51
|
Neural response to prosocial scenes relates to subsequent giving behavior in adolescents: A pilot study. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2019; 18:342-352. [PMID: 29464552 DOI: 10.3758/s13415-018-0573-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescence is characterized by extensive neural development and sensitivity to social context, both of which contribute to engaging in prosocial behaviors. Although it is established that prosocial behaviors are linked to positive outcomes in adulthood, little is known about the neural correlates of adolescents' prosociality. Identifying whether the brain is differentially responsive to varying types of social input may be important for fostering prosocial behavior. We report pilot results using new stimuli and an ecologically valid donation paradigm indicating (1) brain regions typically recruited during socioemotional processing evinced differential activation when adolescents evaluated prosocial compared with social or noninteractive scenes (N = 20, ages 13-17 years, MAge = 15.30 years), and (2) individual differences in temporoparietal junction recruitment when viewing others' prosocial behaviors were related to adolescents' own charitable giving. These novel findings have significant implications for understanding how the adolescent brain processes prosocial acts and for informing ways to support adolescents to engage in prosocial behaviors in their daily lives.
Collapse
|
52
|
Ascigil E, Uysal A, Saracgil Cosar SN. Longitudinal Associations Between Provision of Autonomy Support and Well-Being in Spouses of Individuals With Chronic Pain. Ann Behav Med 2019; 53:372-382. [PMID: 29947732 DOI: 10.1093/abm/kay049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Caregiving spouses of individuals with chronic pain often experience poor well-being. PURPOSE The current study aimed to examine the association between chronic pain-related provision of autonomy support and well-being in support providers (spouses) of individuals with chronic pain. METHODS Spouses of individuals with a diagnosed musculoskeletal chronic pain condition (N = 172) were recruited for a five-time point longitudinal study. Participants completed the questionnaires once every 6 months across 2 years. In a follow-up diary study, participants (N = 41) completed daily records of provision of autonomy support and well-being. RESULTS Multilevel analyses showed that provision of autonomy support was associated with greater well-being in support providers at both within-person and between-person levels. Longitudinal cross-lagged analyses also provided some evidence that it is provision of autonomy support that predicts well-being, and not the opposite. These effects held true in the follow-up diary study; however, some findings also suggested that the short-term associations between provision of autonomy support and well-being could be reciprocal. CONCLUSIONS Current findings extend the existing literature by suggesting provision of autonomy support as a beneficial type of support for the provider within the chronic pain context and lay the groundwork for caregiver-focused interventions.
Collapse
Affiliation(s)
- Esra Ascigil
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Ahmet Uysal
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | | |
Collapse
|
53
|
Shaffer KM, Nightingale CL. Comparison of Healthcare Utilization Between Informal Caregivers and Non-Caregivers: An Analysis of the Health Information National Trends Survey. J Aging Health 2019; 32:453-461. [PMID: 30793639 DOI: 10.1177/0898264319830262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The demands of providing unpaid care for someone with a disabling health condition (i.e., informal caregiving) can limit attention to one's own health needs. Using a nationally representative survey, this study examines whether caregivers report different healthcare utilization relative to non-caregivers. Method: Participants in the Health Information National Trends Survey 5, Cycle 1 reported whether they provided unpaid care and healthcare utilization outcomes. Logistic regressions and chi-square tests with jackknife variance estimation were used. Results: Caregivers (N = 391) did not differ from non-caregivers (N = 2,894) in time since routine checkup or number of healthcare appointments in the past year (p values > .25). Among caregivers, number of healthcare appointments differed according to caregivers' relationship to the care recipient (p = .04). Discussion: Findings suggest that informal caregivers access routine healthcare at a frequency similar to non-caregivers. Further research should determine whether this utilization is optimal, or whether increased utilization during caregiving might help attenuate caregivers' longer term morbidity.
Collapse
Affiliation(s)
- Kelly M Shaffer
- University of Virginia School of Medicine, Charlottesville, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
54
|
Miyawaki A, Tanaka H, Kobayashi Y, Kawachi I. Informal caregiving and mortality―Who is protected and who is not? A prospective cohort study from Japan. Soc Sci Med 2019; 223:24-30. [DOI: 10.1016/j.socscimed.2019.01.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 02/01/2023]
|
55
|
Juntunen K, Salminen AL, Törmäkangas T, Tillman P, Leinonen K, Nikander R. Perceived burden among spouse, adult child, and parent caregivers. J Adv Nurs 2018; 74:2340-2350. [PMID: 29869807 DOI: 10.1111/jan.13733] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 01/14/2023]
Abstract
AIMS To identify what factors are associated with the caregiver burden of spouse caregivers, adult child caregivers, and parent caregivers. BACKGROUND Caregivers often feel stressed and perceive caregiving as a burden. The caregiver burden has been little studied from the perspective of the personal relationship between caregiver and care recipient. DESIGN Cross-sectional study. METHODS A random sample of 4,000 caregivers in Finland was drawn in 2014 and those who remained either spouse, adult child, or parent caregivers at data collection were included in the analysis (N = 1,062). Data collection included recipients' characteristics. Caregivers' perceived burden was measured using the Caregivers of Older People in Europe index. General linear models were used to explain perceived caregiver burden. RESULTS Care recipients' low level of cognitive function was associated with greater perceived burden. Higher quality of support was associated with lower perceived burden among female and male spouse caregivers, daughter caregivers, and mother caregivers. Low cognitive function explained 3-6% and high quality of support 2-5% of the total variation in the burden explained by the models, which ranged between 45-55%. CONCLUSION Because cognitive challenges of care recipient are associated with greater perceived burden and high quality of support with lower burden among most of the caregiver groups, high-quality tailored nursing interventions will be needed especially for the caregivers of the most frail care recipients.
