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Singh Solorzano C, Rowlands H, Ronaldson A, Kidd T, Steptoe A, Leigh E, Jahangiri M, Poole L. Caregiver burden in informal spousal caregivers predicts psychological and physical health in patients following coronary artery bypass graft surgery: a longitudinal clinical cohort study. J Behav Med 2024:10.1007/s10865-024-00512-3. [PMID: 39183251 DOI: 10.1007/s10865-024-00512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024]
Abstract
Previous research has shown that informal caregiver burden can have deleterious effects on patient recovery; however, this relationship has yet to be investigated in patients undergoing coronary artery bypass graft (CABG) surgery. This study aimed to examine the impact of the change of caregiver burden from pre- to post-surgery on patients' mental and physical health after CABG surgery. Ninety patient-caregiver dyads were assessed one month before the surgery, two months and one year after the surgery. Caregivers completed the Oberst Burden Scale to measure caregiver burden. Patients completed the Beck Depression Inventory to measure depressive symptoms, a subscale of the Hospital Anxiety and Depression Scale to measure anxiety symptoms, the Short Form-12 health assessment to measure health-related quality of life, and the Coronary Revascularisation Outcomes Questionnaire to measure surgery symptoms. Hierarchical linear regression analyses were conducted to explore the association between change in caregiver burden and post-surgery patient outcomes. A greater increase in caregiver burden from pre- to two-months post-surgery significantly predicted higher patients' depressive symptoms (β = 0.179, p = 0.010), anxiety symptoms (β = 0.114, p = 0.017), reported post-surgery symptoms (β = 0.335, p = 0.008) and reduced physical health-related quality of life (β = -0.358, p = 0.003), after controlling for a wide range of covariates. These findings were not replicated at a one-year follow-up. These results provide insights into the impact of caregiver burden on patient distress following CABG surgery, supporting the idea of psychological support interventions for caregivers to increase patients' short-term recovery outcomes.
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Affiliation(s)
- Claudio Singh Solorzano
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, 25125, Italy.
| | - Hannah Rowlands
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Amy Ronaldson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Tara Kidd
- School of Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Elizabeth Leigh
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, London, SW17 0QT, UK
| | - Lydia Poole
- Department of Psychological Interventions, School of Psychology, University of Surrey, Stag Hill Campus, Guildford, GU2 7XH, Surrey, UK
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Lee J, Chung ML, Kim E, Yoo JH. Impact of caregiver relationship on self-care in patients with Parkinson's disease: A cross-sectional study using Riegel's theory of self-care of chronic illness. J Clin Nurs 2024; 33:1036-1047. [PMID: 37817476 DOI: 10.1111/jocn.16905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023]
Abstract
AIMS To explore how the characteristics of patients and caregivers affect self-care in patients with Parkinson's disease (PD). DESIGN A multicentre cross-sectional study. METHOD We followed the STROBE checklist. Parkinson's disease patients aged 50 years and older and their caregivers were recruited from two tertiary hospitals and the Korean Parkinson's Disease Association website. Patient characteristics, including social support, relationship quality with caregivers, self-care efficacy and self-care, were analysed. Caregiver characteristics were also evaluated, including caregiving duration, social support, relationship quality with patients, contribution to patients' self-care efficacy and contribution to patients' self-care. RESULTS The characteristics of patients and caregivers (103 pairs) were hierarchically regressed into patient self-care domains (maintenance, monitoring and management). Most patients and caregivers gave a self-care efficacy and self-care management rating of moderate. In three regression models, patient self-care efficacy was positively related to three domains of patient self-care. Self-care maintenance decreased as patients' disease duration increased. Self-care monitoring was positively related to the education level of patients and caregiving duration. Self-care management showed an inverse relationship with caregiving duration and a positive relationship with caregiver contribution. CONCLUSION Self-care efficacy was important in promoting PD patients' self-care maintenance, monitoring and management. The contributions of caregivers were also critical in increasing PD patients' self-care management. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE To increase patients' self-care efficacy and self-care, educational interventions containing information about the disease, symptom management, and problem-solving should be implemented. Since caregivers are deeply involved in patients' self-care, educational interventions for caregivers should also be provided. IMPACT This study closed the literature gap by examining the self-care efficacy and self-care of Korean PD patients. Findings demonstrated the importance of caregiver roles on patients' self-care and health. PATIENT OR PUBLIC CONTRIBUTION Two tertiary hospitals and the Korean Parkinson's Disease Association assisted during the recruitment process.
