A meta-review of stress, coping and interventions in dementia and dementia caregiving

Carer-reported measures for a dementia registry: A systematic scoping review and a qualitative study

OBJECTIVES

Informal carers play a critical role in supporting people with dementia. We conducted a scoping review and a qualitative study to inform the identification and development of carer-reported measures for a dementia clinical quality registry.

METHODS

Phase 1-Scoping review: Searches to identify carer-reported health and well-being measures were conducted in three databases (MEDLINE, PsycINFO and Embase). Data were extracted to record how the measures were administered, the domains of quality-of-life addressed and whether they had been used in a registry context. Phase 2-Qualitative study: Four focus groups were conducted with carers to examine the acceptability of selected measures and to identify outcomes that were important but missing from these measures.

RESULTS

Phase 1: Ninety-nine carer measures were identified with the top four being the Zarit Burden Interview (n = 39), the Short-Form12/36 (n = 14), the Brief Coping Orientation to Problems Experienced scale and the Sense of Coherence scale (both n = 9). Modes of administration included face-to-face (n = 50), postal (n = 11), telephone (n = 8) and online (n = 5). No measure had been used in a registry context. Phase 2: Carers preferred brief measures that included both outcome and experience questions, reflected changes in carers' circumstances and included open-ended questions.

CONCLUSIONS

Carer-reported measures for a dementia clinical quality registry need to include both outcome and experience questions to capture carers' perceptions of the process and outcomes of care and services. Existing carer-reported measures have not been used in a dementia registry context and adaption and further research are required.

Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia

Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.

Italian guidance on Dementia Day Care Centres: A position paper

Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient.

Neighborhood infrastructure-related risk factors and non-communicable diseases: a systematic meta-review

BACKGROUND

With rapid urbanization, the urban environment, especially the neighborhood environment, has received increasing global attention. However, a comprehensive overview of the association between neighborhood risk factors and human health remains unclear due to the large number of neighborhood risk factor-human health outcome pairs.

METHOD

On the basis of a whole year of panel discussions, we first obtained a list of 5 neighborhood domains, containing 33 uniformly defined neighborhood risk factors. We only focused on neighborhood infrastructure-related risk factors with the potential for spatial interventions through urban design tools. Subsequently, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic meta-review of 17 infrastructure-related risk factors of the 33 neighborhood risk factors (e.g., green and blue spaces, proximity to major roads, and proximity to landfills) was conducted using four databases, Web of Science, PubMed, OVID, and Cochrane Library, from January 2000 to May 2021, and corresponding evidence for non-communicable diseases (NCDs) was synthesized. The review quality was assessed according to the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) standard.

RESULTS

Thirty-three moderate-and high-quality reviews were included in the analysis. Thirteen major NCD outcomes were found to be associated with neighborhood infrastructure-related risk factors. Green and blue spaces or walkability had protective effects on human health. In contrast, proximity to major roads, industry, and landfills posed serious threats to human health. Inconsistent results were obtained for four neighborhood risk factors: facilities for physical and leisure activities, accessibility to infrastructure providing unhealthy food, proximity to industry, and proximity to major roads.

CONCLUSIONS

This meta-review presents a comprehensive overview of the effects of neighborhood infrastructure-related risk factors on NCDs. Findings on the risk factors with strong evidence can help improve healthy city guidelines and promote urban sustainability. In addition, the unknown or uncertain association between many neighborhood risk factors and certain types of NCDs requires further research.

Family Caregiver Comorbidities in Lewy Body Dementia Versus Alzheimer Disease and Associated Disorders

BACKGROUND

Family caregivers of people living with dementia have high caregiver strain and poor health consequences. Limited research exists on Lewy body dementia (LBD) caregivers and their specific comorbidities. This study aimed to (1) identify the prevalence of self-reported comorbidities among LBD caregivers and (2) contextualize these findings with historical data on caregivers of persons living with Alzheimer disease and associated disorders (ADADs).

METHODS

In a national, online survey, LBD family caregivers completed the Self-Administered Comorbidity Questionnaire and we compared these findings with extant literature on ADAD caregiver comorbidities.

RESULTS

Among 217 LBD caregivers, 84.3% were female, 39.1% were 64 years old or younger, and 66.8% had >2 years of caregiving experience. Caregivers self-identified as current (83.9%) or former (16.1%) caregivers. The most frequent comorbidities were hypertension (38.2%), depression (35.0%), back pain (34.1%), and arthritis (27.7%). LBD caregivers, particularly younger caregivers, had a higher prevalence of depression compared with ADAD caregivers and older adult populations, and back pain prevalence nearly equivalent to spinal cord injury caregivers.

CONCLUSIONS

Our study is the first to illustrate and contextualize specific comorbidities among LBD caregivers. Understanding the causality and impact of these conditions will be critical in designing effective interventions to improve the lives of families affected by LBD.

How to create value with unobtrusive monitoring technology in home-based dementia care: a multimethod study among key stakeholders

BACKGROUND

There is a growing interest to support extended independent living of people with dementia (PwD) via unobtrusive monitoring (UM) technologies which allow caregivers to remotely monitor lifestyle, health, and safety of PwD. However, these solutions will only be viable if developers obtain a clear picture of how to create value for all relevant stakeholders involved and achieve successful implementation. The aim of this study was therefore to explore the value proposition of UM technology in home-based dementia care and preconditions for successful implementation from a multi-stakeholder perspective.

METHODS

We conducted an expert-informed survey among potential stakeholders (n = 25) to identify key stakeholders for UM technology in home-based dementia care. Subsequently, focus groups and semi-structured interviews were conducted among 5 key stakeholder groups (n = 24) including informal caregivers (n = 5), home care professionals (n = 5), PwD (n = 4), directors and managers within home care (n = 4), and policy advisors within the aged care and health insurance sector (n = 6). The sessions addressed the value proposition- and business model canvas and were analyzed using thematic analysis.

RESULTS

Stakeholders agreed that UM technology should provide gains such as objective surveillance, timely interventions, and prevention of unnecessary control visits, whereas pains mainly included information overload, unplannable care due to real-time monitoring, and less human interaction. The overall design-oriented need referred to clear situation classifications including urgent care (fall- and wandering detection), non-urgent care (deviations in eating, drinking, sleeping), and future care (risk predictions). Most important preconditions for successful implementation of UM technology included inter-organizational collaboration, a shared vision on re-shaping existing care processes, integrated care ICT infrastructures, clear eligibility criteria for end-users, and flexible care reimbursement systems.

CONCLUSIONS

Our findings can guide the value-driven development and implementation of UM technology for home-based dementia care. Stakeholder values were mostly aligned, although stakeholders all had their own perspective on what UM technology should accomplish. Besides, our study highlights the complexity of implementing novel UM technology in home-based dementia care. To achieve successful implementation, organizational and financial preconditions, as well as digital data exchange between home care organizations, will be important.