Collapse
Affiliation(s)
- Kristiina Juntunen
- Unit of Health Sciences, Faculty of Sports and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Field of Social Services and Health Care, JAMK University of Applied Sciences, Jyväskylä, Finland
| | | | - Timo Törmäkangas
- Unit of Health Sciences, Faculty of Sports and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Päivi Tillman
- Social Insurance Institution of Finland, Helsinki, Finland
| | | | - Riku Nikander
- Unit of Health Sciences, Faculty of Sports and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Central Hospital of Central Finland, Jyväskylä, Finland
| |
Collapse
|
56
|
Tseliou F, Rosato M, Maguire A, Wright D, O’Reilly D. Variation of Caregiver Health and Mortality Risks by Age: A Census-Based Record Linkage Study. Am J Epidemiol 2018; 187:1401-1410. [PMID: 29394307 DOI: 10.1093/aje/kwx384] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 12/19/2017] [Indexed: 11/14/2022] Open
Abstract
Due to the focus of studies about caregiving responsibilities on older caregivers, there has been a deficit of research on young caregivers. We aimed to investigate the association between caregiving and health/mortality risk in young caregivers when compared with their noncaregiving peers and older caregivers. A census-based record linkage was implemented, linking all residents enumerated in the 2011 Northern Ireland Census with subsequently registered deaths data, until the end of 2015. Among those aged 5-24 years at the 2011 Census, approximately 4.5% (19,621) of the cohort reported that they were caregivers. The presence of a chronic physical condition (such as mobility difficulties) and/or mental health condition was measured through the Census; all-cause mortality was assessed by official mortality records. Young caregivers were less likely than their noncaregiving peers to report chronic mobility problems (adjusted odds ratio (OR) = 0.84, 95% confidence interval (CI): 0.73, 0.96) but more likely to report chronic poor mental health (adjusted OR = 1.44, 95% CI: 1.31, 1.58). They also differed from older caregivers (P < 0.001) and were at significantly higher mortality risk than their peers (adjusted hazard ratio = 1.54, 95% CI: 1.10, 2.14). A dose-response relationship between hours devoted to caregiving duties and mortality risk was evident. We found that young caregivers were at significantly increased risk of poor health outcomes.
Collapse
Affiliation(s)
- Foteini Tseliou
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Londonderry, United Kingdom
| | - Aideen Maguire
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - David Wright
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Dermot O’Reilly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| |
Collapse
|
57
|
Roth DL, Brown SL, Rhodes JD, Haley WE. Reduced mortality rates among caregivers: Does family caregiving provide a stress-buffering effect? Psychol Aging 2018; 33:619-629. [PMID: 29723004 PMCID: PMC6002922 DOI: 10.1037/pag0000224] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple studies have confirmed a seemingly paradoxical finding that family caregivers have lower mortality rates than comparable samples of noncaregivers. Caregivers are often also found to report more symptoms of depression and higher stress levels, but psychological distress and mortality are rarely examined in the same study. This study tests a possible mechanism for the mortality effect by applying a theoretical model that posits psychological and physiological stress-buffering benefits from prosocial helping behaviors. Participants in the population-based REasons for Geographic and Racial Differences in Stroke (REGARDS) study included 3,580 family caregivers who were individually matched to 3,580 noncaregivers on 15 demographic, health history, and health behavior variables using a propensity score matching algorithm. Baseline measures of depressive symptoms and perceived stress levels were also collected. The results indicated that caregivers reported significantly more depressive symptoms and higher perceived stress levels than propensity-matched noncaregivers (ps < .0001). However, consistent with our previous analysis (Roth et al., 2013), an analysis of 7-year survival rates showed that caregivers had a 16.5% lower mortality rate than noncaregivers (hazard ratio = 0.835, 95% CI = 0.719, 0.970). Significant caregiving*psychological distress interaction effects supported the stress-buffering hypothesis. Both depressive symptoms and perceived stress scores were significant predictors of mortality for the matched noncaregivers (ps < .0001), but not for the caregivers (ps > .49). Family caregiving appears to be similar to other prosocial helping behaviors in that it provides stress-buffering adaptations that ameliorate the impact of stress on major health outcomes such as mortality. (PsycINFO Database Record
Collapse
Affiliation(s)
- David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University
| | | | - J David Rhodes
- Department of Biostatistics, University of Alabama at Birmingham
| | | |
Collapse
|
58
|
Pucciarelli G, Ausili D, Galbussera AA, Rebora P, Savini S, Simeone S, Alvaro R, Vellone E. Quality of life, anxiety, depression and burden among stroke caregivers: A longitudinal, observational multicentre study. J Adv Nurs 2018; 74:1875-1887. [PMID: 29700840 DOI: 10.1111/jan.13695] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Abstract
AIM To longitudinally describe stroke caregivers' quality of life, anxiety, depression and burden and to identify predictors of stroke caregivers' quality of life, anxiety, depression and burden. BACKGROUND Caregivers have a key role in stroke survivor care and the first year of caregiving is the most challenging. To give tailored interventions, it is important to capture changes and identify predictors of caregiver quality of life, anxiety, depression and burden during the first year. DESIGN A 12-month longitudinal study. Data were collected between June 2013-May 2016. METHODS Changes in stroke caregiver quality of life, anxiety and depression and burden and their predictors were identified using linear mixed-effects models. RESULTS The caregivers (N = 244) were 53 years old and mostly female. Caregiver quality of life did not change significantly over the 12 months, anxiety and depression decreased up to 9 months and caregiver burden decreased from baseline to 3 months, then increased up to 9 months. Higher caregiver quality of life was predicted by caregiver younger age, higher education, living with a stroke survivor, survivor older age and higher physical functioning; higher anxiety and depression were predicted by older caregiver age and younger survivor age; higher burden was predicted by caregiver male gender, the caregiver not living with survivor and survivor lower physical functioning. CONCLUSION The first 9 months of caregiving are particularly problematic for caregivers. The trajectories of the above variables and their predictors may be useful for policy makers, clinicians, investigators and educators to give better care to stroke caregivers and their survivors.
Collapse
Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessia Antonella Galbussera
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paola Rebora
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Silvio Simeone
- Department of Cardiology, Policlinico Federico II, Naples, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
59
|
Impact of Parenthood, Informal Caregiving and its Combination on Self-Rated Health - a Population-Based Study in Switzerland. JOURNAL OF POPULATION AGEING 2017. [DOI: 10.1007/s12062-017-9208-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
60
|
Sneed RS, Schulz R. Grandparent Caregiving, Race, and Cognitive Functioning in a Population-Based Sample of Older Adults. J Aging Health 2017; 31:415-438. [PMID: 29254404 DOI: 10.1177/0898264317733362] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to evaluate the association between noncustodial grandparent caregiving and cognition using the Health and Retirement Study (HRS), a population-based study of older adults. Method: Participants were White and African American grandparents aged ≥65 years. Only noncustodial grandparents who reported not living with their grandchildren over the three waves were included in our analyses. Grandparent caregiving status and cognition were assessed in 2006, 2008, and 2010. Analyses controlled for demographics, baseline health, depressive symptoms, and baseline cognition. Results: Both the number of waves of grandparent caregiving and the total number of grandparent caregiving hours across the three waves were associated with better cognitive functioning at 4-year follow-up in 2010. Associations were observed among Whites, but not among African Americans. Discussion: This study uses longitudinal data to evaluate the association between grandparent caregiving and cognitive functioning. Findings suggest that providing care may be beneficial for some grandparents.
