients, anxiety was the most frequent "very severe" symptom, while sleep disorders and agitation caused the most frequent "very severe" caregiver distress. After controlling for dementia severity and medication use, family caregiving remained an independent risk predictor for clinically significant symptoms and moderate-to-severe caregiver distress. The prediction of caregiver distress based on symptom scores varied across caregiver types and individual symptoms (R² 0.36-0.82). Group differences in clinically significant symptoms and moderate-to-severe caregiver distress showed at the stage of moderate-to-severe dementia.

CONCLUSIONS AND IMPLICATIONS

Tailored management strategies to relieve family caregivers' BPSD-induced distress are needed, especially at the stage of moderate-to-severe dementia. An effective service system should be established for supporting family caregivers to cope with BPSD.

A feasibility study of virtual group therapy to improve quality of life of cancer caregivers

BACKGROUND

Cancer caregiving can negatively impact the quality of life (QOL) of the caregiver. In-person interventions for improving coping skills have been shown to be effective in improving QOL for caregivers.

OBJECTIVES

This pilot project explored the feasibility and acceptability of a virtual group therapy intervention to improve short-term cancer caregiver QOL.

METHODS

Caregivers of cancer patients were enrolled in a structured multidisciplinary intervention of eight virtual group therapy sessions provided over four weeks between September 9, 2013 and November 17, 2014. Group sessions were led by trained facilitators and included components of physical therapy, occupational therapy, psychosocial education, cognitive-behavioral intervention, supportive discussion, spiritual reflection, and mindfulness therapy. Feasibility was based on acceptable number of recruited participants per session; acceptability was defined using attendance and 80% QOL completion rates. QOL domains and symptom burden were assessed using validated single items.

RESULTS

The 20 cancer caregivers who enrolled were mostly older (80% were ≥ 65 years), female (76.5%), married to the patient (88.2%), Caucasian (100%), and highly educated (100%). 60% attended one to five sessions, 15% attended six to eight sessions, and 25% attended no sessions. Thirty percent completed pre- and post- intervention ratings of QOL items.

SIGNIFICANCE OF RESULTS

Findings suggested that a virtual group therapy intervention is feasible for the cancer caregivers in this study. Although not statistically significant, the caregivers reported higher QOL and less symptom burden in multiple domains after participating in the virtual group therapy intervention.

Family caregivers' distress responses to daily behavioral and psychological symptoms of dementia: The moderating role of relationship quality

OBJECTIVES

Behavioral and psychological symptoms of dementia (BPSD) are associated with distress among caregivers of persons with dementia (PWD), but less is known about how relationship quality may buffer this association. This study examines the association between daily BPSD and daily perceived distress among family caregivers and the moderating role of relationship quality.

METHODS

Data were from 173 family caregivers of PWD from the Daily Stress and Health study. Relationship quality was assessed at the baseline interview; then on each of the 8 following consecutive days, caregivers reported frequency of daily BPSD (six domains) and their respective distress (calculated as daily distress sum and daily distress mean scores) through daily evening phone interviews at home. A 2-level multilevel model approach was employed to differentiate within-person (WP) and between-person (BP) effects.

RESULTS

Greater daily BPSD occurrence was associated with higher daily distress (sum and mean scores) at WP and BP levels. However, relationship quality moderated the association between daily BPSD occurrence and daily distress sum scores at both WP and BP levels. Caregivers who reported better relationship quality with the PWD had lower levels of daily distress sum scores in response to daily BPSD occurrence, compared to their counterparts with poorer relationship quality.

CONCLUSIONS

This study revealed that relationship quality attenuated the effect of daily BPSD occurrence on caregivers' distress. Future dementia caregiver education and support programs should consider building relationship quality into the personalized program design to improve caregiver mental health and well-being.

Associations Between Hospice Care and Scary Family Caregiver Experiences

CONTEXT

Hospice deaths in the U.S. are increasing. Dying hospice patients may have rapidly emerging needs the hospice team cannot immediately meet, exposing family caregivers to fright-inducing (i.e., scary) situations.

