Burden and Quality of Life of Family Caregivers of Stroke Patients

Determinants of caregiver burden of persons with disabilities in a rural district in Egypt

BACKGROUND

Family caregivers are critical partners in the plan of care of people with disabilities. The study aims to demonstrate the factor structure and internal consistency of the Caregiver Burden Inventory (CBI) among the studied caregivers of disabled persons and to determine the effects of patients' and caregivers' characteristics on the burden and its dimensions.

METHODS

A cross-sectional study among 260 family caregivers of disabled patients was carried out in a randomly chosen rural area, Minia, Egypt, 2019. Exploratory factor analysis (EFA) was conducted to determine the factorial validity of the CBI. Multiple linear regression was used to identify the significant factors affecting the burden.

RESULTS

Factor analysis resulted in a five-factor solution using 20 items (four for each dimension) accounting for 72.7% of the total variance. The CBI and its dimensions showed high internal consistency (Cronbach's alpha value > 0.70). Education of caregiver, family income, mental impairments, and mixed disabilities were significant predictors of total CBI burden.

CONCLUSIONS

CBI is an effective multidimensional measure of the caregiver burden of disabled subjects. Caregivers experienced a distinct level of burden that is determined by caregiver and care recipient characteristics. Therefore, support and individualized counseling services should be optimized.

Evaluation of burden and depression among caregivers of stroke patients: The role of percutaneous endoscopic gastrostomy feeding tube

BACKGROUND & AIMS

Malnutrition problems are very common after a stroke. Several clinical studies have shown the contribution of percutaneous endoscopic gastrostomy (PEG) feeding after stroke in terms of improving nutritional status and reducing mortality. The aim of this study is to compare the burden and depression among caregivers of ischemic stroke patients fed with PEG and orally.

METHODS

A total of 63 caregivers of patients with acute ischemic stroke who were followed up in the neurointensive care unit with modified Rankin Scale 4 or 5 were recruited in this cross-sectional survey. Clinical data of patients and demographical profile as age, gender, kinship to patient, income, and level of education of caregivers were recorded. On their 3rd-month follow-up visit, Beck Depression Inventory and The Zarit Burden Interview (ZBI) were administered to caregivers to evaluate depressive symptoms and caregiver burden. A semi-structured questionnairre was developed and conducted by the researchers with the caregivers to assess their thoughts of nutrition.

RESULTS

Thirty-two caregivers of stroke patients on PEG and 31 caregivers of stroke patients who were fed orally were evaluated. The groups did not differ statistically in terms of demographic variables and depression scores (p > 0.05). However, the mean score of ZBI was significantly higher in the group of caregivers of stroke patients who were fed orally (p = 0.00). Caregivers of stroke patients on PEG had higher scores of caregivers' thoughts of nutrition support therapy questionnairre (p = 0.00).

CONCLUSIONS

Our findings demonstrate that caregivers of stroke patients report lower burden and higher level of positive thinking with PEG feeding than oral feeding. This suggests that nutritional care could include convenient and practicable methods for caregivers of patients with stroke in order to meet patients' nutritional requirements.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

PROSPERO REGISTRATION

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

Functional Outcomes After Hip Fracture in Independent Community-Dwelling Patients

OBJECTIVES

To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients.

DESIGN

Retrospective cohort study.

SETTING

Academic hospital with ambulatory follow-up.

PARTICIPANTS

Community-dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184).

MEASUREMENTS

Baseline, 3- and 6-month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race.

RESULTS

Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in-hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in-hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in-hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in-hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility.

CONCLUSION

Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.