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Chan KT, Marsack-Topolewski CN, Ratnayake M, Kaplan DB, Voet KA, Riemenschneider M, Graves J. The Impact of an Intergenerational Service Learning Program on Psychological Distress for Homebound Older Adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-18. [PMID: 38934724 DOI: 10.1080/01634372.2024.2373290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 06/24/2024] [Indexed: 06/28/2024]
Abstract
This study examined the benefits of an intergenerational home-based service learning program to reduce psychological distress for homebound older adults. Multivariate regression analyses were conducted with a sample of 182 to examine the association of length of service from the program and presence of caregivers with psychological distress. Findings indicated length of service (β = -0.15, p < .05) and having a child as a caregiver (β = -0.14, p < .05) were associated with a reduction in psychological distress. Policies and practice can support a pipeline of geriatric health professionals through innovative service learning models to benefit older adults, caregivers, and students.
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Affiliation(s)
- Keith T Chan
- Hunter College, Silberman School of Social Work, New York, New York, USA
| | | | | | - Daniel B Kaplan
- School of Social Work, Adelphi University, Garden City, New York, USA
| | - K Alida Voet
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jillian Graves
- School of Social Work, Eastern Michigan University, Ypsilanti, Michigan, USA
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Pérez-Núñez P, O’Callaghan C, López-Paz JF, Ruiz de Lazcano A, Rodríguez AA, Amayra I. Songwriting Group Music Therapy to promote psychological adjustment in informal caregivers of elderly people with dependency: a mixed methods study. Front Psychol 2024; 15:1334875. [PMID: 38510302 PMCID: PMC10953728 DOI: 10.3389/fpsyg.2024.1334875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Informal caregivers of elderly people with dependency (EPD) provide intensive care that can affect their quality of life (QoL). Psychosocial interventions such as music therapy are important to work on their self-care. The aim of this study is to analyze, with a mixed method approach, the experience of participating in a Songwriting Group Music Therapy (SGMT) intervention on informal caregivers of EPD. Methods A total of 11 groups, with a convenience sample of 61 caregivers, received 10 SGMT sessions. Quantitative information related to QoL variables (anxiety, depression, spirituality, burden, and coping) was collected before and after the intervention and at 3 months of follow-up. Regarding qualitative data, an open-ended question about the experience of participating was asked. Results Significant changes were shown, sustained over time, in trait anxiety and depression and subscales including inner peace, social functioning, and mental health. Three themes were generated from the thematic analysis, including that SGMT participation can enhance personal growth, bring out and enable work on emotions, and promote helpful interpersonal dynamics. Discussion The findings indicate that SGMT is a useful intervention for informal caregivers of EPD, promoting psychological adjustment, enhanced coping, emotional regulation, and social support. This study reinforces the findings with caregivers of other populations, providing new results and highlighting the benefits of SGMT for caregivers of EPD.
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Affiliation(s)
- Paula Pérez-Núñez
- Faculty of Health Sciences, Department of Psychology, University of Deusto, Bilbao, Spain
| | - Clare O’Callaghan
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Caritas Christi (Palliative Care Unit) and Psychosocial Cancer Care, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | | | - Aitana Ruiz de Lazcano
- Faculty of Health Sciences, Department of Psychology, University of Deusto, Bilbao, Spain
| | | | - Imanol Amayra
- Faculty of Health Sciences, Department of Psychology, University of Deusto, Bilbao, Spain
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Kastl A, Rauner YN, Mayer-Huber S, Oestreich C, Benstetter F, Fettke U. Stakeholder needs assessment for developing ageing in place solutions - a qualitative study. BMC Geriatr 2024; 24:104. [PMID: 38287254 PMCID: PMC10823612 DOI: 10.1186/s12877-024-04722-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Ageing in place is a common desire among older adults and people in need of care. Accessible housing and ambient assisted living (AAL) technologies can help to live independently at home. However, they cannot replace the human support network of informal caregivers, healthcare professionals and social workers. The needs of these stakeholders should be considered and analysed in order to develop user-friendly and acceptable (digital) solutions for ageing in place while supporting human support networks in fulfilling their roles. This paper presents the first step for a comprehensive multi-level needs analysis within the framework of an user-centered design thinking approach. METHODS Guideline-based interviews were conducted with healthcare professionals, social workers and an informal caregiver to collect data about the needs of older adults as well as people in need of care, and their human support networks. RESULTS The call for more information that is easier to find is a common desire of the three groups. There is agreement on system-based communication and orientation problems, the existence of physical and psychological stress exacerbated by a lack of human resources, the desire for personalised care, the need to feel safe and supported in emergencies, and the need for advice and help with administrative tasks. Overall, the needs of one group are closely linked to those of the other. CONCLUSION Stakeholder selection and diversity are decisive for findings about ageing in place. The overlaps between the stakeholders' needs offer chances and challenges at the same time for the development of user-friendly, acceptable (digital) solutions and products that support ageing in place.
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Affiliation(s)
- Andrea Kastl
- Technical University of Applied Sciences Rosenheim, Hochschulstraße 1, Rosenheim, 83024, Germany.
| | - Yvonne Nadine Rauner
- Technical University of Applied Sciences Rosenheim, Hochschulstraße 1, Rosenheim, 83024, Germany
| | - Sandra Mayer-Huber
- Technical University of Applied Sciences Rosenheim, Hochschulstraße 1, Rosenheim, 83024, Germany
| | - Claudia Oestreich
- Technical University of Applied Sciences Rosenheim, Hochschulstraße 1, Rosenheim, 83024, Germany
| | - Franz Benstetter
- Technical University of Applied Sciences Rosenheim, Hochschulstraße 1, Rosenheim, 83024, Germany
| | - Ulrike Fettke
- Technical University of Applied Sciences Rosenheim, Hochschulstraße 1, Rosenheim, 83024, Germany
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Goto Y, Morita K, Suematsu M, Imaizumi T, Suzuki Y. Caregiver Burdens, Health Risks, Coping and Interventions among Caregivers of Dementia Patients: A Review of the Literature. Intern Med 2023; 62:3277-3282. [PMID: 36858522 PMCID: PMC10713358 DOI: 10.2169/internalmedicine.0911-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023] Open
Abstract
Over 55 million people reportedly suffer from dementia worldwide. In Japan, it is estimated that 1 in 5 people over 65 years old will have dementia by 2025, of which more than 20% will live with symptoms that require home/nursing care. Given the lack of effective medical treatments for dementia, informal caregivers play essential roles in allowing dementia patients to live with dignity. Our review focusing on caregiver burden showed that this burden has not been sufficiently addressed, despite having negative effects on caregivers' health, employment, and finances. It is important to consider non-pharmacological interventions that contribute to effective coping strategies for mitigating the caregiver burden. Online communication tools may be a viable intervention measure to educate caregivers on the importance of sharing resilient coping strategies to reduce their stress so that they can continue to provide care for their loved ones.
