Positive and negative experiences of caregiving in dementia: The role of sense of coherence

A Double Whammy? Psychosocial Disadvantages of Dementia Caregivers with Cancer Histories

Guided by the Diathesis-Stress model, this study examined how cancer history interacted with caregiving status to determine the psychosocial functioning of dementia caregivers. This study assessed a set of indicators for psychological health and social connections among 85 spousal caregivers of persons with Alzheimer's disease and 86 age- and gender-matched spouses of healthy controls at study entry and 15-18 months later. Results showed that dementia caregivers with cancer histories reported lower social connections relative to caregivers without cancer histories or non-caregivers with or without cancer histories, and reported lower psychological health relative to non-caregivers with and without cancer histories at two time points. The findings highlight that a history of cancer is a predisposing vulnerability factor for psychosocial dysfunctions among dementia caregivers and address gaps in knowledge about the psychosocial adjustment of cancer survivors as caregivers.

Risk, Resilience, and the Two-Track Model of Dementia Grief Among Spouses of People Living With Cognitive Decline

Pre-death grief in the context of dementia caregiving is a significant risk factor for depression, burden, anxiety, and adjustment difficulties. The Two-Track Model of Dementia Grief (TTM-DG) provides a bifocal perspective addressing the nature of the emotional attachment to a loved one living with cognitive impairment, along with a medico-psychiatric perspective associated with stress, trauma, and change in life. The aims of the present study were to empirically validate the components of the model as to identify salutary and risk factors for maladaptive grief responses. Participants were 62 spouses of people living with cognitive impairment, and a control group of 32 spouses. All completed a battery of self-report questionnaires. Structural Equation Modeling yielded six variables consistent with the TTM-DG: partner's behavioral disorders; caregiver's burden; social support; physical health; attachment anxiety; and dementia grief as an outcome measure. Additional findings addressed participants at risk for grief difficulties. The findings provide empirical support for the utility of the TTM-DG in the identification of risk factors associated with maladaptive responses and pre-death grief following a spousal cognitive decline. The TTM-DG can assist in the formulation of evidence-based evaluations and interventions to assist spouses caring for their loved ones living with dementia.

Trajectories of relationship quality in dementia: a longitudinal study in eight European countries

OBJECTIVES

Relationship quality (RQ) between a person with dementia and a family carer may influence their health and quality of life. However, evidence regarding its course and influencing factors is limited. We aimed to explore RQ trajectories in dementia, and identify predictors of change.

METHODS

We analysed longitudinal data from a cohort of 350 community-dwelling people with dementia and their informal carers, participating in the Actifcare study in eight European countries. The Positive Affect Index, rated separately by both people with dementia and their carers, assessed RQ. Other measures included the Neuropsychiatric Inventory Questionnaire (regarding persons with dementia), and the Relative Stress Scale, Sense of Coherence Scale and Lubben Social Network Scale (for carers). Trajectories and influencing factors were explored applying a latent growth model (LGM).

RESULTS

RQ in the group of carers declined over 1 year, but RQ scores for the persons with dementia did not change. Higher stress in carers negatively influenced their baseline RQ ratings. Carer sense of coherence and being a spouse were associated with more positive baseline RQ carer assessments. Higher levels of neuropsychiatric symptoms were linked to decline in carers' RQ, whereas social support was associated with more positive RQ trajectories.

CONCLUSION

This study provides a valuable insight into the course of RQ. LGM proved useful to explore the factors that influence RQ trajectories and variability within- and between-persons. Our findings emphasise the importance of carer-perceived social support and sense of coherence, and of reducing neuropsychiatric symptoms, in maintaining a good RQ.

The effect of salutogenic approach-based interviews on sense of coherence and resilience in people with schizophrenia: A randomized controlled trial

PURPOSE

The aim of this study was to determine the effect of interviews based on a salutogenic approach on the sense of coherence and resilience in schizophrenic patients.

DESIGN AND METHODS

A pretest-posttest randomized controlled experimental trial was conducted with 49 patients.

FINDINGS

The posttest and follow-up mean scores of the subscales and the overall scale of sense of coherence and resilience differed in favor of the intervention group (p < 0.01). In the intra-group comparison, the pretest, posttest, and 1-month follow-up all the subscales and the total mean scores of the sense of coherence and resilience differed in the intervention group (p < 0.001).

PRACTICAL IMPLICATIONS

The salutogenic approach-based interview is an effective intervention to increase the sense of coherence and resilience.