Meaning Making as a Lifebuoy in Dementia Caregiving: Predicting Depression from a Generation Perspective Using a Fuzzy-Set Qualitative Comparative Analysis

Depressive symptomatology is associated with caregiver burden and poor health outcomes among dementia caregivers. Scholars called for a paradigm shift to focus on positive aspects of caregiving, in particular, meaning making during the caregiving journey. This study draws on the meaning making model and a generation perspective to predict depression among dementia caregivers from two generations, including Baby Boomers who were born between 1946 and 1964 and Generation X who were born between 1965 and 1980, using a configuration approach. Data was collected in a two-wave longitudinal design, from December 2019 to March 2021 in Hong Kong. A fuzzy-set qualitative comparative analysis resulted in six configurations with an overall solution consistency and overall solution coverage of 0.867 and 0.488, respectively. These configurations consist of a different combination of conditions that predict high depressive symptomatology among dementia caregivers in two generations. Specifically, generation is related to five out of six configurations. This study is the first to predict depression among dementia caregivers using a meaning making model from a generation perspective. It advances the understanding of factors contributing to high depressive symptomatology among dementia caregivers from two generations, thus contributing to the future development of generation-responsive assessments, interventions, and policies.

Cultural adaptation of the savvy caregiver program for Korean Americans with limited English proficiency: a feasibility and acceptability study

Background

Limited English proficiency (LEP) of dementia caregivers poses a critical barrier to these caregivers’ access to evidence-based interventions. In an effort to make such interventions available and accessible to dementia caregivers with LEP, in the present study we use Barrera and colleagues’ (2011) three-step model of cultural adaptation: (1) information gathering, (2) preliminary adaptation, and (3) full adaptation. Selecting Korean Americans as a target group and the Savvy Caregiver Program (SCP) as a target intervention, we demonstrate the sequential process of cultural adaption and report the outcomes on feasibility and acceptability.

Methods

Preliminary adaptation with linguistic attunement was conducted by translating the SCP manual into Korean and certifying two lay individuals who were bilingual in English and Korean as Savvy trainers. The 6-week online SCP program was delivered by the two trainers in Korean with six to seven caregiver participants per trainer (N = 13). Feasibility and acceptability of the SCP for both caregiver participants and trainers were assessed using mixed methods, and their data then informed full adaptation.

Results

Findings not only showed the initial efficacy of the linguistically attuned SCP but also suggested areas for further modification. Data-driven assessment yielded a list of recommended changes for full adaptation, which was reviewed by the SCP developer to ensure fidelity and by community and research partners to confirm contextual and cultural relevance.

Conclusions

The adopted changes are broadly summarized as representing logistical, technical, and cultural issues. Given our refined set of educational materials and implementation guidelines, we discuss future directions for research and development.

Attitudes toward Alzheimer's disease and dementia caregiving and health outcomes: Racial and ethnic differences

This study aimed to explore racial/ethnic differences in the attitudes toward Alzheimer's Disease (AD) and dementia caregiving among midlife women who were family caregivers of persons living with AD (MWPLAD) in the U.S. and examine the associations of the attitudes to their health outcomes. This was a cross-sectional online survey study among 172 MWPLAD. The instruments included: the Attitude toward AD and Related Dementias Scale, the Questions on Attitudes toward AD Caregiving, the Social Readjustment Rating Scale, the EQ-5D-5L and the Midlife Women's Symptom Index. Multiple linear regression analyses were conducted. There were significant racial/ethnic differences in caregivers' attitudes toward dementia caregiving, health-related quality of life, and total severity scores of symptoms (p < .01). Controlling for covariates including race/ethnicity, caregivers' positive attitudes toward dementia caregiving were significantly associated with their health outcomes (p ≤ .05). Interventions for MWPLAD need to consider racial/ethnical differences in their attitudes toward dementia caregiving.

Barriers and facilitators of using dementia community support services provided by an Alzheimers organisation: Perceptions of informal caregivers receiving services

Known barriers prevent informal caregivers of a person with dementia using community services; however, there is a dearth of knowledge on how organisations can overcome these barriers. This study examined caregivers' perceptions of the barriers and facilitators of service use with regards to their membership to one Alzheimers organisation and their recommendations for improvements. In-depth interviews were conducted with 19 informal caregivers. Thematic analysis revealed personal and organisational barriers to service use, and associated recommendations. Six recommendations were made for dementia service organisations: (a) be proactive and arrange regular scheduled meetings with clients; (b) utilise consistent, trusting, empathic support personnel who can build strong relationships with clients; (c) provide support groups; (d) tailor support; (e) ensure expert knowledge and numerous channels of information delivery to clients, the general public and health professionals and (f) actively promote the organisation and services offered. This study provides novel insights into how a community organisation can overcome client barriers to service use. In addition, the study reveals caregivers perceived value of an Alzheimers organisation, argued to be an essential service, but until now clients' perceptions of the value received have not been explored.

How family dementia caregivers perceive benefits of a 4-week Mentalizing Imagery Therapy program: a pilot study

Background

Family caregivers of dementia patients experience high levels of interpersonal stress that often results in elevated anxiety, and depression, and negative impacts on interpersonal relationships. Changes in behaviors and the structure of relationships with the care recipient (CR) and others in the social milieu challenge the caregivers' ability to mentalize, or understand the links between mental states and behaviors. This study investigates the experiences and perceived benefits of family dementia caregivers who underwent Mentalizing Imagery Therapy (MIT), a treatment aiming to improve balanced self-other mentalizing and reduce psychological symptoms.

Methods

Purposeful sampling was used to select 11 family dementia caregivers who underwent a 4-week pilot trial of MIT. Semi-structured interviews were completed post-intervention to identify subjective benefits, putative psychological mediators and perceived active components.

Results

Caregivers reported improvements in well-being, mood, anxiety, and sleep, and a majority stated MIT helped with forming and maintaining healthier relationships. Some participants noted benefits extending to how they reacted to their social environment and perceived themselves more objectively from others' perspectives. Specific elements of MIT, including self-compassion, self-care, and the ability to reflect on emotionally arousing challenges, might have mediated these improvements.

Conclusion

Family dementia caregivers perceived salutary benefits of MIT on multiple domains of well-being. The self reports suggest MIT holds promise for improving well-being, reducing non-mentalizing patterns of thought, and facilitating improvements in balanced mentalization within the caregivers' relationships.

Effects of an e-health intervention 'iSupport' for reducing distress of dementia carers: protocol for a randomised controlled trial and feasibility study

INTRODUCTION

In the UK, National Health Service (NHS) guidelines recommend that informal carers of people living with dementia should be offered training to help them develop care skills and manage their own physical and mental health. The WHO recommends access to affordable, proven, well-designed, online technologies for education, skills training and support for dementia carers. In response to these recommendations, this multisite randomised controlled trial (RCT) is the first study in the UK to evaluate the clinical and cost-effectiveness of an online support programme developed by the WHO called 'iSupport for dementia carers'.

METHODS AND ANALYSIS

350 informal carers (age 18+ years) living in Britain who self-identify as experiencing stress and depression will be recruited. They will be randomised to receive 'iSupport', or standardised information about caring for someone with dementia (control-comparison). Data will be collected via videoconferencing (eg, Zoom) or telephone interview at baseline, 3 months and 6 months. Intention-to-treat analysis will ascertain effectiveness in the primary outcomes (distress and depression) and combined cost, and quality-adjusted life-year data will be used to assess cost-effectiveness compared with usual care from a public sector and wider societal perspective. A mixed-methods process evaluation with a subgroup of carers in the intervention (~N=50) will explore the barriers and facilitators to implementing 'iSupport'. A non-randomised feasibility study will adapt 'iSupport' for young carers (n=38 participants, age 11-17 years).

ETHICS AND DISSEMINATION

The research plan was scrutinised by National Institute for Health Research reviewers ahead of funding being awarded. Ethical approval was granted by Bangor University's School of Health and Medical Sciences Academic Ethics Committee, reference number 2021-16915. Dissemination plans include delivering events for stakeholders, social media, a project website, developing policy briefings, presenting at conferences and producing articles for open access publications.

