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Price J, Hurley F, Kiernan G. 'Managing an unexpected life - a caregiver's career': Parents' experience of caring for their child with a non-malignant life-limiting condition. J Child Health Care 2024; 28:348-361. [PMID: 36222549 PMCID: PMC11141083 DOI: 10.1177/13674935221132920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parents of children with non-malignant life-limiting conditions frequently accept roles that exceed the conventional activities of parenting in relation to the intensity, complexity and temporal nature of the family caregiver experience. This paper explores the prevalent and all-consuming experiences of parents caring for their children. A qualitative descriptive study design was used. Twenty-three parents (both mothers and fathers) were interviewed. Transcribed interview data were analyzed using thematic analysis. 'Managing an unexpected life' was the central concept when parents recounted ongoing efforts to address the emotional and practical effects of their child's condition on their life and that of their family. Analysis revealed three main distinct but interrelated themes within the concept of 'Managing an unexpected life' helping us enhance our understanding of parents' experiences: 'Striving for normality', 'Becoming the expert' and 'Fighting for your child'. Findings suggest that the central concept of 'Managing an unexpected life' appeared to be in keeping with a caregiver's career. Findings likewise suggest the need for improved and focused support and services to enhance parents' career caregiving.
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Affiliation(s)
- Jayne Price
- School of Nursing, Faculty of Health Social Care and Education, Kingston University and St George's University London, Kingston-Upon-Thames, UK
| | - Fiona Hurley
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Gemma Kiernan
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Thai GH, Rivette S, Sharman J, Epps F, Masoud S. Dementia Caregiver Experiences: Insights From a Telephone-Based Support Program. J Appl Gerontol 2024:7334648241234745. [PMID: 38459827 DOI: 10.1177/07334648241234745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Dementia caregivers face daunting challenges as both the oldest subpopulation of those providing unpaid care and the most at risk of adverse health outcomes as a result of their role, including depression, anxiety, and increased mortality. To better understand the experiences and needs of dementia caregivers, a qualitative content analysis was conducted of secondary data extracted from call logs (N = 569) recorded by a provider-initiated, telephone-based support program. Experiences identified from the call logs were coded, categorized, and ranked to determine the most prevalent dementia caregiving-related experiences. Features of the program, particularly the semi-structured call format and directionality of calls, helped to uniquely capture common experiences of family caregivers and their day-to-day concerns. Findings from this analysis reflect the high prevalence of caregiver mental and emotional health-related concerns. This analysis supports the development of interventions that align with the experiences of dementia caregivers.
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Affiliation(s)
- Glory H Thai
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Dieker JL, Yun SW, Weber KL, Qualls S. Family conflict over illness beliefs and care strategies: implications for burden in family caregivers. Aging Ment Health 2024; 28:457-465. [PMID: 37993412 DOI: 10.1080/13607863.2023.2282683] [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: 04/18/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Family conflict is an understudied aspect of the caregiver experience. Drawing from the stress process model, the present study examined the prevalence and correlates of conflict over illness beliefs (e.g. conflict over the care recipient's illness and need for facility placement) and family care strategies (e.g. lack of involvement and support from family members). METHODS Adult child and spouse caregivers (N = 579) of persons with physical or cognitive impairment from clinic and internet samples completed the Caregiver Reaction Scale (CRS) to assess each topic of conflict and burden. RESULTS Most caregivers reported conflict with family members over care strategies (63%) or illness beliefs (55%). Clinic caregivers reported greater illness beliefs conflict than online caregivers. Adult children reported greater illness beliefs and family care strategies than spouses. Male caregivers were more likely than female caregivers to report care strategies conflict. Caregiver overload was significantly associated with family care strategies conflict. Both conflicts were positively associated with caregiver burden. CONCLUSIONS Findings further support that family conflict is a widespread concern associated with burden among online and help-seeking caregivers. Caregiving relationship type and gender may increase likelihood of each conflict. Findings inform recommendations for clinical intervention and assessment of family caregivers.
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Affiliation(s)
- JoAnna L Dieker
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
- Psychology Service, South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Stacy W Yun
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
| | - Kendall L Weber
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
| | - Sara Qualls
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
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Ruyant Belabbas E, Manceau C, Wawrziczny E. The relationship at the heart of the experience of daughter caregivers of a parent with dementia: An interpretative phenomenological analysis. DEMENTIA 2024; 23:175-190. [PMID: 38078431 DOI: 10.1177/14713012231220223] [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] [Indexed: 12/21/2023]
Abstract
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.
