Cognitive functioning in spousal caregivers of dementia patients: findings from the prospective MAASBED study

Informal caregiving and the risk for coronary heart disease: the Whitehall II study

BACKGROUND

The stress associated with informal caregiving has been shown to be associated with poor health, including coronary heart disease (CHD). However, it is unclear if the risk of CHD is attributable to caregiving or prior poor health of the caregiver.

METHODS

We used data from the Whitehall II cohort study. Caregiving and caregiver's health (using 3 measures: self-rated health, mental health using the General Health Questionnaire, and physical component score of the SF-36) were assessed in 1991-1993 among 5,468 men and 2,457 women aged 39-63 years. CHD (fatal CHD, clinically verified nonfatal myocardial infarction, and definite angina) incidence was recorded for a mean 17 years; sociodemographic variables, health behaviors, and cardiovascular risk factors were included as covariates.

RESULTS

Cox regression showed the risk of CHD in caregivers not to be higher (hazard ratio = 1.18; 95% CI: 0.96, 1.45) compared with noncaregivers. Analyses stratified by health status showed that compared with noncaregivers in good health, caregivers with poor self-rated (hazard ratio = 2.00; 95% CI: 1.44, 2.78), mental (hazard ratio = 1.63; 95% CI: 1.16, 2.30), or physical (hazard ratio =1.87; 95% CI: 1.34, 2.62) health had greater risk of CHD. A similar elevated risk was observed in noncaregivers with poor health; no excess risk was observed among caregivers reporting good health, and the combined effect of poor health and caregiving did not exceed their independent effects.

CONCLUSIONS

Caregiving in midlife is not in itself associated with greater risk of CHD, but it is associated with increased risk for CHD among caregivers who report being in poor health.

Long-Term Impact of Caregiving and Metabolic Syndrome with Perceived Decline in Cognitive Function 8 Years Later: A Pilot Study Suggesting Important Avenues for Future Research

The chronic stress of caregiving has been associated with increased risk for cognitive decline and dementia. One theoretical model suggests that a group of risk factors known as the metabolic syndrome MET_SYN (e.g. hypertension, poor glucose regulation, central obesity, and high triglyceride levels) that have demonstrated associations with both stress and cognitive decline, may mediate the association between caregiver stress and cognitive decline. It is also possible that caregiving may moderate the association between MET_SYN and cognitive decline. The present study examined these two potential models. The study sample consisted of 53 caregivers for a relative with dementia and 24 participants who did not have caregiving responsibilities at baseline. We examined associations among caregiving history (yes/no), self-reported decline in cognitive function (the AD8) at follow-up, and a MET_SYN factor comprised of increased systolic blood pressure (SBP), glycosylated hemoglobin concentration (HbA1c), waist circumference, and triglyceride levels at baseline when caregiving was assessed. MET_SYN was associated with AD8 (p = 0.010). Caregiving history was not directly associated with AD8 ratings, however, caregiving did moderate the association between MET_SYN and AD8 (p = 0.043) assessed 8 years later. In caregivers MET_SYN scores reflecting higher risk were associated with scores on the AD8 indicting decline, whereas, in controls MET_SYN was unrelated to AD8 assessment. Thus, it can be concluded that caregiver stress may increase the association between metabolic risk factors and decline in cognitive functioning up to 8 years later.

Gerontechnology: providing a helping hand when caring for cognitively impaired older adults-intermediate results from a controlled study on the satisfaction and acceptance of informal caregivers

The incidence of cognitive impairment in older age is increasing, as is the number of cognitively impaired older adults living in their own homes. Due to lack of social care resources for these adults and their desires to remain in their own homes and live as independently as possible, research shows that the current standard care provisions are inadequate. Promising opportunities exist in using home assistive technology services to foster healthy aging and to realize the unmet needs of these groups of citizens in a user-centered manner. ISISEMD project has designed, implemented, verified, and assessed an assistive technology platform of personalized home care (telecare) for the elderly with cognitive impairments and their caregivers by offering intelligent home support services. Regions from four European countries have carried out long-term pilot-controlled study in real-life conditions. This paper presents the outcomes from intermediate evaluations pertaining to user satisfaction with the system, acceptance of the technology and the services, and quality of life outcomes as a result of utilizing the services.

Stress-related cognitive dysfunction in dementia caregivers

In a cross-sectional study, 31 dementia caregivers were compared to a group of 25 noncaregiving controls to evaluate whether the stress of being the primary caregiver of a person with dementia produces cognitive dysfunction. Cognitive differences were examined to evaluate the relationships between cognitive function and stress-related physiological and psychological measures to contribute information regarding its potential mechanism. The cognitive assessments were 2 measures of attention-executive function and 1 word list memory task. Physiological and self-rated stress-related measurements included cortisol, perceived stress, depression, self-efficacy, mindfulness, sleep quality, fatigue, and neuroticism. Caregivers performed worse than noncaregivers on the 2 attention tasks but not on the word list memory test. There was no interaction of caregiver status and age on cognitive performance. The caregivers and noncaregivers differed in morning salivary cortisol and most of the self-rated stress-related measures with the caregiver values reflecting greater stress. Of note, impaired sleep was the only potential mediator of the caregiver effect on cognitive performance in our small sample.