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Affiliation(s)
- Yasuyuki Goto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Japan
| | | | - Mina Suematsu
- Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, Japan
| | | | - Yusuke Suzuki
- Centre for Community Liason & Patient Consultations, Nagoya University Hospital, Japan
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Chan KT, Marsack-Topoleswki C, LaFave S, Ratnayake M, Graves J, Fenski D, Jones L. Teaching Note-Supporting Homebound Older Adults and Caregivers Through Integrative Service Learning. JOURNAL OF SOCIAL WORK EDUCATION 2022; 59:1249-1257. [PMID: 38143590 PMCID: PMC10746131 DOI: 10.1080/10437797.2022.2045238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/26/2023]
Abstract
The Supporting Older Adults & Caregivers: Integrative Service Learning (SOCIAL) partnership trains undergraduate social work students to provide practical home-based support for older adults with chronic illness and their family caregivers, serving as a pipeline for future leaders in older adult care. More than 2 million older adults are homebound, and 5 million need help leaving their homes due to physical limitations from chronic conditions or cognitive impairments. Family members often assume daily caregiving tasks to assist their loved ones, navigate health care systems, and provide much needed emotional support. The challenges of caregiving are further compounded by the problems associated with insufficient health care professionals who are trained to work with older adults. Integrative service learning models can provide home-based support to older adults while offering valuable, hands-on learning experiences for students. In this teaching note, we acknowledge a need for developing an educational pipeline that can provide training opportunities for students to work with older adults and their caregivers at home. We provide an example of an integrative service-learning model which offers valuable pedagogical experiences to baccalaureate students along with strategies for curriculum building, community engagement, research and evaluation, and program sustainability.
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Affiliation(s)
- Keith T. Chan
- Silberman School of Social Work at Hunter College, New York, NY
| | | | - Sarah LaFave
- Johns Hopkins University, Baltimore, MD
- Lori’s Hands, Newark, DE
| | | | - Jillian Graves
- School of Social Work, Eastern Michigan University, Ypsilanti, MI, USA
| | - Diane Fenski
- School of Social Work, Eastern Michigan University, Ypsilanti, MI, USA
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Lo HHM, Au A, Cho WV, Lau ENS, Wong JYH, Wong SYS, Yeung JWK. Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095447. [PMID: 35564839 PMCID: PMC9104052 DOI: 10.3390/ijerph19095447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022]
Abstract
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.
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Affiliation(s)
- Herman H. M. Lo
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong;
- Correspondence:
| | - Alma Au
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong;
| | - W. V. Cho
- Caritas Medical Centre, Hospital Authority, Hong Kong;
| | - Elsa N. S. Lau
- Department of Social Sciences, Education University of Hong Kong, Hong Kong;
| | | | - Samuel Y. S. Wong
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong;
| | - Jerf W. K. Yeung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong;
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Sattar K, Yusoff MSB, Arifin WN, Yasin MAM, Nor MZM. Effective coping strategies utilised by medical students for mental health disorders during undergraduate medical education-a scoping review. BMC MEDICAL EDUCATION 2022; 22:121. [PMID: 35193564 PMCID: PMC8863569 DOI: 10.1186/s12909-022-03185-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/16/2022] [Indexed: 06/09/2023]
Abstract
BACKGROUND Coping denotes cognitive, emotional and behavioural struggles to tackle a troubled person-environment association. Therefore, coping strategies (CSs) are vital for mental well-being. Widespread research studies have explored this domain, targeting caregivers, nurses, physicians and medical teachers, but limited research has been done to explore the common CSs utilised by medical students at the undergraduate medical education level. Therefore, we aimed to identify the frequently occurring CSs and their effects on mental health disorders (MHDs) through the evidence available in the existing literature. METHODS For this scoping review, we searched the available literature (articles published from January 1, 1986, to March 31, 2021) on CSs at Google Scholar, PubMed and Scopus using the terms coping, medical students and undergraduate medical education. We included in our search all peer-reviewed journal articles whose central topics were the CSs employed by undergraduate medical students of any age, nationality, race and gender. RESULTS From among the 2,134 articles that were found, 24 were ultimately included in the study. The articles were authored in 14 countries, allowing us to gather broader data to answer our research question. The first identified theme (MHDs) had four subthemes: stress (55% of the articles), depression (30%), anxiety (25%) and burnout (15%). The second theme (CSs), on the other hand, had eight subthemes: support seeking (60%), active coping (40%), acceptance (40%), avoidance/denial (40%), substance abuse (35%), faith/religion (25%), sports (25%) and miscellaneous (40%). CONCLUSIONS Themes and subthemes were identified about the most common CSs utilised by undergraduate medical students to tackle common MHDs in the context of medical education. Among the most used CSs was support (social and emotional) seeking. Teaching medical students how to cope with challenging times is essential.
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Affiliation(s)
- Kamran Sattar
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Wan Nor Arifin
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Azhar Mohd Yasin
- Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - Mohd Zarawi Mat Nor
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Tan X, An Y, Chen C. Avoidant coping as mediator of the relationship between rumination and mental health among family caregivers of Chinese breast cancer patients. Eur J Cancer Care (Engl) 2021; 31:e13523. [PMID: 34658090 DOI: 10.1111/ecc.13523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/07/2021] [Accepted: 09/24/2021] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Family caregivers of cancer patients were often referred to the 'forgotten patients', yet little researches have been conducted on their mental health. Rumination might put family caregivers at risk for psychological distress during the caregiving, such as stress and anxiety. The aim of the present study was to explore the relationship between rumination, stress and anxiety among family caregivers of breast cancer patients in China and examine the mediating role of avoidant coping in this relationship. METHODS Face-to-face questionnaire interviews were conducted with a sample of 99 caregivers from the public oncology hospital. They were assessed with stress, anxiety, rumination and avoidant coping by Chinese Perceived Stress Scale, Zung's Self-Rating Anxiety Scale, Ruminative Responses Scale and Coping Strategy Indicator. Structural equation modelling was applied to assess the mediation analysis. RESULTS The reporting scores of participants indicated the incidence of anxiety was 17.2%. Rumination could directly predict stress (β = 0.58, p < 0.01) and anxiety (β = 0.46, p < 0.01) and also predict stress and anxiety via the mediator of avoidant coping (stress: β = 0.087, p < 0.01; anxiety: β = 0.109, p < 0.01). CONCLUSIONS The important role played by family caregivers in supporting breast cancer patients is well recognised. The findings suggested that rumination and avoidant coping may be two critical risk factors for family caregivers of breast cancer developing stress and anxiety. This study highlights the importance of preventing avoidant coping, which plays a critical role for developing interventions for this vulnerable group.
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Affiliation(s)
- Xing Tan
- School of Psychology, Nanjing Normal University, Nanjing, China.,School of Psychology, South China Normal University, Guangzhou, China
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Chen Chen
- Department of Social and Behavioural Sciences, City University of Hongkong, Hongkong, China
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Abstract
OBJECTIVES Providing care for a person with dementia or other chronic illness at home often places stress on the primary caregiver. In an Irish population, ~67% of carers reported experiencing extreme physical or mental tiredness. This study aimed to identify factors that influence carer burden and identify the sub-populations of carers who are most susceptible to burden. METHODS Consecutive carers referred to a local carers' support organisation completed the following measurements: the Neuropsychiatric Inventory, Zarit Burden Interview, Social Network Index, General Health Questionnaire, Short Form Survey, Hamilton Depression Rating Scale, Brown's Locus of Control scale and provided demographic data on themselves and their patient. RESULTS The sample consisted 53 carers, mean age: 64.5±11.7, of whom 43 (81.1%) were females. A linear regression model found significant independent (p<0.05) factors for carer burden were: increased behavioural problems of the patient, carer characteristics including female gender, younger age, high number of contacts, lower physical functioning and emotional problems, while protective factors were marriage and higher number of embedded networks. CONCLUSIONS The ability to predict which carers are more susceptible to burden allows service providers to more quickly and accurately identify 'higher risk' carers, facilitating routine check-ups by physicians and carer support services.