Collapse
Affiliation(s)
- Rodlescia S Sneed
- University of Pittsburgh, PA, USA.,Michigan State University, Flint, USA
| | | |
Collapse
|
61
|
Maguire A, Rosato M, O'Reilly D. Mental health and morbidity of caregivers and co-residents of individuals with dementia: a quasi-experimental design. Int J Geriatr Psychiatry 2017; 32:1104-1113. [PMID: 27594205 DOI: 10.1002/gps.4573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine if providing informal care to a co-resident with dementia symptoms places an additional risk on the likelihood of poor mental health or mortality compared with co-resident non-caregivers. DESIGN A quasi-experimental design of caregiving and non-caregiving co-residents of individuals with dementia symptoms provides a natural comparator for the additive effects of caregiving on top of living with an individual with dementia symptoms. METHODS Census records, providing information on household structure, intensity of caregiving, presence of dementia symptoms and self-reported mental health were linked to mortality records over the following 33 months. Multi-level regression models were constructed to determine the risk of poor mental health and death in co-resident caregivers of individuals with dementia symptoms compared with co-resident non-caregivers, adjusting for the clustering of individuals within households. RESULTS The cohort consisted of 10 982 co-residents (55.1% caregivers), with 12.1% of non-caregivers reporting poor mental health compared with 8.4% of intense caregivers (>20 h of care per week). During follow-up, the cohort experienced 560 deaths (245 to caregivers). Overall, caregiving co-residents were at no greater risk of poor mental health but had lower mortality risk than non-caregiving co-residents (adjusted odds ratio (ORadj) = 0.93, 95% confidence interval (CI) 0.79, 1.10 and ORadj = 0.67, 95% CI 0.56, 0.81, respectively); this lower mortality risk was also seen amongst the most intensive caregivers (ORadj = 0.65, 95% CI 0.53, 0.79). CONCLUSION Caregiving poses no additional risk to mental health over and above the risk associated with merely living with someone with dementia and is associated with a lower mortality risk compared with non-caregiving co-residents. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| |
Collapse
|
62
|
O'Reilly D, Rosato M, Ferry F, Moriarty J, Leavy G. Caregiving, volunteering or both? Comparing effects on health and mortality using census-based records from almost 250,000 people aged 65 and over. Age Ageing 2017; 46:821-826. [PMID: 28338778 DOI: 10.1093/ageing/afx017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Indexed: 11/13/2022] Open
Abstract
Background the health impacts of caregiving and volunteering are rarely studied concurrently, despite the potential for both synergies and conflicts. This population-based study examines the association of these activities on health and subsequent mortality. Method a census-based record-linkage study of 244,429 people aged 65 and over, with cohort characteristics, caregiving and volunteering status, and presence of chronic health conditions derived from the Census returns. Mortality risk was assessed over the following 45 months with adjustment for baseline characteristics. Results caregivers and volunteers were individually more mobile than those undertaking neither activity; caregivers who also volunteered were more mobile than those who did not volunteer, but no less likely to suffer from poor mental health. Both caregiving and volunteering were separately associated with reduced mortality risk (HR = 0.74: 95% confidence intervals (CIs) = 0.71, 0.77 and HR = 0.76: 0.73, 0.81, respectively); the lowest mortality was found amongst light caregivers who also volunteered (HR = 0.53: 95% CIs = 0.45, 0.62), compared to those engaged in neither. There was no evidence of a multiplicative effect of caregiving and volunteering at more intense levels of caregiving. Conclusion there is a large overlap in caregiving and volunteering activities with complex associations with health status. There is some evidence that combining caregiving and volunteering activities, for those involved in less intense levels of caregiving, maybe associated with lower mortality risk than associated with either activity alone. Further research is needed to understand which aspects of caregiving and volunteering are best and for whom and in which circumstances.
Collapse
Affiliation(s)
- Dermot O'Reilly
- Queen's University Belfast - Centre for Public Health, Belfast, UK
| | - Michael Rosato
- Ulster University - Bamford Centre for Mental Health and Wellbeing, Derry, UK
| | - Finola Ferry
- Ulster University - Bamford Centre for Mental Health and Wellbeing, Derry, UK
| | - John Moriarty
- Queen's University Belfast - Administrative Data Research Centre for Northern Ireland, ICBS-B Grosvenor Road, Belfast BT76BA, UK
| | - Gerard Leavy
- Ulster University - Bamford Centre for Mental Health and Wellbeing, Derry, UK
| |
Collapse
|
63
|
Abstract
OBJECTIVE Reliable and valid measures of caregiver experience are critical components of researching the caregiver experience and providing effective care to family caregivers. Assessments should be comprehensive, including positive aspects of caregiving as well as multiple dimensions of stress and burden (Family Caregiver Alliance, 2006). One such measure is the Caregiver Reaction Scale (CRS), a clinical tool adapted from research protocols in 1990. METHODS This study is a preliminary examination of the psychometric properties of the CRS using a sample of family caregivers (N = 502) seeking services at a community based mental health and aging family service agency. RESULTS The eight subscales of the CRS exhibited very good internal reliability α ≥ .81. Test-retest reliability was r ≥ .62, and convergent validity evidence is positive. Means and standard deviations are reported. CONCLUSIONS Initial psychometrics suggest the CRS offers a reliable and valid assessment of multiple dimensions of the caregiving experience and warrants further research.
Collapse
Affiliation(s)
- Kelly A O'Malley
- a University of Colorado Colorado Springs , Colorado Springs , Colorado , USA
| | - Sara H Qualls
- a University of Colorado Colorado Springs , Colorado Springs , Colorado , USA
| |
Collapse
|
64
|
Miyawaki A, Tomio J, Kobayashi Y, Takahashi H, Noguchi H, Tamiya N. Impact of long-hours family caregiving on non-fatal coronary heart disease risk in middle-aged people: Results from a longitudinal nationwide survey in Japan. Geriatr Gerontol Int 2017; 17:2109-2115. [PMID: 28464424 DOI: 10.1111/ggi.13061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/10/2017] [Accepted: 02/20/2017] [Indexed: 12/01/2022]
Abstract
AIM The effects of family caregiving, especially long-hours caregiving, on coronary heart disease (CHD) are debatable. We examined the impact of family caregiving on incident non-fatal CHD. METHODS We used data from the Longitudinal Survey of Middle-Aged and Elderly Persons from 2005 to 2010, a nationwide panel survey for Japanese people aged 50-59 years in 2005 (baseline). After we excluded non-respondents and people with missing key variables at baseline, 25 121 individuals without CHD, stroke or cancer were followed up for a mean of 4.6 years. The exposure was assessed at baseline by three indicators: (i) family caregiving; (ii) hours spent caregiving; and (iii) kinship type of care recipient. The non-fatal CHD incidence was identified according to questionnaire responses from 2006 to 2010. RESULTS Cox's proportional hazards analysis did not show a statistically significant association between family caregiving and incident non-fatal CHD (hazard ratio [HR] 1.13, 95% confidence interval [CI] 0.92-1.40). Caregivers who spent 20-69 h per week on care showed a statistically significant increased risk for non-fatal CHD (HR 1.78, 95% CI 1.23-2.58) compared with non-caregivers; whereas this increased risk was statistically significant only among women (HR 1.98, 95% CI 1.27-3.08), but not among men (HR 1.35, 95% CI 0.67-2.71). Kinship type of care recipient did not make a significant difference to the effects of family caregiving on incident non-fatal CHD. CONCLUSIONS Long-hours family caregiving could be an independent risk factor for incident non-fatal CHD among middle-aged women in Japan. Geriatr Gerontol Int 2017; 17: 2109-2115.
