A two-factor model of caregiving appraisal and psychological well-being

Psychological Well-Being Among Informal Caregivers in the Canadian Longitudinal Study on Aging: Why the Location of Care Matters

Objectives

A caregiving stress perspective suggests that caregiving harms psychological well-being in informal caregivers, whereas a caregiving rewards perspective suggests that provision of care benefits psychological well-being. This research examines whether both perspectives apply to caregiving experiences, but differently by the primary location of caregiving (i.e., in-home, other residence, and institution), as well as by gender.

Methods

We analyzed depression and life satisfaction in the nationally representative Canadian Longitudinal Study on Aging (N = 48,648), first comparing noncaregivers (N = 27,699) to a combined caregiver group (N = 20,949) and then stratifying caregivers by the primary location of care.

Results

When considered as a single group, caregivers suffered relative to noncaregivers in terms of life satisfaction and depression. When stratified by the location of care, only in-home caregivers reported both greater depression and lower life satisfaction. Nonresidential caregivers did not differ significantly in levels of depression from noncaregivers and reported higher life satisfaction. Institutional caregivers reported greater depression than noncaregivers, but did not differ significantly in life satisfaction. These patterns were stronger among women than men.

Discussion

Both the caregiving stress and caregiving rewards perspectives are applicable to the caregiving experience, with the stress perspective more applicable to in-home caregivers and the rewards perspective more relevant to nonresidential caregivers. Recommendations include targeted practice focused on the location of care as well as the gender of the caregiver. Given that nonresidential caregivers actually benefit from providing care, interventions need to focus on identifying and bolstering positive aspects of the caregiving experience.

Informal Caregiver Burden, Benefits, and Older Adult Mortality: A Survival Analysis

OBJECTIVE

Informal caregivers are crucial to maintaining older adults' health, but few studies examine how caregiving receipt is associated with older person longevity. In a nationally representative sample, we prospectively explore whether and how having an informal caregiver is associated with older adult overall mortality, and how caregivers' burden and benefits perceptions relate to care recipient mortality.

METHODS

We match six National Health and Aging Trends Study waves (2011-2016) with 2011 National Study of Caregiving data, conducting survival analysis on 7,369 older adults and 1,327 older adult-informal caregiver dyads.

RESULTS

Having an informal caregiver is associated with 36% (p < .001) higher mortality risk over 6-year follow-up, adjusting for demographic, economic, and health factors. Older adults whose caregivers perceive only burden have 38% higher (p < .05) mortality risk than those with caregivers reporting neither burden nor benefits. This risk is reduced from 38% higher to 5% higher (p < .001) for older adults with caregivers reporting benefits alongside burden, compared to those with caregivers reporting neither perception.

DISCUSSION

Having a caregiver may signal impending decline beyond known mortality factors. However, interventions to increase caregivers' benefit perceptions and reduce their burden may decrease mortality risk for older adults with declining health and functional ability.

Developing and testing of an integrative theoretical model to predict positive aspects of caregiving among family caregivers of persons with dementia: A study protocol

AIMS

The aim is to develop and test an integrative model based on the stress and coping paradigm and the existential paradigm, to explain positive aspects of caregiving among family caregivers of persons with dementia.

DESIGN

A mixed method research, comprises a longitudinal exploratory study and a descriptive qualitative study.

METHODS

A total of 370 family caregivers will be recruited from community elderly centres. Questionnaires on positive aspects of caregiving and its predictors (including active dementia management strategies, meaning-focused coping, and self-efficacy) and contextual factors (including social support, religiosity, continuous good dyadic relationship quality, and intrinsic motivation towards caregiving) will be administered. Positive aspects of caregiving will be reassessed six months later. Path analysis will be used to test the hypothesized model. A subsample of 30 family caregivers will be interviewed individually to explore how positive aspects of caregiving develop from the caregiving experience. Inductive thematic analysis will be used to for the qualitative data analysis. The funding was approved in January 2018.

DISCUSSION

Positive aspects of caregiving represents the extent to which the caregiving experience is seen as enriching an individual's life space and resulted in health protective effects. With the increasing evidence to indicate its associating factors, it is imperative to identify the theoretical model to comprehensively elucidate the process for its development.

IMPACT

Theoretically, this study will advance the knowledge of dementia caregiving by generating a comprehensive theory-driven predictive model to explain how positive aspects of caregiving is developed among the family caregivers. In terms of nursing practice, the findings can inform the development of intervention to improve positive aspects of caregiving and thereby acts as a catalyst to promote the paradigm shift from 'reducing limitations' to 'optimizing strengths' in family caregivers support services.

Mediators of burden and depression in dementia family caregivers: Kinship differences

OBJECTIVES

To investigate kinship differences in the caregiver stress process by developing multiple mediation models for two distinct caregiver subgroups (spouses and adult children of older adults living with dementia). The effect of four potential mediating variables (mastery, self-efficacy, satisfaction with social support, positive caregiving appraisals) on the relationship between perceived burden and depression was evaluated.

METHOD

Family caregivers of a person living with dementia were recruited through national dementia and carer organisations. Participants completed a paper-based or electronic version of the study survey. A bias-corrected, accelerated bootstrapping method was used to test the effect of the four proposed mediating variables on the relationship between perceived burden and depression in each caregiver subgroup (spouses and adult children).

RESULTS

Perceived burden was directly and significantly related to depression for both spouse caregivers and adult child caregivers. The mediation models explained approximately 50% of the variance in the burden-to-depression pathway for both caregiver subgroups. Mastery and social support (but not self-efficacy, nor positive caregiving appraisals) were found to individually significantly influence the impact of perceived burden on depression in spouse caregivers. All four proposed mediators failed to reach statistical significance as individual mediators of the burden-to-depression pathway in adult child caregivers.

CONCLUSION

These findings demonstrate differences in the dementia caregiver experience according to kinship, and that certain mediating variables are more relevant for some subgroups of caregivers than others. Implications for the design of psychosocial interventions are discussed.

Stressors and Resources Related to Medication Management: Associations With Spousal Caregivers' Role Overload

BACKGROUND AND OBJECTIVES

Managing medications can be stressful for spousal caregivers, but little is known about particular aspects of medication management that are most consequential for caregiving outcomes. We examined care stressors and resources related to medication management, their associations with role overload among spousal caregivers, and whether these links vary by care recipients' number of chronic health conditions and dementia status.

RESEARCH DESIGN AND METHODS

This cross-sectional study included 377 spousal caregivers of adults aged 65 and older from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate how medication-related stressors (ordering medication, keeping track of medications, giving injections) and resources (medication reminder systems, shared medication management within the spousal dyad) are associated with caregivers' role overload. Care recipients' number of chronic health conditions and dementia status were considered as moderators. Models controlled for caregivers' sociodemographic characteristics, chronic health conditions, and other care tasks.

RESULTS

Caregivers who administered injections reported more role overload, whereas those who worked with care recipients to jointly manage medications reported less role overload. Keeping track of medications was linked to caregivers' greater role overload when care recipients had 5 or more chronic health conditions. Finally, care recipients' use of medication reminder systems was linked to less role overload for caregivers of a partner with dementia.

DISCUSSION AND IMPLICATIONS

Devising strategies to assist spousal caregivers in the more onerous components of medication management and promote resources that mitigate medication-related stress may improve caregiver well-being.