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Affiliation(s)
- JuHee Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Misook Lee Chung
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Eunyoung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea
| | - Jee-Hye Yoo
- College of Nursing, CHA University, Pochean, Korea
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Hwang Y, Kim J. Influence of caregivers' psychological well-being on the anxiety and depression of care recipients with dementia. Geriatr Nurs 2024; 55:44-51. [PMID: 37972435 DOI: 10.1016/j.gerinurse.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
This study was conducted to examine how caregivers' psychological well-being influences the anxiety or depression of care recipients with dementia. A secondary data analysis was conducted using 666 dyads of older adults with dementia and their caregivers. The odds that care recipients with dementia would experience anxiety increased when caregivers had a negative relationship with care recipients (OR = 1.22, p = 0.042), lower perception of the positive aspects of caregiving (OR = 0.86, p = 0.047), or anxiety (OR = 2.41, p = 0.036). The odds that care recipients with dementia would experience depression increased when caregivers had a greater perception of the negative aspects of caregiving (OR = 1.15, p = 0.023) or anxiety (OR = 2.21, p = 0.045). Since care recipients with dementia and their caregivers spend considerable time together daily, caregivers' psychological well-being can impact care recipients' anxiety and depression.
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Affiliation(s)
- Yeji Hwang
- Seoul National University, College of Nursing and Research Institute of Nursing Science, Seoul, Korea.
| | - Jayeong Kim
- Seoul National University, College of Nursing and Research Institute of Nursing Science, Seoul, Korea
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Dong X, He D, Zhang Y, Zhao Q, Zhang X, Fan X. Dyadic Associations Between Burden and Depressive Symptoms Among Patients With Heart Failure and Their Caregivers: The Mediating Role of Perceived Stress. J Cardiovasc Nurs 2023; 38:517-527. [PMID: 37816079 DOI: 10.1097/jcn.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with heart failure and their family caregivers. Given the interpersonal interactions between dyadic individuals with intimate relationship, it is essential to consider the dyads as a unit when exploring the factors associated with depressive symptoms in heart failure patient-caregiver dyads. OBJECTIVE The aims of this study were to explore the dyadic effects of burden on depressive symptoms in heart failure patient-caregiver dyads and investigate whether perceived stress acts as a mediator in these relationships. METHODS In this cross-sectional study, 237 heart failure patient-caregiver dyads were recruited from 3 hospitals in China between November 2018 and June 2019. Symptom burden, caregiving burden, perceived stress, and depressive symptoms were assessed using self-report questionnaires. The actor-partner interdependence model and actor-partner interdependence mediation model were used to analyze the data. RESULTS Patients' symptom burden had an actor effect on their own depressive symptoms and a partner effect on their caregivers' depressive symptoms. Similarly, caregivers' caregiving burden had an actor effect on their own depressive symptoms and a partner effect on patients' depressive symptoms. The actor effects between burden and depressive symptoms were partially mediated by their own perceived stress in heart failure patient-caregiver dyads. Furthermore, the partner effect between caregivers' caregiving burden and patients' depressive symptoms was completely mediated by patients' perceived stress. CONCLUSIONS Patients' symptom burden and caregivers' caregiving burden aggravated their depressive symptoms by increasing their own perceived stress. Moreover, patients' symptom burden led to caregivers' depressive symptoms, and caregivers' caregiving burden contributed to patients' depressive symptoms through patients' perceived stress. These interdependent relationships suggest that dyadic interventions focused on reducing burden and perceived stress may be beneficial for relieving depressive symptoms in heart failure patient-caregiver dyads.