OBJECTIVES

To examine relationships between hospice care and family caregiver exposures and psychological responses to witnessing common and distressing patient symptoms near the end of life.

METHODS

Secondary analysis of prospective cohort study of 169 patients with advanced cancer and their family caregivers was analyzed. Multivariable regression analyses modeled associations between hospice use and caregiver exposures and psychological responses (fear and helplessness) to witnessing distressing symptoms common near death, adjusting for potential confounding influences (e.g., home death, patient characteristics, and suffering). Caregiver self-reported exposures and responses to observing patient symptoms during the last month of life were assessed using the validated Stressful Caregiving Response to Experiences of Dying (SCARED) scale.

RESULTS

Hospice care was significantly positively associated with more exposures and negative psychological responses to distressing patient symptoms, adjusting for home death, patient characteristics, and physical and mental suffering. On average, hospice patients' caregivers scored 1.6 points higher on the SCARED exposure scale and 6.2 points higher on the SCARED psychological response scale than caregivers of patients without hospice (exposure: 10.53 vs. 8.96; psychological responses: 29.85 vs. 23.67). Patient pain/discomfort, delirium, and difficulty swallowing/choking were reported by three-fourths of caregivers and associated with the most fear and helplessness among caregivers.

CONCLUSION

Hospice care is associated with more exposures to and caregiver fear and helplessness in response to scary patient experiences. Research is needed to understand how better to support family caregivers of hospice patients to enable them to cope with common distressing symptoms of dying cancer patients. Hospice clinicians providing additional education and training about these symptoms might enable caregivers to better care for dying loved ones and reduce the stresses of end-of-life caregiving.

Caregiver Speaks Study Protocol: A Technologically-Mediated Storytelling Intervention for Hospice Family Caregivers of Persons Living With Dementia

OBJECTIVE

We present the protocol of a study aiming to examine the efficacy of a technologically-mediated storytelling intervention called Caregiver Speaks in reducing distress and grief intensity experienced by active and bereaved hospice family caregivers of persons living with dementia (PLWD).

DESIGN

The study is a mixed-method, 2-group, randomized controlled trial.

SETTING

This study takes place in 5 hospice agencies in the Midwest and Northeastern United States.

PARTICIPANTS

Participants include hospice family caregivers of PLWD.

INTERVENTION

Participants are randomized to usual hospice care or the intervention group. In the Caregiver Speaks intervention, caregivers engage in photo-elicitation storytelling (sharing photos that capture their thoughts, feelings, and reactions to caregiving and bereavement) via a privately facilitated Facebook group. This intervention will longitudinally follow caregivers from active caregiving into bereavement. The usual care group continues to receive hospice care but does not participate in the online group.

OUTCOMES MEASURED

We anticipate enrolling 468 participants. Our primary outcomes of interest are participant depression and anxiety, which are measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder screening (GAD-7). Our secondary outcomes of interest are participants' perceived social support, measured by the Perceived Social Support for Caregiving (PSSC) scale, and grief intensity, which is measured by the Texas Revised Inventory of Grief Present Subscale (TRIG-Present).

Caregiver distress and quality of life in primary caregivers of oncology patients in active treatment and follow-up

OBJECTIVE

As the number of informal caregivers and their caregiving responsibilities increase, this study aims at evaluating caregiver distress, quality of life (QoL) and their predictors in informal caregivers of cancer patients during active treatment and follow-up.

METHODS

This cross-sectional descriptive study targeted primary caregivers of patients with different cancer diagnoses. Caregiver-reported outcomes were measured by the Caregiver Risk Screen (CRS), Distress Thermometer (DT) and Caregiver Quality of Life Index-Cancer (CQOLC).

