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Zwingmann I, Michalowsky B, Esser A, Kaczynski A, Monsees J, Keller A, Hertel J, Wucherer D, Thyrian JR, Eichler T, Kilimann I, Teipel S, Dreier Wolfgramm A, Hoffmann W. Identifying Unmet Needs of Family Dementia Caregivers: Results of the Baseline Assessment of a Cluster-Randomized Controlled Intervention Trial. J Alzheimers Dis 2020; 67:527-539. [PMID: 30584136 PMCID: PMC6398541 DOI: 10.3233/jad-180244] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Caregivers providing informal care for people with dementia (PwD) often report unmet needs, burden, and health impairments. Optimal support for family dementia caregivers will likely benefit from better understanding and assessment of the prevalence and types of caregivers' unmet needs and associated socio-demographic and clinical characteristics. OBJECTIVE The present study investigates 1) the number and types of caregivers' unmet needs, 2) socio-demographic and clinical characteristics of both PwD and caregivers, and 3) caregivers' burden and health-related outcomes that are related to caregivers' unmet needs. METHODS The present analyses are based on cross-sectional data of n = 226 dyads of caregivers and their community-dwelling PwD participating in a comprehensive standardized, computer-based caregivers' needs assessment within a general practitioner (GP)-based, cluster-randomized intervention trial. RESULTS A total of n = 505 unmet needs were identified for n = 171 caregivers from the intervention group at baseline. Only 24.3% caregivers reported no unmet need (n = 55), whereas 75.7% caregivers had at least one unmet need (n = 171). Caregivers had on average 2.19 unmet needs (mean = 2.19, SD = 2.15). Specifically, 53.1% of caregivers had one up to three unmet needs (n = 120), 18.6% (n = 42) had three up to six unmet needs, and 4.0% (n = 9) had more than six unmet needs. DISCUSSION Our results underline the importance of a comprehensive needs assessment for family dementia caregivers to develop and implement concepts that can provide family dementia caregivers with optimal support.
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Affiliation(s)
- Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Alexander Esser
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Anika Kaczynski
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Armin Keller
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Rostock, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Adina Dreier Wolfgramm
- Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Zwingmann I, Dreier-Wolfgramm A, Esser A, Wucherer D, Thyrian JR, Eichler T, Kaczynski A, Monsees J, Keller A, Hertel J, Kilimann I, Teipel S, Michalowsky B, Hoffmann W. Why do family dementia caregivers reject caregiver support services? Analyzing types of rejection and associated health-impairments in a cluster-randomized controlled intervention trial. BMC Health Serv Res 2020; 20:121. [PMID: 32059724 PMCID: PMC7023728 DOI: 10.1186/s12913-020-4970-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although there are a number of support services accessible for most family dementia caregivers, many caregivers reject available and affordable support. Previous research suggests that rejections of support services may result from insufficient fit of available services with caregivers’ unmet needs and a lack of acknowledgement of caregivers’ unmet needs and associated support services. The present study investigates (a) the number, proportion and types of caregivers’ rejection on recommended tailored support, (b) socio-demographic and clinical determinants of caregiver’s rejection of both people with dementia (PwD) and caregivers, and (c) caregivers’ health-related variables related to caregivers’ rejection. Methods Caregivers’ rejection of tailored support services was identified based on a standardized, computerized unmet needs assessment conducted by dementia-specific qualified nurses. The present analysis is based on data of n = 226 dyads of caregivers and their community-dwelling PwD who participated in a general practitioner (GP)-based, cluster-randomized intervention trial. The trial was approved by the Ethical Committee of the Chamber of Physicians of Mecklenburg-Western Pomerania, registry number BB 20/11. Data analyses were conducted using Stata/IC 13.1. We conducted Welch’s t-test, Pearson’s product-moment correlation, and conditional negative binomial regression models with random effects for GP to account for over-dispersed count data. Results In sum, n = 505 unmet needs were identified and the same number of tailored recommendations were identified for n = 171 family dementia caregivers from the intervention group at baseline. For n = 55 family dementia caregivers not a single unmet need and recommendation were identified. A total of 17.6% (n = 89) of the recommendations were rejected by caregivers. Rejection rates of caregivers differed by type of recommendation. Whereas caregivers’ rejection rate on recommendations concerning mental health (3.6%), physical health (2.5%), and social, legal, and financial affairs (0%) were low, caregivers’ rejection rates concerning social integration (especially caregiver supporting groups) was high (71.7%). Thus, the rejections of family dementia caregivers are mainly linked to the delegation to caregiver supporting groups. Caregivers’ rejections were mainly related to personal factors of caregivers (n = 66), service-related factors (n = 6), relational factors (n = 1), and other factors (n = 17). Furthermore, our results showed that the number of caregivers’ rejections was associated with a higher functional status of the PwD and are mainly associated with the rejection of caregiver supporting groups. Thus, caregivers visit supporting groups more often when the PwD shows low abilities in activities of daily living. Importantly, this is independent of the status of cognition and depression of the PwD as well as the physical and mental health of the family dementia caregivers. Conclusions Our results underline the importance of understanding factors that determine caregivers’ rejection of support services. These need to be specifically addressed in tailored solutions for caregivers’ support services. Trial registration ClinicalTrials.gov Identifier: NCT01401582 (date: July 25, 2011, prospective registered).