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Jiang N, Lou VWQ. Caregivers' depressive symptom trajectories and risk of cognitive impairment among older adults with functional limitations: A prospective cohort study. Int J Geriatr Psychiatry 2023; 38:e5850. [PMID: 36484558 DOI: 10.1002/gps.5850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Caregiver (CG)'s depression is common and its prevalence is rising. The relationship of CG depression with care recipients (CR)'s subsequent cognitive impairment remains unclear. This study examines the association of CG depressive symptoms trajectories with 6-year cognitive impairment risk among care recipients (CR) who are older adults with functional limitations. METHODS Retrospective analysis of prospectively collected data cohorts from 2010 to 2016. The sample included 810 community-dwelling older adults aged ≥75 years, dementia free at baseline, with their primary caregiver dyads. CG's depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. The main outcomes were incident mild, moderate, and severe cognitive impairment of CRs measured using Short Portable Mental Status Questionnaire. Group-based trajectory modeling identified three CG depressive symptom trajectory groups. Competing risks regression analysis modeled the hazards as a function of CG depressive symptom trajectories. RESULTS Of 810 CRs, 3% developed severe cognitive impairment, 21% had moderate cognitive impairment, and 37% had mild cognitive impairment. Only CG's "Increasing" trajectory group predicted increased risk of CR's mild and moderate cognitive impairment relative to "persistently low" group (subhazard ratio [SHR] = 1.52, 95% confidence interval [CI], p < 0.05; SHR = 1.87, 95% CI, p < 0.05, respectively). CONCLUSIONS AND IMPLICATIONS Finding highlight the intricate and non-linear association between CG depressive trajectory and CR cognitive impairment. This evidence can be used to enlighten policymakers and health providers about the need for risk stratification screening for CG mental health and early treatment for CG depression to prevent or delay CR's cognitive impairment.
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Affiliation(s)
- Nan Jiang
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong.,Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, Hong Kong
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Kirk DL, Kabdebo I, Whitehead L. Prevalence of distress and its associated factors among caregivers of people diagnosed with cancer: A cross-sectional study. J Clin Nurs 2022; 31:3402-3413. [PMID: 34894019 PMCID: PMC9787485 DOI: 10.1111/jocn.16167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES To (i) determine prevalence of distress among caregivers of people living with cancer, (ii) describe caregivers' most commonly reported problems and (iii) investigate which factors were associated with caregivers' distress. BACKGROUND The psychological distress associated with a cancer diagnosis jointly impacts those living with cancer and their caregivers(s). As the provision of clinical support moves towards a dyadic model, understanding the factors associated with caregivers' distress is increasingly important. DESIGN Cross-sectional study. METHODS Distress screening data were analysed for 956 caregivers (family and friends) of cancer patients accessing the Cancer Council Western Australia information and support line between 1 January 2016 and 31 December 2018. These data included caregivers' demographics and reported problems and their level of distress. Information related to their care recipient's cancer diagnosis was also captured. Caregivers' reported problems and levels of distress were measured using the distress thermometer and accompanying problem list (PL) developed by the National Comprehensive Cancer Network. A partial-proportional logistic regression model was used to investigate which demographic factors and PL items were associated with increasing levels of caregiver distress. Pearlin's model of caregiving and stress process was used as a framework for discussion. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. RESULTS Nearly all caregivers (96.24%) recorded a clinically significant level of distress (≥4/10) and two thirds (66.74%) as severely distressed (≥7/10). Being female, self-reporting sadness, a loss of interest in usual activities, sleep problems or problems with a partner or children were all significantly associated with increased levels of distress. CONCLUSIONS Caregivers of people with cancer reporting emotional or familial problems may be at greater risk of moderate and severe distress. RELEVANCE TO CLINICAL PRACTICE Awareness and recognition of caregiver distress are vital, and referral pathways for caregivers are the important area of development.