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de Wit J, Bakker LA, van Groenestijn AC, Baardman JF, van den Berg LH, Visser-Meily JM, SchrÖder CD. Psychological distress and coping styles of caregivers of patients with amyotrophic lateral sclerosis: a longitudinal study. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:235-241. [DOI: 10.1080/21678421.2018.1534976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jessica de Wit
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Leonhard A. Bakker
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annerieke C. van Groenestijn
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost F. Baardman
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Leonard H. van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M.A. Visser-Meily
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carin D. SchrÖder
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Monteiro AMF, Santos RL, Kimura N, Baptista MAT, Dourado MCN. Coping strategies among caregivers of people with Alzheimer disease: a systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:258-268. [DOI: 10.1590/2237-6089-2017-0065] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/11/2017] [Indexed: 11/22/2022]
Abstract
Abstract Introduction Caregivers of people with Alzheimer disease (PwAD) report significant stress, burden and depression compared to caregivers of people with other dementias, especially when neuropsychiatric symptoms are prominent. Adequate coping strategies can modify the impact of stressful situations and increase the caregivers’ quality of life. Objective To systematically review the different coping strategies used by caregivers of PwAD to manage neuropsychiatric symptoms. Method We carried out electronic searches using MEDLINE (PubMed), SciELO, Web of Knowledge Cross Search (Thomson Scientific/ISI Web Services) and PsycINFO databases to select studies on coping in PwAD caregivers published from January 2005 to July 2017. The search terms were coping, caregivers, strategy, onset, adaptation, family, behavior, dementia and Alzheimer. The studies were organized in three categories: problem-focused, emotion-focused and dysfunctional coping strategies. Results We found 2,277 articles. After application of exclusion criteria and exclusion of redundant references, 24 articles were analyzed. Emotion-focused coping was the most commonly used strategy among PwAD caregivers. The use of this strategy associated with religion and spirituality may help reduce symptoms of depression and anxiety. Problem-focused coping strategies were mostly used with active coping interventions. Problem-solving coping may have buffered the impact of acute psychological stressors on procoagulant activity. Dysfunctional coping strategies were associated with increase of caregiver burden. Conclusion The evaluated studies showed that the use and development of coping strategies may have ameliorated the depressive symptoms, anxiety and burden of caregivers. However, longitudinal studies are still needed that clearly describe the type of coping strategy used in relation to the presented results.
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12
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Examining spiritual support among African American and Caucasian Alzheimer's caregivers: A risk and resilience study. Geriatr Nurs 2018; 39:663-668. [PMID: 29807671 DOI: 10.1016/j.gerinurse.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/04/2018] [Indexed: 11/24/2022]
Abstract
Research shows African Americans at greater risk of developing Alzheimer's disease (AD) compared to the Caucasian population, suggesting African American AD caregivers are rising in numbers at a greater rate than Caucasian counterparts. Over a decade ago, an article in Geriatric Nursing revealed spiritual well-being differences among these caregiver groups. The purpose of this study was a quasi-follow-up, utilizing a larger caregiver sample to test spiritual support as a moderator via a risk-and-resilience framework. Secondary data analysis from a sample of 691 AD caregivers examined data on demographics and standardized measures of spiritual support, caregiver burden, and psychological resilience. One-third of the sample reported as African American. Resilience negatively regressed, though not significantly, on caregiving burden among both groups. Spiritual support positively, significantly impacted resilience among both groups, slightly stronger among African Americans. Spiritual support did not significantly moderate risk with either group. Implications for professional healthcare practice are discussed.
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Aravena JM, Albala C, Gitlin LN. Measuring change in perceived well-being of family caregivers: validation of the Spanish version of the Perceived Change Index (PCI-S) in Chilean dementia caregivers. Int J Geriatr Psychiatry 2018; 33:e120-e130. [PMID: 28509367 PMCID: PMC5800416 DOI: 10.1002/gps.4734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/05/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Few instruments evaluate family caregiver perceptions of challenges caring for persons with dementia and improvement or worsening in these areas. To address this measurement gap, we examine psychometric properties of a Spanish version of the 13-item Perceived Change Index (PCI-S), originally validated with English-speaking caregivers. METHODS Cross-sectional study with 94 caregivers of persons with mild to moderate dementia in Chile. Interviews included caregiver demographics, burden, health perception, distress with behaviours, dementia severity, behavioural symptoms and functionality. RESULTS Caregiver mean age was 55.9 (SD ± 14.14) years and mean years caregiving was 3 (SD ± 2.60). The scale had strong internal consistency (Cronbach α = 0.94), and inter-observer consistency (CCI = 0.99; 95% CI = 0.95-0.99). Two factors were identified: Management skills (α = 0.89), and somatic well-being and affects (α = 0.92), explaining 63% of scale variance. Significant associations supporting convergent validity were observed for PCI-S and subscales with caregiver burden (p < 0.01), health perceptions (p < 0.01), depressive symptoms (p < 0.01) and distress with behaviours (p < 0.01); and in persons with dementia, functionality (p < 0.05), dementia severity (p < 0.05) and behavioural symptoms (p < 0.01) in expected directions. In logistic regression models, perceived worsening (PCI-S and subscale scores) was associated with more behavioural symptoms (OR = 1.07; 95% CI = 1.03-1.15) and caregiver burden (OR = 1.48; 95% CI = 1.18-1.86); whereas perceived improvement was associated with higher physical functioning (OR = 0.95; 95% CI = 0.91-0.99) in persons with dementia. PCI-S scores were not associated with socio-demographic characteristics reflecting divergent validity. CONCLUSIONS Spanish version of the 13-item Perceived Change Index and its two-factor solution is a valid and reliable measure with clinical utility to detect improvement or worsening in caregivers concerning daily care challenges. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- José M Aravena
- Public Nutrition Unit, Nutrition and Food Technology Institute, INTA, University of Chile, Santiago, Chile
| | - Cecilia Albala
- Public Nutrition Unit, Nutrition and Food Technology Institute, INTA, University of Chile, Santiago, Chile
| | - Laura N Gitlin
- Department of Community Public Health, School of Nursing, Joint appointments, Department of Psychiatry, and Division of Geriatrics and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
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14
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Bouldin ED, Shaull L, Andresen EM, Edwards VJ, McGuire LC. Financial and Health Barriers and Caregiving-Related Difficulties Among Rural and Urban Caregivers. J Rural Health 2017; 34:263-274. [PMID: 28940539 DOI: 10.1111/jrh.12273] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/11/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess whether financial or health-related barriers were more common among rural caregivers and whether rural caregivers experienced more caregiving-related difficulties than their urban peers. METHODS We used data from 7,436 respondents to the Caregiver Module in 10 states from the 2011-2013 Behavioral Risk Factor Surveillance System. Respondents were classified as caregivers if they reported providing care to a family member or friend because of a long-term illness or disability. We classified respondents as living in a rural area if they lived outside of a Metropolitan Statistical Area (MSA). We defined a financial barrier as having an annual household income <$25,000 or not being able see a doctor when needed in the past year because of cost. We defined a health barrier as having multiple chronic health conditions, a disability, or fair or poor self-rated health. FINDINGS Rural caregivers more frequently had financial barriers than urban caregivers (38.1% vs 31.0%, P = .0001), but the prevalence of health barriers was similar (43.3% vs 40.6%, P = .18). After adjusting for demographic differences, financial barriers remained more common among rural caregivers. Rural caregivers were less likely than their urban peers to report that caregiving created any difficulty in both unadjusted and adjusted models (adjusted prevalence ratio = 0.90; P < .001). CONCLUSIONS Informal caregivers, particularly in rural areas, face financial barriers. Rural caregivers were less likely than urban caregivers to report caregiving-related difficulties. Rural caregivers' coping strategies or skills in identifying informal supports may explain this difference, but additional research is needed to explore this hypothesis.