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Affiliation(s)
- Ina Zwingmann
- European University of Applied Science (EUFH), Werftstrasse 5, 18057, Rostock, Germany.
| | | | - Alexander Esser
- German Alzheimer Association regional association Mecklenburg-Western Pomerania, Rostock, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Anika Kaczynski
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Armin Keller
- German Alzheimer Association regional association Mecklenburg-Western Pomerania, Rostock, Germany.,Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Rostock, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany.,Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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Panzeri A, Rossi Ferrario S, Vidotto G. Interventions for Psychological Health of Stroke Caregivers: A Systematic Review. Front Psychol 2019; 10:2045. [PMID: 31551881 PMCID: PMC6743500 DOI: 10.3389/fpsyg.2019.02045] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 02/03/2023] Open
Abstract
Background: The increasing number of stroke patients (SPs) requires informal caregivers to bear a high burden of responsibilities and heavy (di)stress. Moreover, these issues could lead to the development of serious psychological problems (e.g., depressive and/or anxious) that in turn could give rise to poor health-related quality of life outcomes. However, although the value of psychological interventions has been widely recognized for SPs, the scientific literature lacks an updated synthesis of interventions addressing the psychological health of their caregivers. Aim: The aim of this review is to summarize the interventions for the psychological health of stroke caregivers and provide a resume of literature-based evidence of their efficacy. Method: A literature review from 2005 to date was conducted in three online databases: PubMed, Scopus, and Google Scholar. Eligibility criteria for studies were (A) English language, (B) caregivers and patients aged 18 years or above, (C) SP's caregiver beneficiating of a specific intervention, and (D) outcome measures addressing depressive and/or anxiety symptomology, quality of life, well-being, or burden. Results: Across the selected 45 studies, substantial differences are observable in three main categories: (a) type of intervention (b) techniques, and (c) operators. Interventions' advantages and results are discussed. Overall, studies using psychological techniques, such as cognitive-behavioral therapy, coping skill-training, and problem-solving therapy, showed their usefulness and efficacy in reducing the caregivers' depressive and anxious symptoms, and burden. Interventions led by psychologists and tailored to meet caregivers' specific needs showed more positive outcomes. Conclusion: This review underlines the usefulness of psychological interventions aimed at reducing the psychological burden, such as anxious and depressive symptomatology, of SPs' informal caregivers. Hence, psychological interventions for caregivers should be integrated as part of the stroke rehabilitation process to improve informal caregivers' and patients' quality of life and well-being.
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Affiliation(s)
- Anna Panzeri
- Psychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri, Veruno, Italy
- General Psychology Department, Università degli Studi di Padova, Padova, Italy
| | - Silvia Rossi Ferrario
- Psychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri, Veruno, Italy
| | - Giulio Vidotto
- General Psychology Department, Università degli Studi di Padova, Padova, Italy
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[Feasibility and effects of a psychotherapeutic group intervention for caregiving relatives of people with dementia]. Z Gerontol Geriatr 2019; 52:641-647. [PMID: 30643963 DOI: 10.1007/s00391-018-01501-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 10/29/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Family caregivers of people with dementia (PwD) have a high burden and therefore are themselves at a high risk for psychiatric and somatic morbidities. Although individual psychotherapy has been shown to be a potentially effective treatment, it is rarely used by family caregivers. Possible reasons are poor accessibility and time restrictions on the side of the caregiver. AIM To test the efficacy of a short-term and low threshold psychotherapeutic group intervention for family caregivers of PwD with respect to mental stability of the caregivers. MATERIAL AND METHODS Data from a 12-week psychotherapeutic group intervention (10 participants each in the intervention and control groups) were analyzed. Main topics of the intervention were: personal limits, dysfunctional thoughts, emotions and resource activation. Primary endpoints were an increase of perceived self-efficacy and reduction of depressive symptoms using SWE and ADS questionnaires before, directly and 3 months after the end of the intervention. RESULTS A gain in perceived self-efficacy did not reach statistical significance, whereas depressive symptoms showed a statistically significant increase in the intervention group over time compared to the control group. DISCUSSION The intervention did not reach its primary endpoints. Possible reasons are the fact that the group was highly heterogeneous with respect to dementia etiology and the low number of participants. The short duration of the intervention may have reduced the potential of the program to address all urgent needs of the participants.
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Abstract
BACKGROUND This article focusses on the possibilities, varieties, indications, and benefits of psychotherapy with elderly patients. OBJECTIVE Which basic principles can be differentiated, what theoretical rationales are helpful for psychotherapy with the elderly and what kind and forms of psychotherapy are available? MATERIAL AND METHODS Based on relevant references and research, clinically relevant and evidence-based psychotherapies are described, to understand the theoretical rationale, the goals, the procedure and main strategies. RESULTS Cognitive behavior therapy, problem solving therapy, life review therapy, interpersonal psychotherapy, and psychodynamic psychotherapy are available to treat various psychological and somatic problems in elderly patients. In particular, cognitive behavior therapy, problem solving therapy, and life review therapy are evidence-based and empirically validated. Evidence for interpersonal psychotherapy is mixed and for psychodynamic psychotherapy is missing. CONCLUSION Psychotherapy with old and very old patients is possible, well received, and successful. Age per se is no longer considered to be a relevant variable for indications of psychotherapy.
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