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Affiliation(s)
- Deborah L. Kirk
- School of Nursing and MidwiferyEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Istvan Kabdebo
- School of Nursing and MidwiferyEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Lisa Whitehead
- School of Nursing and MidwiferyEdith Cowan UniversityJoondalupWestern AustraliaAustralia
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Smith H, Grindey C, Hague I, Newbould L, Brown L, Clegg A, Thompson C, Lawton R. Reducing delayed transfer of care in older people: A qualitative study of barriers and facilitators to shorter hospital stays. Health Expect 2022; 25:2628-2644. [PMID: 36193616 PMCID: PMC9700150 DOI: 10.1111/hex.13588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/11/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Growing numbers of older patients occupy hospital beds despite being 'medically fit' for discharge. These Delayed Transfers of Care amplify inefficiencies in care and can cause harm. Delayed transfer because of family or patient choice is common; yet, research on patient and family perspectives is scarce. To identify barriers to, and facilitators of, shorter hospital stays, we sought to understand older people's and caregivers' thoughts and feelings about the benefits and harms of being in hospital and the decisions made at discharge. METHODS A multimethod qualitative study was carried out. Content analysis was carried out of older people's experiences of health or care services submitted to the Care Opinion online website, followed by telephone and video interviews with older people and family members of older people experiencing a hospital stay in the previous 12 months. RESULTS Online accounts provide insight into how care was organized for older people in the hospital, including deficiencies in care organization, the discharge process and communication, as well as how care was experienced by older people and family members. Interview-generated themes included shared meanings of hospitalization and discharge experiences and the context of discharge decisions including failure in communication systems, unwarranted variation and lack of confidence in care and lack of preparation for ongoing care. CONCLUSION Poor quality and availability of information, and poor communication, inhibit effective transfer of care. Communication is fundamental to patient-centred care and even more important in discharge models characterized by limited assessments and quicker discharge. Interventions at the service level and targeted patient information about what to expect in discharge assessments and after discharge could help to address poor communication and support for improving discharge of older people from hospital. PATIENT OR PUBLIC CONTRIBUTION The Frailty Oversight Group, a small group of older people providing oversight of the Community Aging Research 75+ study, provided feedback on the research topic and level of interest, the draft data collection tools and the feasibility of collecting data with older people during the COVID-19 pandemic. The group also reviewed preliminary findings and provided feedback on our interpretation.
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Affiliation(s)
- Helen Smith
- Improvement Science Theme, NIHR Applied Research Collaboration Yorkshire and HumberBradford Institute for Health ResearchBradfordUK
| | - Chloe Grindey
- Improvement Science Theme, NIHR Applied Research Collaboration Yorkshire and HumberBradford Institute for Health ResearchBradfordUK
| | - Isabel Hague
- Improvement Science Theme, NIHR Applied Research Collaboration Yorkshire and HumberBradford Institute for Health ResearchBradfordUK
| | | | - Lesley Brown
- Academic Unit for Aging and Stroke ResearchBradford Institute for Health ResearchBradfordUK
| | - Andrew Clegg
- Academic Unit for Aging and Stroke ResearchBradford Institute for Health ResearchBradfordUK
| | - Carl Thompson
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
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Litzelman K, Al Nassar N. Partner effects on caregiver and care recipient depressed mood: heterogeneity across health condition and relationship type. J Behav Med 2022; 45:750-759. [PMID: 35907099 PMCID: PMC10202032 DOI: 10.1007/s10865-022-00343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/23/2022] [Indexed: 10/16/2022]
Abstract
The well-being of caregivers and their care recipients is interrelated, although conflicting evidence has emerged across different caregiving populations. Using data from the National Health and Aging Trends Study and the National Study of Caregiving (2015 and 2017, n = 742 dyads), we constructed actor-partner interdependence models assessing how spillover (i.e., interdependence) of depressed mood varied by care recipient health condition (specifically cancer, dementia, stroke, and diabetes) and kinship type (spouse/partner, child, other relative, or non-relative). Across condition types, care recipient-to-caregiver partner effects were significantly larger in dyads with vs. without cancer and significantly smaller in dyads with vs. without diabetes (pinteractions < .05). Substantive differences in partner effects were observed by kinship type, although moderation was not statistically significant. The findings highlight potential heterogeneity in caregiver-care recipient interdependence with implications for future research and delivery of supportive care.