Caregiving and cognitive function in older women: evidence for the healthy caregiver hypothesis

OBJECTIVES

Recent findings of better health outcomes in older caregivers than noncaregivers suggest a healthy caregiver hypothesis (HCH) model may be more appropriate than the stress process model for evaluating the health effects of caregiving. In a cross-sectional study, we tested the HCH on two cognitive domains: verbal memory and processing speed.

METHOD

Participants from the Caregiver Study of Osteoporotic Fractures who had a 2-year follow-up interview were categorized as continuous caregivers (n = 194), former caregivers (n = 148), or continuous noncaregivers (n = 574). The Hopkins Verbal Learning Test (HVLT; memory) and Digit Symbol Substitution Task (DSST; processing speed) were administered at the follow-up interview.

RESULTS

Continuous caregivers had better memory performance and processing speed than continuous noncaregivers: adjusted mean scores for HVLT were 18.38 versus 15.80 (p < .0001), and for DSST were 35.91 versus 34.38 (p = .09).

DISCUSSION

Results support the HCH model for cognitive outcomes in older women caregivers; however, the relationship may be domain specific.

Informal caregiving and self-reported mental and physical health: results from the Gazel Cohort Study

OBJECTIVES

We investigated whether, and under what conditions, informal caregiving is associated with improved self-reported physical and mental health, most notably in terms of cognitive functioning.

METHODS

We performed a cross-sectional analysis of 2008 data from the Gazel Cohort Study, which involved 10 687 men and women aged 54 to 70 years. Multivariate linear and logistic regression models were used to estimate the associations between self-reported health and caregiving status and burden.

RESULTS

Regular caregivers with the highest burden scores reported significantly worse health status than did noncaregivers for almost all of the physical and mental outcomes evaluated after adjustment for potential confounding factors. In particular, they reported more cognitive complaints (odds ratio [OR] = 1.44; 95% confidence interval [CI] = 1.21, 1.73). Conversely, caregivers with the lowest burden scores reported better perceived health status, less physical and mental tiredness, and fewer depressive symptoms (OR = 0.50; 95% CI = 0.37, 0.68) than did noncaregivers; however, they did not report decreases in cognitive difficulties (OR = 0.98; 95% CI = 0.81, 1.18).

CONCLUSIONS

Our findings support the hypothesis that caregiving can have positive effects on health, provided that caregiving activities themselves are not too heavy a burden.

Behavioral symptoms of dementia: a dyadic effect of caregivers' stress process?

This study used multilevel modeling to evaluate a newly revised model in which dementia caregivers' stress process variables-perceived stress and emotional-behavioral responses-were posited as predictors of behavioral symptoms of dementia (BSD) within community-based dyads. Secondary analyses were conducted on data from a primary two-group (experimental and control) trial, in which experimental participants received a home monitoring system for managing nighttime activity in individuals with dementia. Models indicated that caregivers' trajectories did not differ significantly between groups over time; however, the time-by-group interaction of BSD approached significance. Because BSD were not targeted, this indicated that the system may have indirectly lowered BSD. In addition, caregivers' perceived stress and emotional-behavioral responses predicted BSD, on average (across all occasions) and from occasion to occasion, with higher levels associated with worse BSD. These limited results provide support for further research to investigate the nature of these relationships.

Greater risk of dementia when spouse has dementia? The Cache County study

OBJECTIVES

To examine the effects of caring for a spouse with dementia on the caregiver's risk for incident dementia.

DESIGN

Population-based study of incident dementia in spouses of persons with dementia.

SETTING

Rural county in northern Utah.

PARTICIPANTS

Two thousand four hundred forty-two subjects (1,221 married couples) aged 65 and older.

MEASUREMENTS

Incident dementia was diagnosed in 255 subjects, with onset defined as age when subject met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria for dementia. Cox proportional hazards regression tested the effect of time-dependent exposure to dementia in one's spouse, adjusted for potential confounders.

RESULTS

A subject whose spouse experienced incident dementia onset had a six times greater risk for incident dementia as subjects whose spouses were dementia free (hazard rate ratio (HRR)=6.0, 95% confidence interval (CI)=2.2-16.2, P<.001). In sex-specific analyses, husbands had higher risks (HRR=11.9, 95% CI=1.7-85.5, P=.01) than wives (HRR=3.7, 95% CI=1.2-11.6, P=.03).

CONCLUSION

The chronic and often severe stress associated with dementia caregiving may exert substantial risk for the development of dementia in spouse caregivers. Additional (not mutually exclusive) explanations for findings are discussed.

Psychological health in older adult spousal caregivers of older adults

OBJECTIVES

The need for informal caregiving has been rapidly increasing across several countries. Spouses comprise a sizeable segment of informal caregivers and typically represent an older cohort with special health concerns. The objective of this review was to examine psychological health outcomes in older adult spouses caring for older adults.

METHODS

Literature review/synthesis (1999-2009).