Collapse
Affiliation(s)
- Atsushi Miyawaki
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideto Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
65
|
Anderson EW, White KM. "It Has Changed My Life": An Exploration of Caregiver Experiences in Serious Illness. Am J Hosp Palliat Care 2017; 35:266-274. [PMID: 28413927 PMCID: PMC5768253 DOI: 10.1177/1049909117701895] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Informal, unpaid caregivers shoulder much of the care burden for individuals with serious illness. As part of a project to create an innovative model of supportive care for serious illness, a series of user interviews were conducted, forming the basis for this article. Objective: To understand both individual and interpersonal aspects of caregiving for serious illness. Methods: Twelve semistructured group interviews were conducted with patients, families, and professionals as part of a larger study of late-life serious illness. Transcript data were analyzed with descriptive coding, and then coded material was analyzed to elicit major themes and subthemes. Results: A total of 73 individuals participated in group interview sessions. Using descriptive coding, quotes were assigned to first-order codes of rewards, challenges, and a category of learnings and adaptations. Subthemes of reward included gratitude, a sense of accomplishment or mastery, and closeness in personal relationships. The most oft-cited challenges included emotional and physical stresses of caregiving and feeling unprepared or unsupported in caregiving. Reflecting on their experiences, caregivers cited new ways in which they had learned to be creative, to show assertiveness and advocacy, and to create personal balance in a demanding situation. Conclusions: The experience of caregiving is a life-altering journey as individuals rise to challenges and reflect on the rewards. Caregivers described intensive caregiving, often without acknowledgment or understanding of their role from the health-care system. This invisibility created its own iatrogenic caregiving challenge. The identified themes suggest avenues of meaningful caregiver support that bear further exploration.
Collapse
Affiliation(s)
- Eric W Anderson
- 1 Late Life Supportive Care, Division of Applied Research, Allina Health, Minneapolis, MN, USA
| | - Katie M White
- 2 Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
66
|
Shu CC, Cumming RG, Kendig HL, Blyth FM, Waite LM, Le Couteur DG, Handelsman DJ, Naganathan V. Health status, health behaviours and anxiety symptoms of older male caregivers: Findings from the Concord Health and Ageing in Men Project. Australas J Ageing 2017; 36:151-157. [PMID: 28211188 DOI: 10.1111/ajag.12376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore differences between older male caregivers and non-caregivers on health status, health behaviours and well-being, including symptoms of anxiety. METHODS Data were collected through self-completed questionnaires and face-to-face interviews with 1705 community living men aged ≥70 in the Concord Health and Ageing in Men Project. RESULTS Eleven per cent of older men were caregivers, of whom 81.7% were looking after their wives or partners. Older male caregivers did not have worse physical health or more depressive symptoms than non-caregivers, but being a caregiver was associated with increased likelihood of reporting anxiety symptoms (OR: 2.32, 95% CI: 1.39-3.87). Caregivers had similar levels and frequencies of leisure activities but did more housework activities than non-caregivers. CONCLUSION Higher anxiety levels were the main adverse health condition in older male caregivers. Strategies to assist minimising anxiety for caregivers should be a target of interventions.
Collapse
Affiliation(s)
- Chen-Chun Shu
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hal L Kendig
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.,College of Medicine, Australian National University, Melbourne, Victoria, Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.,ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
67
|
Caregivers for older adults: Prevalence, characteristics, and health care utilization and expenditures. Geriatr Nurs 2017; 38:9-16. [DOI: 10.1016/j.gerinurse.2016.06.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/24/2022]
|
68
|
Wharton T, Zivin K. Relationships Among Caregiving, Income, Gender, and Health: A Cross-Sectional Examination of a Representative Sample of Older Americans. JOURNAL OF SOCIAL SERVICE RESEARCH 2016; 43:141-148. [PMID: 28553004 PMCID: PMC5441305 DOI: 10.1080/01488376.2016.1239597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although there is substantial evidence to support the impact of burden on caregivers, few studies have compared caregivers to their non-caregiving counterparts on the basis of health and wellbeing outcomes. This study examines the relationship between caregiving and health, and whether other factors may have stronger influence on well-being measures. Using a nationally representative sample of older adults in the United States (N=3,005), this study examines relationships between caregiving status, gender, and income, and nine outcomes (self-rated physical and mental health, time since seeing a doctor, time since most recent pap smear or prostate-specific antigen [PSA] test, depression, loneliness, stress, anxiety), using logistic and linear regression models. Results support that paradoxically, caregiving was associated with increased likelihood of PSA test in male caregivers, although data also indicated higher levels of anxiety and stress, as might be expected. Income was associated with eight of nine outcomes, and gender predicted depression, anxiety, stress, and self-rated mental health. The study highlighted the importance of psychosocial stressors, such as income and gender on the health outcomes of older adults who may be caregiving. Considering complexity of unique experience is necessary to accurately assess vulnerability to poor mental health or health related outcomes.