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Affiliation(s)
- Erin D Bouldin
- Department of Health and Exercise Science, Appalachian State University, Boone, North Carolina
| | - Lynn Shaull
- Association of State and Territorial Health Officials, Washington, DC
| | - Elena M Andresen
- Institute on Development and Disability, School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Valerie J Edwards
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C McGuire
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Health-related quality of life in community dwelling patients with mild-to-moderate Alzheimer's disease. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dalpai D, Reis RC, de Pádua AC. Effect of caregiver characteristics on dementia management strategies. Dement Neuropsychol 2016; 10:143-147. [PMID: 29213445 PMCID: PMC5642405 DOI: 10.1590/s1980-5764-2016dn1002010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Caregiving has an important influence on the prognosis of dementia, particularly regarding the management strategy implemented. Therefore, evaluating which characteristics of caregivers can influence the choice of a particular strategy for managing dementia is needed. Objective To evaluate the association between characteristics of caregivers and their management strategies as applied to patients with dementia. Methods A cross-sectional study involving 45 professional caregivers from two nursing homes in Porto Alegre, Brazil, was conducted. Age, gender, education, years as a caregiver, income, burden, depressive and anxiety symptoms and dementia management strategies were evaluated for all participants. Pearson's or Spearman's correlation tests were applied according to the variable distribution (parametric or non-parametric). Bivariate correlation analysis was applied. P<0.05 was considered statistically significant. Results There was a significant and moderate positive correlation between burden measured by the Zarit Burden Interview and criticism measured by the Dementia Management Strategies Scale (Spearman's rho = 0.555, p < 0.001). No other correlations were observed. Conclusion Among the caregiver characteristics that directly affect the approach to managing dementia, high caregiver burden was found to be associated with high criticism, an authoritative way of managing dementia. This exploratory study indicated that a possible way of decreasing negative dementia management is to reduce caregiver burden.
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Affiliation(s)
- Débora Dalpai
- Medical student at Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil, with FAPERGS scholarship scientific initiation
| | | | - Analuiza Camozzato de Pádua
- MD.PhD. Psychiatrist, PhD, professor of Psychiatry at Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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The Concept of Missing Incidents in Persons with Dementia. Healthcare (Basel) 2015; 3:1121-32. [PMID: 27417817 PMCID: PMC4934635 DOI: 10.3390/healthcare3041121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 11/16/2022] Open
Abstract
Behavioral symptoms of dementia often present the greatest challenge for informal caregivers. One behavior, that is a constant concern for caregivers, is the person with dementia leaving a designated area such that their whereabouts become unknown to the caregiver or a missing incident. Based on an extensive literature review and published findings of their own research, members of the International Consortium on Wandering and Missing Incidents constructed a preliminary missing incidents model. Examining the evidence base, specific factors within each category of the model were further described, reviewed and modified until consensus was reached regarding the final model. The model begins to explain in particular the variety of antecedents that are related to missing incidents. The model presented in this paper is designed to be heuristic and may be used to stimulate discussion and the development of effective preventative and response strategies for missing incidents among persons with dementia.
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Raggi A, Tasca D, Panerai S, Neri W, Ferri R. The burden of distress and related coping processes in family caregivers of patients with Alzheimer's disease living in the community. J Neurol Sci 2015; 358:77-81. [DOI: 10.1016/j.jns.2015.08.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/09/2015] [Accepted: 08/14/2015] [Indexed: 01/28/2023]
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Bekhet AK. Resourcefulness in African American and Caucasian American Caregivers of Persons With Dementia: Associations With Perceived Burden, Depression, Anxiety, Positive Cognitions, and Psychological Well-Being. Perspect Psychiatr Care 2015; 51:285-94. [PMID: 25495263 DOI: 10.1111/ppc.12095] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 10/30/2014] [Accepted: 11/10/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Providing care to persons with dementia can have negative effects on caregivers' physical and psychological well-being. This secondary analysis explored relationships among perceived burden, depression, anxiety, resourcefulness, and psychological well-being in 28 African American (AA) and 45 Caucasian American (CA) caregivers of persons with dementia. DESIGN AND METHODS Descriptive, cross-sectional design was used to examine the hypothesized relationships in a sample of 73 caregivers. FINDINGS CAs reported greater burden (t=-3.68, p<.001), more anxiety (t=-2.66, p<.01), depression (t=-2.21, p<.05), and hostility (t=-2.30, p<.05) than AAs. AAs reported higher scores than CAs on resourcefulness, positive cognitions, and psychological well-being. PRACTICE IMPLICATIONS The study findings provided directions for the development of resourcefulness interventions to enhance the psychological well-being among dementia caregivers.
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Affiliation(s)
- Abir K Bekhet
- Mental Health Nursing, Marquette University College of Nursing, Milwaukee, Wisconsin, USA
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Raccichini A, Spazzafumo L, Castellani S, Civerchia P, Pelliccioni G, Scarpino O. Living with mild to moderate Alzheimer patients increases the caregiver's burden at 6 months. Am J Alzheimers Dis Other Demen 2015; 30:463-7. [PMID: 25712057 PMCID: PMC10852853 DOI: 10.1177/1533317514568339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The objective of our study was to demonstrate that living with a person affected by mild to moderate Alzheimer's disease can lead to an increased perception of the caregiver's burden using the Caregiver Burden Inventory (CBI). The sample consisted of 153 dyads, caregiver-patient. At baseline, a greater perception of the caregiver's burden was observed in the live-in caregivers. A further increase in the total burden of the live-in caregivers was noticed at the 6-month follow-up. More specifically, with the inclusion of correction factors such as the caregiver's age and the CBI subscales at baseline, the social and emotional burden becomes statistically significant (P < .001). The present paper confirms our hypothesis that live-in caregivers perceive a greater burden than nonlive-in, and this difference increases further after 6 months. The difference in involvement between live-in and nonlive-in caregivers could be the foundation to tailor more specific interventions.
