[Quality of sleep in caregiving relatives of people with dementia: investigation of the prevalence and possible predictors]

Factors associated with reduced sleep among spouses and caregivers of older adults with varying levels of cognitive decline

BACKGROUND

Caregivers of persons with cognitive decline (PWCD) are at increased risk of poor sleep quantity and quality. It is unclear whether this is due to factors in the caregiver versus in the PWCD.

METHODS

This secondary data analysis using Aging, Demographics, and Memory Study data from the Health Retirement Study examined factors contributing to reduced sleep/rest among spouses and caregivers of older adults with varying levels of cognitive decline (cognitively normal (CN), cognitive impairment but not dementia (CIND), or dementia).

RESULTS

In our preliminary analysis, among N = 218 spouses (not necessarily caregivers) (mean age (SD) = 73.77 (7.30); 70.64% female) of older adults with varying levels of cognitive decline, regression revealed that frequency of sleep complaints was lowest among spouses with CN partners, second highest with CIND partners, and highest with dementia-partners, X2  = 26.810, P = 0.002.

PRIMARY AIM

among n = 136 caregivers of PWCD (mean age (SD) = 59.27 (13.97); 74.26% female; 22.79% spouses), we analyzed whether caregiver reduced sleep/rest was predicted by PWCD factors (i.e., frequent nighttime waking, dementia severity) and/or caregiver factors (i.e., depression symptoms, caregiver role overload). Regression revealed that caregiver depression symptoms (d = 0.62) and role overload (d = 0.88), but not PWCD factors, were associated with reduced caregiver sleep/rest after adjusting for demographic factors, caregiving frequency, and shared-dwelling status (overall model: X2  = 31.876, P = 0.002). Exploratory analyses revealed that a caregiver was 7.901 times more likely (95% CI: 0.99-63.15) to endorse experiencing reduced sleep/rest if back-up care was not available (P = 0.023).

CONCLUSION

Findings highlight that the frequency of reported sleep problems among spouses increases in a stepwise fashion when partners have dementia versus CIND versus CN. The results also emphasise that caregiver mental health and burden are strongly associated with caregiver sleep disturbances and thus may be targets of intervention for caregiver sleep problems.

[Burden experienced by caregiving relatives during the corona pandemic]

Hintergrund

Bereits vor der Coronapandemie waren pflegende Angehörige mit einer Vielzahl an Herausforderungen und Belastungen konfrontiert. Erste Onlineerhebungen zeigten eine Zunahme der Pflegebelastung während der Pandemie. Ergänzend hierzu wurde eine Erhebung zu Auswirkungen der Pandemie auf bereits belastete pflegende Angehörige in Deutschland durchgeführt.

Methode

Im Rahmen einer Evaluationsstudie zu einem gestuften Beratungsansatz für hochbelastete pflegende Angehörige wurden von 165 Pflegenden quantitative und qualitative Daten zum Belastungserleben, zu Ängsten und Wünschen in der Coronapandemie bezüglich der Pflege erhoben. Die Auswertungen erfolgten deskriptiv und mittels qualitativer Inhaltsanalyse.

Ergebnisse

Von den Angehörigen gaben 26 % starke Ängste an, sich mit SARS-CoV‑2 zu infizieren, 50 % befürchteten, dass die gepflegte Person erkranken könnte. Die Hälfte berichtete deutliche Auswirkungen auf den Pflegealltag (47 %) und nahm eine deutliche Erhöhung der Pflegbelastung (51 %) wahr. Als häufigste negative Auswirkungen auf den Pflegealltag wurden der Ausfall von Pflegedienstleistungen und ein Mangel an Zeit für sich selbst genannt. Dementsprechend wurde am häufigsten der Wunsch nach Unterstützung geäußert. Der Pflegegrad, das Alter der Pflegenden und die vorherige Nutzung des Pflegedienstes erwiesen sich als Prädiktoren für das durch die Pflegenden eingeschätzte Belastungserleben der Erkrankten.

Diskussion

Die Ergebnisse verdeutlichen die negativen Auswirkungen der Coronapandemie auf die Belastung pflegender Angehöriger eindrücklich. Zur Bewältigung der komplexen Zusatzbelastungen benötigen Angehörige Angebote, die zu deren Teilhabechancen sowie zur Verbesserung der Versorgung und sozialen Teilhabe der Pflegebedürftigen während der Pandemie beitragen.

How does beginning or ceasing of informal caregiving of individuals in poor health influence sleep quality? Findings from a nationally representative longitudinal study

BACKGROUND

Various cross-sectional studies exist examining the association between informal caregiving and sleep quality. However, there is a lack of longitudinal studies investigating whether beginning and ceasing of informal caregiving is associated with changes in sleep quality.

AIMS

Investigating whether beginning and ceasing of informal caregiving of individuals in poor health is associated with changes in sleep quality in both sexes.

METHODS

Data were taken from a nationally representative sample of individuals ≥ 40 years in Germany from 2008 to 2017. In our analytical sample, n equaled 22,910 observations. Based on the Pittsburgh Sleep Quality Index, the sleep quality was assessed by the difficulties falling asleep during the last month, difficulties with sleep because of waking up during the last month (in both cases: (from 1 = not during the last month to 4 = three or more times a week) and the overall assessment of sleep quality during the last month (from 1 = very good to 4 = very bad).

RESULTS

Asymmetric fixed effects regressions showed that in men beginning to provide informal care was associated with decreased overall sleep quality (β=-.09 (95% CI: -.15 - -.03), p<.01) and an increased likelihood of difficulties because of waking up (OR: 1.54 (95% CI: 1.07-2.20), p<.05), whereas ceasing to provide informal care was not associated with the outcome measures (both, in women and in men).

DISCUSSION

Starting informal caregiving had deleterious effects on sleep quality in men.

CONCLUSIONS

Efforts to assist men in maintaining sleep quality may be beneficial.