Collapse
Affiliation(s)
- Tracy Wharton
- School of Social Work, College of Health & Public Affairs, University of Central Florida
| | - Kara Zivin
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI
- University of Michigan Medical School, Ann Arbor, MI
| |
Collapse
|
69
|
O'Reilly D, Rosato M, Maguire A. Caregiving reduces mortality risk for most caregivers: a census-based record linkage study. Int J Epidemiol 2016; 44:1959-69. [PMID: 26371207 DOI: 10.1093/ije/dyv172] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Countries with advanced welfare systems are increasingly relying on the input of informal caregivers, and there are growing concerns for their mental and physical wellbeing. However, the evidence about the relationship between caregiving and mortality risk is less clear. METHODS A census-based record linkage study with mortality follow-up of 33 months: participants totalled 1 122 779 individuals including 183 842 caregivers, of whom 28.2% (51 927) were providing 50 or more hours caregiving per week. RESULTS Over 33 months of follow-up a total of 29 335 deaths occurred, 2443 of these among caregivers. Mortality risk for caregivers was lower than for non-caregivers [hazard ratio (HR) = 0.72: 95% confidence interval (CI) = 0.69, 0.75 in the fully adjusted model], and the lower risk was evident even for those providing 50 or more h of caregiving per week (adjusted HR = 0.77: 95% CI = 0.71, 0.83 and 0.76: 95% CI = 0.69, 0.83 for men and women, respectively). There was no evidence that this relationship varied by either age or marital status. Even among people with chronic health problems such as poor mental health, caregivers had lower mortality risk than non-caregivers. Caregiving is associated with reduced mortality risk for most causes—for example, the risk of death from ischaemic heart disease for caregivers providing 50 or more h was 27% and 31% lower for men and for women, respectively, compared with non-caregivers (HR = 0.73: 95% CI = 0.60, 0.88 and HR = 0.69: 95% CI = 0.51, 0.92). CONCLUSIONS This large population-based study confirms that for the majority of caregivers the beneficial effects of caregiving in terms of short-term mortality risk appear to outweigh any negative effects, even among people with significant health problems. These results underscore the need for a reappraisal of how caregiving is perceived.
Collapse
Affiliation(s)
- Dermot O'Reilly
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland.
| | | | | |
Collapse
|
70
|
Shah SM, Carey IM, Harris T, DeWilde S, Victor CR, Cook DG. The mental health and mortality impact of death of a partner with dementia. Int J Geriatr Psychiatry 2016; 31:929-37. [PMID: 26833866 DOI: 10.1002/gps.4411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Caring for a partner with dementia and partner bereavement are independently associated with poor health. An understanding of the health effects of living with a partner dying with dementia can help optimise support. We describe health in the year before and after loss of a partner with dementia compared with other bereavements. METHODS In a UK primary care database, 2624 older individuals whose partner died with dementia during 2005-2012 were matched with 7512 individuals experiencing bereavement where the deceased partner had no dementia recorded. RESULTS Prior to bereavement, partners of the deceased with dementia were more likely to be diagnosed with depression (OR 2.31, 1.69-3.14) and receive psychotropic medication (OR 1.34, 1.21-1.49) than partners from bereavements without dementia. In contrast, psychotropic medication initiation two months after dementia bereavement was lower (HR 0.69, 0.56-0.85). Compared with other bereaved individuals, mortality after bereavement was lower in men experiencing a dementia bereavement (HR 0.68, 0.49-0.94) but similar in women (HR 1.02, 0.75-1.38). Prior to bereavement, those who died with dementia were less likely to receive palliative care (OR 0.47, 0.41-0.54). CONCLUSION In the year before bereavement, partners of individuals dying with dementia experience poorer mental health than those facing bereavement from other causes, and their partner is less likely to receive palliative care. In the year after, individuals whose partner died with dementia experience some attenuation of the adverse health effects of bereavement. Services need to address the needs of carers for individuals dying with dementia and improve access to palliative care. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Sunil M Shah
- Population Health Research Institute, St George's University of London, London, UK
| | - Iain M Carey
- Population Health Research Institute, St George's University of London, London, UK
| | - Tess Harris
- Population Health Research Institute, St George's University of London, London, UK
| | - Stephen DeWilde
- Population Health Research Institute, St George's University of London, London, UK
| | - Christina R Victor
- School of Health Sciences and Social Care, Brunel University, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's University of London, London, UK
| |
Collapse
|
71
|
Roth DL, Skarupski KA, Crews DC, Howard VJ, Locher JL. Distinct age and self-rated health crossover mortality effects for African Americans: Evidence from a national cohort study. Soc Sci Med 2016; 156:12-20. [PMID: 27015163 PMCID: PMC5084845 DOI: 10.1016/j.socscimed.2016.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 03/09/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022]
Abstract
The predictive effects of age and self-rated health (SRH) on all-cause mortality are known to differ across race and ethnic groups. African American adults have higher mortality rates than Whites at younger ages, but this mortality disparity diminishes with advancing age and may "crossover" at about 75-80 years of age, when African Americans may show lower mortality rates. This pattern of findings reflects a lower overall association between age and mortality for African Americans than for Whites, and health-related mechanisms are typically cited as the reason for this age-based crossover mortality effect. However, a lower association between poor SRH and mortality has also been found for African Americans than for Whites, and it is not known if the reduced age and SRH associations with mortality for African Americans reflect independent or overlapping mechanisms. This study examined these two mortality predictors simultaneously in a large epidemiological study of 12,181 African Americans and 17,436 Whites. Participants were 45 or more years of age when they enrolled in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007. Consistent with previous studies, African Americans had poorer SRH than Whites even after adjusting for demographic and health history covariates. Survival analysis models indicated statistically significant and independent race*age, race*SRH, and age*SRH interaction effects on all-cause mortality over an average 9-year follow-up period. Advanced age and poorer SRH were both weaker mortality risk factors for African Americans than for Whites. These two effects were distinct and presumably tapped different causal mechanisms. This calls into question the health-related explanation for the age-based mortality crossover effect and suggests that other mechanisms, including behavioral, social, and cultural factors, should be considered in efforts to better understand the age-based mortality crossover effect and other longevity disparities.
Collapse
Affiliation(s)
- David L Roth
- Center on Aging and Health, Johns Hopkins University, USA; Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, USA.