Do informal caregivers experience more burnout? A meta-analytic study

Informal caregivers often report exhaustion when providing care, which can be related to forms of burnout. Yet, there is no systematic inventory of studies comparing caregivers and non-caregivers in terms of burnout. For the present meta-analysis, studies comparing burnout in informal caregivers and non-caregivers were screened and included. Two categories of studies were found: those on family care burnout (spousal or parental burnout) and those on professional burnout (mostly in healthcare). For family care burnout studies, informal caregivers reported more emotional exhaustion, and, to a lesser extent, depersonalization and reduced personal accomplishment than non-caregivers. For studies on professional burnout, workers providing informal care also reported more emotional exhaustion than workers not providing such a care. Overall, the results indicate that providing informal care represents a risk for role burnout. In family care burnout studies, these results confirm the assumption that providing informal care adds extra weight on the individuals' shoulders. In professional burnout, these results support the role accumulation theory, pointing that an additional weight in one's role, i.e., providing informal care, has an impact on another role, work. This work emphasizes the consideration of the multifaceted impact that the caregiving role can have on the individual.

Positive aspect of caregiving among primary informal dementia caregivers in Singapore

Background

The present study investigated the factor structure of positive aspects of caregiving (PAC) scale among primary informal caregivers providing care to persons with dementia (PWD) in Singapore.

Methods

282 primary informal caregivers of PWD were recruited from the Institute of Mental Health, and Changi General Hospital and administered the 9-item PAC scale. A confirmatory factor analyses (CFA) was conducted to test the model fit of the 9-item PAC proposed by the scale developer and multiple linear regression was used to investigate the significant socio-demographic correlates.

Results

CFA showed that the 2-factor structure including ‘Self-Affirmation’ and ‘Outlook on Life’ had an acceptable model fit. After controlling for confounding variables, Malay caregivers were associated with higher scores on PAC and ‘Self-Affirmation’ compared to caregivers of other ethnicities. Caregivers with Secondary or below education level had higher PAC and ‘Outlook on Life’ scores. Caregivers who had received formal training scored higher in PAC, ‘Self-Affirmation’ and ‘Outlook on Life’.

Discussion

The present study confirmed that the 2-factor structure of the 9-item PAC was suitable for informal caregivers of PWD in Singapore. The findings have important implications for locally available interventions to enhance caregiver’s psychological well-being and reduce burden of care.

The experience of being a father of a son or daughter with an intellectual disability: Older fathers' perspectives

BACKGROUND

As life expectancy for people with an intellectual disability increases, there is a growing cohort of older father carers. This study aimed to gain a more in-depth understanding of older father carers' experiences of parenting.

METHODS

Semi-structured interviews were conducted with 7 older fathers (M = 63.9 years) and analysed using constructivist grounded theory.

RESULTS

Three conceptual categories were identified. "Wearing different hats: how fathers' sense of identity had altered over the years. "Family comes first": importance placed on the family unit. "Getting on in years": the challenges faced by ageing fathers parenting their son/daughter.

CONCLUSIONS

Fathers re-evaluated their priorities and found a new identity in their parenting role, although they continued to see themselves as secondary carers. Fathers worried about the future as their health declined but drew strength from the benefits they had derived and the challenges that they had overcome to do their best for their son/daughter and their family.

Revealing the Invisible Emotion Work of Caregivers: A Photovoice Exploration of Informal Care Provided by Family Caregivers for Post-9/11 Veterans With Traumatic Brain Injuries

OBJECTIVE

Describe the different forms of emotion work performed by family caregivers of veterans living with a traumatic brain injury (TBI).

DESIGN

Collaborators were provided cameras to take photographs illustrating their experiences as family caregivers. The meaning behind caregiver photographs was solicited using photoelicitation interviews and coded.

SETTING

Homes of veterans or other informal settings in 2 regions of the United States served by the Southeast Louisiana Veterans Health Care System and the Veterans Affairs Portland Health Care System.

PARTICIPANTS

Twenty-six family caregivers of post-9/11 era veterans with TBI.

RESULTS

Caregivers described performing different types of intangible, and largely invisible, work centered on emotion management. Emotion work primarily involved creating a new normal, keeping things calm, and suppressing their own emotional experiences to "put on a brave face." Although having derived a sense of satisfaction and identity from their role, caregivers acknowledged that emotion work was challenging and sometimes stressful. The Photovoice method allowed caregivers to express through metaphor experiences that otherwise would have been hard to articulate and share with others.

CONCLUSION

Findings signal a need for healthcare systems and providers to acknowledge emotion work as a potential source of stress and to provide multifaceted support for veterans and family caregivers.

Positive aspects of care in informal caregivers of community-dwelling dementia patients

WHAT IS KNOWN ON THE SUBJECT?: Positive aspects of care are considered an essential part of caregiving research. They have been related to a wide range of dimensions of the caregiving circumstances, but there are few valid, reliable and brief measures to assess them. One of the most frequently used internationally is the Positive Aspects of Caregiving (PAC) scale, whose psychometric properties have received little attention. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The present study analyses the psychometric properties of the Portuguese version of the PAC scale in a sample of informal caregivers of someone with dementia and further explores the association of different factors (e.g. caregiver health, sociodemographic variables) with the PAC. The Portuguese version of PAC scale presented good psychometric characteristics, and the factor analysis revealed the presence of two factors: affirming self and enriching life. Our study also verified that higher levels of PAC are more likely to be associated with better caregiver health perception, lower levels of psychological distress and burden, the care recipient's older age, providing care to more than one care recipient, not receiving social support services and not considering institutionalizing the care recipient. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings from this study can assist professionals, including mental health nurses, to develop and implement effective interventions that help dementia caregivers to maintain their emotional health by identifying and focusing specific positive aspects of care. The study stresses the Portuguese version of the PAC scale as a reliable and valid measure for practice. ABSTRACT: Introduction Positive aspects of care refer to the psychosocial benefits of caregiving. The Positive Aspects of Caregiving (PAC) scale is one of the instruments most frequently used internationally, but its psychometric properties and correlates within the caregiving experience have received limited attention. Aim To examine the factorial structure of the Portuguese version of PAC scale and to analyse background and contextual factors that are more likely to be associated with higher levels of PAC. Method The PAC scale, a sociodemographic questionnaire and measures assessing burden and physical and mental health were administered to 204 informal caregivers of dementia patients. Results Exploratory factor analysis revealed a two-factor structure; internal consistency was adequate. Higher scores were negatively correlated with caregiver burden and distress. Better health perception, care recipient's older age, providing care to more than one care recipient and overall self-reliance were correlated with higher levels of PAC. Discussion The PAC scale was found to be a reliable and valid measure. Dementia caregiving circumstances and caregivers' and care receivers' characteristics play an important role for the presence of PAC, but relate distinctively with its dimensions. Implications for Practice Findings can help mental health nurses to recognize distinctive relations between PAC and caregiving variables.

Race/Ethnicity and Informal Caregiver Burden After Traumatic Brain Injury: A Scoping Study

Background: Informal caregivers for persons with traumatic brain injury (TBI) face a range of unique issues, and racial/ethnic group differences in caregiver challenges are poorly understood. We undertook a scoping study of peer-reviewed literature to assess the quantity and quality of available research describing differences by race/ethnicity in informal caregiving roles and burden.

Methods: Using Arksey and O'Malley's framework and guided by the Preferred Reporting Items of Systematic Reviews and Meta-analyses Extension for Scoping Reviews, we conducted electronic searches of PubMed, CINAHL, PsycARTICLES, PsycINFO, Social Work Abstracts, Embase, and Scopus to identify peer-reviewed studies that examined TBI informal caregiver burden and reported on the influences of race or ethnicity.