TRIAL REGISTRATION NUMBER

ISRCTN17420703.

Peer support for people living with rare or young onset dementia: An integrative review

Objectives

The aim of this integrative review was to identify and synthesize the literature on peer support interventions for people living with or caring for someone with a rare or young onset dementia.

Design

A literature search of articles was performed using the Nipissing University Primo search system, a central index that enables simultaneous searches across databases which included MEDLINE (PubMed), Web of Science, PsycINFO, CINAHL, Sociological Abstracts, Cochrane Library.

Results

The eleven papers that met the inclusion criteria spanned eighteen years and from five countries. Studies reported on peer support programs that were either hospital-based (n = 6) or community-based (n = 4), and were predominantly led by disciplines in the health sciences. Only one study did not involve delivering services. There was a range of methodological quality within the studies included in the review. Further analysis and synthesis led to the identification of three overarching peer support themes. These included: (1) peers as necessarily part of social support interventions; (2) a theoretical portmanteau; and (3) dementia spaces and relationality.

Conclusion

Consistent with a much larger body of work examining peer involvement in social interventions, this review reinforced the valuable contribution of peers. A full understanding of the mechanisms of change was not achieved. Notwithstanding, the issue of studies neglecting to sufficiently conceptualize and describe interventions is an important one – drawing attention to the need to continue to explore varied delivery, including co-produced models, and more effective evaluation strategies to inform the dementia care sector.

Use of dementia and caregiving-related internet resources by informal caregivers: A cross-sectional study

Informal dementia caregivers are at greater risk of experiencing physical and mental health issues as compared to the general population. Internet-based resources may provide accessible opportunities to backing informal dementia caregivers by addressing their information and support needs. This cross-sectional study aims to characterize the use of dementia and caregiving-related internet resources by caregivers and identify variables associated with such use. Primary data were collected through a web-based survey (N = 158). Linear regression models were used to assess the associations of predisposing, enabling, and need variables with the frequency of using the internet for caregiving-related purposes. Most caregivers (93%) have ever used the internet to gather general information about dementia. The frequency of using internet resources was, however, moderate. The multivariable linear regression model suggests that being younger (β = −0.110, p = 0.009), not having a source of support to provide care (β = −2.554, p = 0.012), having used a face-to-face psychosocial intervention at some point (β = 2.731, p = 0.003), being employed (β = 2.558, p = 0.013), and appraising one's own physical health negatively (vs. appraising it as similar; β = 3.591, p < 0.001), are associated with a higher frequency of using caregiving-related internet resources. Our findings confirmed the association of age and perceived health status with caregiving-related internet use reported in other studies. The role of enabling variables as lifetime access to psychosocial interventions and having a usual source of support to provide care was a new addition. This study informs the design and deployment of information and support to dementia caregivers.

Application of virtual reality for dementia management

Age is recognized as the major factors of dementia, especially in for Alzheimer’s disease (AD). Given to the aged population, the increased number of demented population has been receiving a great impact in our society. Unfortunately, so far, no cured medicines have been demonstrated to provide effective treatment in AD. The combination of pharmacological and non-pharmacological interventions has been proposed to manage dementia with potential benefits especially in decreasing caregiver’s burden and behavior, as well as psychological problems of demented patients. Recently, giving to the glorious development in digital technologies, the virtual reality, one of the non-pharmacological interventions has been used extensively in dementia managements for its strengths which can be adapted in accordance with the heterogeneous needs from demented patients and their caregivers. However, various study designs and other reasons made these results difficult to be interpreted. In this review our goal is to provide a better understanding for these points.

Sleep Interventions for Informal Caregivers of Persons with Dementia: A Systematic Review

We conducted a systematic review on the state of the science related to sleep interventions for informal caregivers of persons with Alzheimer's disease or related dementia (ADRD). This review included English-written, peer-reviewed articles that studied the effect of an intervention on sleep health outcomes for informal caregivers of persons with ADRD. Our search yielded 15 articles that met our a priori inclusion criteria. We categorized interventions into four categories: environmental, physical, cognitive, and collaborative. Intervention effects were heterogeneous, with most yielding nonsignificant sleep health effects. There is a need for theoretically sound and robust sleep health interventions for informal caregiver samples. Future research in this area could benefit from the use of more controlled, pragmatic, and adaptive research designs, and the use of objective measures that conceptually represent the multiple domains of sleep health to enhance intervention quality.

Helping the Helpers - A research protocol for user-centered technology to aid caregiver management of medications for people with Alzheimer's disease and related dementias

BACKGROUND AND OBJECTIVE

Systematically supporting caregiver-assisted medication management through IT interventions is a critical area of need toward improving outcomes for people living with ADRD and their caregivers, but a significant gap exists in the evidence base from which IT interventions to support caregivers' medication tasks can be built. User-centered design can address the user needs evidence gap and provide a scientific mechanism for developing IT interventions that meet caregivers' needs. The present study employs the three phases of user-centered design to address the first two stages of the NIH Stage Model for Behavioral Intervention Development.

METHODS

We will conduct a three-phase study employing user-centered design techniques across three aims: Aim 1) assess the needs of ADRD caregivers who manage medications for people with ADRD (Stage 0); Aim 2) co-design a prototype IT intervention to support caregiver-assisted medication management collaboratively with ADRD caregivers (Stage IA); and Aim 3) feasibility test the prototype IT intervention with ADRD caregivers (Stage IB).

DISCUSSION

Our user-centered design protocol provides a template for integrating the three phases of user-centered design to address the first two stages of the NIH Stage Model that can be used broadly by researchers who are developing IT interventions for ADRD caregivers.

The mediating effect of social support and coping strategies on the relation between family stigma and caregiver burden among Israeli Arab family caregivers of people with Alzheimer's disease (AD)

OBJECTIVES

Many studies have attempted to identify the factors that are associated with caregiver burden among family caregivers of people with Alzheimer's disease (AD), because of its plethora of negative consequences. One unique factor that has been investigated recently is family stigma. However, the path leading from family stigma to caregiver burden has not been thoroughly studied. Hence, this study had two main objectives. The first was to examine whether family stigma was a predictor of caregiver burden among Israeli Arab family caregivers of a person with AD. The second was to examine the interplay of family stigma and caregiver burden with coping strategies and social support.

METHODS

Structured face-to-face interviews were conducted with 175 Israeli Arab family caregivers (adult children and spouses) of elderly people with AD (87.4% female; 71.4% adult children; mean age = 54.28).

RESULTS

Overall, the participants reported moderate levels of caregiver burden and family stigma. Additionally, as expected, family stigma made a unique - although modest - contribution to the explanation of caregiver burden. Whereas neither problem-focused coping nor emotion-focused coping played a significant role in mediating the relation between family stigma and caregiving burden, social support did mediate the relation between these variables.

CONCLUSIONS

Our findings reveal how social support is important as a specific way to reduce the impact of family stigma on caregiver burden.

