Attachment style and filial obligation in the burden of caregivers of dementia patients

The relationship between filial values and preparedness in adult -child caregivers of patients with chronic heart failure: A cross-sectional study

OBJECTIVES

To explore the relationship between filial values (responsibility, reciprocity, and obligation) and caregiving preparedness in adult child carers of patients with chronic heart failure (CHF).

METHODS

A total of 339 adult child caregivers of CHF patients were recruited from six hospitals in China. Self-report questionnaires were used to measure caregivers' filial values and their caregiving preparedness. Descriptive analysis, Spearman's correlation analysis, and hierarchical regression analysis were performed. The study adhered to the STROBE guidelines.

RESULTS

Filial values were positively correlated with caregiving preparedness. Hierarchical regression analysis revealed a positive relationship between the combined variables of care and respect with caregiver preparedness, jointly explaining 7.9 % of the variance.

CONCLUSIONS

Filial values promote caregiver preparedness, broadening the applicability of the Caregiver Empowerment Model.

Filial piety and older adult caregiving among Chinese and Chinese-American families in the United States: a concept analysis

BACKGROUND

The culturally sensitive nursing practice has not embedded filial piety as a cultural value and stance pertaining to caregiving among aging Chinese and Chinese-American (CCA) families in the United States, yet it is critical for healthy aging among CCAs.

PURPOSE

To understand filial piety when caring for aging CCAs and conceptualize an operational definition and framework.

METHODS

A systematic search was conducted in CINAHL, PubMed, Scopus, and PsycINFO databases. Analysis of the concept of filial piety among CCAs used Walker and Avant's methods. Twenty-six studies were selected in the final full-text analysis.

FINDINGS

Synthesis of evidence identified four antecedents: (a) filial obligation as a 'cultural gene', (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of 'birth right'. Attributes included familial material and emotional support, obedience, pious reverence, and societal norms. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity.

CONCLUSION

Filial piety is an intrinsic desire to support aging parents and an extrinsic desire to adhere to Chinese societal moral tenets. The proposed operational framework "Caregiving for aging CCAs in the United States" merits further study.

The relationship at the heart of the experience of daughter caregivers of a parent with dementia: An interpretative phenomenological analysis

BACKGROUND

Parents with dementia require emotional, physical, psychological and financial support from their child caregivers to continue living at home. Daughter caregivers have been shown to be more involved in self-care and household tasks and to experience higher levels of distress than son caregivers.

OBJECTIVE

The aim of this study was to investigate the experience of daughter caregivers who provide informal care for a parent with dementia living in their own home.

METHOD

Semi-structured interviews were conducted with 11 daughter caregivers of a parent with Alzheimer's disease. Interviews were analysed using Interpretative Phenomenological Analysis.

RESULTS

Three axes emerged from the analyses: [1] the before conditions the after: the quality of the previous relationship with the parent with Alzheimer's disease is a determining factor and allows the identification of three profiles of daughter caregivers: 'the grateful', 'the resentful' and 'the ambivalent', [2] when the relationship protects against the sense of burden: the feeling of being invaded by the caregiving situation is influenced by the quality of the relationship with the parent with Alzheimer's disease, and [3] alone or almost: the support network is desired when it is absent but kept at arm's length when it is present.

DISCUSSION

The results underline the importance of assessing the quality of attachment and supporting the relationship with the parent (especially when the relationship prior to the disease was difficult). Daughter caregivers should also be encouraged to delegate tasks and refocus their actions related to their values. Family mediation sessions may be planned to improve the organisation of care and set up an efficient collaboration.

The experiences of East Asian dementia caregivers in filial culture: a systematic review and meta-analysis

Background

With the aging population in East Asia, the prevalence of dementia and the need for patient care is increasing. Family caregivers of people with dementia are at risk of physical and mental health problems. Filial piety culture regulates relationships within East Asian families and effects the well-being and behavior of dementia family caregivers (CGs).

Objective

To systematically assess the experience of East Asian dementia caregivers in filial culture. Methods: Electronic databases, including MEDLINE, APA PsycINFO, CINAHL (via EBSCOhost), Web of Science, and Cochrane Library, were searched for relevant studies up to July 2021. Only original articles were included.