Results: Among 4523 unique publications identified and screened, 11 studies included sufficient race/ethnicity data and were included in the analysis. Of these, six studies described civilian populations and five described military Veterans Affairs (VA). Included studies revealed that nonwhite caregivers and white caregivers use different approaches and coping strategies in their caregiving role. Some studies found differences in caregiver burden by race or ethnicity, others did not. Most were limited by a small sample size and overdependence on assessment tools not validated for the purposes or populations for which they were used. This was particularly true for race/ethnicity as a factor in TBI caregiver burden in VA groups, where essential characteristics moderate the association of race/ethnicity with socioeconomic factors.

Conclusions: This scoping study highlights the paucity of information on race/ethnicity as a factor in TBI caregiver burden and roles, and suggests that innovative and alternative approaches to research are needed to explore needed changes in practice.

School satisfaction in parents of children with severe developmental disabilities

BACKGROUND

Previous research suggests parents' level of satisfaction with their child's school experience is highly variable. The present author explored school satisfaction in a Canadian sample of parents of children with severe and often complex developmental disabilities.

METHOD

Parents of 185 children completed questionnaires regarding their satisfaction with nine aspects of their child's school experience. Satisfaction was examined in relation to child's age, diagnosis of Autism, adaptive level, and maladaptive behaviour; parents' mental health difficulties and perception of caring burden; and the child's classroom type and level of clinical services at school.

RESULTS

School satisfaction was unrelated to parents' mental health or burden scores, was related to child's adaptive and maladaptive behaviour, as well as type of classroom placement.

CONCLUSIONS

It is important to understand what aspects of the school experience are influential for different children and families so that their experience can be optimized as far as possible.

Positive and negative experiences and life satisfaction among spousal caregivers for frail older adults in urban China: a parallel process model

OBJECTIVES

Previous literature has suggested that negative and positive aspects of spousal caregiving co-exist. However, positive and negative experiences were often examined independently. This study aimed to empirically test a parallel process model of spousal caregiving.

METHODS

This cross-sectional survey of family caregiving involved 269 frail older adults living in Shanghai, China, in 2016. Quota sampling was conducted to find community-dwelling frail older adults with a primary caregiver. Path analysis was used to identify the relationship between negative and positive caregiving experiences and life satisfaction.

RESULTS

We found two independent paths towards life satisfaction: (i) activities of daily living were negatively associated with burden, and burden was associated with lower life satisfaction; and (ii) spousal caregivers' self-reported health and financial state were positively associated with positive appraisal, and positive appraisal was associated with higher life satisfaction. Caregiving time contributed to both aspects of caregiving experiences. The covariance between caregiving burden and positive appraisals was not statistically significant.

CONCLUSION

Spousal caregiving involves a parallel process. Negative and positive experiences are separate constructs and their associations with life satisfaction vary. We advocate for policy and interventions that promote positive views of caregiving that encourage caregivers to develop a high level of overall life satisfaction despite the hardships of their caregiving tasks.

Randomized Controlled Trial of the Caregiver Orientation for Mobilizing Personal Assets and Strengths for Self-Care (COMPASS) for Caregiving Journey: A National Family Caregiver Support Program in a Long-Term Care Insurance System

OBJECTIVES

To investigate the effects of a national support program on family caregivers for long-term care (LTC) recipients.

DESIGN

A single-blinded randomized controlled trial compared the 8-week Caregiver Orientation for Mobilizing Personal Assets and Strengths for Self-Care (COMPASS) program consisting of 6 individual in-home, 3 group support, and 2 telephone sessions with a multicomponent intervention, and a control group.

SETTING AND PARTICIPANTS

In total, 969 caregivers who were living with LTC recipients assessed as having a high caregiving burden in 12 Korean cities.

MEASURES

The primary outcomes were depression, burden, and stress levels of caregivers, the secondary outcomes were caregiver self-efficacy, positive aspects of caregiving, social support, social activities, and health risk behaviors. These outcomes were measured at baseline and after the 8-week program, analyzed using modified intention-to-treat, per-protocol (PP), and non-PP analyses.

RESULTS

The modified intention-to-treat analysis revealed significant improvements in burden (effect size, = 0.010, P = .008), depression (η_p² = 0.012, P = .003), and health risk behaviors (η_p² = 0.010, P = .012) for the experimental group compared with the control group. However, there were no significant differences between the 2 groups in improving stress (P = .997), social support (P = .234), or social activities (P = .816). The PP analysis indicated that the COMPASS program was successful in increasing positive aspects of caregiving (η_p² = 0.013, P = .004) and self-efficacy (η_p² = 0.010, P = .032) compared with the control group.

CONCLUSIONS AND IMPLICATIONS

The COMPASS program was effective in family caregivers of LTC recipients in critical aspects of physical and psychological outcomes, especially in demonstrating the important role of participating in group support sessions. It is feasible for the program to become a formal national support program as part of the national insurance system in Republic of Korea.

Influence of Positive Aspects of Dementia Caregiving on Caregivers' Well-Being: A Systematic Review

BACKGROUND AND OBJECTIVES

There is a growing evidence base that informal caregivers can identify positive aspects of providing care and that this may have a beneficial influence on their well-being. The aim of this systematic review was to explore how positive aspects of caregiving (PAC) affects the well-being of caregivers of people with dementia.

RESEARCH DESIGN AND METHODS

We searched electronic databases for quantitative studies exploring the association between PAC and caregiver well-being. Studies were included if they involved informal (unpaid) caregivers of people with dementia, at least 75% of whom had to be residing in the community. A narrative synthesis was used to explore patterns within the data.

RESULTS

Fifty-three studies were included in the narrative synthesis. Most studies utilized a cross-sectional design. The majority of samples consisted primarily of spouses and female caregivers. Twenty different PAC measures were employed and studies referred to a variety of constructs, such as satisfactions, gains, meaning, and rewards. PAC was associated with lower depressive symptoms and burden. Conversely, PAC was associated with better mental health, quality of life, satisfaction with life, and competence/self-efficacy. PAC was not associated with self-rated health or personal strain/stress.

DISCUSSION AND IMPLICATIONS

The findings suggest that identifying PAC is associated with better caregiver well-being, although further longitudinal studies are required to explore how this relationship changes over time. Interventions that enable caregivers to gain a more positive experience of caregiving could be beneficial for their well-being.

Providing informal care next to paid work: explaining care-giving gratification, burden and stress among older workers

With an increasing retirement age, more older adults are combining employment with informal care-giving responsibilities. However, little is known about how older workers experience care-giving activities next to their paid jobs. This study aims to fill this gap by examining how the work situation (i.e. working hours, occupational status and perceived access to human resources practices) is associated with feelings of gratification, burden and stress in care-giving. Using data from the NIDI Pension Panel Survey, we study care-giving experiences – in other words, the extent to which care-giving activities are gratifying, burdensome or stressful – of 1,651 Dutch older workers (age 60–65) who provide care at least once per week. Multivariate analyses reveal that the work situation plays an explanatory role next to socio-demographic factors and indicators of the care-giving situation. Working care-givers who feel they have access to phased retirement and organisational health support experience care-giving as relatively less burdensome and stressful. Moreover, those with access to phased retirement experience relatively higher levels of gratification in care-giving. Our findings suggest that the availability of organisational support relates to lower levels of care-giving burden and stress, and to some extent to higher levels of gratification. Organisations thus play an important role in facilitating the combination of work and care-giving obligations in a context of longer working lives.

