Anger, spiritual meaning and support from the religious community in dementia caregiving

What You Believe Can Affect How You Feel: Anger Among Caregivers of Elderly People With Dementia

Background and Purpose: Anger has been recognized as a commonly experienced emotion among caregivers of elderly people with dementia. While several cognitive behavioral therapy (CBT)-based intervening methods have been developed, limited research has systematically examined the associations between dementia-related cognition and caregiving anger. Currently, we focused on three representative and well-studied cognitive constructs, person-centered attitude (PCA), dementia representation (DR), and empathy, exploring how they related to caregiving anger. Methods & Results: In total, 327 caregivers (239 female) participated in the study and finished online questionnaires. Multi-variable regression analyzes showed that PCA (β_PCA = -0.22^**) and empathy (β_empathy = -0.18^**) could negatively predict caregiving anger. However, all DR dimensions had no influence on caregiving anger except coherence (β_coherence = -0.24^**) in the current study. Conclusion: Generally, lower caregiving anger was associated with: (1) being more empathic; (2) having a person-centered attitude; and (3) having a comprehensive understanding of dementia. The results of this study provide detailed suggestions for the development of anger management programs for caregivers of people with dementia.

Changes in Measures of Dementia Awareness in UK Church Congregations Following a ‘Dementia-Friendly’ Intervention: A Pre–Post Cohort Study

Given their stability, their ability to influence public attitudes and capacity to mobilise human resources, it seems likely that many faith communities can have a significant impact on the wellbeing of people living with dementia (PLWD) and their carers, who may be dependent on the commitment of informal communities of support over months or years. This paper reports on a pre–post cohort study undertaken in an Anglican (Church of England) diocese in the UK. Representatives (N = 61) of 11 church communities completed the Dementia Awareness Scale immediately before and 12 months after an intervention to promote ‘Dementia-Friendly Church’ in their congregation. Results showed a robust improvement in scores on both the ‘Knowledge’ and ‘Comfort’ subscales, with the largest effect size in the latter. Within each subscale, improvements were evenly distributed across the individual items. These findings indicate that such an intervention is likely to significantly improve the environment for people living with dementia and their companions who are members of or engage with the Church community. They also suggest that a similar programme could be extended to other intentional communities, whether in faith-based organisations or societies with shared interests.

Spiritual Orientation, Meaning in Life, Life Satisfaction, and Well-Being in Mothers with Disabled Children

This study was planned in order to investigate the relationship between spiritual orientation with meaning in life, life satisfaction and well-being in mothers with disabled children. The research was carried out with 128 mothers in a private rehabilitation center at eastern Turkey. The Spiritual Orientation Scale (SOS), Meaning in Life Questionnaire (MLQ), Life Satisfaction Scale (LSS), and Well-Being Index (WBI) were used in the data collection. The mean score of the mothers on the SOS was found to be high (89.34 ± 7.14). It was determined that as the mean scores of mothers on the SOS increased, their mean scores on MLQ, LSS, and WBI increased and that the relationship between them was significant (p < 0.05). It was found that as the spiritual orientation of the mothers increased, meaning in life, life satisfaction, and well-being increased as well.

Spirituality and Religion-Relevance and Assessment in the Clinical Setting

Background:

There has been an increasing interest in the past several decades to study the relationship between spirituality and religion with physical and mental health as well as the various quality of life measures. This trend has led to the creation of an area of study called epidemiology of religion and spirituality. The policy shifts at various levels, in the mental health field, has occurred as well to educate healthcare providers, and address patients’ spiritual /religious needs in clinical settings. Despite these advances in research and policy shift, there is still some resistance in the health care community to assess and address the spiritual needs of patients in clinical settings.

Objective:

The objective is to review the published articles on spirituality/religion and its relationship with mental and physical wellbeing and discuss limitations of such research. The review articles on assessment and interventions to address spiritual or religious needs in clinical settings were also included.

Methods:

Author conducted a literature search using books@Ovid, Journals@Ovid Full Text, Your Journals@Ovid, Ovid MEDLINE® 1946 to January week 4 2019, Ovid Medline® and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily without Revisions 2015-January 28, 2019; Ovid MD and Psychiatry Online.

Results:

A total of 1,040 articles were identified using keywords spirituality, religion, mental health, physical health, psychological well-being, healthy beliefs, psychopathological beliefs and quality of life. The search result included original research papers, review articles and commentaries.