RESULTS

Caregivers (n = 1580) experienced a low-to-moderate risk of caregiver distress and a moderate QoL during both treatment and follow-up. About 13% reported a high caregiver risk and 20% reported severe distress. There was a strong and significant correlation between caregiver distress and caregivers' QoL (0.793). Predictive factors for higher distress and poorer QoL were: fewer emotional and practical resources, being female, non-spousal relationship or not living together (p < 0.05). Caregivers of patients with head-and-neck, skin, lung and brain cancers reported the highest distress and lowest QoL.

CONCLUSION

Caregiver distress is highly variable, but a minority of caregivers is at high risk for caregiver distress. Professional caregivers play an important role at supporting caregivers and detecting high-risk caregivers.

Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on Neuropsychiatric Outcomes in Australia

Background/Objective: People living with dementia (PLWD) in residential aged care homes (RACHs) are frequently prescribed psychotropic medications due to the high prevalence of neuropsychiatric symptoms, also known as behaviours and psychological symptoms of dementia (BPSD). However, the gold standard to support BPSD is using psychosocial/non-pharmacological therapies. This study aims to describe and evaluate services and neuropsychiatric outcomes associated with the provision of psychosocial person-centred care interventions delivered by national multidisciplinary dementia-specific behaviour support programs. Methods: A 2-year retrospective pre-post study with a single-arm analysis was conducted on BPSD referrals received from Australian RACHs to the two Dementia Support Australia (DSA) programs, the Dementia Behaviour Management Advisory Service (DBMAS) and the Severe Behaviour Response Teams (SBRT). Neuropsychiatric outcomes were measured using the Neuropsychiatric Inventory (NPI) total scores and total distress scores. The questionnaire version "NPI-Q" was administered for DBMAS referrals whereas the nursing home version "NPI-NH" was administered for SBRT referrals. Linear mixed effects models were used for analysis, with time, baseline score, age, sex, and case length as predictors. Clinical significance was measured using Cohen's effect size (d; ≥0.3), the mean change score (MCS; 3 points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change (MPC; ≥30%) in NPI parameters. Results: A total of 5,914 referrals (55.9% female, age 82.3 ± 8.6 y) from 1,996 RACHs were eligible for analysis. The most common types of dementia were Alzheimer's disease (37.4%) and vascular dementia (11.7%). The average case length in DSA programs was 57.2 ± 26.3 days. The NPI scores were significantly reduced as a result of DSA programs, independent of covariates. There were significant reductions in total NPI scores as a result of the DBMAS (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All metrics (d, MCS, MPC) were above the threshold set for determining a clinically significant effect. Conclusions: Multimodal psychosocial interventions delivered by DSA programs are clinically effective as demonstrated by positive referral outcomes, such as improved BPSD and related caregiver distress.

iCCareD: The Development of an Algorithm to Identify Factors Associated With Distress Among Caregivers of Children and Youth Referred for Mental Health Services

Caregiver well-being plays an important role in children's development and a number of factors have been found to impact distress levels among caregivers of children and youth referred for mental health services. Further, caregiver distress impacts youth psychopathology, its acuity as well as related mental health interventions. The purpose of this study was to develop and validate an algorithm for identifying caregivers who are at greatest risk of experiencing caregiver distress. This algorithm was derived from, and will be embedded in, existing comprehensive interRAI child and youth instruments. Ontario data based on the interRAI Child and Youth Mental Health assessment instruments (ChYMH and ChYMH-DD) were analyzed to identify predictors of distress among caregivers of children and youth ages 4-18 years. Starting with proactive aggression, the algorithm uses 40 assessment items to assign one of 30 nodes that are grouped into five levels of risk. The interRAI ChYMH Caregiver Distress (iCCareD) algorithm was validated using longitudinal data from mental health agencies across Ontario and was found to be a good predictor among this sample with a c-statistic of 0.71 for predicting new or ongoing caregiver distress and 65% for both sensitivity and specificity using algorithm values of 3 or greater. This algorithm provides an evidence-based decision-support tool embedded within a comprehensive assessment tool that may be used by clinicians to inform their selection of supports and services for families.