Conceptual Framework to Guide Intervention Research Across the Trajectory of Dementia Caregiving

This article presents a comprehensive conceptual framework designed to foster research in the changing needs of caregivers and persons with dementia as they move through their illness trajectory. It builds on prior theoretical models and intervention literature in the field, while at the same time addressing notable gaps including inadequate attention to cultural issues; lack of longitudinal research; focus on primary caregivers, almost to the exclusion of the person with dementia and other family members; limited outcome measures; and lack of attention to how the culture of health care systems affects caregivers' quality of life. The framework emphasizes the intersectionality of caregiving, sociocultural factors, health care systems' factors, and dementia care needs as they change across time. It provides a template to encourage longitudinal research on reciprocal relationships between caregiver and care recipient because significant changes in the physical and/or mental health status of one member of the dyad will probably affect the physical and/or mental health of the partner. This article offers illustrative research projects employing this framework and concludes with a call to action and invitation to researchers to test components, share feedback, and participate in continued refinement to more quickly advance evidence-based knowledge and practice in the trajectory of dementia caregiving.

Staging dementia based on caregiver reported patient symptoms: Implications from a latent class analysis

Background

Tailoring interventions to the needs of caregivers is an important feature of successful caregiver support programs. To improve cost-effectiveness, group tailoring based on the stage of dementia could be a good alternative. However, existing staging strategies mostly depend on trained professionals.

Objective

This study aims to stage dementia based on caregiver reported symptoms of persons with dementia.

Methods

Latent class analysis was used. The classes derived were then mapped with disease duration to define the stages. Logistic regression with receiver operating characteristic curve was used to generate the optimal cut-offs.

Results

Latent class analysis suggested a 4-class solution, these four classes were named as early (25.9%), mild (25.2%), moderate (16.7%) and severe stage (32.3%). The stages based on the cut-offs generated achieved an overall accuracy of 90.8% compared to stages derived from latent class analysis.

Conclusion

The current study confirmed that caregiver reported patient symptoms could be used to classify persons with dementia into different stages. The new staging strategy is a good complement of existing dementia clinical assessment tools in terms of better supporting informal caregivers.

Do Caregiver Experiences Shape End-of-Life Care Perceptions? Burden, Benefits, and Care Quality Assessment

CONTEXT

Researchers, hospices, and government agencies administer standardized questionnaires to caregivers for assessing end-of-life care quality. Caregiving experiences may influence end-of-life care quality reports, which have implications for caregiver outcomes, and are a clinical and policy priority.

OBJECTIVES

This study aims to determine whether and how caregivers' end-of-life care assessments depend on their burden and benefit perceptions.

METHODS

This study analyzes data from 391 caregivers in the 2011 National Study of Caregiving and their Medicare beneficiary care recipients from the 2011-2016 National Health and Aging Trends Study. Caregivers assessed five end-of-life care aspects for decedents. Logistic regression was used and predicted probabilities of caregivers positively or negatively assessing end-of-life care based on their burden and benefit experiences calculated. Analyses adjusted for caregiver and care recipient demographic and health characteristics.

RESULTS

No or minimal caregiving burden is associated with ≥0.70 probability of caregivers reporting they were always informed about the recipient's condition and that the dying person's care needs were always met, regardless of perceived benefits. High perceived caregiving benefit is associated with ≥0.80 probability of giving such reports, even when perceiving high burden.

CONCLUSION

Caregiver burden and benefit operate alongside one another regarding two end-of-life care evaluations, even when years elapse between caregiver experience reports and care recipient death. This suggests that caregiver interventions reducing burden and bolstering benefits may have a positive and lasting impact on end-of-life care assessments.

Multiple Chronic Conditions in Spousal Caregivers of Older Adults With Functional Disability: Associations With Caregiving Difficulties and Gains

OBJECTIVES

Multiple chronic conditions (MCCs) are common and have harmful consequences in later life. Along with managing their own health, many aging adults care for an impaired partner. Spousal caregiving may be more stressful when caregivers have MCCs, particularly those involving complex management. Yet, little is known about combinations of conditions that are most consequential for caregiving outcomes.

METHOD

Using a U.S. sample of 359 spousal caregivers and care recipients from the 2011 National Aging Trends Study and National Study of Caregiving, we examined three categories of MCCs based on similarity of management strategies (concordant only, discordant only, and both concordant and discordant) and their associations with caregiving difficulties and gains. We also considered gender differences.

RESULTS

Relative to caregivers without MCCs, caregivers with discordant MCCs reported fewer gains, whereas caregivers with both concordant and discordant MCCs reported greater emotional and physical difficulties. Wives with discordant MCCs only reported a trend for greater physical difficulties. Caregivers with concordant MCCs did not report more difficulties or gains.

DISCUSSION

Spousal caregivers with MCCs involving discordant management strategies appear to be at risk for adverse care-related outcomes and may benefit from support in maintaining their own health as well as their caregiving responsibilities.

Explaining the Gender Gap in the Caregiving Burden of Partner Caregivers

Objectives

We examine gender differences in the experienced burden of partner caregivers using the stress-appraisal model. Gender differences can be explained by differences in conditions of burden (primary stressors, help from others, hours of caregiving, and secondary stressors) and how strong their effects are.

Method

The data are from the Netherlands’ Older Persons and Informal Caregivers Survey—Minimum Data Set (N = 1,611 caregivers). We examine mediation and moderation effects using structural equation modeling.

Results

Women experience greater partner caregiver burden than men, which is related to women experiencing more secondary stressors (relational and financial problems, problems combining different tasks). For women and men alike, there is a positive association between burden and more primary stressors (partner’s care need indicated by health impairment), help from other caregivers, and secondary stressors. For male caregivers, caregiving intensity also contributes to a greater burden.

Discussion

This study corroborates the structural impact of gender on the conditions of as well as their effects on the partner caregiver burden. Reducing the hours of caregiving for male caregivers in severe care situations and helping female and male caregivers deal emotionally with the caregiving situation can reduce the partner caregiver burden.

An empowerment program for family caregivers of people with dementia

OBJECTIVES

Family caregivers of people with dementia (PWD) often feel powerless and experience decreased well-being. Our aim was to develop an intervention program based on the caregiver empowerment model (CEM) and apply it with the Korean caregivers to evaluate its effects.

DESIGN AND SAMPLE

The study population comprised 115 family caregivers (experimental group, n = 35, control group 1, n = 40, control group 2, n = 40).

METHODS

Using an experimental design with two control groups. The experimental group received a 12-week program including intensive counseling, education, and telephone calls. The control group 1 (CG1) received usual service. The control group 2 (CG2) was provided with a handbook during the first week. A mixed-effects model was used to clarify longitudinal changes in participants' outcomes.

RESULTS

The experimental group showed significantly increased caregiving appraisal (effect size in CG1 = -7.25; CG2 = -5.63), caregiving attitude (CG1 = -21.47; CG2 = -17.79), self-efficacy (CG1 = -12.42; CG2 = -10.12), and well-being (CG1 = -4.33; CG2 = -2.35) after the program.

CONCLUSIONS

The empowerment program can be used to promote family caregivers' positive adaptation and to help caregivers who care for PWD to effectively cope with their problems.

The Burden and Benefits of Caregiving: A Latent Class Analysis

BACKGROUND AND OBJECTIVES

Informal caregiving to older adults is a key part of the U.S. long-term care system. Caregivers' experiences consist of burden and benefits, but traditional analytic approaches typically consider dimensions independently, or cannot account for burden and benefit levels and combinations that co-occur. This study explores how benefits and burden simultaneously shape experiences of caregiving to older adults, and factors associated with experience types.

RESEARCH DESIGN AND METHODS

2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC) data were linked to obtain reports from caregivers and recipients. Latent class and regression analysis were conducted on a nationally representative sample of U.S. informal caregivers to older persons.