Evaluating the efficacy of TeleFAMILIES: a telehealth intervention for caregivers of community-dwelling people with dementia

Examine the efficacy of a telehealth-administered intervention for caregivers of persons with dementia. Two hundred sixteen caregivers engaged in the FAMILIES intervention over six months, either virtually (n = 59) or in-person (n = 157). The telehealth protocol (TeleFAMILIES) was conducted online. Caregivers engaged in six sessions, including individual and family/group counseling, ad hoc counseling, and had access to support groups. Sessions included person-centered assessments of caregivers' physical, emotional, social needs, and current support networks. Primary outcome variables were change in total score between baseline and completion on the Zarit Burden Interview (ZBI), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), and the Revised Memory and Behavior Problems Checklist (RMBPC). TeleFAMILIES caregivers reported significant reductions in ZBI (p = .002) and CESD-R scores (p < .001). RMBPC reaction scores significantly improved (p = .02) and improved more than in-person caregivers' scores (F (3, 119) = 2.71, p = .048, partial eta² = .06). For those classified as having a higher risk of depression at baseline, a significantly larger portion TeleFAMILIES caregivers converted to a classification of lower depression risk at completion (p = .02). Compared to the in-person group, TeleFAMILIES caregivers experienced the same, if not greater improvements in perceived burden, depressive symptomatology, and their ability to manage their reactions to behavioral symptoms of dementia. The strengths of TeleFAMILIES are the convenience of telehealth services and its mitigation of barriers to care.

Association between familism and mental health in dementia caregivers: a systematic review and meta-analysis

BACKGROUND

Dementia caregivers suffer from mental health problems while caring for dementia patients. As a core value, familism has been linked to the mental health of dementia caregivers. This study aims to systematically review the familism of dementia caregivers and to examine the association between familism and mental health of anxiety, depression, and burden in empirical research studies.

METHODS

We conducted a systematic search in various databases like Medline, PubMed, and Embase databases from inception till April 2021. Fisher's z was calculated with correlation coefficient or regression coefficient values for three familism dimensions and mental health of anxiety, depression, and burden. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 2.0 software.

RESULTS

A total of seven studies with 1178 participants were eligible for the meta-analysis. For caregivers' anxiety, three of seven studies, with 358 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that dementia caregivers' familism was significantly related to anxiety. The pooled z-value was 0.148 (95% CI = 0.043-0.253). In addition, caregivers' familism significantly affected depression (z = 0.080; 95% CI = 0.003-0.156), as did familial obligation (z = 0.122; 95% CI = 0.034-0.211), but perceived family support was not associated with this (z = 0.051, 95% CI = -0.038-0.140). As for caregiver burden, there was no evidence that familism was significantly associated with it (z = -0.073; 95% CI = -0.297 to 0.151), including familial obligation and perceived family support (z = -0.087 and -0.089, respectively; 95% CI = -0.278 to 0.104 and -0.335 to 0.157, respectively).

CONCLUSIONS

An association between caregiver familism and anxiety/depression exists in dementia patients. More research is needed to explore the relationship between familism and burden.

Neuropsychiatric symptoms of dementia and caregivers' burden: a study among Indian caregivers

Dementia is considered a most serious and disabling condition, affecting both the individual suffering from it and their caregiver.

Objective

The study aimed to evaluate the relationship between neuropsychiatric problems of dementia and caregiver burden.

Methods

A total of 138 caregivers of people with dementia participated in this cross-sectional study. The caregivers completed the questionnaires containing sociodemographic information as well as neuropsychiatric problems of dementia and caregiver burden.

Results

The findings showed that all of the care-recipients were suffering from some kind of neuropsychiatric symptoms, the most common being apathy, anxiety, motor disturbance, and hallucination. Out of 12 symptoms, 11 were significantly associated with caregivers' burden. The most important finding is that the severity of neuropsychiatric symptoms is highly responsible for severe caregivers' burden.

Conclusions

The identification of neuropsychiatric symptoms of dementia that influence caregiver burden is very critical for both caregivers' and care-recipients' health perspective. These findings can also be utilized to create care settings for demented people and help determine policies in the future.

Help-Seeking in Informal Family Caregivers of People with Dementia: A Qualitative Study with iSupport as a Case in Point

Supportive measures and training interventions can improve the care of people with dementia and reduce the burden on informal caregivers, whose needs remain largely unmet. iSupport is an evidence-based online intervention developed by the World Health Organization to provide support and self-guided education to informal family caregivers of people with dementia. This qualitative study explored barriers and facilitators in the access and use of supportive measures for family caregivers of people with dementia living in Southern Switzerland (Ticino). We conducted five focus groups and explored experiences, beliefs, and attitudes toward seeking help (SH), and used thematic analysis to identify key themes. Participants (N = 13) reported a general reluctance to SH. We identified four main barriers to SH: high level of burden; sense of duty; fear of being misunderstood by others; and difficulty in reaching information. We also identified facilitators of help seeking behaviors and unveiled the need of caregivers to be assisted by a dementia case manager to facilitate access to support resources. Local services and interventions should be adapted to caregivers' needs and expectations, with the aim of facilitating the acceptance of, access to, and service integration of existing and future support measures, including iSupport.

Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol

Studies have consistently showed that informal caregivers have worse health, more medical consultations, anxiety and depression, and lower quality of life than those who do not provide such care. Positive outcomes of psychoeducation interventions have been found, but many of them are relatively long in duration, making them less cost-effective in implementation. The proposed study is a multi-site, three-arm randomized controlled trial of a mindfulness-based intervention for Chinese family caregivers. Effects of the intervention will be compared with those of an evidence-based psychoeducation program and treatment-as-usual. Two hundred forty cross-generational caregivers of frail older adults with moderate to severe levels of frailty will be recruited and randomly assigned to mindfulness-based intervention, psychoeducation, and treatment-as-usual experimental conditions. Program effectiveness will be analyzed on measures of caregiver burden, depression, anxiety, positive caregiving experience, spirituality, family conflict, and the biomarker of heart rate variability. Measures on coping styles, experiential avoidance, and self-efficacy will be explored to see if they mediate the changes to participant improvements in outcomes. Six-month follow-up will be included to investigate the maintenance effects. This study will provide evidence on mindfulness-based interventions on caregivers of frail older adults and expand the existing models of intergenerational caregiving in Chinese culture.

A Path Analysis of the Effect of Neighborhood Built Environment on Public Health of Older Adults: A Hong Kong Study

Introduction

Health deterioration among frail older adults is a public health concern. Among the multi-dimensional factors, the neighborhood built environment is crucial for one's health. Although the relationship between the built environment and health in the general population has been thoroughly investigated, it has been ignored in the case of frail older adults, who may have difficulties in their daily basic living skills. A path analysis is constructed to model the proposed theoretical framework involving the neighborhood built environment and health among frail older adults. This study thus aims to investigate the environmental influences on health, and to validate the theoretical framework proposed for health and social services.

Methods

This study used secondary data collected in Hong Kong. A sample of 969 older community dwellers aged 60 or above were frail with at least one activity of daily living. Demographic information, neighborhood built environment data, service utilization, and health conditions were collected from these participants and their caregivers. A path analysis was performed to examine the proposed theoretical framework.

Results

The health condition was of general concern, including frailty and incapacities in daily activities in frail older adults. Besides psychosocial factors, service use, and caregivers' care quality, the built environment had a significant impact on the health of older adults as well. Specifically, more facilities offering services and groceries, a shorter distance to the nearest metro station, and more greenery exposure are associated with a better-expected health condition among frail older adults.

Discussion

The proposed theoretical framework successfully supplements past negligence on the relationship between the built environment and the health of frail older adults. The findings further imply that policymakers should promote the usability of transit and greenery in neighborhoods and communities. In addition, service utilization should be improved to meet the basic needs of frail older adults in the communities.