Mental Health Status of Psychogeriatric Patients During the 2019 New Coronavirus Disease (COVID-19) Pandemic and Effects on Caregiver Burden

Introduction: There is a growing awareness about the noxious effects of the 2019 Coronavirus Disease (COVID-19) pandemic on the mental health of the elderly. However, there is limited information from clinically driven research. The objectives of the present study were to examine the magnitude of psychiatric symptoms and to determine their association with caregiver distress, in a cross-section of community-dwelling older adults and a subsample of aging adults with Down syndrome (DS) attending a psychogeriatric service in São Paulo, Brazil. Method: Telephone-based interviews and electronically filled self-assessment questionnaires were used to collect information from patients and caregivers, addressing their impressions and concerns about the pandemic and related effects on the patient's emotional state and behavior. Clinical information was obtained from hospital charts, medical records, and psychometric tests administered through telephone interviews [Hospital Anxiety and Depression Scale (HADS) and Neuropsychiatric Inventory Questionnaire (NPI-Q)]. Results: We included 100 consecutive participants, comprising 71 older adults with psychogeriatric/neurocognitive disorders and 29 aging adults with DS. Higher HADS and NPI-Q scores were significantly associated with caregiver distress (p < 0.05) in both groups. Correlation analyses indicated strong, positive associations between caregiver burden and scores in HADS anxiety (HADS-A) and HADS depression (HADS-D) scales in the subsamples of euploid and DS subjects. Higher NPI-Q scores in the former group were also correlated with caregiver distress, with stronger associations for neuropsychiatric symptoms. Similar findings were observed among DS subjects. ANOVA tests indicated significant associations between NPI-Q scores and caregiver distress among dementia patients, as well as with HADS scores. Similar results were found after multiple linear regressions; as such, among the elderly subsample, higher scores in HADS-A (p = 0.002) and HADS-D (p = 0.001) predict a significant impact on caregiver burden (p < 0.00001, R 2 0.46); taking into consideration caregiver burden as a dependent variable and NPI-Q total score as an independent variable, we obtained significant strong prediction values for either DS (p < 0.00001, R 2 0.95) or elderly adults (p < 0.00001, R 2 0.88). Conclusion: During the COVID-19 pandemic, patients with neurocognitive disorders present with clinically relevant neuropsychiatric symptoms, with significant impact on caregiver distress. Apathy, aberrant motor behavior, sleep disorders, and psychoses were the main psychopathological domains, which had determined caregiver burden worsening.

Caregiver accommodation in adolescents with avoidant/restrictive food intake disorder and anorexia nervosa: Relationships with distress, eating disorder psychopathology, and symptom change

OBJECTIVE

The role of family and caregiver accommodation is a well-defined maintenance factor for anxiety disorders and OCD. Family accommodation for patients with eating disorders is beginning to be described and characterized, but gaps in the literature remain. The current project compares levels of accommodation in families of those with anorexia nervosa (AN) to those with avoidant/restrictive food intake disorder (ARFID). It additionally establishes whether accommodation changes over the course of treatment and the extent to which these changes are related to changes in eating disorder pathology.

METHODS

A total of 39 adolescents with ARFID and 59 with AN presenting to a partial hospitalization program were included, with measures completed at intake and discharge.

RESULTS

Caregivers of adolescents with AN and those with ARFID reported similar levels of accommodation, with the exception of the Reassurance Seeking subscale of the Accommodation and Enabling Scale for Eating Disorders (AESED). Additionally, accommodation decreased significantly from intake to discharge for both patient groups. Intake AESED scores were also significantly related to caregiver distress, and changes in AESED scores were related to decreases in relevant eating disorder psychopathology for both groups.

CONCLUSIONS

The results of the current study highlight the importance of considering family accommodation for ARFID patients and point to the need for future research to capture changes in accommodation over the course of treatment in relation to the delivery of evidence-based interventions and subsequent changes in ED symptoms.

