The three dimensions of caregiver grief in dementia caregiving: Validity and utility of the subscales of the Marwit-Meuser Caregiver Grief Inventory

Partner Caregiver Resilience: A Scoping Review

PURPOSE

Caring for older adults with Alzheimer's disease and related dementias (ADRD) is a significant challenge for partner caregivers (i.e., committed, married, or cohabiting individuals). Understanding partner caregivers' needs is crucial to promote their well-being during the disease trajectory. The concept of resilience may help explain how ADRD partner caregivers manage in the face of significant challenges. The purpose of the current scoping review was to synthesize the qualitative evidence of the level of resilience among partner caregivers of persons with ADRD.

METHOD

A scoping review was conducted, which resulted in 19 research studies meeting inclusion criteria.

RESULTS

Findings were grouped by significant aspects of resilience as reflected in the studies reviewed, including risk and protective factors, partner caregivers' characteristics, and challenges and facilitators of resilience. Knowledge, skills, and access to social, psychological, and emotional support are needed to foster partner caregiver resilience.

CONCLUSION

Further resilience research is necessary to inform development of public policies, programs, and interventions tailored to the unique needs of ADRD partner caregivers. [Research in Gerontological Nursing, 17(2), 99-108.].

Anticipatory grief prevalence among caregivers of persons with a life-threatening illness: A meta-analysis

OBJECTIVES

Caring for a family member with a life-threatening illness may lead to increased levels of psychological morbidity. Given the lack of recognition of caregivers' grief, this study aimed to determine the prevalence of anticipatory grief disorders in caregivers of persons with a life-threatening illness for better intervention and management.

METHODS

CINAHL, Cochrane, Embase, Medline, PubMed, Scopus, PsycINFO and Web of Science were searched up to 21 March 2021 without language and time restrictions. The quality of the included studies was assessed with Hoy's criteria. A random-effects model was applied to calculate pooled prevalence rates, and multi-regression was performed to examine heterogeneity among studies.

RESULTS

A total of 3278 citations were retrieved, and 18 studies met the eligibility criteria involving 5470 caregivers. The pooled prevalence of anticipatory grief was 24.78% (95% CI 19.04% to 30.99%). The prevalence rates were significantly higher in female caregivers (16.64%; 95% CI 12.24% to 21.53%) compared with male caregivers (6.11%; 95% CI 4.55% to 7.87%). The married group also had a higher risk (14.66%; 95% CI 10.66% to 19.16%) than single group (5.47%; 95% CI 4.31% to 6.76%).

CONCLUSIONS

The overall pooled prevalence is substantially higher compared with after-loss grief in the general population and supported the presumptions that preloss grief has a greater magnitude compared with after-loss grief. Bereavement support, educational programmes and relevant resources should be delivered even before the actual loss to address the burden of caregivers.

Grief in family carers of people living with dementia: A systematic review

OBJECTIVES

Grief research in family carers of people with dementia has increased. We aimed to report the prevalence of pre-death and post-death grief and to synthesize associated factors and the relationship between pre-death factors and post-death grief and services used to manage grief.

DESIGN

(Prospero protocol: CRD42020165071) We systematically reviewed literature from PsycINFO, MEDLINE, CINAHL, and ASSIA until April 2020. Effectiveness of intervention data and studies not written in English were excluded; qualitative studies were additionally excluded during study selection. Study quality was assessed using the Mixed Methods Appraisal Tool. Evidence was narratively summarized.

PARTICIPANTS

Family non-paid carers of somebody with any dementia type.

MEASUREMENTS

Validated measures of pre-death and/or post-death grief.

RESULTS

We included quantitative data from 55 studies (44 rated as high quality). Most included solely spouse or adult child carers. Forty-one studies reported pre-death grief, 12 post-death grief, and 6 service use; eight were longitudinal. 17% met the Prolonged Grief Disorder criteria pre-death (n = 1) and 6-26% (n = 4) of participants met the Complicated Grief criteria post-death. Being a spouse, less educated, caring for somebody with advanced dementia, and greater burden and depression were associated with higher pre-death grief. Lower education level and depression were predictive of higher post-death grief. Pre-death factors found to influence post-death grief were grief and depression. Limited service use evidence was reported.