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Affiliation(s)
| | - Liana Spazzafumo
- Biostatistical Center, Italian National Research Center on Aging, Ancona, Italy
| | - Simona Castellani
- Neurology Unit, Italian National Research Center on Aging, Ancona, Italy
| | - Patrizia Civerchia
- Neurology Unit, Italian National Research Center on Aging, Ancona, Italy
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21
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Sutter M, Perrin PB, Peralta SV, Stolfi ME, Morelli E, Peña Obeso LA, Arango-Lasprilla JC. Beyond Strain: Personal Strengths and Mental Health of Mexican and Argentinean Dementia Caregivers. J Transcult Nurs 2015; 27:376-84. [PMID: 25712148 DOI: 10.1177/1043659615573081] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Life expectancy is increasing in Latin America resulting in the need for more family caregivers for older adults with dementia. The purpose of the current study was to examine the relationships between personal strengths (optimism, sense of coherence [SOC], and resilience) and the mental health of dementia caregivers from Latin America. METHOD Primary family dementia caregivers (n = 127) were identified via convenience sampling at the Instituto de Neurociencias de San Lucas, Argentina, and CETYS University, in Baja California, Mexico and completed measures of these constructs. FINDINGS Personal strengths explained between 32% and 50% of the variance in caregiver mental health. In a series of hierarchical multiple regressions, more manageability (β = -.38, p = .001), general resilience (β = -.24, p = .012), and social competence (β = -.21, p = .034) were uniquely associated with lower depression. Greater comprehensibility (β = -.28, p = .008) was uniquely associated with decreased burden, and manageability was marginally related (β = -.21, p< .10). Greater optimism (β = .37, p< .001) and manageability (β = .27, p = .004) were uniquely associated with increased life satisfaction. DISCUSSION The personal strengths of caregivers in Latin America may be particularly important for their mental health because of the culturally imbedded sense of duty toward older family members. IMPLICATIONS Incorporating strengths-based approaches into research on caregiver interventions in regions where caregiving is a highly culturally valued role such as Latin America may have the potential to improve the mental health of dementia caregivers.
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Affiliation(s)
- Megan Sutter
- Virginia Commonwealth University, Richmond, VA, USA
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Snyder CM, Fauth E, Wanzek J, Piercy KW, Norton MC, Corcoran C, Rabins PV, Lyketsos CG, Tschanz JT. Dementia caregivers' coping strategies and their relationship to health and well-being: the Cache County Study. Aging Ment Health 2015; 19:390-9. [PMID: 25093439 PMCID: PMC4845636 DOI: 10.1080/13607863.2014.939610] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Prior research identifies that psychological outcomes among dementia caregivers are associated with their use of coping strategies. Few studies have tested the association of coping and health longitudinally. METHOD This study examined factors associated with the use of coping strategies over time and their associations with physical and mental health outcomes in a population-based sample of 226 dementia caregivers in Cache County, Utah, USA. Caregivers annually completed the Ways of Coping Checklist-Revised, the Beck Anxiety Inventory, and a health interview. Care-recipient cognitive and functional abilities were obtained using the Mini-Mental State Exam and the Clinical Dementia Rating. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory. RESULTS Caregivers most frequently identified providing care as a problem (37.6%). Linear mixed models of caregiver coping strategies found that the use of most strategies were stable except for increasing Avoidance among adult child caregivers (β = 0.14, p = 0.048). On average, increased Wishful Thinking (β = 2.48, p < 0.001) or Blames Self (β = 1.06, p = 0.002) was associated with higher anxiety scores. Increased use of Blames Others among males (interaction, β = 0.28, p = 0.02) and greater use of Wishful Thinking among younger caregivers (interaction, β = -0.01, p = 0.01) were associated with more caregiver health conditions. Coping strategies were not associated with change in anxiety or health conditions over time. CONCLUSION Our results emphasize the importance of caregiver coping strategies on caregiver health and well-being and may identify subgroups of persons at risk for worse outcomes.
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Affiliation(s)
| | - Elizabeth Fauth
- Family Consumer and Human Development, Utah State University
| | | | | | - Maria C. Norton
- Family Consumer and Human Development, Utah State University,Center for Epidemiological Studies, Utah State University
| | - Chris Corcoran
- Center for Epidemiological Studies, Utah State University,Mathematics and Statistics Department, Utah State University
| | | | | | - JoAnn T. Tschanz
- Psychology Department, Utah State University,Center for Epidemiological Studies, Utah State University,Corresponding author.
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Abstract
AIM To report a concept analysis of family homeostasis. BACKGROUND As family members are a majority of informal caregivers, negative consequences from caregiving duty create a vicious cycle in the family unit resulting in ongoing health crises and care challenges. DESIGN Concept analysis. DATA SOURCES Forty empirical studies published from 1956-2012 were selected by searching five electronic bibliographical databases and by a manual search conducted from 2012-2013. Search terms included 'family homeostasis', 'homeostasis in family', 'homeostatic care' and 'family equilibrium'. Clinical experiences in nursing practice were used for constructing cases and clinical implications. METHODS Walker and Avant's method guided this analysis. RESULTS Family homeostasis is defined as the capacity and mechanisms by which equilibrium is re-established in the family after a change occurs. Five critical attributes are identified: (1) predetermined setpoint; (2) self-appraised antecedents; (3) interdependence; (4) tendency to stability; and (5) feedback mechanisms. Antecedents include any type of causative change beyond the tolerable limit, while consequences encompass intermediate and long-term outcomes as well as equilibrium itself. CONCLUSION Family homeostasis provides a conceptual rationale of family caregiving. While care recipients remain the primary beneficiaries of healthcare provision, homeostatic mechanisms are required to support the family caregiver's valuable contribution in the caring process to enhance family well-being. Further study should expand the definition and settings of family to reflect healthcare needs of diverse types of families and from the perspectives of different healthcare providers.
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Affiliation(s)
- Heejung Kim
- University of Kansas, School of Nursing, Kansas, USA
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24
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Guedes AC, Pereira MDG. Burden, coping, physical symptoms and psychological morbidity in caregivers of functionally dependent family members. Rev Lat Am Enfermagem 2014; 21:935-40. [PMID: 23970231 DOI: 10.1590/s0104-11692013000400015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 05/21/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES this study assessed burden, coping, physical symptoms and psychological morbidity in caregivers of functionally dependent family members. METHODS fifty family caregivers completed self-reported measures of burden, physical symptoms, psychological morbidity and coping strategies. RESULTS there was a significant negative correlation between coping strategies and the different clinical variables, as well as a significant positive correlation between coping strategies and duration of care. It appears that the stronger bond between caregiver and family member leads to a poorer use of adaptive coping strategies. It also appears that the deterioration of the relationship between them and the lower perceived self-efficacy are more prominent in caregivers of family members with cognitive impairment, indicating that caregivers with family members without cognitive impairment face fewer difficulties. CONCLUSION these results emphasize the need for interventions to include coping strategies, since they are important in reducing caregivers' burden, psychological morbidity and physical symptoms.
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Tan L, Yap P, Ng WY, Luo N. Exploring the use of the Dementia Management Strategies Scale in caregivers of persons with dementia in Singapore. Aging Ment Health 2014; 17:935-41. [PMID: 23410096 DOI: 10.1080/13607863.2013.768209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Well-being in persons with dementia (PWD) depends much on the quality and type of care received. The Dementia Management Strategies Scale (DMSS) is a useful instrument to appraise care styles of caregivers. The present study expanded on previous research by refining and establishing the scale's content validity and psychometric properties in the Singapore context. METHOD Five family caregivers and four dementia care professionals (nurse, occupational therapist, social worker and doctor) reviewed the DMSS for content validity. Two hundred and forty-six family caregivers completed questionnaires which assessed caregiver and patient characteristics, and dementia management strategies with DMSS. Internal consistency reliability was assessed and construct validity was evaluated through Pearson's correlation with extant instruments. RESULTS Eight items from the 28-item DMSS were omitted after content review as they were deemed inappropriate in our socio-cultural setting. A factor analysis with Varimax rotation confirmed a two-factor structure (positive and negative dimensions) for the revised DMSS (rDMSS). The two subscales showed good internal consistency (Cronbach's alpha .89 and .87). Moderate to strong correlations (.35-.53) with the scales, Zarit Burden Instrument, Revised Memory and Behavioural Problems Checklist, General Health Questionnaire, Short Sense of Competence Scale, Gains in Alzheimer's Care Instrument and Positive Aspects of Caregiving established convergent and divergent construct validity of rDMSS. CONCLUSION The shortened 20-item rDMSS is a psychometrically valid instrument which can serve as a measure of dementia care strategy from the perspective of the caregiver in Singapore.