Awareness of Psychiatric Symptoms in a Mixed Clinical Sample of Older Adults

OBJECTIVE

This study examined the neuropsychological correlates and impact on caregiver distress of reduced awareness of mood symptoms in patients with suspected neurodegenerative disease.

METHOD

Records from a clinical sample of older adults were examined (N = 940).

RESULTS

More than one-third of patient and caregiver ratings of mood symptoms did not agree (comparing patient and caregiver self-report measures); 27.9% of patients were unaware of depression (UoD) and 16.6% of patients were unaware of anxiety (UoA). The UoD group exhibited poorer verbal memory and executive abilities and the UoA group exhibited poorer verbal memory than those with preserved awareness. Unawareness was not associated with caregiver distress.

CONCLUSIONS

These findings highlight the importance of capturing informant report in clinical practice with older adults suspected of cognitive impairment. Unawareness of mood symptoms was related to memory dysfunction and-to a lesser extent-to executive abilities and may have implications for addressing patient and caregiver needs for disorders affecting these cognitive systems.

Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study

OBJECTIVES

The objectives of this study are to explore the feasibility of a multicomponent intervention programme and to evaluate its impacts on behavioural and psychological symptoms of dementia (BPSD) and psychological health of caregivers.

METHODS

Fifty-six community-dwelling people with dementia (PWD) and knee osteoarthritis (OA) and their caregivers were recruited and randomized into the intervention group (IG) or comparison group (CG). Each participant in both groups received an individual physiotherapy session (personalized home exercises and care education) and underwent 8 weeks of a 1-hour-structured group exercise session weekly at a day care centre. They were instructed to follow the prescribed home exercise. The IG received a multicomponent programme, combining knee OA-specific therapeutic exercise with self-management support, while the CG attended the routine group exercise programme. The attendance rate and reasons for non-attendance were recorded for evaluating the feasibility. The Chinese versions of the Revised Scale for Caregiving Self-Efficacy (RSCSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) were measured at the baseline and postintervention.

RESULTS

Fifty-four dyads completed the programme with high attendance rate (94.4%). Compared with the CG, caregivers in the IG significantly improved in three domains of RSCSE scores (P ≤ .005) and caregivers' distress (P = .004) after the intervention. However, no effects were observed in terms of BPSD severity in PWD. No adverse events or falls were reported.

CONCLUSION

This multicomponent programme is feasible and safe for dementia caregivers and older people with mild-to-moderate dementia and knee OA. The programme has beneficial effects on caregiving self-efficacy and distress of dementia caregivers.

Impact of a Community Health Worker Program to Support Caregivers of Children With Special Health Care Needs and Address Social Determinants of Health

Few studies have evaluated the effects of a community health worker (CHW) intervention on social determinants and caregiver distress. This study assesses the impact of a CHW program for caregivers of children with special health care needs (CSHCN) on these factors in addition to confidence in self-management. A retrospective, pre-post analysis was conducted for those who completed a CHW program. Caregivers reported high levels of distress, low educational attainment, linguistic isolation, positive depression screens, and food and housing issues at baseline. On completion of the program, there was significant improvement in caregiver distress scores (P < .001) and in understanding of their children's diagnoses (P < .001). Furthermore, the number of caregivers reporting food or housing issues was significantly reduced (P < .01 and P < .01, respectively). This study demonstrates the feasibility and potential effects of a CHW intervention for CSHCN and highlights the need for a large-scale controlled trial to further evaluate impact.

Mediating role of caregiver burden among family caregivers of patients with Parkinson's disease in Mexico

OBJECTIVE

This study examined the mediating role of caregiver distress on family factors and caregiver life satisfaction among an understudied population of Parkinson's disease caregiver in Mexico.

METHODS

A cross-sectional design was used to examine psychosocial factors pertinent to caregiver of individuals with Parkinson's disease ( n = 95). Guided by a caregiver stress process model, relations among family factors (e.g., cohesion, flexibility, quality of functioning), gender, distress, and satisfaction with life among caregiver were examined. Mediation analyses were performed to test the role of caregiver distress on the associations between family factors, gender, and caregiver satisfaction with life.