RESULTS

Five distinguishable caregiving experiences types and their population prevalence were identified. Subjective burden and benefits level and combination uniquely characterize each group. Primary stressors (recipient depression, medical diagnoses), primary appraisal (activities of daily living, instrumental activities of daily living, medical task assistance, hours caregiving), and background/contextual factors (caregiver age, race, relationship to recipient, mental health, coresidence, long-term caregiving) are associated with experience types.

DISCUSSION AND IMPLICATIONS

Findings highlight caregivers' experience multiplicity and ambivalence, and identify groups that may benefit most from support services. In cases where it is not possible to reduce burden, assistance programs may focus on increasing the benefits perceptions.

Caregiving for Older Adults Requiring Hemodialysis: A Comparison Study

This study examined differences in caregiving appraisal between primary family caregivers of disabled older adults receiving hemodialysis (PFCGs-wHD) and disabled older adults not receiving dialysis (PFCGs-woD). A total of 242 PFCGs-wHD and 335 PFCGs-woD were included in the analyses. We used adjustment by propensity score to control for bias by confounding factors. Caregiving appraisal was measured in terms of role strain, emotional exhaustion, and caregiving satisfaction. On the first task, PFCGs-wHD demonstrated significantly worse levels on all three appraisal indicators than did PFCGs-woD. On the second task, only higher emotional exhaustion was significantly mediated by higher role strain in PFCGs-wHD. Further, PFCGs-wHD status directly influenced lower caregiving satisfaction without mediation by higher role strain. Caregiving for disabled older adults receiving HD may be associated with significant challenges for caregivers.

Purpose in Life Among Family Care Partners Managing Dementia: Links to Caregiving Gains

BACKGROUND AND OBJECTIVES

Purpose in life is associated with better health and has been found to minimize caregiving stress. Greater purpose may also promote caregiving gains (i.e., rewards or uplifts from providing care), yet the implications of purpose for positive aspects of the care role are largely unknown. The present study determined how perceptions of purpose in life among persons with dementia (PWDs) and their family caregivers are linked to caregiving gains.

RESEARCH DESIGN AND METHODS

This cross-sectional study examined 153 co-resident family caregivers drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate associations between caregivers' and PWDs' reports of their own purpose in life and caregivers' perceived caregiving gains, along with whether these associations vary by caregiver gender. Models controlled for caregivers' sociodemographic characteristics, relationship to the PWD, care tasks, role overload, negative caregiving relationship quality, and both care partners' chronic health conditions.

RESULTS

Caregivers' higher purpose in life was significantly linked to greater caregiving gains. Beyond this association, PWDs' higher purpose in life was significantly associated with greater caregiving gains for women but not for men.

DISCUSSION AND IMPLICATIONS

Purpose in life is a psychological resource that contributes to positive caregiving outcomes. Interventions to improve caregiver well-being could benefit from strategies that strengthen and maintain feelings of purpose among caregivers and PWDs.

The impact of caregiving on caregivers of older persons and its associated factors: a cross-sectional study

INTRODUCTION

Many older people rely on caregivers for support. Caring for older people can pose significant burdens for caregivers yet may also have positive effects. This study aimed to assess the impact on the caregivers and to determine factors associated with caregivers who were burdened.

METHODS

This was a cross-sectional study of 385 caregivers of older people who attended a community clinic in Malaysia. Convenience sampling was employed during the study period on caregivers who were aged ≥ 21 years and provided ≥ 4 hours of unpaid support per week. Participants were asked to complete a self-administered questionnaire, which included the Carers of Older People in Europe (COPE) index and the EASYCare Standard 2010 independence score. The COPE index was used to assess the impact of caregiving. A highly burdened caregiver was defined as one whose scores for all three COPE subscales were positive for burden. Care recipients' independence was assessed using the independence score of the EASYCare Standard 2010 questionnaire. Multiple logistic regression was used to determine the factors associated with caregiver burden.

RESULTS

73 (19.0%) caregivers were burdened, of whom two were highly burdened. Caregivers' median scores on the positive value, negative impact and quality of support scales were 13.0, 9.0 and 12.0, respectively. Care recipients' median independence score was 18.0. Ethnicity and education levels were found to be associated with caregiver burden.

CONCLUSION

Most caregivers gained satisfaction and felt supported in caregiving. Ethnicity and education level were associated with a caregiver being burdened.

Caregiving to Older Adults: Determinants of Informal Caregivers' Subjective Well-being and Formal and Informal Support as Alleviating Conditions

Objectives

In response to concerns about the sustainability of health care systems that increasingly rely on informal care, we first investigate explanations of informal caregivers' subjective well-being: primary stressors (care-receivers' cognitive impairment, functional disability, and problem behavior), primary appraisal (hours of informal caregiving), and secondary appraisal (burden). Second, we investigate the extent that formal (professional home care) and informal support (from other caregivers/volunteers and from family/friends) alleviate well-being losses due to informal care provision. We modified the stress-appraisal model to explicitly include buffering effects of support.

Method

We analyzed 4,717 dyads of Dutch informal caregivers and their older care-receivers from the Older Persons and Informal Caregivers Survey Minimum DataSet with multilevel techniques.

Results

Caregivers' subjective well-being was directly correlated with burden, hours of informal caregiving, and problem behavior of care-receivers. It was indirectly correlated with care-receivers' cognitive impairment and functional disability. Formal and informal support weakened the positive relationship between primary stressors and caregiving hours.

Discussion

Modification of the stress-appraisal model appears useful as it identifies which sources of support buffer at which stages of the stress process. Findings suggest that cutbacks in formal/professional care may aggravate negative well-being outcomes of informal caregiving and compromise informal caregivers' labor market participation.

Determining the caregivers' burden in caregivers of patients with mental illness

Objective:

To examine the factors associated with caregivers’ burden in individuals providing care to family members suffering from serious mental illness.

Methods:

This Cross Sectional Study was carried out at Armed Forces Institute of Mental Health, Rawalpindi, from May 2015 to December 2015. A purposive sample of 120 family caregivers (60 males and 60 females, age range= 18-65) who were taking care of patients with serious mental illness (i.e. Major Depressive Disorder, Bipolar Disorder & Schizophrenia) for at least one year were recruited from the hospital and assessed through Zarit Burden Interview (ZBI) and Brief COPE inventory. The decline in functional status, and diminished physical capacity compromising the independent living of the care recipient was assessed through Katz Index of Independence in Activities of daily living (ADL) and Lawton Instrumental activities of daily living (IADL).

Results:

The results suggest that the longer the duration of illness (F=25.71, p < 0.01), with increased impairments of care-recipients, (decline in functional status, F=21.33, p < 0.001; diminished physical capacity F =32.41, p < 0.001) the more the burden experienced by the caregivers. Moreover, caregivers who were married (t=-2.98, p < .01), less educated (t =5.48, p < .01), lived in rural area (t = -7.99, p < .01), had lower monthly income (t = -4.95, p < .01) provide longer hours of caregiving (F=19.12, p < 0.001) and used avoidant coping behavior (F= 56.37, p < 0.001) reported significantly higher caregiver burden than caregivers who were unmarried, more educated, lived in urban area and had better income.

Conclusion:

The results of study demonstrate that caring for family members with serious mental illness impacts the caregivers’ wellbeing. It, therefore, highlights the need for support and counseling services for the caregivers to reduce the burden of caring.