Results

Thirteen eligible studies were included, of which eight were qualitative and five were quantitative. Meta-analysis showed a negative association (r = -0.18, 95%CI [-0.28, -0.08]) between filial culture and caregiver burden. The quantitative studies identified four themes related to dementia caregivers' experiences: (1) Recognition and understanding of filial piety as part of cultural identity, (2) Role transitions- from child to CG, (3) Filial piety's constraints on CGs; (4) CGs' self-compassion through changing cultural norms of filial practice.

Conclusion

Filial culture influences the whole process behind caregiving for East Asian dementia caregivers. At the same time, cultural transition has also brought about new connotations and practices to filial culture.

The Relationship Between Dual Filial Piety and Caregiver Burden Among Arab Family Caregivers in Israel

The current study examined the association between dual filial piety (FP) (reciprocal and authoritarian) and caregiver burden in adult children caregivers and attempted to understand the underlying mechanisms of these links. A cross-sectional study of 222 family caregivers of older relatives in an Arab community in Israel was performed. Data were collected via face-to-face interviews in Arabic using structured questionnaires. Bootstrapping with resampling strategies tested the multiple mediator model. Reciprocal and authoritarian components of FP were associated negatively with caregiver burden. The link with reciprocal FP was partially mediated by role engagement and relationship strain between caregiver and care recipient, whereas the link between authoritarian FP and caregiver burden was mediated by role engagement, but not by relationship strain between caregiver and care recipient. The study highlights the positive effect of cultural values (dual FP) and the underlying mechanisms working against the harmful effects of caregiving stressors in traditional societies, such as Arab-Israeli society. Practitioners should be sensitive to issues of family cultural values and family care among traditional populations. [Research in Gerontological Nursing, xx(x), xx-xx.].

Psychological distress in sons as resident carers of older mothers in Japan

In Japan, care-giving sons are noted for their high rates of abuse of care recipients. This study revealed, for the first time, the difficulties unique to sons caring for their mothers. All sons used long-term care insurance services. However, they provided care that could not be covered by such public services while harbouring psychological distress. In this study, we interviewed 13 sons living with their older mothers as the primary carer and conducted a thematic analysis focusing on their psychological distress. As part of our study findings, we have identified nine themes during analysis: uncomfortable feelings that cannot be mitigated as a son; feeling of futility in being unrecognised as a carer; fear of losing something important; a strong sense of responsibility for one's mother's life; disappointment in being unable to obtain understanding and co-operation from one's siblings in providing care; irritation and anger towards one's wayward mother; guilt about treatment of one's mother; sense of exhaustion due to demanding care; and experiencing hopelessness and despair. Thus, it is important to understand what psychological distress carers experience and to consider possible approaches for their support. The study findings provide suggestions for long-term care support in regions, such as East Asia, where the numbers of son carers are increasing inevitably owing to declining birth rates and ageing population, as in Japan.

Extremely Distant and Incredibly Close: Physical Proximity, Emotional Attachment and Caregiver Burden

Informal caregivers are at risk of caregiver burden, and physical proximity to the care recipient may add to this negative outcome. Yet, individual differences in emotional proximity to the care recipient such as attachment orientations may contribute to caregivers’ comfort towards different degrees of physical proximity, leading to varying levels of burden. The current study is the first to explore the role of physical proximity on caregiver burden as moderated by attachment orientations. A sample of 162 Israeli caregivers who are active users of the Camoni website completed our online survey. Sociodemographic characteristics, including a self-reported questionnaire on the physical proximity to the care recipient, were collected. Caregivers’ attachment orientations were assessed with the Experiences in Close Relationships–Relationship Structures questionnaire. Caregiver burden was assessed using the Caregiver Burden Inventory. Multiple regression and simple slope analyses were conducted. Attachment anxiety and avoidance were positively associated with burden, whereas physical proximity was not. Attachment avoidance, but not attachment anxiety, moderated the association between physical proximity and caregiver burden, with caregivers who live closer to their care recipient experiencing greater burden when high levels of avoidance were present. Our findings reveal the complex dynamics between attachment orientations and physical proximity in the context of informal care, highlighting the need for better integration of these two interlinked constructs in both care research and practice.