RESULTS

Mediation models demonstrated that caregiver distress fully mediated the relation between quality of family functioning and caregiver satisfaction with life and partially mediated the association between family flexibility and caregiver satisfaction with life. Caregiver gender did not emerge as a significant covariate, and null results were found in the model examining family cohesion as a predictor.

CONCLUSION

These results underscore the critical role of caregiver distress and family factors on features of caregiver well-being, notably satisfaction with life. This evidence also offers cross cultural evidence for the caregiver stress process model, which has primarily been observed in Western samples. Accordingly, the need to build and disseminate empirically supported family-based treatments that emphasize caregiver distress is warranted.

Effect of memantine combined with citalopram on cognition of BPSD and moderate Alzheimer's disease: A clinical trial

Among Alzheimer's disease (AD) patients, it is very common to develop behavioral and psychological symptoms of dementia (BPSD), which has a close relation to the excess morbidity and mortality, greater healthcare use, earlier institutionalization, and caregiver burden. With evaluation of AD patients, the present study mainly aims to investigate whether citalopram would be efficient for BPSD, and examines citalopram's effects on cognitive function, caregiver distress, safety and tolerability. Eighty patients diagnosed with moderate AD and clinically significant BPSD from April 2015 to January 2016 were enrolled in this study. Patients randomly received memantine plus either citalopram (n=40, study group) or placebo (n=40, control group) in a 12-week period. The target dose of memantine was 20 mg/day. The dose of citalopram was 10 mg/day in the beginning with planned titration to 30 mg/day over 2 weeks on the basis of response and tolerability. Blood routine, urine routine, biochemical tests, electrocardiogram and electroencephalogram were carried out for each patient every month routinely to check the change induced by using medication. Treatment Emergent Symptom Scale (TESS) was used to measure untoward effects every 2 weeks. All of the agitation/aggression, irritability/lability, night-time behavioral disturbances, caregiver distress and Neuropsychiatric Inventory (NPI) total scores after treatment were found to be dramatically lower than those before treatment in both groups. Apathy, dysphoria and anxiety received lower scores in participants who received memantine combined with citalopram, compared to those before treatment. QTc interval prolongation was observed in 2 patients who were treated with 30 mg/day citalopramin. In conclusion, memantine combined with citalopram can more effectively improve the cognitive function, and reduce behavioral and psychological symptoms in patients with moderate AD. Cardiac adverse effects of citalopram are not common when the dose is <30 mg/day, which does not limit its practical application. Thus, citalopram has shown potential efficacy in adjunctive therapy of AD patients with BPSD.

The influence of the individual neuropsychiatric symptoms of people with Alzheimer disease on family caregiver distress-A longitudinal ALSOVA study

OBJECTIVES

Family caregivers (FCs) face a variety of demands while caring for persons with Alzheimer disease (AD). Longitudinal studies identifying the specific AD-related neuropsychiatric symptoms (NPS) that contribute to FC distress are rare. We analyzed which NPS in association with care recipient and caregiver demographic factors are associated with FC psychological distress over a 36-month follow-up period.

DESIGN

This is a longitudinal study with annual follow-up. Participants were people with AD (n = 226) and their FCs (n = 226).

MEASUREMENTS

The Neuropsychiatric Inventory was used to assess NPS, and The General Health Questionnaire was used as a measure of caregiver distress. The effect of NPS on FC psychological distress over time was analyzed using a linear-mixed effect model.

RESULTS

Delusions (P = .003), agitation (P < .001), and sleep disturbance (P = .005) are associated with FC psychological distress. One of four people with AD developed delusions and agitation during the early stages of the disease. Sleep disturbances increased over the follow-up time. A marital relationship was associated with FC distress, while some prevalent symptoms, such as depression, did not affect distress.