| | - Kimberly A Skarupski
- Center on Aging and Health, Johns Hopkins University, USA; Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, USA
| | - Deidra C Crews
- Center on Aging and Health, Johns Hopkins University, USA; Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA
| | - Julie L Locher
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, USA
| |
Collapse
|
72
|
Sampson EL, Lodwick R, Rait G, Candy B, Low J, King M, Petersen I. Living With an Older Person Dying From Cancer, Lung Disease, or Dementia: Health Outcomes From a General Practice Cohort Study. J Pain Symptom Manage 2016; 51:839-48. [PMID: 26891605 DOI: 10.1016/j.jpainsymman.2015.12.319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 12/21/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Increasing numbers of people will die from chronic disease. Families contribute significantly to end-of-life care, but their role may not be recognized. OBJECTIVES To 1) establish the proportion of older cohabitees identified in primary care as "carers"; 2) describe demographic and lifestyle characteristics of cohabitees of people terminally ill with cancer, dementia, and chronic obstructive pulmonary disease (COPD); 3) describe their health a year before and after bereavement; and 4) compare health outcomes between cohabitees of people dying with cancer, COPD, or dementia. METHODS Retrospective cohort study using a U.K. primary care database (The Health Improvement Network) of 13,693 bereaved cohabitees (a proxy marker for being a carer), aged 60 years or older of people dying from cancer, COPD, or dementia. Characteristics were described one year before and after bereavement. We compared cancer, COPD, and dementia cohabitee outcomes using incidence rate ratios one year before and after bereavement and calculated mortality risk after bereavement. RESULTS A total of 6.9% of cohabitees were recorded as carers. Health outcomes differed little between the three groups of cohabitees in the year before or after bereavement. The proportion of cohabitees with six or more consultations increased the year after bereavement (cancer cohabitees 16.0% to 18.8%, COPD cohabitees 17.8% to 20.4%, and dementia cohabitees 15.5% to 17.5%). At postbereavement (follow-up median 3 years, interquartile range 1.3-5.4), we found no mortality differences between the three groups. CONCLUSION Recording of carers of terminally ill people was suboptimal. Cause of bereavement produced few differential effects on health outcomes or mortality.
Collapse
Affiliation(s)
- Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry University College London, London, United Kingdom.
| | - Rebecca Lodwick
- Marie Curie Palliative Care Research Department, Division of Psychiatry University College London, London, United Kingdom; Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry University College London, London, United Kingdom
| | - Joe Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry University College London, London, United Kingdom
| | - Michael King
- Division of Psychiatry, University College London, London, United Kingdom
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| |
Collapse
|
73
|
Capistrant BD. Caregiving for Older Adults and the Caregivers’ Health: an Epidemiologic Review. CURR EPIDEMIOL REP 2016. [DOI: 10.1007/s40471-016-0064-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
74
|
Miller C, Kapp S. Informal carers and wound management: an integrative literature review. J Wound Care 2015; 24:489-90, 492, 494--7. [DOI: 10.12968/jowc.2015.24.11.489] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C. Miller
- PhD Research Fellow, La Trobe University, 99 Commercial Road, Prahran, VIC 3181
| | - S. Kapp
- BN; PGDipAdvNsg (community); MNSci. Adjunct Lecturer, La Trobe University, 99 Commercial Road, Prahran, VIC 3181
| |
Collapse
|
75
|
Roth DL, Dilworth-Anderson P, Huang J, Gross AL, Gitlin LN. Positive Aspects of Family Caregiving for Dementia: Differential Item Functioning by Race. J Gerontol B Psychol Sci Soc Sci 2015; 70:813-9. [PMID: 26033356 PMCID: PMC4841161 DOI: 10.1093/geronb/gbv034] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/14/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Due to increasing interest in the positive experiences associated with family caregiving, potential demographic group differences were examined on the Positive Aspects of Caregiving (PAC) scale at both the item and scale levels. METHOD Family caregivers (N = 642) completed the PAC as part of their participation in the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) clinical trial. Multiple indicators, multiple causes models were used to examine potential differential item functioning (DIF) across demographic subgroups. RESULTS Overall PAC scale scores indicated that both Hispanics and African Americans experienced more PAC than Whites. Two items with statistically significant (p < .004) and practically meaningful (odds ratio > 2.0) DIF were found for African American caregivers. After controlling for the underlying unidimensional construct, African Americans reported that caregiving gave them "a more positive attitude toward life" and enabled them to "appreciate life more" than either Whites or Hispanics. No instances of meaningful DIF were found between Hispanics and Whites, women and men, or spouses and nonspouses. DISCUSSION PAC scores differ significantly by race. In addition, 2 items with meaningful race DIF identify content areas that are particularly relevant to the cultural experiences of African American caregivers.
Collapse
Affiliation(s)
- David L Roth
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD.
| | | | - Jin Huang
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Alden L Gross
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Laura N Gitlin
- Department of Community-Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
76
|
Dahlrup B, Ekström H, Nordell E, Elmståhl S. Coping as a caregiver: A question of strain and its consequences on life satisfaction and health-related quality of life. Arch Gerontol Geriatr 2015; 61:261-70. [DOI: 10.1016/j.archger.2015.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/17/2022]
|
77
|
Connecting prosocial behavior to improved physical health: Contributions from the neurobiology of parenting. Neurosci Biobehav Rev 2015; 55:1-17. [DOI: 10.1016/j.neubiorev.2015.04.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 03/19/2015] [Accepted: 04/10/2015] [Indexed: 12/13/2022]
|
78
|
Thomas GPA, Saunders CL, Roland MO, Paddison CAM. Informal carers' health-related quality of life and patient experience in primary care: evidence from 195,364 carers in England responding to a national survey. BMC FAMILY PRACTICE 2015; 16:62. [PMID: 25975608 PMCID: PMC4446949 DOI: 10.1186/s12875-015-0277-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 05/06/2015] [Indexed: 01/21/2023]
Abstract
Background We aim to describe the health-related quality of life of informal carers and their experiences of primary care. Methods Responses from the 2011-12 English General Practice Patient Survey, including 195,364 informal carers, were analysed using mixed effect logistic regressions controlling for age, gender, ethnicity and social deprivation to describe carer health-related quality of life (mobility, self-care, usual activities, pain, and anxiety/depression, measured using EQ-5D) and primary care experience (access, continuity and communication). Results Informal carers reported poorer health-related quality of life than non-carers of similar age, gender, ethnicity and social deprivation. Increasing caring commitment was associated with worse EQ-5D scores, with carers of 50+ hours a week scoring 0.05 points lower than non-carers (95 % CI 0.05 to 0.04), equivalent to 18 fewer days of full health annually. Considering each domain of EQ-5D separately, carers of 50+ hours/week were more likely to report pain OR = 1.53 (1.50-1.57), p < 0.0001, and anxiety/depression OR = 1.69 (1.66-1.73), p < 0.0001, than non-carers. Younger carers scored lower on EQ-5D than non-carer peers but the converse was true among over-85s. In the most deprived areas carers reported the equivalent of 37 fewer days of full health annually than carers in the most affluent areas. On average, carers reported poorer patient experiences in all areas of primary care than non-carers (odds ratios 0.84-0.97), with this difference being most marked in the domain of access. Conclusions Informal carers experience a double disadvantage of poorer health-related quality of life and poorer patient experience in primary care. We find no evidence for health benefits of caregiving. We recommend physicians identify and treat carer health problems, including pain and anxiety/depression, particularly among young, deprived and high time-commitment carers. Improving patient experience for carers, including access to primary care, should be a priority. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0277-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gwilym P A Thomas
- Cambridge Centre for Health Services Research Primary Care Unit, University of Cambridge, Cambridge, UK.