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Affiliation(s)
- Kristin Litzelman
- School of Human Ecology, Department of Human Development and Family Studies, University of Wisconsin-Madison, 1300 Linden Drive, Madison, WI, 53716, USA.
| | - Nadia Al Nassar
- School of Human Ecology, Department of Human Development and Family Studies, University of Wisconsin-Madison, 1300 Linden Drive, Madison, WI, 53716, USA
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Miyawaki CE, Liu M, Markides KS. Association between caregivers' characteristics and older care recipients' well-being among Vietnamese immigrant families in the United States. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2214-2224. [PMID: 34882808 PMCID: PMC9177710 DOI: 10.1002/jcop.22768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 06/01/2023]
Abstract
AIMS We examined the association between caregivers' psychological status and their older family members' (care recipients) mental health in the Vietnamese American community (N = 58 dyads). METHODS Logistic regression models were used. RESULTS Caregivers and care recipients were on average 53 and 75 years old, immigrated at ages 32 and 51, and had 10 and 6 years of formal education, respectively. Approximately two-thirds of caregivers provided care for 20+ h/week for 7 years with the majority of care recipients reporting fair or poor health. Care recipients' physical and cognitive health had a significant association with their depressive symptoms. However, care recipients acting as burdened caregivers' "company" helped themselves and felt less depressed (OR = 0.89, 95% CI: 0.80, 0.99). CONCLUSION Leveraging the tradition of Vietnamese multigeneration households, we should promote being a good company to each other that will help the caregiver-care recipient dyad, as well as their family unit when planning future interventions.
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Affiliation(s)
| | - Minhui Liu
- Department of Community Care, Xiangya School of Nursing Central South University, Changsha, China
| | - Kyriakos S. Markides
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
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Jiang N, Sun Q, Lou VWQ. The impact of caregiver's depressive symptoms on trajectories of cognitive function in older adults with functional limitations. Int J Geriatr Psychiatry 2021; 36:1284-1294. [PMID: 33608917 DOI: 10.1002/gps.5523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/14/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Family caregivers are important to older adults' health, but few studies have examined how caregivers' mental health is associated with older adults' cognitive function. This study examined the trajectories of cognitive function of older adults and whether caregivers' depressive symptoms shape the pattern of cognitive function trajectories. METHODS This 6-year longitudinal sample consisted 1188 older adults aged ≥75 years with deficits in activities of daily living (ADL) and their family caregivers in Shanghai, China (Rounds 1-3). Cognitive function trajectories were identified based on an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression tested the association between caregivers' depressive symptoms and older adults' cognitive function trajectory. RESULTS Three trajectory groups were identified: a "newly onset" group (50.4%) had an increased risk of being cognitive impaired during the 6-year period; a "never" group (46.2%) remained cognitive active; and a "chronic" group was largely persistently cognitive impaired (3.4%). Caregivers' depressive symptoms increased the relative risk of having the "onset" or "chronic" versus "never" trajectory. Among the four dimensions of depressive symptoms, only somatic complaints were associated with a higher risk of the "newly onset" trajectory in 6 years. CONCLUSION The progression of cognitive function among older adults with deficits in ADL followed three distinct trajectories during a 6-year period. Addressing the mental health of caregivers may prevent or delay progression of cognitive impairment among older adults.