Conclusion:

The review articles were narrowed to 100 articles based on relevance to the objectives outlined above. Seventy-five articles were referenced at the end.

Mediating effect of spiritual coping strategies and family stigma stress on caregiving burden and mental health in caregivers of persons with dementia

Background A considerable number of the persons living with dementia rely on family members for care and assistance when performing activities of daily living. As a result, caregivers may be at increased risk for mental health problems such as depression, anxiety and caregiver burden. This study examined if and how spiritual coping and stigma-related family stress impacted the associations between the patient activities of daily living impairment and caregiver mental health. Methods Using a longitudinal design, 664 caregivers were assessed at baseline for spiritual coping strategies and family stigma stress, along with patients' instrumental activities of daily living and cognitive functioning. After 12 months, caregivers were assessed for depressive and anxiety symptoms, caregiver burden, and quality of life (physical and mental). Sequential mediation of spiritual coping strategies and stigma-related family stress on the relationship between patient instrumental activities of daily living and caregiver mental health outcomes was examined using the PROCESS macro statistical method. Results Participants had been caring for someone with dementia for an average of 46.4 (SD, 16.9) months and 63% of caregivers were female. There were significant indirect associations between patient instrumental activities of daily living and caregiver anxiety, depression, caregiving burden, and the mental health component of quality of life. Spiritual coping and stigma-related stress mediated these associations (-0.54 Collapse

Key Words

• caregiver
• coping
• dementia
• elderly
• mental health
• spiritual

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Affiliation(s)

Mohsen Saffari Baqiyatallah University of Medical Sciences, Iran
Harold G Koenig Duke University Medical Center, USA; King Abdulaziz University, Saudi Arabia; Ningxia Medical University, China
Keisha N O'Garo Duke University Medical Center, USA
Amir H Pakpour Qazvin University of Medical Sciences, Iran; Jönköping University, Sweden

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Examining spiritual support among African American and Caucasian Alzheimer's caregivers: A risk and resilience study

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.

Qualitative Analysis of Faith Community Nurse-Led Cognitive-Behavioral and Spiritual Counseling for Dementia Caregivers

This article presents themes emerging from semistructured interviews with dementia family caregivers in rural communities who participated in an integrative, cognitive-behavioral and spiritual counseling intervention, and with faith community nurses (FCNs) who delivered the intervention. The primary objectives of the counseling intervention were to ameliorate dementia caregivers' depressive affect and the severity of their self-identified caregiving and self-care problems. The qualitative portion of the study was intended to elicit caregivers' and FCNs' perceptions of the benefits and drawbacks of the intervention. We conducted interviews with seven FCN/caregiver pairs 4 times during the 6-month counseling process, totaling 56 interviews. Themes emerging from the interviews included caregivers' perception of burden and care partners' problem behavior; formation of therapeutic alliance between FCNs and caregivers; problem-solving skills, tools, and resources; caregivers' use of problem-solving strategies; spirituality in caregiving and counseling processes; FCNs' prior professional experience; and caregiver and FCN time constraints.

Influence of Religion on Later Burden and Health of New Black and White Caregivers

Objective: We assessed the relationship between positive aspects of religiosity and reduced stress in caregivers, and negative aspects of religiosity and increased caregiver burden. Method: Using data from the Biopsychosocial Religion and Health Study, we performed multiple linear regression analysis on 584 caregivers. Results: Mental health, but not physical health, was predicted by caregiver burden. Caregivers who viewed God as loving and not controlling and felt a sense of community with their church family had less burden. Caregivers who engaged in negative religious coping had a greater decline in mental health than those who saw God as loving and not controlling and who gave emotional support to others. Discussion: Some aspects of religion appear to play an important role in alleviating the mental stresses of being a caregiver.

Older Adult Spouses with Multiple Chronic Conditions: Challenges, Rewards, and Coping Strategies

There is a paucity of research exploring how spouses to older adults with multiple chronic conditions make meaning of their caregiving experience. For this study, we asked: What is the experience of spousal caregivers to persons with multiple chronic conditions? We applied Thorne's interpretive description approach, interviewing 18 spouses who provided a rich description of their caregiving experience; interviews were transcribed verbatim and thematically analysed. Themes were categorized according to challenges encountered, rewards gleaned, and sustaining strategies employed by participants in caregiving to their spouse with multiple chronic conditions. Unique findings relate to the challenges inherent in decision-making within the context of multiple chronic conditions. This article begins to address the gap in the literature regarding the caregiving experience within the context of multiple chronic conditions.