RESULTS

Compared to demographically matched married non-caregiving controls, older adult spousal caregivers experienced more cognitive functioning difficulties, strain, distress, stress, loneliness, depression, anxiety and poorer mental health. Caregivers of spouses with cognitive impairments, quite often wives, were especially affected by poor psychological health, as were caregivers who were new to the caregiving role and those who rated caregiving as stressful. Psychological health improved when the caregiving role ceased.

DISCUSSION

Several poor psychological outcomes were found in older adults caring for their spouses; the magnitude of which varied and were more pronounced under certain circumstances. To preserve caregiver health, maintain recipient health and care quality and avoid exceeding system of care capacity, efforts are needed to provide support to older adult spousal caregivers and recipients. Couples may need to be assessed as a unit, taking gender and cultural considerations into account, and additional resources may be required.

Small, homelike care environments for older people with dementia: a literature review

BACKGROUND

There is large cross-national variation in the characteristics of small, domestic-style care settings which emphasize normalized living. However, a systematic overview of existing types is lacking. This study provides an international comparison of the care concepts which have adopted a homelike philosophy in a small-scale context. Insight into their characteristics is vital for theory, planning and implementation of such dementia care settings.

METHOD

A literature search was performed using various electronic databases, including PubMed, Medline, CINAHL and PsycINFO. In addition, "gray" literature was identified on the internet. Concepts were analyzed according to five main characteristics: physical setting, number of residents, residents' characteristics, domestic characteristics and care concept.

RESULTS

75 papers were included covering 11 different concept types in various countries. Similarities among concepts reflected a focus on meaningful activities centered around the daily household. Staff have integrated tasks and are part of the household, and archetypical home-style features, such as kitchens, are incorporated in the buildings. Differences among concepts were found mainly in the physical settings, numbers of residents and residents' characteristics. Some concepts have become regular dementia care settings, while others are smaller initiatives.

CONCLUSION

The care concepts are implemented in various ways with a changing staff role. However, many aspects of these small, homelike facilities remain unclear. Future research is needed, focusing on residents' characteristics, family, staff and costs.

Depressed mood mediates decline in cognitive processing speed in caregivers

PURPOSE

Very few studies have examined cognitive decline in caregivers versus noncaregivers, and only 1 study has examined mediators of such decline. We evaluated the relationship between caregiver status and decline on the digit symbol test (DST; a measure of processing speed, attention, cognitive-motor translation, and visual scanning) and whether this relationship was mediated by depressed mood.

DESIGN AND METHODS

Caregivers for spouses with Alzheimer's disease (n = 122) were compared with demographically similar noncaregiver spouses (n = 117) at study entry (Time 1 = T1), T2 (1 year later), and T3 (2 years after T1).

RESULTS

Caregivers had lower DST scores and higher Hamilton depression scores at T1, T2, and T3 than noncaregivers (all p < .05). Hierarchical linear modeling revealed that although caregivers started well below noncaregivers, they experienced a more rapid rate of decline than noncaregivers (p = .047). Caregivers declined 4.5 times faster than noncaregivers. Greater depressed mood at T1 (p < .01) and T2 (p < .01) predicted DST decline and mediated DST decline in caregivers vs. noncaregivers.

IMPLICATIONS

Depressed mood in caregivers relative to noncaregivers may influence their greater risk for DST decline. This is important because the DST predicts problem solving and everyday functions necessary for independent living and the potential well-being of their care recipients.

Effect of a residential respite admission for older people on regional Queensland family carers

OBJECTIVE

This study undertaken in regional Queensland aimed to determine the effect of a residential respite care (RRC) admission for older people on family carers.

METHOD

The study used a repeated measures, prospective design. The participants were 100 family carers and their older dependants who were studied before and after the RRC admission.

RESULTS

Family carer psychological distress increased after a period of RRC [F(1, 57) = 250.9, p < .001] as did the level of caregiver burden [F(1, 57) = 189.8, p < .001]. The presence of dementia and hearing problems in the RRC recipients, the psychological distress of the family carer, being younger and a spouse of the RRC recipient all predicted carer burden.

CONCLUSIONS

It is not surprising that RRC, once over, does not necessarily reduce psychological distress and carer burden if this is associated with ongoing caring responsibilities that are resumed after RRC. Nurses need to discuss these issues with family carers and inform them of the likely outcomes of RRC and how they may better utilise the 'break' provided by RRC to counteract some of this response.

Health-related quality of life in significant others of patients dying from lung cancer

This study compares health-related quality of life (HRQOL) in significant others of patients dying from lung cancer, with a general population sample. Further, it explores the course of HRQOL from diagnosis (T1), at a time point close to the patient's death (T2), and six months after the patient's death (T3). The group comparisons at T1 showed that the significant others scored significantly lower on the scales in the mental domain compared with a general population sample. These results were the same at T3, when the significant others also scored lower on most of the scales in the physical and social domains. In the longitudinal analyses, there were significant changes in four scales, and three patterns of change were identified: a decrease-increase pattern for 'self-rated health' and 'positive affect'; a constant decrease pattern for 'family functioning'; and a decrease-stable pattern for 'satisfaction with family functioning'. Thus, living with inoperable lung cancer in the family and then facing the death of a family member affects most of the HRQOL dimensions.