| | | | - Martin O Roland
- Cambridge Centre for Health Services Research Primary Care Unit, University of Cambridge, Cambridge, UK.
| | - Charlotte A M Paddison
- Cambridge Centre for Health Services Research Primary Care Unit, University of Cambridge, Cambridge, UK. .,Department of Psychology, Anglia Ruskin University, Cambridge, UK.
| |
Collapse
|
79
|
Fredman L, Lyons JG, Cauley JA, Hochberg M, Applebaum KM. The Relationship Between Caregiving and Mortality After Accounting for Time-Varying Caregiver Status and Addressing the Healthy Caregiver Hypothesis. J Gerontol A Biol Sci Med Sci 2015; 70:1163-8. [PMID: 25878033 DOI: 10.1093/gerona/glv009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Previous studies have shown inconsistent associations between caregiving and mortality. This may be due to analyzing caregiver status at baseline only, and that better health is probably related to taking on caregiving responsibilities and continuing in that role. The latter is termed The Healthy Caregiver Hypothesis, similar to the Healthy Worker Effect in occupational epidemiology. We applied common approaches from occupational epidemiology to evaluate the association between caregiving and mortality, including treating caregiving as time-varying and lagging exposure up to 5 years. METHODS Caregiving status among 1,068 women (baseline mean age = 81.0 years; 35% caregivers) participating in the Caregiver-Study of Osteoporotic Fractures study was assessed at five interviews conducted between 1999 and 2009. Mortality was determined through January 2012. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals adjusted for sociodemographics, perceived stress, and functional limitations. RESULTS A total of 483 participants died during follow-up (38.8% and 48.7% of baseline caregivers and noncaregivers, respectively). Using baseline caregiving status, the association with mortality was 0.77, 0.62-0.95. Models of time-varying caregiving status showed a more pronounced reduction in mortality in current caregivers (hazard ratios = 0.54, 0.38-0.75), which diminished with longer lag periods (3-year lag hazard ratio = 0.68, 0.52-0.88, 5-year lag hazard ratios = 0.76, 0.60-0.95). CONCLUSIONS Overall, caregivers had lower mortality rates than noncaregivers in all analyses. These associations were sensitive to the lagged period, indicating that the timing of leaving caregiving does influence this relationship and should be considered in future investigations.
Collapse
Affiliation(s)
- Lisa Fredman
- Epidemiology Department, Boston University School of Public Health, Massachusetts.
| | - Jennifer G Lyons
- Epidemiology Department, Boston University School of Public Health, Massachusetts
| | - Jane A Cauley
- Epidemiology Department, University of Pittsburgh, Pennsylvania
| | - Marc Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Katie M Applebaum
- Department of Environmental and Occupational Health, George Washington University, Milken Institute School of Public Health. Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| |
Collapse
|
80
|
Haley WE, Roth DL, Hovater M, Clay OJ. Long-term impact of stroke on family caregiver well-being: a population-based case-control study. Neurology 2015; 84:1323-9. [PMID: 25740862 DOI: 10.1212/wnl.0000000000001418] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Three-year changes in well-being were studied among family caregivers of an epidemiologically derived sample of stroke survivors from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and compared to matched noncaregivers. METHODS Family caregivers of REGARDS participants who experienced a stroke event completed telephone interviews assessing depressive symptoms, mental and physical health quality of life (QOL), life satisfaction, and leisure satisfaction at approximately 9, 18, 27, and 36 months after the stroke (n = 235). For each stroke caregiver, a family member of a stroke-free REGARDS participant was enrolled as a matched noncaregiving control (n = 235) and completed similar interviews. RESULTS Multilevel longitudinal models found that caregivers showed poorer well-being at 9 months poststroke than controls on all measures except physical health QOL. Significant differences were sustained for 22 months after the stroke event for depressive symptoms, 31 months for mental health QOL, and 15 months for life satisfaction. For leisure satisfaction, differences were still significant at 36 months poststroke. Caregiving effects were similar across race and sex. CONCLUSIONS Stroke caregiving is associated with persistent psychological distress, but life satisfaction, depression, and mental health QOL became comparable to noncaregivers by 3 years after stroke. Caregiver leisure satisfaction was chronically lower than in noncaregivers. Intervention for stroke caregivers should recognize both the strains faced by caregivers and their capacity for successful coping over time.
Collapse
Affiliation(s)
- William E Haley
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham.
| | - David L Roth
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
| | - Martha Hovater
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
| | - Olivio J Clay
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
| |
Collapse
|
81
|
Vable AM, Subramanian SV, Rist PM, Glymour MM. Does the "widowhood effect" precede spousal bereavement? Results from a nationally representative sample of older adults. Am J Geriatr Psychiatry 2015; 23:283-92. [PMID: 24974142 PMCID: PMC5511695 DOI: 10.1016/j.jagp.2014.05.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Increased mortality risk following spousal bereavement (often called the "widowhood effect") is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. DESIGN Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. METHOD Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: "recent widows" (N=396) were bereaved between 2004 and 2006, before outcomes were assessed; "near widows" (N=380) were bereaved between 2006 and 2008, after outcomes were assessed; "married" individuals (N=7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. RESULTS Compared to married individuals, recent widows had worse depressive symptoms (β=0.71, 95% confidence interval (CI): [0.57, 0.85]). Near widows had worse depressive symptoms (β=0.21, 95% CI: [0.08, 0.34]), mobility (β=0.14, 95%CI: [0.01, 0.26]), and word recall (β=-0.13, 95%CI: [-0.23, -0.02]) compared to married individuals. CONCLUSIONS Health declines before spousal death suggests some portion of the "widowhood effect" may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse.