CONCLUSIONS

Delusions, agitation, and sleep disturbances may cause distress to the FCs of persons with AD, especially if they live together. Clinicians should meet with FCs regularly and recognize those FCs at risk for a decline in psychosocial health.

Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides

Effective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents. Several communication intervention studies have been conducted to improve communication between nursing home staff and nursing home residents with dementia. These studies have shown that communication skills training can improve nursing aides’ communication with nursing home residents. However, these studies tended to be time-consuming and fairly difficult to implement. Moreover, these studies focused on the communicative benefits for the nursing home residents and their well-being, while benefits and well-being for the nursing aides were neglected. The current study focused on implementing a brief communication skills training program to improve nursing aides’ (N=24) communication with residents with dementia (N=26) in a nursing home. The effects of the training on nursing aides’ communication, caregiver distress, and job satisfaction and residents’ psychopathology and agitation were assessed relative to a control group condition. Nursing aides in the intervention group were individually trained to communicate effectively with residents during morning care by using short instructions, positive speech, and biographical statements. Mixed ANOVAs showed that, after training, nursing aides in the intervention group experienced less caregiver distress. Additionally, the number of short instructions and instances of positive speech increased. Providing nursing aides with helpful feedback during care aids communication and reduces caregiver burden, even with a brief intervention that requires limited time investments for nursing home staff.

Partner distress in the context of adult anorexia nervosa: the role of patients' perceived negative consequences of AN and partner behaviors

OBJECTIVE

Romantic partners can play an important role in the recovery from anorexia nervosa (AN). It is important to understand partners' behaviors and variables associated with their own distress. The aim was to examine associations of patients' perceived negative consequences of AN, behavioral strategies employed by partners, and partner distress.

METHOD

We used a cross-sectional design to assess associations between self-reports of patients' perceived negative consequences of AN, partners' caregiver distress, negative affect, relationship satisfaction, and observational coding measures of partners' behavioral strategies of change promotion and acceptance/validation. Sixteen adult patient-partner dyads in committed relationships were assessed at baseline of a couple-based intervention for AN.

RESULTS

Partners' change promotion moderated the association between patients' perceived negative consequences of AN and partners' caregiver distress. Partners' acceptance/validation was associated with partners' negative affect.

DISCUSSION

This report represents the first description of specific partner behaviors in the context of AN. Partners who reported the least distress were those who were trying to promote changes in AN behaviors in patients who reported high negative consequences of AN, and partners who were trying to show understanding of the patients' experience. Future studies should examine the impact of partner behaviors on AN treatment outcome.

Efficacy of musical interventions in dementia: evidence from a randomized controlled trial

Although musical interventions have recently gained popularity as a non-pharmacological treatment in dementia, there is still insufficient evidence of their effectiveness. To investigate this issue, a single-center randomized controlled trial was conducted with forty-eight patients with Alzheimer's disease or mixed dementia to compare the effects of music versus cooking interventions in the emotional, cognitive, and behavioral domain, as well as on professional caregiver distress. Each intervention lasted four weeks (two one-hour sessions a week). Multi-component evaluations (with blind assessors) were conducted before, during, and after the interventions to assess their short and long-term effects (up to four weeks post interventions). Analyses revealed that both music and cooking interventions led to positive changes in the patients' emotional state and decreased the severity of their behavioral disorders, as well as reduced caregiver distress. However, no benefit on the cognitive status of the patients was seen. While results did not demonstrate a specific benefit of music on any of the considered measures, the present study suggests the efficacy of two pleasant non-pharmacological treatments in patients with moderate to severe dementia. Our findings highlight the potential of such interventions in improving the well-being of patients living in residential care, as well as reducing caregiver distress.