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Affiliation(s)
| | - Charlotte Manceau
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d'Ascq, France
| | - Emilie Wawrziczny
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d'Ascq, France
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Bannon S, Brewer J, Ahmad N, Cornelius T, Jackson J, Parker RA, Dams-O'Connor K, Dickerson BC, Ritchie C, Vranceanu AM. A Live Video Dyadic Resiliency Intervention to Prevent Chronic Emotional Distress Early After Dementia Diagnoses: Protocol for a Dyadic Mixed Methods Study. JMIR Res Protoc 2023; 12:e45532. [PMID: 37728979 PMCID: PMC10551792 DOI: 10.2196/45532] [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: 05/04/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND By 2030, approximately 75 million adults will be living with Alzheimer disease and related dementias (ADRDs). ADRDs produce cognitive, emotional, and behavioral changes for persons living with dementia that undermine independence and produce considerable stressors for persons living with dementia and their spousal care-partners-together called a "dyad." Clinically elevated emotional distress (ie, depression and anxiety symptoms) is common for both dyad members after ADRD diagnosis, which can become chronic and negatively impact relationship functioning, health, quality of life, and collaborative management of progressive symptoms. OBJECTIVE This study is part of a larger study that aims to develop, adapt, and establish the feasibility of Resilient Together for Alzheimer Disease and Related Dementias (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress. This study aims to gather comprehensive information to develop the first iteration of RT-ADRD and inform a subsequent open pilot. Here, we describe the proposed study design and procedures. METHODS All procedures will be conducted virtually (via phone and Zoom) to minimize participant burden and gather information regarding feasibility and best practices surrounding virtual procedures for older adults. We will recruit dyads (up to n=20) from Mount Sinai Hospital (MSH) clinics within 1 month of ADRD diagnosis. Dyads will be self-referred or referred by their treating neurologists and complete screening to assess emotional distress and capacity to consent to participate in the study. Consenting dyads will then participate in a 60-minute qualitative interview using an interview guide designed to assess common challenges, unmet needs, and support preferences and to gather feedback on the proposed RT-ADRD intervention content and design. Each dyad member will then have the opportunity to participate in an optional individual interview to gather additional feedback. Finally, each dyad member will complete a brief quantitative survey remotely (by phone, tablet, or computer) via a secure platform to assess feasibility of assessment and gather preliminary data to explore associations between proposed mechanisms of change and secondary outcomes. We will conduct preliminary explorations of feasibility markers, including recruitment, screening, live video interviews, quantitative data collection, and mixed methods analyses. RESULTS This study has been approved by the MSH Institutional Review Board. We anticipate that the study will be completed by late 2023. CONCLUSIONS We will use results from this study to develop the first live video telehealth dyadic resiliency intervention focused on the prevention of chronic emotional distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from dyads on important factors to address in an early prevention-focused intervention and to explore feasibility of study procedures to inform future open pilot and pilot feasibility randomized control trial investigations of RT-ADRD. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45532.
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Affiliation(s)
- Sarah Bannon
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Julie Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Nina Ahmad
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Talea Cornelius
- Department of Medicine, Columbia University Irvine Medical Center, New York, NY, United States
| | - Jonathan Jackson
- Community Access, Recruitment, and Engagement Research Center, Division of Clinical Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Robert A Parker
- Biostatistics Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Departments of Rehabilitation and Human Performance and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bradford C Dickerson
- Frontotemporal Disorders Unit, Departments of Neurology and Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Christine Ritchie
- Mongan Institute Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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Novais T, Vanhems E, Coste MH, Krolak-Salmon P. Educational care for patients with Alzheimer's disease and their caregivers in France: A mapping proposal. PATIENT EDUCATION AND COUNSELING 2023; 111:107692. [PMID: 36917885 DOI: 10.1016/j.pec.2023.107692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To formalize a proposal for educational approach for patients with Alzheimer's disease and related dementias (ADRD) and caregivers across existing diagnosis/care organizations and structures. METHODS Three steps:1/ identifying the existing organizations and structures that could be involved in educational care; 2/ identifying the main educational skills of interest for ADRD patients and caregivers; 3/ conducting a survey among these organizations and structures to achieve a mapping proposal of educational care. RESULTS Nine organizations and structures, and 29 educational skills of interest were identified for the step 3 survey. Overall, 423 organizations/structures completed the step 3 survey. Twelve of 29 educational skills were covered by 50% of organizations/structures included. The most covered skills were "Maintaining autonomy in daily living activities", "coping with cognitive disorders", and "coping with behavioral disorders". CONCLUSIONS A mapping of educational care that could be provided by the different structures and organizations involved in the ADRD care pathway was proposed regarding their missions and intervention place. PRACTICE IMPLICATIONS Policy makers and funding bodies will need to invest in the healthcare professionals' training about educational approach and ADRD in order to extend educational care throughout the patient's care pathway.