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Affiliation(s)
- Nan Jiang
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
| | - Qian Sun
- Department of Social Security, School of Public Administration, Hebei University of Economics and Business, Shijiazhuang, China
| | - Vivian W Q Lou
- Department of Social Work & Social Administration, Sau Po Centre on Ageing, University of Hong Kong, Hong Kong
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Bristol AA, Mata AC, Mickens M, Dassel KB, Ellington L, Scammon D, Thompson A, Towsley GL, Utz RL, Terrill AL. "You Feel Very Isolated": Effects of COVID-19 Pandemic on Caregiver Social Connections. Gerontol Geriatr Med 2021; 7:23337214211060166. [PMID: 34993276 PMCID: PMC8724994 DOI: 10.1177/23337214211060166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022] Open
Abstract
One in five individuals in the United States provides care and support to ill, disabled, and aging family members in the home, leading to feelings of burden, stress, and poor health and well-being. Social support represents an important buffer for family caregivers that allows them to feel less isolated and more positive about their caregiving role. This sequential mixed-methods study aimed to examine the effect of the COVID-19 pandemic on family caregivers' social connections. Eighty-two caregivers completed a web-based survey which comprised of fixed-choice and open-ended questions. Survey data showed that the majority of caregivers (83%) reported an increase in stress and feeling lonely (77%) during the pandemic. Qualitative interviews with a subsample of caregivers (n=27) further explored social connections during the pandemic. Three themes echoed the quantitative findings and centered around defining boundaries, intentionality in social interactions, and loss of social resources. Although caregivers were often strained by new or increased caregiving demands, many experienced positive changes such as feeling a deeper connection with the care-recipient. Findings from this study highlight the need for further consideration of the impact of social isolation on the well-being of caregivers.
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Affiliation(s)
- Alycia A. Bristol
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Aaron C. Mata
- College of Social & Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Melody Mickens
- Division of Rehabilitative Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kara B. Dassel
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Debra Scammon
- Department of Marketing, School of Business, University of Utah, Salt Lake City, UT, USA
| | - Amber Thompson
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Gail L. Towsley
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Rebecca L. Utz
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Alexandra L. Terrill
- Department of Occupational & Recreational Therapy, College of Health, University of Utah, Salt Lake City, UT, USA
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Pristavec T, Luth EA. Informal Caregiver Burden, Benefits, and Older Adult Mortality: A Survival Analysis. J Gerontol B Psychol Sci Soc Sci 2020; 75:2193-2206. [PMID: 31903481 PMCID: PMC7664316 DOI: 10.1093/geronb/gbaa001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Informal caregivers are crucial to maintaining older adults' health, but few studies examine how caregiving receipt is associated with older person longevity. In a nationally representative sample, we prospectively explore whether and how having an informal caregiver is associated with older adult overall mortality, and how caregivers' burden and benefits perceptions relate to care recipient mortality. METHODS We match six National Health and Aging Trends Study waves (2011-2016) with 2011 National Study of Caregiving data, conducting survival analysis on 7,369 older adults and 1,327 older adult-informal caregiver dyads. RESULTS Having an informal caregiver is associated with 36% (p < .001) higher mortality risk over 6-year follow-up, adjusting for demographic, economic, and health factors. Older adults whose caregivers perceive only burden have 38% higher (p < .05) mortality risk than those with caregivers reporting neither burden nor benefits. This risk is reduced from 38% higher to 5% higher (p < .001) for older adults with caregivers reporting benefits alongside burden, compared to those with caregivers reporting neither perception. DISCUSSION Having a caregiver may signal impending decline beyond known mortality factors. However, interventions to increase caregivers' benefit perceptions and reduce their burden may decrease mortality risk for older adults with declining health and functional ability.