Informal Caregiver Burnout? Development of a Theoretical Framework to Understand the Impact of Caregiving

Informal caregiving is a rewarding but demanding role. The present theoretical framework proposes to adapt the tridimensional concept of burnout to informal caregiving as a way to address the potential consequences of caregiving. This adaptation reflects caregivers' reported difficulties, as well as empirical findings on emotional exhaustion, depersonalization, and personal accomplishment as caregiving outcomes. But to understand burnout in informal caregiving contexts, it is also necessary to find ways to model it. The Informal Caregiving Integrative Model (ICIM) is thus proposed. This model is based on the integration of elements from literature on both informal caregiving stress and professional burnout. The goal of the ICIM is to emphasize the importance of every category of determinants of informal caregiver burnout (i.e., relating to the caregiver, the caregiving setting, and the sociocultural context), with a key mediating role for the caregivers' appraisal of their situation and their relationship with the care-recipient. This article is a first integrative step in the consideration of a form of burnout specific to informal caregivers and supports the design of empirical and interventional studies based on the theoretical foundation that the ICIM proposes.

Factors related to sense of competence in family caregivers of people living with dementia in the community: a narrative synthesis

ABSTRACTObjectives:Sense of competence defines a caregiver's feeling of being capable to manage the caregiving task and is an important clinical concept in the caregiving literature. The aim of this review was to identify the factors, both positive and negative, associated with a caregiver's perception of their sense of competence.

DESIGN

A systematic review of the literature was conducted, retrieving both quantitative and qualitative papers from databases PsycINFO, CINAHL, EMBASE, and Medline. A quality assessment was conducted using the STROBE and CASP checklists, and the quality rating informed the inclusion of papers ensuring the evidence was robust. Narrative synthesis was employed to synthesize the findings and to generate an updated conceptual model of sense of competence.

RESULTS

Seventeen papers were included in the review, all of which were moderate to high quality. These included 13 quantitative, three mixed-methods and one qualitative study. Factors associated with sense of competence included: behavioral and psychological symptoms of dementia (BPSD), caregiver depression, gratitude, and the ability to find meaning in caregiving.

CONCLUSIONS

The results of this review demonstrate that both positive and negative aspects of caring are associated with caregiver sense of competence. Positive and negative aspects of caregiving act in tandem to influence caregiver perception of their competence. The proposed model of sense of competence aims to guide future research and clinical interventions aimed at improving this domain but requires further testing, as due to the observational nature of the include papers, the direction of causality could not be inferred.

The association between subjective caregiver burden and depressive symptoms in carers of older relatives: A systematic review and meta-analysis

BACKGROUND

Family carers are an important source of care for older people. Although several studies have reported that subjective caregiver burden is related to depressive symptoms there are no systematic reviews quantifying this association.

OBJECTIVE

To establish the extent to which subjective caregiver burden is associated with depressive symptoms and whether this association would vary by study or care characteristics.

METHODS

We searched major databases such as PubMed, CINAHL, PsycINFO, Scopus and ISI Proceedings up to March 2018, and conducted a meta-analysis of included studies. Summary estimates of the association were obtained using a random-effects model to improve generalisation of findings.

RESULTS

After screening of 4,688 articles, 55 studies were included providing a total of 56 independent comparisons with a total of 9,847 carers from data across 20 countries. There was a large, positive association between subjective caregiver burden and depressive symptoms ([Formula: see text] = 0.514; 95% CI = 0.486, 0.541), with very low heterogeneity amongst individual studies (I2 = 8.6%). Sensitivity analyses showed no differences between cross-sectional or repeated measures ([Formula: see text] = 0.521; 95% CI = 0.491, 0.550; 51 samples) and longitudinal studies ([Formula: see text] = 0.454; 95% CI = 0.398, 0.508; 6 samples). We found a higher effect size for those caring for people living with dementia compared to those caring for frail older people, and stroke survivors. Carer sex, age and kinship did not change the estimate of the effect.

CONCLUSIONS

Subjective caregiver burden is a significant risk factor for depressive symptoms in carers of older people and may precipitate clinical depression. Those caring for people with dementia experience greater burden. There is a need for longitudinal evaluations examining the effects of potential mediators of the association of subjective burden and depressive symptoms. Future interventions should test whether minimizing subjective burden may modify the risk of developing depression in carers of older relatives.

How parents describe the positive aspects of parenting their child who has intellectual disabilities: A systematic review and narrative synthesis

Background

Identifying what parents describe to be positive about parenting their child who has intellectual disabilities is important for professional practice and how parents can be supported over a lifespan.

Methods

Studies in which parents describe the positive aspects of parenting their child with intellectual disabilities were identified via electronic databases searches and analysed in a narrative synthesis.

Results

Twenty‐two studies were included. Consistent themes emerged relating to positive change, increased personal strength, growth and development largely related to parental intrapersonal orientation. Several studies emphasized that the presence of growth or positive change does not imply the absence of distress.

Conclusions

Positive aspects are not consistently defined and measured differently across studies. Consistent themes are described variously attributed to theories relating to coping, adaptation or growth following adversity; however, no single theoretical framework emerged. Factors likely to predict a parent's ability to identify positive aspects are inconclusive.

Does the Disease of the Person Receiving Care Affect the Emotional State of Non-professional Caregivers?

Research on mental health of non-professional caregivers has focused on caregivers of people with specific diseases, especially dementia. Less is known about caregivers of people with other diseases. The aims of this study were (a) to determine the caregivers’ emotional state in a random sample of caregivers of people in situations of dependency, (b) to analyze the association between each disease of the care-recipient (a variety of 23 diseases included in the International Classification of Diseases) and the emotional state of the caregiver, and (c) based on the theoretical model, to analyze the relationship of the different study variables in the appearance of the emotional distress of the caregiver. A sample of 491 non-professional caregivers was selected randomly (89.0% women, average age 55.3 years). Trained psychologists collected sociodemographic and care-related characteristics and evaluated the global emotional distress, somatic symptoms, anxiety-insomnia, social dysfunction, depression, probable mental disorder case, self-esteem, and social support. It was found that (a) the caregivers showed moderate emotional distress, and 33.8% presented a probable mental disorder. (b) Caring for a care-recipient with cat’s cry syndrome or epilepsy was related to suffering from social dysfunction, and caring for a care-recipient with autism was related to having a probable mental health case. (c) Social support mediated the relationship between social class, daily hours of care, monthly family income, self-esteem and global emotional distress. There is an important impact on the emotional state of the caregivers. This impact was similar in caregivers of care-recipients with different diseases, except in caregivers caring for a care-recipient with cat’s cry syndrome or epilepsy (related to social dysfunction), and in caregivers caring for a care-recipient with autism (related to having a probable mental health case).

The TBI-CareQOL Measurement System: Development and Preliminary Validation of Health-Related Quality of Life Measures for Caregivers of Civilians and Service Members/Veterans With Traumatic Brain Injury

OBJECTIVE

To develop a new measurement system, the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL), that can evaluate both general and caregiving-specific aspects of health-related quality of life (HRQOL) in caregivers of persons with traumatic brain injury (TBI).

DESIGN

New item pools were developed and refined using literature reviews, qualitative data from focus groups, and cognitive debriefing with caregivers of civilians and service members/veterans with TBI, as well as expert review, reading level assessment, and translatability review; existing item banks and new item pools were assessed using an online data capture system. Exploratory and confirmatory factor analysis, item response theory, and differential item functioning analyses were utilized to develop new caregiver-specific item banks. Known-groups validity was examined using a series of independent samples t tests comparing caregivers of low-functioning vs high-functioning persons with TBI for each of the new measures, as well as for 10 existing Patient-Reported Outcomes Measurement Information System (PROMIS) measures.

SETTING

Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.

PARTICIPANTS

Caregivers (N=560) of civilians (n=344) or service members/veterans with TBI (n=216).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The TBI-CareQOL measurement system (including 5 new measures and 10 existing PROMIS measures).