Longitudinal effect of dementia carers' sense of coherence on burden

BACKGROUND

A sense of coherence (SOC) could help us better understand why there are individuals who cope better than others in similar situations. The study aimed to assess the effect of SOC on the course of burden reports in relatives of persons with dementia.

METHODS

This was a prospective cohort study of 156 dementia carers. The SOC was assessed by the Orientation to Life Questionnaire (OLQ-13), burden by Burden Interview, and personal and contextual characteristics were collected via ad hoc questions. The main dementia symptoms, including functional difficulties (Disability Assessment for Dementia), neuropsychiatric symptoms (Neuropsychiatric Inventory), and cognitive impairment (Mini-Mental State Examination), were also assessed. A general linear model was adjusted to determine the effect of SOC and other covariates on burden throughout the follow-up. Burden differences between baseline and 12 and 24 months were analysed, and the baseline OLQ-13 score was grouped by quartiles.

RESULTS

The global burden reported increased after 24 months (F = 9.98; df = 2; p < 0.001), but not equally for all carers; daughters reported the greatest increase. SOC, functional disability, and neuropsychiatric disorders showed a significant effect on burden, but time did not. Carers with higher SOC at baseline tend to remain with lower burden levels, whereas carers with low SOC reported higher burden at each visit.

CONCLUSIONS

This study reports evidence of the effect of SOC on burden at baseline, 12 and 24 months of follow-up. Burden scores differ by carers' SOC; those with higher SOC showed lower burden levels, whereas the low-SOC group reported a greater burden at each visit.

Two sides of the same coin? Revisiting the relationship between burden and positive aspects of caregiving in dementia

OBJECTIVES

Studies have shown that items on the Zarit Burden Interview (ZBI) purported to measure self-criticism do not correlate well with the other items. Examination of item content suggests they may be measuring mixed sentiments-both positive and negative-about caregiving. This study examined whether self-criticism is related to positive aspects of caregiving (PAC) in a way that is different from caregiver strain, and if so, which types of PAC.

METHODS/DESIGN

The baseline data of two Alzheimer caregiver intervention studies were merged (N = 225). Based on previous factor analysis, 2 ZBI items formed the self-criticism measure while 16 ZBI items measured global strain. PAC was assessed by coding caregivers' narratives about positive gains into seven themes (relationship gains, growth, insights, competence/mastery, purpose, emotional rewards, and miscellaneous).

RESULTS

Global strain was mildly associated with fewer total PAC, in a way consistent with the literature, and with less competence/mastery. However, self-criticism was associated with stronger relationship gains and purpose. Younger caregivers reported more relationship gains but less emotional rewards. Longer caregiving duration was associated with more growth, but the reverse was true for chronic illnesses. Additionally, relationship closeness was associated with more emotional rewards, whereas care-recipient neuropsychiatric symptoms and functional impairment were associated with fewer relationship gains and emotional rewards respectively.

CONCLUSION

Thinking one is not doing enough may indicate feelings of inadequacy/guilt but may also signal devotion to the relative and a sense of purpose in the caregiving role. Analyzing total burden and PAC scores may obscure the relationships between their components.

Family resilience and subjective responses to caregiving for children with epilepsy

OBJECTIVES

This study quantified caregiver burdens and the positive aspects of caregiving for the parents of children with epilepsy, with a focus on the impacts of family resilience as a protective factor for the caring process.

METHODS

This cross-sectional study was conducted among 173 parents of children with epilepsy, all of whom responded to questionnaires containing the shortened Chinese version of the Family Resilience Assessment Scale (FRAS-C), positive aspects of caregiving scale (PAC), and Chinese version of the Zarit Caregiver Burden Interview (CZBI). They also provided relevant sociodemographic data.

RESULTS

The mean CZBI total score was 22.16 (SD, 14.26; range, 0-71), while the mean PAC total score was 40.05 (SD, 11.09; range 11-55). The FRAS-C total score was positively correlated with the PAC total score (r = 0.368, p < 0.001), but negatively correlated with the CZBI total score (r = -0.301, p < 0.001). A multiple linear regression analysis showed that family resilience explained PAC and CZBI at rates of 11.4% and 5.5%, respectively.

CONCLUSIONS

Parents have both positive and negative experiences when caring for children with epilepsy. In this context, family resilience may enhance the positive aspects of caregiving while reducing the frequency of negative feelings, thus highlighting the need for clinicians to focus on adequate interventions aimed at improving family resilience.