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Affiliation(s)
- Louisa Tan
- a Department of Psychology , National University of Singapore
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26
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Abstract
Caregiving in a rural context is unique, but the experience of rural caregivers is understudied. This paper describes how rural caregivers cope with caring for a loved one diagnosed with mild cognitive impairment or dementia using qualitative description to generate a low-inference summary of a response to an open-ended question. This approach allowed these rural caregivers to describe their positive experiences in addition to the more commonly explored caregiver experiences related to stress. Analyses of coping revealed use of social support, engaging in relaxing and physical activity, and cognitive reframing. In addition, caregivers reported strong faith and religiosity, and to a lesser frequency behavioral changes, checking in with the person with dementia via telephone, and joint activity. Predominantly, these methods reflect approach-based strategies. The current data suggest that these caregivers manage well and adopt adaptive coping strategies to meet the demands of the caregiving role.
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27
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García-Alberca JM, Lara JP, Garrido V, Gris E, González-Herero V, Lara A. Neuropsychiatric Symptoms in Patients With Alzheimer's Disease: The Role of Caregiver Burden and Coping Strategies. Am J Alzheimers Dis Other Demen 2014; 29:354-61. [PMID: 24408750 PMCID: PMC10852959 DOI: 10.1177/1533317513518649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
This study was conducted to obtain data regarding the association of caregiver burden (CB) and neuropsychiatric symptoms (NPSs) in patients with Alzheimer's disease. We conducted a series of multiple linear regressions to determine the relationship between CB and NPSs and whether the caregiver coping strategies mediated this relationship. The NPSs were assessed using the Neuropsychiatric Inventory, and caregivers were evaluated with the Caregiver Burden Interview and the Inventory and the Coping Strategies Inventory. Results show that patients with more frequent and severe NPS were more likely to be cared for by more burdened caregivers, and this was partially mediated by caregiver coping strategies. More disengagement (β = .330,P< .001) and less engagement coping (β = -.347,P< .001) were predictors for NPS after adjusting for patient and caregiver characteristics. These results may be useful with a view to designing treatment interventions that aim to modify the use of caregiver coping strategies and to reduce NPSs.
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Affiliation(s)
- José María García-Alberca
- Dementia Unit, Instituto Andaluz de Neurociencia y Conducta, Málaga, Spain Cognitive Neurophysiology Unit, Centro de Investigaciones Médico-Sanitarias, University of Málaga, Málaga, Spain
| | - José Pablo Lara
- Cognitive Neurophysiology Unit, Centro de Investigaciones Médico-Sanitarias, University of Málaga, Málaga, Spain
| | - Victoria Garrido
- Dementia Unit, Instituto Andaluz de Neurociencia y Conducta, Málaga, Spain
| | - Esther Gris
- Dementia Unit, Instituto Andaluz de Neurociencia y Conducta, Málaga, Spain
| | | | - Almudena Lara
- Asociación Criptana de Enfermos de Alzheimer, Campo de Criptana, Spain
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van der Lee J, Bakker TJ, Duivenvoorden HJ, Dröes RM. Multivariate models of subjective caregiver burden in dementia: a systematic review. Ageing Res Rev 2014; 15:76-93. [PMID: 24675045 DOI: 10.1016/j.arr.2014.03.003] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/11/2014] [Accepted: 03/17/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Burden in dementia caregivers is a complex and multidimensional construct. Several models of burden and other representations of burden like depression or mental health are described in literature. To clarify the state of science, we systematically reviewed complex models that include both patient and caregiver determinants of caregiver burden. OBJECTIVE A review of determinant models of caregiver burden. DESIGN Systematic review. DATA SOURCES Electronic databases PubMed, PsycInfo and EMbase were searched in December 2013. STUDY SELECTION AND ANALYSIS Research studies with quantitative outcome measures of caregiver burden or burden-related concepts, including both patient and caregiver functional characteristics as determinants. We categorized the determinant variables in the models and calculated the percentages of proven determinants within each category. RESULTS We found 32 studies with burden models and 24 depression and mental health models. Patient behavioral problems, caregiver coping and personality traits and competence are most consistent determinants of caregiver burden, depression and mental health. Behavioral problems are more significant than cognitive disorders or lack of self-care. Of all measured caregiver personality traits, neuroticism has the strongest impact on caregiver burden. Regarding caregiver competences, feeling competent or enjoying higher self-efficacy in general diminish caregiver burden and promote caregiver mental health.
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Bekhet AK. Effects of positive cognitions and resourcefulness on caregiver burden among caregivers of persons with dementia. Int J Ment Health Nurs 2013; 22:340-6. [PMID: 23009397 DOI: 10.1111/j.1447-0349.2012.00877.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Currently, 5.4 million persons in the USA are diagnosed with dementia, and this number is projected to rise to 7.7 million by the year 2030. Family caregivers provide up to 80% of the care needed by persons with dementia and published work suggests that caring for persons with dementia can be very costly to caregivers' health. This study examined the mediating and the moderating effects of positive cognitions on the relationship between caregiver burden and resourcefulness in 80 caregivers of persons with dementia. A descriptive, correlational, and cross-sectional design was used in this study. The researcher contacted the administrators at the Alzheimer's Association early stage programs in Southeastern Wisconsin and questionnaires were distributed to interested caregivers. Positive cognitions explained 31% of the variance in resourcefulness (F (1, 78) = 35.46, P < 0.001) and as positive cognitions increased, caregivers' resourcefulness increased. Positive cognitions were found to be a mediator as evidenced by a substantial drop in the beta weight of caregiver burden from B = -0.28 to B = -0.11 when positive cognitions were entered into the equation. Interventions to strengthen positive thinking among caregivers of persons with dementia are needed to help caregivers overcome their burden.
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Affiliation(s)
- Abir K Bekhet
- College of Nursing, Marquette University, Milwaukee, WI 53233, USA.
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30
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Cruz MDN, Hamdan AC, Fonseca RP. Adaptação transcultural da Dementia Management Strategies Scale ao português brasileiro. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2012. [DOI: 10.1590/s0103-166x2012000500006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo tem por objetivo apresentar a adaptação transcultural da Dementia Management Strategies Scale ao português brasileiro. Essa escala foi desenvolvida para verificar a frequência do uso de três tipos de estratégias de gerenciamento da demência, utilizadas por familiares cuidadores de idosos: crítica, gerenciamento ativo e encorajamento. Participaram do processo de adaptação 3 tradutores, 100 juízes não especialistas, 5 juízes especialistas e 15 cuidadores. Os procedimentos utilizados foram duas traduções independentes, elaboração de uma versão síntese das duas traduções, avaliação do instrumento pelos juízes e, por fim, a condução de estudo piloto com 15 cuidadores de idosos com demência do tipo Alzheimer. Após as adaptações realizadas em todas as etapas do processo de adaptação transcultural, constatou-se equivalência satisfatória entre as versões.