RESULTS

Exploratory and confirmatory factor analysis, item response theory, and differential item functioning analyses supported the development of 5 new item banks for Feelings of Loss-Self, Feelings of Loss-Person with TBI, Caregiver-Specific Anxiety, Feeling Trapped, and Caregiver Strain. In support of validity, individuals who were caring for low-functioning persons with TBI had significantly worse HRQOL than caregivers that were caring for high-functioning persons with TBI for both the new caregiver-specific HRQOL measures, and for the 10 existing PROMIS measures.

CONCLUSIONS

The TBI-CareQOL includes both validated PROMIS measures and newly developed caregiver-specific measures. Together, these generic and specific measures provide a comprehensive assessment of HRQOL for caregivers of civilians and service members/veterans with TBI.

The caregiving dyad: Do caregivers' appraisals of caregiving matter for care recipients' health?

Caregiving experiences matter for caregivers' own wellbeing, but few studies link caregivers' burden and benefit perceptions with recipient outcomes. Following the stress process model, I prospectively explore how caregivers' experiences shape recipients' mental health. I match US National Health and Aging Trends Study and National Study of Caregivers, employing logistic regression on 781 older adult-informal caregiver dyads. I examine how caregivers' appraisals shape recipients' subsequent depression and anxiety, with caregiver mental health and recipient unmet care need as key covariates. Recipients receiving care from caregivers reporting predominantly benefits are less likely to become depressed than counterparts receiving care from persons reporting predominantly burden. Recipients receiving care from persons reporting benefits even alongside low or moderate burden are also less likely to become anxious. Recipient unmet care need, but not caregiver mental health, is associated with recipient mental health. Improving caregiver conditions may have benefits for both dyad members.

Psychological Interventions for Dementia Caregivers: What We Have Achieved, What We Have Learned

With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver's ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, the use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts has received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined.

Caregiving Appraisal by Family Caregivers of Stroke Survivors in Nigeria

Introduction: Attending to caregiving experiences of family caregivers of stroke survivors is important in person-centered stroke rehabilitation. This study explored caregiving appraisals by family caregivers of stroke survivors in Nigeria. Methods: A cross-sectional survey of family caregivers' negative and positive appraisals of caregiving was conducted using the 24-item 4-domain revised Caregiving Appraisal Scale (rCAS). Mann Whitney U and Kruskal-Wallis tests were used to identify differences in caregiving appraisals based on specific caregiver and stroke survivor variables. Results: Seventy-three caregiver and care recipient dyads participated in the study. Mean age of the caregivers was 31.51 (9.82) years. From a score of 5, and higher scores depicting higher appraisal, mean (SD) score for caregiving satisfaction and caregiving mastery (positive appraisal domains) was 4.23 (0.97) and 4.04 (0.92) respectively while 2.29 (0.98) and 2.11 (0.93) were respectively recorded for caregiving burden and environmental impact (negative appraisal). Caregivers' gender, age, and employment status resulted in significantly different appraisals with female caregivers having higher caregiving mastery (U = 446, P<0.05), caregiving satisfaction (U = 384.5, P<0.01), and also caregiving burden (U = 382.5, P<0.01) compared to their male counterparts; while older (U = 330; P<0.05) and employed (U = 437.5, P<0.05) family caregivers reported higher caregiving satisfaction and burden respectively than younger and unemployed family caregivers. Conclusion: Given the comparatively higher positive caregiving appraisal, and the documented benefits of positive caregiving appraisal, efforts should be geared towards identifying effective means of reinforcing positive appraisal, and reducing negative stroke caregiving appraisal, especially for female, older and employed family caregivers.

Positive Caregiving Characteristics as a Mediator of Caregiving Burden and Satisfaction With Life in Caregivers of Older Adults

BACKGROUND

Satisfaction with life is recognized to be a factor in alleviating burden in stressful caregiving duties. However, the mechanism underlying this relationship is indistinct. Positive aspects of caregiving (PAC) may help to regulate caregiving burden among caregivers of older adults. The study aims to examine whether positive caregiving characteristics mediate the effect between satisfaction with life and burden of care.

METHODS

Participants were 285 caregivers of older adults (aged 60 and above) in Singapore and were recruited in a cross-sectional, self-report study (mean [M] = 47.0 years; 64.6% females). Measures included in the study were the Zarit Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), and the Satisfaction with Life Scale (SWLS). Mediation analyses were used to study the indirect effects of life satisfaction on caregiver burden through features of PAC.

RESULTS

Mean scores for the ZBI, PAC, and SWLS scales were M = 23.15 (standard deviation [SD] = 15.98), M = 34.55 (SD = 8.19), and M = 23.56 (SD = 6.62) respectively. Results from the mediation analysis revealed that the association between life satisfaction and caregiving burden was significantly mediated by the PAC ( P < .001).

DISCUSSION

Positive aspects of caregiving may be a mechanism that links satisfaction with life and caregiver burden. Findings may represent attempts to manage caregiving duties as well as maintaining a positive attitude toward their responsibilities.

Correlates of Positive Aspects of Caregiving Among Family Caregivers of Patients with Acute Myeloblastic Leukaemia

To evaluate the positive aspects of caregiving and its sociodemographic and clinical correlates in family caregivers of patients with Acute Myeloblastic Leukaemia (AML). A total of 30 caregivers of the patients with AML were evaluated on the Scale for Positive Aspects of Caregiving Experience (SPACE), Family Burden Interview (FBI) and Schedule and Caregiver Strain Index (CSI). On the SPACE, the mean score was highest for the domain of motivation for the caregiving role, followed by the domain of 'caregiving personal gains', 'caregiver satisfaction' and least score was seen in the domain of 'self-esteem and social aspect of caring'. All the SPACE domains were negatively correlated with financial burden, disruption of routine family activities, disruption of family interaction, physical health and subjective burden domains of FBI. Effect on physical health of others domain of FBI correlated negatively with all domains of SPACE except 'self esteem and social aspect of caregiving'. FBI total objective burden was negatively correlated with motivation for caregiving role, caregiver satisfaction and total SPACE score. All SPACE domains were negatively correlated with adaptation and inconvenience domains and total CSI score. Lower level of positive caregiving experience is reported by caregivers who experience high level of caregiver burden.

The Impact of a Care Recipient's Pet on the Instrumental Caregiving Experience

Older adults report strong emotional bonds with their pets which often become increasingly important as health declines and dependence upon others increases. Individuals requiring assistance meeting their own needs are likely to need assistance in meeting the needs of their pet. The care recipient's pet may be an important, though presently overlooked, factor in the caregiving experience. This study measured the amount of care tasks/ activities informal caregivers of older adults devoted to their care recipients' pet. Caregivers for an individual aged 50 and older who did not consider the care recipient's pet to be his/her own animal completed an online questionnaire. Descriptive statistics and Pearson correlations were used in analyses. Caregivers (N = 34) performed an average of 14.9 (SD = 5.4) different pet care tasks/activities and an average of 11.21 (SD = 1.33) hours per week in pet care. The total number of tasks/activities performed was significantly and positively correlated with the care recipients' degree of functional limitation (r = 0.49, p = 0.004). Care recipients' pets may be a significant factor in shaping the instrumental caregiving experience.

'Who Cares?' The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease and coronary artery disease: a mixed methods systematic review

OBJECTIVE

To assess the experiences of unpaid caregivers providing care to people with heart failure (HF) or chronic obstructive pulmonary disease (COPD) or coronary artery disease (CAD). Design Mixed methods systematic review including qualitative and quantitative studies. Data sources Databases searched: Medline Ebsco, PsycInfo, CINAHL Plus with Full Text, Embase, Web of Science, Ethos: The British Library and ProQuest. Grey literature identified using: Global Dissertations and Theses and Applied Sciences Index and hand searches and citation checking of included references. Search time frame: 1 January 1990 to 30 August 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion was limited to English language studies in unpaid adult caregivers (>18 years), providing care for patients with HF, COPD or CAD. Studies that considered caregivers for any other diagnoses and studies undertaken in low-income and middle-income countries were excluded. Quality assessment of included studies was conducted by two authors.