In-home dementia caregiving is associated with greater psychological burden and poorer mental health than out-of-home caregiving: a cross-sectional study

INTRODUCTION

Caregivers who live with a person with dementia who receives care, compared with those who live elsewhere, are often considered to experience greater levels of psychological and affective burden. The evidence for this is, however, only limited to studies employing small sample sizes and that failed to examine caregivers' psychological wellbeing. We address these issues in a large cohort of dementia caregivers.

METHODS

We conducted a cross-sectional study comparing caregivers living with a dementia care recipient (n = 240) to caregivers living elsewhere (n = 255) on caregivers' burden, anxiety, and depression.

RESULTS

We found that caregivers living with the care recipient relative to those living elsewhere showed significantly greater burden and depression, but we found no group difference in anxiety.

CONCLUSIONS

Our study adds to the evidence by showing that cohabiting with a care recipient with dementia is associated with greater burden and poorer psychological wellbeing. Strategies aiming to improve caregivers' burden and psychological wellbeing should take account of caregivers' living arrangements.

Linking Problems Reported by Care Partners of Individuals With Alzheimer’s Disease and Lewy Body Dementia to the International Classification of Functioning Disability and Health

Aim

This study aims to classify, describe, and compare the problems reported by care partners of adults with Alzheimer’s disease (AD) and Lewy body dementia (LBD) using the International Classification of Functioning Disability and Health (ICF)

Methods

Problems that care partners experience were collected during a problem-solving training intervention. The meaningful concepts were then extracted and linked to the ICF using a standardized linking technique.

Results

402 meaningful concepts were extracted from 128 problems reported by care partners. 79.4% of the concepts were linkable to the ICF. “Body functions” was most frequently addressed followed by “Activities and participation.” LBD care partners reported more problems (M = 23.6 ± 13.4) on average than AD care partners (M = 19.4 ± 12.1). LBD care partners reported greater relative proportions of problems in mental function (emotional and sleep functions) than AD care partners.

Conclusion

This study suggests that the experience of LBD care partners may include significantly more challenges and may be more emotionally demanding than the care experience of AD care partners. Interventions designed to support care partners of adults with dementia may need to be tailored to meet the needs of care partners based on the care receiver’s type of dementia.

Non-Pharmacological Treatments of Neuropsychiatric Symptoms in Mild Cognitive Impairment (MCI)

Mild cognitive impairment (MCI) is a syndrome defined by objective cognitive deficits that do not impact functional independence. Individuals with MCI develop dementia at an annual rate of 10 to 15%. Neuropsychiatric symptoms (NPS) are common non-cognitive features of neurocognitive disorders and have a major impact on the wellbeing and quality of life of affected individuals and their families. Non-pharmacological interventions for NPS are considered the first-line treatment because of the limited efficacy and side-effect potential of current pharmacological agents. This article summarizes the literature on non-pharmacological treatments for NPS in MCI. The limited number of studies specific to individuals with MCI and its various etiologies, as well as the overall heterogeneity of research design and methodologies, make the evidence base inconclusive. Nevertheless, some studies support psychosocial interventions aimed at individuals with MCI and their caregivers.

Feasibility of an online training and support program for dementia carers: results from a mixed-methods pilot randomized controlled trial

Background

iSupport is an online program developed by the World Health Organization to provide education, skills training, and social support to informal carers of persons with dementia. This pilot study examines the feasibility of the protocol for a main effectiveness trial of iSupport-Portugal and explores how the intervention and control arms compare over time on well-being outcomes.

Methods

A mixed-methods experimental parallel between-group design with two arms is followed. Participants were recruited nationwide, by referral or advertising, through the National Alzheimer’s Association. Inclusion criteria are being Portuguese adults, providing e-consent, providing unpaid care to someone with dementia for at least 6 months, experiencing relevant scores on burden (≥ 21 on ZBI) or depression or anxiety (≥ 8 on HADS), and using webpages autonomously. Participants were consecutively randomized to receive iSupport-Portugal or an education-only e-book and were not blinded to group assignment. Data were collected online with self-administered instruments, at baseline, 3 and 6 months after. Outcomes comprise caregiver burden, depression, anxiety, QoL, positive aspects of caregiving, and self-efficacy. Generalized estimating equations were used to estimate group, time, and group-by-time effects. Intervention engagement data were extracted from iSupport’s platform. Semi-structured interviews were conducted.

Results

Forty-two participants were allocated to the intervention (N = 21) and control (N = 21) arms. Participation (78.1%) and retention rates (73.8%) were fair. More carers in the control arm completed the study (N = 20, 95.2%) than in the intervention arm (N = 11; 52.4%) (χ² = 9.98, p = .002). Non-completers were younger, spent less time caring, and scored higher on anxiety. Among carers in the intervention arm, the average attendance rate was of 53.7%. At post-test 38.9% of participants still used iSupport; the remainder participants interrupted use within 2 weeks (Mdn). For per-protocol analyses, significant group-by-time interaction effects favouring the intervention were found for anxiety (Wald χ2 = 6.17, p = .046) and for environmental QoL (Wald χ² = 7.06, p = .029). Those effects were not observed in intention-to-treat analyses adjusted for age. Interviewees from the intervention arm (N = 12) reported positive results of iSupport on knowledge and on experiencing positive feelings. No adverse effects were reported.

Conclusions

This study provides information for a forthcoming full-scale effectiveness trial, as on the acceptability and potential results of iSupport-Portugal. iSupport is suggested as a relevant resource for Portuguese carers.

Trial registration

ClinicalTrials.gov, NCT04104568. 26/09/2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02831-z.

Psychosocial Stressors and Adaptive Coping Strategies in Couples After a Diagnosis of Young-Onset Dementia

BACKGROUND AND OBJECTIVES

Diagnoses of young-onset dementias (YODs) are devastating for persons with dementia and spousal caregivers yet limited work has examined both partners' perceptions of challenges and coping after diagnosis. This qualitative study investigated the psychosocial stressors and adaptive coping strategies in couples diagnosed with YOD to inform the development of psychosocial support resources.

RESEARCH DESIGN AND METHODS

We conducted live video dyadic interviews with couples (persons with YOD and spousal caregivers together; N = 23 couples). We transcribed interviews and coded data based on a hybrid deductive-inductive approach, with the structure of the coding framework informed by the stress and coping framework, and all codes derived from the data. We derived themes and subthemes related to psychosocial stressors and adaptive coping.

RESULTS

We identified 5 themes related to psychosocial stressors: the impact of diagnosis, social and family relationships, changing roles and responsibilities, planning for an uncertain future, and couple communication and relationship strain. We identified 7 themes related to adaptive coping strategies: processing emotions and cultivating acceptance, promoting normalcy, efforts to preserve persons with YOD's independence and identity, collaborative and open communication, social support, meaning-making, humor, and positivity, and lifestyle changes and self-care.

DISCUSSION AND IMPLICATIONS

We replicated several themes regarding stressors and adaptive coping strategies from prior YOD research and identified novel themes and subthemes related to dyadic stressors, sources of couples' relationship strain, and the ways in which couples effectively cope with YOD. Findings inform the development of dyadic interventions to reduce YOD-related distress for both persons with dementia and spousal caregivers.

Dementia care in the age of COVID-19: Community resources for nurses

ABSTRACT

The COVID-19 pandemic and related measures, such as social distancing, have adversely impacted persons with dementia (PWD) and their caregivers. Nurses must be able to identify the care needs of PWD and their caregivers and intervene with relevant resources.