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Caregiving burden and out-of-home mobility of cognitively impaired care-recipients based on GPS tracking. Int Psychogeriatr 2012; 24:1836-45. [PMID: 22874772 DOI: 10.1017/s1041610212001135] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Out-of-home mobility refers to the realization of trips outside the home, by foot or by other means of transportation. Although out-of-home mobility is important for the well-being of older people with cognitive impairment, its importance for their caregivers is not clear. This study aims to clarify the relationship between caregiving burden and out-of-home mobility of care-recipients using Global Positioning Systems (GPS) technology. METHODS Seventy-six dyads (care-recipients and caregivers) were recruited from a psychogeriatric center, where they underwent cognitive assessment, followed by psychosocial interviews at home. Care-recipients received GPS tracking kits to carry for a period of four weeks, whenever they left home. Mobility data and diagnostic and psychosocial data were examined in relation to caregiver burden. RESULTS The strongest predictors of burden were care-recipients' lower cognitive status and more time spent walking out-of-home. An interaction was found between cognitive status and time spent walking in relation to caregiver burden. The relationship between walking and burden was stronger among caregivers of care-recipients with dementia than caregivers of care-recipients with no cognitive impairment or mild cognitive impairment. Care-recipients' behavioral and emotional states were also positively related to caregiver burden. CONCLUSIONS The findings stress the importance of maintaining older persons' out-of-home mobility during cognitive decline.
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Anxiety and depression are associated with coping strategies in caregivers of Alzheimer's disease patients: results from the MÁLAGA-AD study. Int Psychogeriatr 2012; 24:1325-34. [PMID: 22340759 DOI: 10.1017/s1041610211002948] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Caregiving for people with Alzheimer's disease (AD) is highly stressful and has significant negative consequences, such as anxiety and depression. Previous research offers conflicting findings as to whether coping strategies are associated with greater psychological distress or not. We conducted this study with a view to obtaining new data regarding the association of coping strategies and psychological distress in AD caregivers. METHODS Eighty people with AD and their primary caregivers living in the community were recruited from local health services. Purposive recruitment was carried out to ensure that the sample was representative of people living with dementia in terms of dementia severity, gender, and care setting. We used the State-Trait Anxiety Inventory to measure anxiety, the Beck Depression Inventory to measure depression, and the Coping Strategies Inventory to measure coping strategies. RESULTS Most caregivers reported higher anxiety and depression levels. Use of disengagement coping strategies (Wald = 3.35, p = 0.01) and higher caregiver burden (Wald = 4.83, p = 0.02) predicted anxiety on logistic regression. In turn, use of disengagement coping strategies (Wald = 12.48, p = 0.001) and higher caregiver burden (Wald = 6.91, p = 0.009) predicted depression on logistic regression. CONCLUSION These results may be useful for designing treatment interventions that aim to modify the use of coping strategies and thus reduces caregiver anxiety and depression.
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O'Connell ME, Germaine N, Burton R, Stewart N, Morgan DG. Degree of rurality is not related to dementia caregiver distress, burden, and coping in a predominantly rural sample. J Appl Gerontol 2012; 32:1015-29. [PMID: 25474826 DOI: 10.1177/0733464812450071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Earlier research suggests that geographic location matters for informal caregivers of persons with dementia: rural caregivers tend to rely on more informal supports and may report more psychological distress and burden than urban caregivers. Differential access to services may underlie these findings, but degree of rurality is typically measured with population size. In contrast, the current article measured degree of rurality with standardized scale of access to metropolitan centers. In a large sample we found nonsignificant and trivial associations between metropolitan access with self-reported caregiver distress, (N = 272; Brief Symptom Inventory), burden (N = 234; Zarit Burden Interview), and coping (n = 46; Jalowiec Coping Scale). The null findings were likely related to the use of a proxy variable for dementia-related caregiver supports (i.e., degree of access to metropolitan centers). In future research, direct measures of access to appropriate dementia related services should be used to study caregiver outcomes.
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Abstract
This study was set out to describe caregiver-perceived burden and coping in early-stage Alzheimer disease (AD). A total of 163 consecutive pairs of patients with AD and their principal caregivers were initially recruited. The caregivers completed the Caregiver Burden Inventory (CBI) and the Coping Orientations to Problems Experienced scale, and also provided sociodemographic information; the patients with AD were assessed by means of the Mini Mental State Examination and the Neuropsychiatric Inventory. Data from 126 patient-caregiver pairs were analyzed. The caregivers (mean age 56.11±12.37 y) were mainly women (76%); 64% were the patient's offspring; 39% lived with the patient. From the CBI data, it emerged that caregivers perceived loss of personal time (objective burden, 33%) and the feeling of missing out on opportunities (developmental burden, 25%) as their main stressors. Total CBI score was negatively correlated with Mini Mental State Examination (P=0.005). As regards coping strategies, the caregivers predominantly used problem-oriented strategies associated with a positive attitude. The use of dysfunctional strategies was predictive of caregiver burden. It is important to be aware that avoidance and dysfunctional coping strategies predispose caregivers of patients with AD to higher level of distress, whereas successful caregiving seems to be based on the use of problem-oriented strategies early in the disease when solutions are still available.
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Lockeridge S, Simpson J. The experience of caring for a partner with young onset dementia: how younger carers cope. DEMENTIA 2012; 12:635-51. [PMID: 24337334 DOI: 10.1177/1471301212440873] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A growing body of literature suggests that the social context of experiencing dementia at a younger age may influence carers' and particularly partners' subjective experience and coping strategies. The current paper aims to explore the coping strategies adopted by six carers in order to adapt to changes in their relationship with their partner with young onset dementia. All were recruited from the north west of England and interpretative phenomenological analysis was used to analyse the data. Four major themes were evident: (1) 'this is not happening': the use of denial as a coping strategy; (2) 'let's not have anymore of this demeaning [treatment]': stigma in young onset dementia; (3) 'I've had to fight every inch': struggling to maintain control of events and emotions; (4) 'what will become of me?': carers' adaptation to loss. Comparisons with existing literature are made and implications for clinical practice are considered.
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Abstract
BACKGROUND The process of taking care of older people with dementia at home is complex and influenced by cultural factors, necessitating a better understanding of the interrelationships of factors within the context of culture. OBJECTIVES The aim of this study was to test the proposed Dementia Caregiving Model, specifying how caregiving appraisal, coping, perceived social support, and familism influence the impact of caregiving stressors on the psychological health of caregivers. METHODS A cross-sectional correlational design with a convenience sample (n = 96) from three outpatient clinics of hospitals in China was used. Questionnaires were utilized to measure the variables in the model. Path analysis was used to assess model fit and paths. RESULTS The original proposed model did not fit the data, butminor modifications produced a very good model fit (χ(10, n = 96) = 8.14, p = .62; goodness-of-fit index = .98, comparative fit index = 1.00, and root mean square error of approximation < .001). Care recipients' behavioral problems had direct and indirect negative effects on caregivers' psychological health. Perceived social support had direct and indirect positive effects on caregivers' psychological health. Familism had indirect positive effects on caregivers' psychological health in relation with caregiving satisfaction and coping. Caregiving appraisal and coping were mediators in the model. CONCLUSIONS The model findings lend support that caregivers' cognitive appraisal and coping explain some observed individual differences in stress response and outcomes. The findings broaden understanding of the effects of familism on caregivers' psychological health. In the future, programs should include interventions for caregivers, as well as interventions for care recipients.