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Affiliation(s)
- Teja Pristavec
- Social and Decision Analytics Division, Biocomplexity Institute and Initiative, University of Virginia, Arlington
| | - Elizabeth A Luth
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
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George ES, Kecmanovic M, Meade T, Kolt GS. Psychological distress among carers and the moderating effects of social support. BMC Psychiatry 2020; 20:154. [PMID: 32252700 PMCID: PMC7137514 DOI: 10.1186/s12888-020-02571-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/25/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Carers provide both practical and emotional support and often play an important role in coordination of care for recipients. The demands of caring may lead to increased levels of stress for the carer, which can affect mental health and quality of life. This study examined the relationship between being a carer and psychological distress (assessed using the Kessler Psychological Distress Scale [K10]), and explored the moderating effect of social support in that relationship using a large sample. METHODS The study used data from the 45 and Up study, a large cohort study of individuals aged 45 years and over in New South Wales, Australia, and applied multiple regression methods and moderation analysis. The sample for the current study comprised 267,041 participants drawn from the baseline dataset, with valid data on the primary outcome (carer status). RESULTS The mean age of participants was 62.73 (±11.18) years, and 4.23% and 7.13% were identified as full-time and part-time carers, respectively. Compared to non-carers, full-time carers had K10 scores that were on average, higher by 1.87, while part-time carers' K10 scores were on average higher by 1.60 points. A perception of social support reduced the strength of the relationship between carer status and psychological distress by 40% for full-time carers and 60% for part-time carers. CONCLUSIONS The findings have important implications, for both prevention and treatment of psychological problems among carers. In terms of prevention, they suggest that public health campaigns focused on increasing awareness regarding the psychological burden faced by carers would be useful. In terms of intervention, potential treatments that focus on improving social support networks may be helpful. The results are particularly important in the current context of an ageing population in Australian and other developed countries, where caregiving is likely to play an increasing role in the care and support services.
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Affiliation(s)
- Emma S. George
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Milica Kecmanovic
- grid.1029.a0000 0000 9939 5719School of Psychology, Western Sydney University, Sydney, Australia
| | - Tanya Meade
- grid.1029.a0000 0000 9939 5719School of Psychology, Western Sydney University, Sydney, Australia
| | - Gregory S. Kolt
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Sydney, Australia
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Luth EA, Pristavec T. Do Caregiver Experiences Shape End-of-Life Care Perceptions? Burden, Benefits, and Care Quality Assessment. J Pain Symptom Manage 2020; 59:77-85. [PMID: 31419541 PMCID: PMC6942199 DOI: 10.1016/j.jpainsymman.2019.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022]
Abstract
CONTEXT Researchers, hospices, and government agencies administer standardized questionnaires to caregivers for assessing end-of-life care quality. Caregiving experiences may influence end-of-life care quality reports, which have implications for caregiver outcomes, and are a clinical and policy priority. OBJECTIVES This study aims to determine whether and how caregivers' end-of-life care assessments depend on their burden and benefit perceptions. METHODS This study analyzes data from 391 caregivers in the 2011 National Study of Caregiving and their Medicare beneficiary care recipients from the 2011-2016 National Health and Aging Trends Study. Caregivers assessed five end-of-life care aspects for decedents. Logistic regression was used and predicted probabilities of caregivers positively or negatively assessing end-of-life care based on their burden and benefit experiences calculated. Analyses adjusted for caregiver and care recipient demographic and health characteristics. RESULTS No or minimal caregiving burden is associated with ≥0.70 probability of caregivers reporting they were always informed about the recipient's condition and that the dying person's care needs were always met, regardless of perceived benefits. High perceived caregiving benefit is associated with ≥0.80 probability of giving such reports, even when perceiving high burden. CONCLUSION Caregiver burden and benefit operate alongside one another regarding two end-of-life care evaluations, even when years elapse between caregiver experience reports and care recipient death. This suggests that caregiver interventions reducing burden and bolstering benefits may have a positive and lasting impact on end-of-life care assessments.
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