Association between having a family member with dementia and perceptions of dementia preventability

BACKGROUND

One's experience with dementia may affect their perceptions about dementia preventability, which in turn could influence preventive health behaviors. We aimed to examine how having a family history of dementia and caregiving experience are associated with perceptions about and self-efficacy for dementia preventability.

METHODS

Cross-sectional, self-administered survey. Participants reported whether they have had a family member with dementia and, among those who reported having a family member with dementia, whether they served as a caregiver. Outcomes were perceptions about the likelihood of dementia preventability, self-efficacy for dementia prevention, and benefits of specific dementia prevention strategies. Associations were assessed via partial proportional odds model for ordinal outcome variables and logistic regression for binary outcome variables.

RESULTS

Of 1,575 respondents, 71% had a family member with dementia, of which 42% served as a caregiver. People with a family member with dementia were less likely to believe that dementia is preventable (aOR = 0.75, 95% CI: 0.58, 0.96) and had lower self-efficacy for dementia prevention (aOR = 0.71, 95% CI: 0.56, 0.90). The subgroup analysis among those with caregiving experience was consistent with the primary findings, showing less belief in the likelihood of dementia preventability (aOR = 0.69, 95% CI: 0.46, 1.03) and self-efficacy (aOR = 0.75, 95% CI: 0.56, 1.00).

CONCLUSION

Having a family member with dementia is associated with unfavorable perceptions about dementia preventability. Incorporating family history of dementia into communication efforts about dementia risk reduction may help address potential barriers to preventive health behaviors.

'Walk a mile in my shoes:' African American caregiver perceptions of caregiving and self-care

African American Alzheimer's disease and related dementia (ADRD) family caregivers are understudied in intervention research with discrepant evidence existing on their mental and physical health outcomes. The stress toll of ADRD caregiving, coupled with the well-documented health disparities for African Americans, place these caregivers at higher risk for morbidity and mortality.Objectives: The purpose of this study was to explore African American ADRD family caregivers' perceptions of caregiving and self-care.Design: Qualitative descriptive study based on individual, one-time, semi-structured interviews from a purposeful sample of current/former African American ADRD community-dwelling family caregivers. Participants agreed to either face-to-face or telephonic interviews between 60 and 90 minutes in length.Results: Twenty-one caregiver interviews were conducted with primarily adult children (mean age = 62.61 (SD = 12.88); 81% completed college; 57% women). Content analysis yielded three major themes: Stressors, Resources, and Coping. The results demonstrate a complex interaction of sociocultural and environmental stressors and perceptions of resources that influence the coping strategies adopted by caregivers to navigate their caregiving experience.Conclusions: These findings suggest a broadened perspective to further inform the development and testing of interventions to address the health outcomes and caregiving needs of African American ADRD caregivers.

Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019

BACKGROUND

Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors.

METHODS

We forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis.

FINDINGS

We estimated that the number of people with dementia would increase from 57·4 (95% uncertainty interval 50·4-65·1) million cases globally in 2019 to 152·8 (130·8-175·9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0·1% [-7·5 to 10·8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1·69 [1·64-1·73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1·67 [1·52-1·85]). There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41-67]) and western Europe (74% [58-90]), and the largest in north Africa and the Middle East (367% [329-403]) and eastern sub-Saharan Africa (357% [323-395]). Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia.

INTERPRETATION

Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia.

FUNDING

Bill & Melinda Gates Foundation and Gates Ventures.

STEP-UP: Enabling Low-Cost IMU Sensors to Predict the Type of Dementia During Everyday Stair Climbing

Posterior Cortical Atrophy is a rare but significant form of dementia which affects people's visual ability before their memory. This is often misdiagnosed as an eyesight rather than brain sight problem. This paper aims to address the frequent, initial misdiagnosis of this disease as a vision problem through the use of an intelligent, cost-effective, wearable system, alongside diagnosis of the more typical Alzheimer's Disease. We propose low-level features constructed from the IMU data gathered from 35 participants, while they performed a stair climbing and descending task in a real-world simulated environment. We demonstrate that with these features the machine learning models predict dementia with 87.02% accuracy. Furthermore, we investigate how system parameters, such as number of sensors, affect the prediction accuracy. This lays the groundwork for a simple clinical test to enable detection of dementia which can be carried out in the wild.

Caregivers of people with dementia and mental health during COVID-19: findings from a cross-sectional study

BACKGROUND

There is sparse evidence on the impact on vulnerable populations of the COVID-19 pandemic. The aim of our study was to explore burden and mental wellbeing (including depressive, anxiety, and stress symptoms) in caregivers of people with dementia during the first wave of the pandemic in Italy and southern Switzerland, two bordering regions severely hit by the COVID-19 pandemic.

METHODS

We conducted an online cross-sectional survey with family carers of people with dementia between May and June 2020. We registered socio-demographic characteristics, and information about the relationship with the care recipient, dementia subtype, care inputs from others, and the need of care of the person with dementia. We measured caregiver burden with the Zarit Burden Interview (ZBI), psychological distress with the Depression, Anxiety and Stress Scale (DASS-21), and perceived isolation with the 3-item UCLA Loneliness Scale (UCLALS3).

RESULTS

Caregivers (N =571) reported moderate to severe care-related burden (mean=54.30; SD=18.33), moderate anxiety symptoms (mean=10.04; SD=6.93), mild depressive symptoms (mean=11.79; SD=6.12) and mild stress (mean=12.95; SD=5.53), and 72.3% of participants reported to feel lonely. All scores were significantly more severe in Swiss compared to Italian caregivers (all p values<0.001).

CONCLUSIONS

We found that caregivers' burden, anxiety symptoms, depression and perceived loneliness were marked during the first wave of the COVID-19 pandemic, in two severely hit bordering countries. Regional differences in the impact of the epidemic on caregivers could be due to contextual, societal, and cultural circumstances. As the pandemic endures, support to caregivers of people with dementia should be proportionate and tailored to needs and adapted to contextual factors.

Mindfulness-Based Cognitive Therapy for Stress Reduction in Family Carers of People Living with Dementia: A Systematic Review

The prevalence of dementia is increasing and the care needs of people living with dementia are rising. Family carers of people living with dementia are a high-risk group for psychological and physical health comorbidities. Mindfulness-based interventions such as mindfulness-based cognitive therapy show potential for reducing stress experienced by family carers of people living with dementia. This study aims to systematically assess the efficacy of mindfulness-based cognitive therapy in reducing stress experienced by family carers of people living with dementia. Electronic databases including MEDLINE, APA PsycINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, AMED, ICTRP, and ALOIS were searched for relevant studies up to August 2020. All types of intervention studies were included. Quantitative findings were explored. Seven studies were eligible for inclusion. The analysis showed that there was a statistically significant reduction in self-rated carer stress in four studies for the mindfulness-based cognitive therapy group compared to controls. One study that was adequately powered also showed reductions in carer burden, depression, and anxiety compared to control. Mindfulness-based cognitive therapy appears to be a potentially effective intervention for family carers of people living with dementia, but large, high-quality randomized controlled trials in ethnically diverse populations are required to evaluate its effectiveness.

Four of a kind: Salient caregiver archetypes to better understand the psychosocial needs and behavioral patterns of dementia caregivers in Singapore

BACKGROUND

Family caregivers' lived experiences are often perceived as a homogenous entity, preventing effective identification of unique caregiving needs and appropriate support. Our study examined and classified the varying dementia caregiving experiences in an Asian setting, through establishing caregiver archetypes.