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García-Alberca JM, Cruz B, Lara JP, Garrido V, Gris E, Lara A, Castilla C. Disengagement coping partially mediates the relationship between caregiver burden and anxiety and depression in caregivers of people with Alzheimer's disease. Results from the MÁLAGA-AD study. J Affect Disord 2012; 136:848-56. [PMID: 22030129 DOI: 10.1016/j.jad.2011.09.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/26/2011] [Accepted: 09/26/2011] [Indexed: 01/16/2023]
Abstract
BACKGROUND Caring for people with Alzheimer's disease can be considered stressful and demand adjustment strategies. While various variables have been associated with caregiver anxiety and depression, a possible mediator role of coping strategies adopted by caregivers between caregiver burden and anxiety and depression is still unclear. We hypothesized that caregivers with clinically significant anxiety and depression were more likely to use disengagement coping strategies that non-anxious and non-depressed caregivers. METHODS This study involved 80 Alzheimer disease patients and their primary caregivers. Patients were evaluated using the Mini Mental State Examination, the Bayer Activities of Daily Living Scale, the Global Deterioration Scale and the Neuropsychiatric Inventory. Caregivers were evaluated with the Caregiver Burden Interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Coping Strategies Inventory. We conducted a series of multiple linear regressions to determine the relationship between caregiver burden and caregiver anxiety and depression, and if the coping strategies mediated this relationship. RESULTS Using more disengagement (β=0.270, p<0.001) and less engagement coping (β=-0.310, p<0.001) were predictors for anxiety scores. Using more disengagement (β=0.250, p<0.001) and less engagement coping (β=-0.261, p<0.001) were predictors for depression scores. LIMITATIONS This study was a cross-sectional design, so the direction of causality should be strengthened by a longitudinal study. CONCLUSIONS Most caregivers reported higher anxiety and depression levels and this was partially mediated by their dysfunctional coping strategies.
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Gräßel E, Adabbo R. Perceived Burden of Informal Caregivers of a Chronically Ill Older Family Member. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2011. [DOI: 10.1024/1662-9647/a000042] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The burden of caregivers has been intensively researched for the past 30 years and has resulted in a multitude of individual findings. This review illustrates the significance of the hypothetical construct of perceived burden for the further development and design of the homecare situation. Following explanations regarding the term informal caregiver, we derive the construct burden from its conceptual association with the transactional stress model of Lazarus and Folkman. Once the extent and characteristics of burden have been set forth, we then present the impact of perceived burden as the care situation. The question of predictors of burden will lead into the last section from which implications can be derived for homecare and relief of caregivers.
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Affiliation(s)
- Elmar Gräßel
- Institut für Medizinische Psychologie und Medizinische Soziologie, Psychiatrische und Psychotherapeutische Klinik des Universitätsklinikums Erlangen, Germany
| | - Raffaela Adabbo
- Institut für Medizinische Psychologie und Medizinische Soziologie, Psychiatrische und Psychotherapeutische Klinik des Universitätsklinikums Erlangen, Germany
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Corcoran MA. Caregiving styles: a cognitive and behavioral typology associated with dementia family caregiving. THE GERONTOLOGIST 2011; 51:463-72. [PMID: 21335422 PMCID: PMC3146804 DOI: 10.1093/geront/gnr002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 01/05/2011] [Indexed: 11/14/2022] Open
Abstract
PURPOSE An increasing number of elderly individuals are diagnosed with Alzheimer's disease and related disorders (ADRD), many of whom receive daily caregiving from spouse or adult child. Caregiving is a "cultural activity," and as such it is strongly influenced by sociocultural beliefs about caregiving and how it should be enacted. Understanding this thinking-action process has important implications for future research and service. Reasoned action theory provides empirical evidence that attitudes and beliefs, as they are influenced by the social environment, predict intentions to act. In turn, behavioral intentions can reliably predict behaviors. This grounded theory study describes a typology of caregiving styles relevant to family members of an individual with ADRD, where caregiving style is defined as a culturally based pattern in thinking and action. The goal of this study was to characterize the relationship between caregiver intentions and care strategies. METHODS Study participants included 97 individuals residing in the Washington, DC, area, who provide daily care for a family member with ADRD. Narrative data were collected from each caregiver during three 1-hr interview sessions. A subset of 30 caregiver-care recipient (CR) dyads was videotaped during typical interactions. RESULTS Four caregiving styles were identified (facilitating, balancing, advocating, and directing), which differ primarily in the intended focus of care and preferred interactions with the CR. IMPLICATIONS The results provide a foundation for future studies of the relationships between sociocultural context, caregiving styles and strategies, and ensuing outcomes for caregiver-CR dyads.
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Affiliation(s)
- Mary A Corcoran
- The George Washington University, Washington, DC 20037, USA.
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Bull MJ. Delirium in older adults attending adult day care and family caregiver distress. Int J Older People Nurs 2010; 6:85-92. [PMID: 21539713 DOI: 10.1111/j.1748-3743.2010.00260.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED BACKGROUND; Delirium is a critical, costly, frequently reversible problem in older adults. Findings of previous studies indicate that delirium occurs in up to 65% of hospitalised older adults and up to 80% of terminally ill patients. Few studies address the frequency of delirium in community dwelling older adults and the extent to which delirium symptoms create distress for their family caregivers. AIMS To determine the frequency of delirium in older people attending two adult day centers (ADC) in the United States and identify the extent to which delirium symptoms were associated with family caregivers' mental health symptoms, and ways of coping with the older adults' care. METHOD A descriptive, cross-sectional design was used. Thirty older adults and their family caregivers were randomly selected from the rosters of the ADC. RESULTS Only 6.7% of the older adults had a positive screen for delirium. The majority of family caregivers (96.6%) stated that they had no knowledge of delirium prior to participating in this study. IMPLICATIONS FOR PRACTICE Both older adults and their family caregivers need education about delirium symptoms and risks.
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Affiliation(s)
- Margaret J Bull
- Marquette University, College of Nursing, Milwaukee, WI 53201-1881, USA.
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Abstract
Lewy body dementia (LBD) is a common cause of dementia but to date, little is known about caregiver burden. The Lewy Body Dementia Association (www.LBDA.org) conducted a web-based survey of 962 caregivers (mean age 56 y; 88% women). The most common initial symptoms were cognitive (48%), motor (39%), or both (13%). Caregivers expressed concerns about fear of future (77%), feeling stressed (54%), loss of social life (52%), and uncertainty about what to do next (50%). Caregivers reported moderate-to-severe burden; 80% felt the people around them did not understand their burden and 54% reported feelings of isolation with spousal caregivers reporting more burden than nonspousal caregivers. Only 29% hired in-home assistance, whereas less than 40% used respite or adult day care, geriatric case managers, or attended a support group meeting. Lack of service utilization occurred despite two-thirds of caregivers reporting medical crises requiring emergency services, psychiatric care, or law enforcement. Caregivers reported preferences for web-based information, directories of LBD expert providers, information on LBD research, and location of local support groups. These findings highlight significant unmet needs for LBD caregivers and provide targets for intervention to reduce caregiver burden. Community resources such as the Lewy Body Dementia Association may serve this end, while also providing practical information and support for caregivers.
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