Collapse
Affiliation(s)
- Anusha M. Vable
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Pamela M. Rist
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA,Division of Preventive Medicine, Department of Medicine, Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA, USA
| | - M. Maria Glymour
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco
| |
Collapse
|
82
|
Atendiendo a las variadas problemáticas de los cuidadores familiares de personas con demencia: aportaciones de la terapia cognitivo-conductual y de la terapia de aceptación y compromiso. CLINICA Y SALUD 2015. [DOI: 10.1016/j.clysa.2015.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
83
|
Roth DL, Fredman L, Haley WE. Informal caregiving and its impact on health: a reappraisal from population-based studies. THE GERONTOLOGIST 2015; 55:309-19. [PMID: 26035608 DOI: 10.1093/geront/gnu177] [Citation(s) in RCA: 468] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/05/2014] [Indexed: 12/11/2022] Open
Abstract
Considerable research and public discourse on family caregiving portrays it as a stressful and burdensome experience with serious negative health consequences. A landmark study by Schulz and Beach that reported higher mortality rates for strained spouse caregivers has been widely cited as evidence for the physical health risks of caregiving and is often a centerpiece of advocacy for improved caregiver services. However, 5 subsequent population-based studies have found reduced mortality and extended longevity for caregivers as a whole compared with noncaregiving controls. Most caregivers also report benefits from caregiving, and many report little or no caregiving-related strain. Policy reports, media portrayals, and many research reports commonly present an overly dire picture of the health risks associated with caregiving and largely ignore alternative positive findings. As the pool of traditional family caregivers declines in the coming years, a more balanced and updated portrayal of the health effects of caregiving is needed to encourage more persons to take on caregiving roles, and to better target evidence-based services to the subgroup of caregivers who are highly strained or otherwise at risk. Recommendations are discussed for research that will better integrate and clarify both the negative and potential positive health effects of informal caregiving.
Collapse
Affiliation(s)
- David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.
| | - Lisa Fredman
- Department of Epidemiology, Boston University, Massachusetts
| | | |
Collapse
|
84
|
Liu G, Dupre ME. Health Trajectories of Women in China: The Role of Parental Caregiving. J Gerontol B Psychol Sci Soc Sci 2014; 71:320-31. [DOI: 10.1093/geronb/gbu144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 09/09/2014] [Indexed: 11/13/2022] Open
|
85
|
Kim Y, Carver CS, Shaffer KM, Gansler T, Cannady RS. Cancer caregiving predicts physical impairments: roles of earlier caregiving stress and being a spousal caregiver. Cancer 2014; 121:302-10. [PMID: 25209592 DOI: 10.1002/cncr.29040] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/14/2014] [Accepted: 08/07/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The objective of this study was to investigate associations between earlier caregiving experience and the development of physical impairments over the subsequent 6 years among family caregivers of patients with cancer. METHODS Family caregivers of cancer survivors participated in a nationwide survey 2 years after their relative's cancer diagnosis (T1) (N=1517) with follow-up at 5 years (T2) and 8 years (T3) postdiagnosis. Caregivers self-reported their demographics and levels of caregiving stress at T1. Caregiving status ("former" for those whose patient was remission, "bereaved" for those whose patient had died, and "current") and the presence of 3 physical impairments (arthritis, chronic back pain, and heart-related diseases) at the time of assessment were measured at T1 through T3. RESULTS Caregiving stress was significantly related to concurrent presence of the 3 impairment markers at T1. Stressed caregivers also were more likely to develop heart diseases, and spousal caregivers were more likely than other caregivers to develop arthritis and chronic back pain several years after the initial caregiving experience (at T2 and T3). These effects were independent of age, sex, education, and income at T1, and they were also independent of caregiving status at each assessment. CONCLUSIONS The current findings suggest that the adverse long-term health effects of earlier caregiving stress and of being a spousal caregiver should be acknowledged and that caregiving-related stress management programs should be incorporated into routine health care for family caregivers of cancer patients.
Collapse
Affiliation(s)
- Youngmee Kim
- Department of Psychology, University of Miami, Coral Gables, Florida
| | | | | | | | | |
Collapse
|
86
|
Tapia Granados JA, House JS, Ionides EL, Burgard S, Schoeni RS. Individual joblessness, contextual unemployment, and mortality risk. Am J Epidemiol 2014; 180:280-7. [PMID: 24993734 DOI: 10.1093/aje/kwu128] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Longitudinal studies at the level of individuals find that employees who lose their jobs are at increased risk of death. However, analyses of aggregate data find that as unemployment rates increase during recessions, population mortality actually declines. We addressed this paradox by using data from the US Department of Labor and annual survey data (1979-1997) from a nationally representative longitudinal study of individuals-the Panel Study of Income Dynamics. Using proportional hazards (Cox) regression, we analyzed how the hazard of death depended on 1) individual joblessness and 2) state unemployment rates, as indicators of contextual economic conditions. We found that 1) compared with the employed, for the unemployed the hazard of death was increased by an amount equivalent to 10 extra years of age, and 2) each percentage-point increase in the state unemployment rate reduced the mortality hazard in all individuals by an amount equivalent to a reduction of 1 year of age. Our results provide evidence that 1) joblessness strongly and significantly raises the risk of death among those suffering it, and 2) periods of higher unemployment rates, that is, recessions, are associated with a moderate but significant reduction in the risk of death among the entire population.
Collapse
|
87
|
Rosso AL, Lee BK, Stefanick ML, Kroenke CH, Coker LH, Woods NF, Michael YL. Caregiving frequency and physical function: the Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2014; 70:210-5. [PMID: 25060315 DOI: 10.1093/gerona/glu104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Informal caregiving is common for older women and can negatively affect health, but its impact on physical function remains unclear. Using inverse probability weighting methods, we quantified the association of caregiving with physical function over 6 years. METHODS Study participants were 5,649 women aged 65 years and older at baseline of the Woman's Health Initiative Clinical Trial (multicenter recruitment, 1993-1998) with complete caregiving data and function at baseline and at least one follow-up. Caregiving was self-reported (low-frequency if ≤2 times per week and high-frequency if ≥3 times per week). Performance-based measures of physical function including timed walk (meters/second), grip strength (kilograms), and chair stands (number) were measured at baseline and years 1, 3, and 6. Associations and 95% confidence intervals of baseline caregiving with physical function were estimated by generalized estimating equations with inverse probability weighting by propensity and attrition scores, calculated by logistic regression of baseline health and demographic characteristics. RESULTS Over follow-up, low-frequency caregivers had higher grip strength when compared with noncaregivers (mean difference = 0.63kg, confidence interval: 0.24, 1.01). There were no observed differences between high-frequency caregivers and noncaregivers on grip strength or for either caregiver group when compared with noncaregivers on walk speed or chair stands. Rates of change in physical function measures did not differ by caregiving status. CONCLUSIONS Caregiving was not associated with poorer physical function in this sample of older women. Low-frequency caregiving was associated with better grip strength at baseline which persisted through follow-up. This study supports the concept that informal caregiving may not have universally negative health consequences.
Collapse
Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Stanford University, School of Medicine, Palo Alto, California
| | | | - Laura H Coker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Nancy F Woods
- School of Nursing, University of Washington, Seattle
| | - Yvonne L Michael
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, Pennsylvania
| |
Collapse
|
88
|
|