METHODS

Secondary analysis of semi-structured interviews conducted with 16 dementia family caregivers in a Singapore hospital was performed. Thematic analysis and typological analysis were utilized.

RESULTS

Four caregiver archetypes (Reluctant, Ambivalent, Enlightened, and Selfless) were identified: Reluctant caregivers possessed poor understanding of dementia and experienced immeasurable distress; Ambivalent caregivers carried mixed feelings towards caregiving and felt unsupported; Enlightened caregivers preserved care-recipients' dignity and accepted challenges with priority on sustainable care; Selfless caregivers were overly-devoted and enmeshed in the caregiver identity.

CONCLUSION

Our findings are useful in providing a framework for: (1) rapid understanding of informal caregivers' varying needs, (2) targeted support in a holistic caregiver-centered manner.

Coping, Social Support, and Caregiver Well-Being With Families Living With SCI: A Mixed Methods Study

OBJECTIVES

To explore coping, problem solving, social support, and well-being among family caregivers of adults with spinal cord injury (SCI).

METHODS

This was a mixed methods study (qualitative interviews and standardized surveys) with a diverse sample of 39 adults with SCI and their caregivers from four rehabilitation hospitals in the United States, including one Veterans Affairs (VA) hospital. Cluster analysis was used to explore whether distinct profiles of caregivers could be identified, and it was used in conjunction with qualitative data to explore patterns in well-being. Measures of well-being included leisure time satisfaction, social integration, anxiety, depression, physical health complaints, caregiver burden, and quality of life.

RESULTS

The importance of individual and extra-individual resources, namely coping and social support, emerged from early qualitative analyses and guided subsequent mixed methods examination of the data. A cluster analysis yielded three caregiver profiles: (1) effective problem solvers with moderate satisfaction with social support, (2) mixed problem solvers with stronger negative orientations and mixed satisfaction with social support, and (3) low endorsers overall. Profiles helped us explore patterns across our data set and efficiently identify differences in caregiver social support, coping, well-being, and unmet needs.

CONCLUSION

Data echo the need for multimodal interventions aimed at skill development, respite options, and screening, support, information, and referral around mental health and burden. SCI care and rehabilitation programs should consider incorporating strategies for bolstering effective caregiver problem-solving skills, reducing negativity and ambivalence, and enhancing social support.

Pilot of a Communication Program for Dementia Caregivers Using Improvisational Techniques

Background/Objectives: This paper is a brief report on a novel pilot program called Improv to Improve for family dementia caregivers to build resilience, communication skills, and improve social caregiving situations in order to reduce caregiver burden and low mood. Methods: We conducted a 6-week improv training for family caregivers including pre- and post-program evaluation of caregiver mood utilizing the Beck Depression Inventory and the Zarit Burden Interview and care-recipient symptoms with the Neuropsychiatric Inventory Questionnaire. Results: Six family caregivers participated in the pilot project and reported small improvements (d = 0.28) in caregiver’s mood and significant improvements in care-recipient’s symptom severity and distress (d = 0.50). Participants all reported agreeing or strongly agreeing with program satisfaction questions and found the training to be useful. Conclusions: These findings have implications for broader implementation of improvisational techniques for educating family dementia caregivers.

Physician-Assisted Suicide in Dementia: Paradoxes, Pitfalls and the Need for Prudence

There has been an increasing drive towards the legalization of physician-assisted suicide (PAS) in patients with dementia, particularly in patients with advanced disease and severe cognitive impairment. Advocacy for this position is often based on utilitarian philosophical principles, on appeals to the quality of life of the patient and their caregiver(s), or on economic constraints faced by caregivers as well as healthcare systems. In this paper, two lines of evidence against this position are presented. First, data on attitudes towards euthanasia for twenty-eight countries, obtained from the World Values Survey, is analyzed. An examination of this data shows that, paradoxically, positive attitudes towards this procedure are found in more economically advanced countries, and are strongly associated with specific cultural factors. Second, the literature on existing attitudes towards PAS in cases of dementia, along with ethical arguments for and against the practice, is reviewed and specific hazards for patients, caregivers and healthcare professionals are identified. On the basis of these findings, the author suggests that the practice of PAS in dementia is not one that can be widely or safely endorsed, on both cultural and ethical grounds. Instead, the medical field should work in collaboration with governmental, social welfare and patient advocacy services to ensure optimal physical, emotional and financial support to this group of patients and their caregivers.

An App-Based Mindfulness-Based Self-compassion Program to Support Caregivers of People With Dementia: Participatory Feasibility Study

BACKGROUND

The number of persons with dementia is steadily growing, as is the number of individuals supporting persons with dementia. Primary caregivers of persons with dementia are most often family members or spouses of the persons with dementia, and they are more likely to experience increased stress and other negative effects than individuals who are not primary caregivers. Although in-person support groups have been shown to help buffer the negative impacts of caregiving, some caregivers live in isolated or rural communities and are unable to make the burdensome commitment of traveling to cities. Using an interdisciplinary approach, we developed a mobile smartphone support app designed for primary caregivers of persons with dementia, with the goal of reducing caregiver burden and easing stress. The app features a 12-week intervention, largely rooted in mindfulness-based self-compassion (MBSC), because MBSC has been linked to minimizing stress, depression, and anxiety.

OBJECTIVE

The primary objectives of our program are twofold: to explore the feasibility of a 12-week mobile support program and to conduct an initial efficacy evaluation of changes in perceived caregiver burden, coping styles, and emotional well-being of caregivers before and after the program.

METHODS

Our feasibility study used a 2-phase participatory pretest and posttest design, focusing on acceptability, demand, practicality, implementation, and efficacy. At phase I, we recruited 57 primary caregivers of persons with dementia (mean age 76.3, SD 12.9 years), comprising spouses (21/57, 37%), children (21/57, 37%), and friends or relatives (15/57, 26%) of persons with dementia, of whom 29 (51%) completed all measures at both pre- and postprogram. The content of the program featured a series of MBSC podcasts. Our primary outcome measure was caregiver burden, with secondary outcome measures including coping styles and emotional well-being. Daily ecological momentary assessments enabled us to ask participants, "How are you feeling today?" Phase II of our study involved semistructured follow-up interviews with most participants (n=21) who completed phase I.

RESULTS

Our findings suggest that our app or program meets the feasibility criteria examined. Notably, participants generally accepted the program and believed it could be a useful resource. Emotional well-being increased significantly (P=.04), and emotion-based coping significantly decreased (P=.01). Participants generally considered the app or program to be a helpful resource.

CONCLUSIONS

Although there were no significant changes in caregiver burden, we were encouraged by the increased emotional well-being of our participants following the completion of our program. We also conclude that our app or program demonstrated feasibility (ie, acceptability, practicality, implementation, and efficacy) and can provide a much-needed resource for primary caregivers of persons with dementia. In the subsequent version of the program, we will respond to participant feedback by incorporating web-based weekly sessions and incorporating an outcome measure of self-compassion.

Satisfaction with caregiving among informal caregivers of elderly people with dementia based on the salutogenic model of health

OBJECTIVES

The main objective was to analyze the variables Sense of Coherence, Resilience and Emotional Regulation as predictors of satisfaction with care in caregivers of older adults people with dementia.

METHODS

An ex post facto cross-sectional study design with a single group. The data were collected between June and October 2020.63 caregivers of older adults people with severe dementia participated, by responding to questionnaires concerning the study variables during a telephone interview. Information was also collected regarding the characteristics of the care provided (years of evolution, degree of dementia, index of independence) and regarding the caregiver (age and years of caregiving) which will be analyzed as control variables. The data were analyzed using correlation analysis and multiple linear regression analysis.