Factors Associated with Anger among Male Adolescents in Western Iran: An Application of Social Cognitive Theory

INTRODUCTION

Anger can be defined a natural emotional response that is gradually formed to protect us in dealing with threats, damages, assaults, and failures; while hatred is a change of attitude which is built following the persistence of anger towards a subject or an individual. One of the main reasons of adolescents' reference to the counseling centers is their anger accompanied by violence.

OBJECTIVE

This study aims to determine the social cognitive factors associated with anger among a population of adolescents in the west of Iran based on the social cognitive theory.

METHODOLOGY

Samples were selected based on multi-stage cluster sampling. Method including the first and the second-grade male high school students from Ilam town (N=360). The Spielberger's anger questionnaire (STAXI 2) and a self-designed questionnaire based on Bandura's social cognitive theory were employed as the data collection instruments in the present study.

RESULTS

Of the selected population, 200 students were the first-grade and 160 students were the second-grade students. 135 students were the first child of the family, 150 students were the second or the third birth, and 75 students were the fifth or above in their families. Descriptive tests and correlation analysis were used to conduct the statistical analysis. Although there was a significant and inverse relationship between all the components of the theory and anger, the strongest relationship was seen in self-efficacy (-0.585) and the weakest relationship was seen in modeling (-0.297).

DISCUSSION & CONCLUSION

If was concluded that helping people to know their abilities and have a better personal judgment in this case, can influence their anger control. In addition, the process of stress management can effectively increase an individual's emotional coping.

Anger and health in dementia caregivers: exploring the mediation effect of optimism

Although previous studies indicate a negative association between caregivers' anger and health, the potential mechanisms linking this relationship are not yet fully understood. The aim of this study was to explore the potential mediating role of optimism in the relationship between anger and caregivers' physical health. Dementia caregivers (n = 108) were interviewed and filled out instruments assessing their anger (reaction), optimism and health (vitality). A mediational model was tested to determine whether optimism partially mediated the relationship between anger and vitality. Angry reaction was negatively associated with optimism and vitality; optimism was positively associated with vitality. Finally, the relationship between angry reaction and vitality decreased when optimism was entered simultaneously. A non-parametric bootstrap approach confirmed that optimism significantly mediated some of the relationship between angry reaction and vitality. These findings suggest that low optimism may help explain the association between caregivers' anger and reduced sense of vitality. The results provide a specific target for intervention with caregivers.

Spirituality and self-efficacy in dementia family caregiving: trust in God and in yourself

BACKGROUND

Research indicates that spirituality and self-efficacy have been associated with higher levels of caregivers' well-being. However, these two concepts have rarely been examined simultaneously. The aim of this study was to analyze the combined effect of spirituality and self-efficacy on the caregiving stress process.

METHODS

The study design was cross-sectional. Dementia family caregivers (n = 122) were assessed in relation to the following variables: stressors (time since caregiving began, daily hours caring, frequency of behavioral problems, patient's functional status); appraisal (caregiver's appraisal of behavioral problems), caregiver's personal resources (self-efficacy, spiritual meaning, social support), and outcomes (depression and anxiety).

RESULTS

Participants were divided into four groups corresponding to four profiles defined by their scores on spiritual meaning and self-efficacy: LELS = Low self-efficacy and low spirituality; HELS = High self-efficacy and low spirituality; LEHS = Low self-efficacy and high spirituality; and HEHS = High self-efficacy and high spirituality. No differences were found between groups in stressors, appraisal, or personal resources. Caregivers in the HEHS group had significantly less depression compared to the LEHS group. Regression analysis showed that being a HEHS caregiver, low appraisal of behavioral problems and high social support were associated with low caregiver depression. Only high appraisal of behavioral problems was associated with high levels of anxiety.

CONCLUSION

The results of this study suggest that spirituality and self-efficacy had an additive effect on caregivers' well-being. A high sense of spiritual meaning and a high self-efficacy, in combination, was associated with lower levels of depression in caregivers.