Brief report: Service implementation and maternal distress surrounding evaluation recommendations for young children diagnosed with autism

There is limited evidence surrounding the ability of families of children with autism spectrum disorders to access and implement recommended interventions following diagnosis. The distress a family may encounter with regard to inability to access recommended services is also poorly understood. In this study, we present preliminary data regarding implementation of clinical recommendations following autism spectrum disorder diagnosis as well as associations of implementation with maternal functioning. In total, 75 mothers of young children diagnosed with autism spectrum disorder through a university-based preschool autism clinic returned surveys regarding access to recommended services as well as maternal mental health and distress. Results indicate that while families were able to implement numerous recommendations, specific categories of intervention were less likely to be received. Challenges implementing recommended services were not related to increased maternal distress. These results suggest that despite potential barriers toward accessing some specific recommended services following diagnosis of autism spectrum disorder, many families may be quite successful in implementing many other core recommended services and that failure to access such services may not necessarily negatively impact maternal mental health and distress.

The association between caregiver distress and individual neuropsychiatric symptoms of dementia

Neuropsychiatric symptoms (NPS) of dementia constitute one of the most related factors to caregiver burden and patients' early institutionalization. Few studies in Brazil have examined which symptoms are associated with higher levels of caregiver distress.

Children's adjustment following Hurricane Katrina: the role of primary caregivers

Hurricane Katrina severely disrupted the lives of many children and families in the central Gulf Coast of the United States. Face-to-face interviews with child-caregiver dyads were conducted at approximately 1 year posthurricane (T1) and 6-10 months later (T2). The contribution of several factors-caregiver's self-reported symptomatology and coping advice and child perceptions of caregiver distress, unavailability, warmth, and caregiver-child conflict-to child-reported posttraumatic stress symptoms (PTSS) and depressive symptoms was examined. Findings provide partial support for the importance of the caregiving context to children's adjustment. Specifically, higher levels of caregiver-child conflict at T1 were associated with more PTSS at T2, controlling for baseline symptoms. In contrast, higher levels of caregiver education were negatively related to child PTSS at T2. After adjusting for objective hurricane exposure and symptoms at T1, none of the caregiving variables was related to child-reported depressive symptoms at T2. The implications of these findings for efforts to promote children's adjustment after disaster are discussed.

Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease

The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer’s disease.

Behavior disorders and subjective burden among caregivers of demented patients

Many patients with dementia live within the community supported by their family and friends. Majority of patient caregivers suffer from high levels of stress.

METHODS

A quasi-experimental study, which compared the effects of nursing interventions on behavior disorders in both patients with moderate to severe dementia and their caregivers, followed over 18 months. The assessments were performed at the outpatient clinic of the Federal University of São Paulo and again at patients' homes with their primary caregiver, after informed consent form. Measurements were performed at baseline and after 18 months (pre and post-test). The instruments used were: The CDR, NPI and NPI-D; Katz Index and FAQ. Simultaneously, caregivers were enrolled onto the Dementia Education Program.

RESULTS

The final sample was composed of 31 subjects, having a mean age of 77.4 y.o. (±8 SD). Nursing interventions were effective in reducing some of the behavioral disturbances (Z= -3.1; p=0.002), such as Aggression (Z= -3.7; p<0.001) and anxiety (Z= -2.3; p=0.023). Caregiver distress also reduced upon interventions (Z= -2.2; p=0.030).

CONCLUSION

Our results indicate nursing interventions may be effective in reducing the frequency and severity of behavioral disorders and subjective burden among caregivers. Education Programs can improve caregiver burden through conveying information on difficulties related to the disease and how to deal with them.

Instrumental help and caregivers' distress: effects of change in informal and formal help

Family caregivers of persons with dementia rely on a range of resources to provide care and cope with caregiving stressors. Informal (unpaid) and formal (paid) instrumental support contribute to diverse caregiver outcomes. Previous research of caregiver support has focused on subjective measures of help or has compared caregivers receiving formal services to those who do not. We focused instead on the effects of change in the amount of formal and informal instrumental assistance on caregivers' distress. We expected that greater gains in assistance would be associated with greater reduction of caregivers' distress. Increases informal but not informal levels of assistance were associated with improvement in each measure of distress. Additional measures may be needed to fully understand the effects of informal and formal assistance.