RESULTS

The participants presented average levels for Sense of Coherence, Resilience, Emotional Regulation (M = 16.93) and a high degree of Satisfaction with care. Sense of Coherence was the main predictor of Satisfaction with care, explaining up to 67% of the variance, through its Significance and Comprehensibility dimensions. Although the Resilience variable presented a significant association with Satisfaction, its role in the predictive model was displaced by Sense of Coherence.

CONCLUSIONS

Sense of Coherence and Resilience are relevant psychological variables because of their positive relationship with satisfaction with care among caregivers of older adults people with dementia. The caregivers' perception of the significance and comprehensibility of the situation are important positive predictors of their satisfaction with the care of older people with dementia. These results are suggestive to guide the follow-up and psychological support of caregivers.

Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA) in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial

Background

Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT).

Objective

This paper reports the protocol of a pilot RCT evaluating the iSupport VA.

Methods

Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed.

Results

This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455).

Conclusions

This protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12621001452886; https://tinyurl.com/afum5tjz

International Registered Report Identifier (IRRID)

PRR1-10.2196/33572

Stress and its contribution to the development of depression symptoms are reduced in caregivers of elderly with higher educational level

Caregivers of elderly people with neurodegenerative diseases are highly vulnerable to stressful situations and mood disorders due to their work conditions. Stress has been associated with an increased risk of developing depression, and studies have supported that caffeine consumption can act as an independent protective factor for disorder. This study investigated indexes of stress and depression symptoms in caregivers of the elderly with neurodegenerative diseases, their caffeine intake and the association between stress and depressive symptoms with the salivary biomarkers cortisol, nitric oxide and DNA damage. Participants (n = 81) were recruited from the community between July 2018 and April 2019. Stress was assessed using Lipp's Inventory of Stress Symptoms, and depressive symptoms were measured using the Hamilton Depressive Rating Scale. Participants provided a 72-hour recall of their diet to measure caffeine intake. Saliva samples were used to measure cortisol and nitric oxide. DNA damage was measured through micronuclei frequency after swabbing on the buccal mucosa. The majority of caregivers displayed stress and depressive symptoms. Stress was associated with educational level, tobacco use and total DNA damage. The indexes found in this population were not associated with caffeine intake or other salivary biomarkers, indicating that only some salivary molecules could be used as biomarkers for stress-related disorders. Caregivers of the elderly are exposed to stressful situations daily, however, we observed that educational level can reduce the psychological symptoms of stress and thus reduce the negative impact on quality of life.

Exploring the impact of Covid-19 on the care and quality of life of people with dementia and their carers: A scoping review

This article reports on findings of a scoping review aimed to map the published literature concerning the impact of Covid-19 on the care and quality of life of people living with dementia and their carers. Twenty-nine articles were included in the review. Three overarching themes were identified: (1) Impact on people with dementia – unmet and increased care needs; (2) Impact on carers – increased stress and burden and (3) Impact according to demographics. Overall, findings show that Covid-19 has led to a reduction in support from health and social services and to a move towards technology-based support. Furthermore, Covid-19 has had a negative impact on the care and quality of life of people living with dementia and their carers, and that this impact was influenced by the severity of dementia.

Pythagorean Self Awareness Intervention in Caregivers of Patients with Motor Disabilities

Caregiving for disabled people is a strenuous task often provided by family members, with adverse repercussions on the caregivers’ health. The aim of this study was to evaluate, for the first time, the effects of a novel cognitive-based stress management technique, the Pythagorean Self-Awareness Intervention (PSAI) on the stress levels and other cognitive and psychological characteristics of non-paid caregivers of patients with motor disability. In this quasi-experimental study, 59 caregivers of first-degree relatives with motor disabilities due to chronic neurological diseases, inpatients at a Rehabilitation Center, in Athens, Greece, were assigned to an intervention (PSAI, n=28) and a control group (received unstructured consultation, n=31). Psychological, cognitive, and sleep-related measurements (Zarit Burden Interview tool, Pittsburgh Sleep Quality Index, Self-Efficacy Scale, Depression, Anxiety and Stress Scale, Symbol Digit Modalities Test, California Verbal Learning Test-II, Brief Visuospatial Memory Test-Revised) were held at baseline and after 8 weeks (at completion of PSAI) in both groups. PSAI was found to decrease caregivers’ stress, depressive symptoms and anxiety and improve their sleep quality, visual memory, self-efficacy, and cognitive speed processing. Future randomized controlled studies are needed to investigate the effects of this novel intervention in larger samples of caregivers.

Paratonia in Dementia: A Systematic Review

Background:

Paratonia is a dementia-induced motor abnormality. Although paratonia affects virtually all people with dementia, it is not well known among clinicians and researchers.

Objective:

The aim of this study was to perform a systematic review of the literature on the definition, pathogenesis, diagnosis, and intervention of paratonia as well as to propose a research agenda for paratonia.

Methods:

In this systematic review, the Embase, PubMed, CINAHL, and Cochrane CENTRAL databases were searched for articles published prior to December 2019. Two independent reviewers performed data extraction and assessed the risk of bias of the studies. The following data were extracted: first author, year of publication, study design, study population, diagnosis, assessment, pathogenesis, therapy and interventions.

Results:

Thirty-five studies met the inclusion criteria and were included. Most studies included in the review mention clinical criteria for paratonia. Additionally, pathogenesis, method of assessment, diagnosis, and paratonia severity as are interventions to address paratonia are also discussed.

Conclusion:

This systematic review outlines what is currently known about paratonia, as well as discusses the preliminary research on the underlying mechanisms of paratonia. Although paratonia has obvious devastating impacts on health and quality of life, the amount of research to date has been limited. In the last decade, there appears to have been increased research on paratonia, which hopefully will increase the momentum to further advance the field.

What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews

OBJECTIVES

To identify and map evidence about the consequences of unpaid caring for all carers of older people, and effective interventions to support this carer population.

DESIGN

A rapid review of systematic reviews, focused on the consequences for carers of unpaid caring for older people, and interventions to support this heterogeneous group of carers. Reviews of carers of all ages were eligible, with any outcome measures relating to carers' health, and social and financial well-being. Searches were conducted in MEDLINE, PsycInfo and Epistemonikos (January 2000 to January 2020). Records were screened, and included systematic reviews were quality appraised. Summary data were extracted and a narrative synthesis produced.

RESULTS

Twelve systematic reviews reporting evidence about the consequences of caring for carers (n=6) and assessing the effectiveness of carer interventions (n=6) were included. The review evidence typically focused on mental health outcomes, with little information identified about carers' physical, social and financial well-being. Clear estimates of the prevalence and severity of carer outcomes, and how these differ between carers and non-carers, were absent. A range of interventions were identified, but there was no strong evidence of effectiveness. In some studies, the choice of outcome measure may underestimate the full impact of an intervention.

CONCLUSIONS

Current evidence fails to fully quantify the impacts that caring for older people has on carers' health and well-being. Information on social patterning of the consequences of caring is absent. Systematic measurement of a broad range of outcomes, with comparison to the general population, is needed to better understand the true consequences of caring. Classification of unpaid caring as a social determinant of health could be an effective lever to bring greater focus and support to this population. Further work is needed to develop and identify suitable interventions in order to support evidence-based policymaking and practice.