CONCLUSION

Awareness of characteristics which increase the likelihood of higher grief can help identify those in need of support. Future research should focus on what supports or services are beneficial to grief experiences.

Assessment of anticipatory grief in informal caregivers of dependants with dementia: a systematic review

OBJECTIVES

Informal caregivers of dependants with dementia commence their bereavement experience long before the physical death of their dependant, a process referred to as "anticipatory grief". This represents an ambiguous state that has been acknowledged as a measurable variable among informal caregivers. The use of assessment tools for the identification of anticipatory grief is important for timely intervention to promote well-being and positive bereavement experiences. The aim of this systematic review is to identify and examine existing tools for assessing anticipatory grief among caregivers of dependants with dementia.

METHODS

MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Science were searched to July 2021. Studies focusing on the development/evaluation of instruments for measuring anticipatory grief in dementia caregivers were eligible. The quality of each measurement was graded as positive, fair, poor or no information based on defined criteria.

RESULTS

100 studies were identified. 33 papers were selected for full-text assessment and 12 papers met the eligibility criteria. Seven assessment tools were identified for measurement of pre-death grief caregivers - the Anticipatory Grief Scale (AGS), Marwit-Meuser Caregiver Grief Inventory (MM-CGI), MM-CGI-short-form (MM-CGI-SF), MM-CGI-brief (MM-CGI-BF), Prolonged Grief Scale (PG-12), Caregiver Grief Scale (CGS) and Caregiver Grief Questionnaire (CGQ). Based on content/construct validity, internal consistency and test-retest reliability the MM-CGI/MM-CGI-SF scored highest for quality followed by the CGS.

CONCLUSION

Anticipatory grief in dementia has multiple facets that can be measured using self-scoring questionnaires. Our findings provide support for different measures of anticipatory grief. Further research is needed for the evaluation of the responsiveness and interpretability of these instruments.

An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review

BACKGROUND

Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist.

AIM

This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity.

DESIGN

A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254).

RESULTS

One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies.

CONCLUSIONS

We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.

Pre-Loss Grief in Caregivers of Older Adults with Dementia with Lewy Bodies

BACKGROUND

Pre-loss grief increases as dementia advances. Caregivers who experience pre-loss grief face risks to their own physical and psychological health.

OBJECTIVE

The study examined factors associated with pre-loss grief in caregivers of older adults with dementia with Lewy bodies (DLB) to determine whether overall caregiver experiences differ based on the stages of DLB in care recipients. The study also compared pre-loss grief in caregivers of DLB patients with that in caregivers of patients with Alzheimer's disease (AD) and other dementias.

METHOD

Using a cross-sectional design, 714 caregivers of older adults with dementia (488 DLB, 81 AD, 145 other dementias) completed an online survey on pre-loss grief. Multivariate linear regression identified risk factors associated with pre-loss grief and analysis of variance examined whether pre-loss grief in caregivers differed significantly based on type of dementia or stage of DLB.

RESULTS

Being the caregiver of a spouse, lower level of caregiver well-being, lower psychological well-being of the caregiver, and higher level of burden were associated (p < 0.005) with increased pre-loss grief in caregivers of older adults with DLB. There was no significant difference in caregiver burden, well-being, or depression according to the various stages of DLB (mild, moderate, severe, deceased) in the care recipients. There was no significant difference in pre-loss grief in caregivers of DLB care recipients compared to caregivers of patients with other dementias.

CONCLUSION

Assessment of DLB caregivers and appropriate interventions should be conducted to reduce their burden and emotional distress to decrease the incidence of pre-loss grief.