The relationship between filial piety and caregiver burden among adult children: A systematic review and meta-analysis

INTRODUCTION

Filial piety is an important cultural value in aging societies. However, mixed findings were identified regarding its influence on caregiver burden. The purpose of this meta-analysis was to clarify the relationships between filial concepts and caregiver burden.

METHOD

Twelve databases on filial piety, filial obligation, and caregiver burden among adult children prior to January, 2020 were systematically cross-culturally reviewed.

RESULTS

Twelve studies were finalized for analysis. Fixed effect models indicated that stronger filial piety was significantly correlated (r = -.23) or associated with (β = -.27) less caregiver burden. However, no significant relationship between filial obligation and caregiver burden was revealed by random effect models.

CONCLUSION

Stronger filial piety may lessen caregiver burden. Therefore, filial piety should be assessed and supported in adult child caregivers, particularly in Eastern cultures. However, the concept of filial piety and its tools should be updated transculturally. PROSPERO Registration Number: CRD42020161969.

Ashamed Caregivers: Self-Stigma, Information, and Coping among Dementia Patient Families

The number of people living with dementia increases almost every year, and the majority of the care system for these individuals is often made up of close family members. This study investigates the relationship between family caregivers' cross-checking of information with healthcare providers and patient health outcomes. Specifically, we examined whether this relationship was mediated by caregivers' enhanced coping efficacy. We also tested the moderation effect of family caregivers' affiliate stigma on information cross-checking, coping efficacy, and coping outcomes. Using a survey of 226 family caregivers of dementia patients in South Korea, this study tested the moderated mediation model with the PROCESS macro. Results indicate that low affiliate stigma moderates coping efficacy on the relationship between information cross-checking and dementia patients' health outcomes. Further implications for family caregiving and general dementia care are discussed.

Carer burden and dyadic attachment orientations in adult children-older parent dyads

BACKGROUND AND OBJECTIVES

This study takes an interpersonal approach to the study of carer burden in families where adult children care for older parents. The aim of the study was to determine whether different pairings of attachment insecurity in older parent-adult child dyads are predictive of carer burden.

RESEARCH DESIGN AND METHODS

Seventy dyads whereby adult children provided weekly care to their older parents completed self-report measures of attachment. Adult children also completed a measure of carer burden.

RESULTS

Anxious-avoidant attachment insecurity pairings in parent-child dyads were associated with increases in carer burden. However, anxious-anxious and avoidant-avoidant attachment insecurity pairings were not associated with burden.

DISCUSSION AND IMPLICATIONS

The attachment insecurity of the care-recipient was found to moderate the association between a carer's attachment insecurity and burden, but only when the care-recipient's attachment insecurity differed to that of the carer's. These findings have implications for research, policy, and practice in aged care. The findings highlight the importance of focusing on attachment insecurity in aging families as well as taking a dyadic perspective when studying caregiving outcomes such as carer burden. The findings suggest that carers who may require the greatest support are those whose parents demonstrate contrasting orientations of attachment insecurity.

Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography

Background

People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this article is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain.

Methods

A systematic literature review was undertaken of published and unpublished literature databases including EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool.

Results

From 534 citations, 10 studies were eligible (360 participants: 171 informal caregivers of 189 care recipients). The evidence was moderate quality. Seven themes arose: the relationship of caregivers to healthcare professionals; role reversal with care recipients; acting the confidant to the care recipient; a constant burden in caregiving; legitimising care recipient's condition; knowledge and skills to provide caregiving; and the perception of other family members and wider society to the caregiver/care recipient dyad.

Conclusion

The lived experiences of caregivers of people with chronic musculoskeletal pain is complex and dynamic. There is an inter-connected relationship between caregivers, care recipients and healthcare professionals. Exploring how these experiences can be modified to improve a caregiving dyad's lived experience is now warranted.

Attachment and aged care: a systematic review of current research

Attachment theory is an important framework from which to examine familial aged care. Despite this, the role of attachment in later-life caregiving remains unclear. The current study presents a systematic review of papers within the last five years on attachment and various outcomes related to familial aged care. For the caregiver, attachment anxiety was associated with poorer mental health, and attachment insecurity with a more controlling manner of caregiving. The few studies conducted with care recipients found that attachment insecurity was associated with greater self-appraisals of dementia symptoms and a lower sense of security. Research continues to suffer from the use of inadequate assessments of individual differences into adult attachment.