DATA ANALYSIS/SYNTHESIS

A results-based convergent synthesis was conducted.

RESULTS

Searches returned 8026 titles and abstracts. 54 studies-21 qualitative, 32 quantitative and 1 mixed method were included. This totalled 26 453 caregivers who were primarily female (63%), with median age of 62 years. Narrative synthesis yielded six concepts related to caregiver experience: (1) mental health, (2) caregiver role, (3) lifestyle change, (4) support for caregivers, (5) knowledge and (6) relationships. There was a discordance between paradigms regarding emerging concepts. Four concepts emerged from qualitative papers which were not present in quantitative papers: (1) expert by experience, (2) vigilance, (3) shared care and (4) time.

CONCLUSION

Caregiving is life altering and complex with significant health implications. Health professionals should support caregivers who in turn can facilitate the recipient to manage their long-term condition. Further longitudinal research exploring the evolution of caregiver experiences over time of patients with chronic cardiopulmonary conditions is required.

TRIAL REGISTRATION NUMBER

CRD42016053412.

Caregiver burden in Alzheimer's disease: Moderation effects of social support and mediation effects of positive aspects of caregiving

OBJECTIVES

Although there are many studies on the relationship between patient-related factors and negative caregiver outcomes, the specifics of this relationship are poorly understood. We aimed to examine whether caregiver social support moderated the relationship between patient factors and negative outcomes for caregivers of community-dwelling older adults with Alzheimer's disease (AD), and whether positive aspects of caregiving mediated this relationship.

METHODS

We conducted a cross-sectional study of patients diagnosed with AD from 2 hospitals and 3 communities in Taiyuan, China, and their caregivers. Latent moderated structural equations and the bias-corrected percentile bootstrap method were used to estimate the parameters of moderating and mediating effects, respectively.

RESULTS

Social support significantly moderated the effects of AD patient cognitive function (P < 0.001) and depression (P = 0.001) on caregiver burden. Positive aspects of caregiving completely mediated the association between patient depression and caregiver burden (P = 0.006), caregiver anxiety (P = 0.007), and caregiver depression (P = 0.034).

CONCLUSIONS

The findings identify social support as a moderator and positive aspects of caregiving as a mediator of the relationship between patient-related factors and negative caregiver outcomes. The results suggest that health care providers must offer more effective social support for caregivers. In addition, prompt identification of patient and caregiver emotional states could help to improve quality of life.

Exploration of Factors Related to Depressive Symptomatology in Family Members of Military Veterans With Traumatic Brain Injury

Traumatic brain injury (TBI) is a family affair, affecting those with the injury and their families. Psychological distress, often measured as depression or depressive symptoms, is highly prevalent among family members. Predictors of depression in family members of civilians with TBI have been examined, but predictors of depression in family members of military veterans have received very little research attention and are poorly understood. To address the knowledge gap, this study explored factors related to depressive symptoms in family members of veterans in the United States, using an ecological framework. Baseline data from 83 family members were used. Family members with higher caregiver burden, presence of a veteran with posttraumatic stress disorder (PTSD), and greater financial difficulty experienced significantly more depressive symptoms. Findings suggest that efforts to support family members and decrease their depression should aim to reduce caregiver burden and financial difficulty, and help family members cope with veteran PTSD and TBI. Family-focused interventions are needed.

The roles of unmet needs and formal support in the caregiving satisfaction and caregiving burden of family caregivers for persons with dementia

ABSTRACTBackground:A growing number of studies are emphasizing the importance of positive and negative appraisals of caregiving and the utilization of social resources to buffer the negative effects of caring for persons with dementia. By assessing the roles of unmet needs and formal support, this study tested a hypothesized model for Korean family caregivers' satisfaction and burden in providing care for persons with dementia.

METHODS

The stress process model and a two-factor model were used as the conceptual framework for this study. Data for 320 family caregivers from a large cross-sectional survey, the Seoul Dementia Management study, were analyzed using structural equation modeling. In the hypothesized model, the exogenous variables were patient symptoms, including cognitive impairment, behavioral problems, and dependency on others to help with activities of daily living and with instrumental activities of daily living. The endogenous variables were the caregiver's perception of the unmet needs of the patient, formal support, caregiving satisfaction, and caregiving burden.

RESULTS

The adjusted model explained the mediating effect of unmet needs on the relationship between patient symptoms or formal support and caregiving satisfaction. Formal support also had a mediating effect on the relationship between patient symptoms and unmet needs. Patient symptoms and caregiving satisfaction had a significant direct effect on caregiving burden.

CONCLUSION

The level of unmet needs of persons with dementia and their family caregivers must be considered in the development of support programs focused on improving caregiving satisfaction.

What seems to matter in public policy and the health of informal caregivers? A cross-sectional study in 12 European countries

In Europe, informal caregiving is frequent and is expected to grow. Caregiving has an impact on caregivers’ health, but its effect may vary according to the policies of support that are available to caregivers. The aim of this study was to assess the association between the policies of support to caregivers available in 12 European countries and the health of caregivers, considering separately the policies based on financial help and those based on training and other non- financial services. We used data from 13,507 caregivers from 12 European countries from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to build a path model. Poor health among caregivers was associated with living in a family-based care country (β = 0.50; 95% CI = 0.42–0.59), and with an increased extent of caregiving (β = 0.18; 95% CI = 0.15–0.22). Non-financial support measures seem to have a larger protective impact (β = –0.33; 95% CI = –0.38 - –0.28) on the health of caregivers than do financial support measures (β = 0.03; 95% CI = 0.01–0.04), regardless of the gender of the caregiver. According to our results, the currently available policies of support associated with better health among caregivers are those that: 1) provide them with some free time, 2) help them to deal emotionally with caregiving, and 3) give them skills to both improve the care situation and to deal with it better.

[Assessment of the sense of coherence in the perceived burden and in the adherence to a psycho-educational program for informal caregivers of dependent persons]

INTRODUCTION

The care of dependent persons is arduous, and requires time, energy, and physical effort on the part of caregivers. Personal characteristics, such as the sense of coherence (SOC), can influence the perceived burden and care giving.

OBJECTIVE

To determine the impact of SOC on the perceived burden and to determine if these characteristics are associated with adherence to a psycho-educational program for informal caregivers.

MATERIAL AND METHOD

Prospective observational study of caregivers of dependent persons participating in the 'School of Caregivers', a psycho-educational program for family and paid caregivers. An analysis was made of the SOC-13 items and the results of the Zarit Burden Interview. The relationship between the SOC and the adherence to the program (≥50% sessions) was also analysed.

RESULTS

The study included 96 participants, with 71.9% family carers. The higher burden was associated with a lower SOC meaningfulness factor (β=-0.388; P=.002), and to be a relative vs. paid carer (β=-0.300; P=.010). Just over half (52.1%) of carers completed 50% or more sessions, and in the case of the relatives, this adherence increased by higher SOC (OR: 1.1, P=.034), and lower burden (OR: 0.95, P=.032). The lack of adherence of paid caregivers was not associated with any of the analysed variables.

CONCLUSIONS

The sense of coherence and mainly the meaning, is a characteristic to take into account for the adaptation of interventions in caregivers and provide them with greater equity working more on the people who need it the most (lower SOC and greater burden).