The Longitudinal Effects of Caregiver Grief in Dementia and the Modifying Effects of Social Services: A Prospective Cohort Study

BACKGROUND

Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of the PWD, with such caregiver grief postulated to affect the well-being of the PWD-caregiver dyads. However, the longitudinal effects of caregiver grief and the moderating effects of social services are not yet clear.

OBJECTIVES

We investigated the longitudinal effects of caregiver grief on caregiver depression, caregivers' quality of life (QoL), and caregivers' perceived positive aspects of caregiving (PAC); and examined potential effect modification of social service utilization (dementia care services, caregiver programs, and paid caregivers).

DESIGN AND SETTING

A prospective cohort study with three time points of assessments (at 0, 6, and 12 months).

PARTICIPANTS

Family caregivers of community-dwelling PWD (n = 178).

MEASUREMENTS

At time point 1 (baseline), participants completed questionnaires that captured caregiver grief, burden, and social service utilization. Outcomes that were captured over time were: depression (time points 1-3), QoL (time point 2), and PAC (time point 3). Caregiver grief as well as interaction terms with social service utilization were included in Tobit regression to examine the association with outcomes.

RESULTS

After accounting for the effect of caregiver burden, caregiver grief remained associated with depressive symptoms (P < .001) and poorer QoL (P < .001). However, compared with burden, grief contributed to larger magnitudes of the adverse effects. Grief, not burden, was associated with less PAC (P = .006 and P = .746, respectively). In contrast, burden, not grief, was associated with poorer physical health (P = .010 and P = .110, respectively). Dementia care services attenuated the effect of burden but not grief; caregiver programs did not affect burden but appeared to aggravate the effect of grief; and paid caregivers attenuated the effect of burden, and partially attenuated the effect of grief.

CONCLUSION

Caregiver grief has an impact on dementia caregivers, likely through a distinct mechanism from that of caregiver burden. However, prevailing social services may not be sufficient to address grief, highlighting the need to further train care workers in this respect. J Am Geriatr Soc 68:2348-2353, 2020.

The three dimensions of caregiver grief in dementia caregiving: Validity and utility of the subscales of the Marwit-Meuser Caregiver Grief Inventory

BACKGROUND

The experience of grief in family caregivers as they provide care for persons with dementia is often overlooked. The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) is one among the few scales that capture such experiences. In a recent study, MM-CGI was found to contain three subscales identifying dimensions of loss in caregivers-Personal-Sacrifice Burden (PSB), Heartfelt Sadness, Longing, and Worry (HSLW), and Felt Isolation (FI). We aimed to evaluate the validity and utility of these dimensions in a multiethnic Asian population.

METHODS

Family caregivers (n = 394) completed MM-CGI and scales assessing caregiver burden, depression, and gains. Internal consistency reliability was examined using Cronbach α; test-retest reliability using intraclass correlation coefficient; and construct validity using Pearson correlation coefficient. The utility of the MM-CGI dimensions was evaluated by comparing caregivers with high subscale scores across dementia stages and caregiving relationship.

RESULTS

The three dimensions of MM-CGI exhibited adequate internal consistency, test-retest reliability, construct validity, and known-group validity. PSB correlated most strongly with caregiver burden (r = 0.78); HSLW with caregiver depression (r = 0.75); and FI with caregiver burden and caregiver depression (r = 0.60, respectively). Caregivers with high total grief scores tended to experience most difficulty with HSLW (90.8%), followed by PSB (75.4%) and FI (46.2%). The three dimensions also increased across the dementia stages, with FI higher in mild dementia, PSB higher in moderate dementia, and HSLW higher in severe dementia. Spousal caregivers experienced most difficulty in HSLW, whereas children caregivers experienced similar levels of difficulty across the dimensions.

CONCLUSIONS

The three dimensions of MM-CGI captured distinct aspects of caregiver grief in a multiethnic Asian population and would enable more individualized assessments and interventions for caregiver grief.