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Affiliation(s)
- Teddy Novais
- Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, Villeurbanne, F-69100, France; Lyon Institute for Aging, Hospices Civils de Lyon, F-69000 Lyon, France; Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, F-69000 Lyon, France.
| | - Elyse Vanhems
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000 Lyon, France
| | | | - Pierre Krolak-Salmon
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000 Lyon, France; Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, Villeurbanne, F-69000 Lyon, France; Neuroscience Research Centre of Lyon (CRNL), F-69000 Lyon, France
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Saragosa M, Kuluski K, Okrainec K, Jeffs L. “Seeing the day-to-day situation”: A grounded theory of how persons living with dementia and their family caregivers experience the hospital to home transition and beyond. J Aging Stud 2023. [DOI: 10.1016/j.jaging.2023.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Feng N. Social disadvantage, context and network dynamics in later life. Eur J Ageing 2023; 20:19. [PMID: 37243805 DOI: 10.1007/s10433-023-00767-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 05/29/2023] Open
Abstract
How do personal networks evolve as individuals age? To what degree do social disadvantage and contextual factors matter for network dynamics in later life? This paper answers these two questions based on egocentric network data of older adults over a ten-year period. Specifically, I use longitudinal and nationally representative data on 1,168 older adults from the National Social Life, Health, and Aging Project. I use between-within models to separate the within- and between-individual effects of sociodemographic characteristics and contextual factors on three aspects of social connectedness in later life: network size, frequency of contact, and proportion of kin. Patterns of network change vary among people of different races and ethnicities as well as educational levels. Black and Hispanic respondents have a significantly smaller network size and a higher average frequency of contact with confidants. Moreover, Hispanic respondents have a higher proportion of kin in the network, compared to White respondents. Similarly, older adults with less education have a smaller network size, higher frequency of contact and higher proportion of kin in their confidant networks compared to those who attended college. Older adults who have better mental health are more likely to have a higher frequency of contact and higher proportion of kin. When an older adult starts to work for pay, their frequency of contact with confidants tends to increase. Older adults living in neighborhoods with stronger social ties are more likely to have a larger network size, higher frequency of contact, and lower proportion of kin in their confidant network. The above results show that disadvantaged backgrounds and contextual factors are associated with certain less favorable network characteristics, which helps to explain the concentration of social disadvantage on certain populations.
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Affiliation(s)
- Nan Feng
- Department of Sociology, Cornell University, 347 Uris Hall, Ithaca, NY, 14850, USA.
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9
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Ohanesian N. Caregiver Burden and the Impact of Diagnostic Disclosure of Dementia: Why Primary Care Physicians Have a Moral Responsibility to Disclose. THE JOURNAL OF CLINICAL ETHICS 2023; 34:128-137. [PMID: 37229740 DOI: 10.1086/724230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AbstractCurrently, the number of individuals affected by Alzheimer's disease is rapidly increasing, expected to reach 14 million in the United States within 30 years. In spite of this impending crisis, less than 50 percent of primary care physicians disclose the diagnosis of dementia to their patients. This failure negatively impacts not only patients but also caregivers, whom dementia patients require to help them meet their needs and who often serve as important decision makers, either as surrogates or as designated healthcare agents for the patient. If caregivers are not informed about and prepared to deal with the challenges they face, their health, both emotional and physical, is put at risk. We will argue that both patient and caregiver have the right to be informed of the diagnosis, as their interests are intertwined, especially as the disease progresses and the caregiver becomes the primary advocate for the patient. The caregiver of an individual with dementia therefore becomes intimately connected to the patient's autonomy in a way few caregivers of other diseases do. In this article, we will show that a timely and thorough disclosure of the diagnosis is morally obligated by the core principles of medical ethics. As the population ages, primary care physicians must see themselves in a triadic relationship with both the dementia patient and caregiver, recognizing that the interests of both are deeply interdependent.
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Li W, Manuel DG, Isenberg SR, Tanuseputro P. Caring for older men and women: whose caregivers are more distressed? A population-based retrospective cohort study. BMC Geriatr 2022; 22:890. [PMID: 36418977 PMCID: PMC9682689 DOI: 10.1186/s12877-022-03583-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To our knowledge, no population-based studies have examined whether family or friend caregivers of men and women differ in their experience of distress over time. Thus, we aimed to describe, on a population-level and longitudinally, how older men and women care-receivers differed in their health and care needs, compare their caregivers' distress trajectories, and identify factors that contribute to the observed differences. METHODS This is a population-based, retrospective cohort study using routinely collected data. We examined longitudinally 485,407 community-dwelling Ontario residents, aged over 50 years, who have received at least one Residential Assessment Instrument-Home Care (RAI-HC) assessment between April 2008 and June 2015. Descriptive analyses were performed on the demographic characteristics, health profiles, and care needs of men and women. We also compared their caregivers' baseline and one-year change in distress status. Logistic regressions were performed to examine if the effect of gender on caregiver distress is reduced after controlling for care-receiver's health and functional status as well as their caregiver's kinship and co-residence status. RESULTS Men (39.5% of our cohort) were frailer, required more care, were mostly cared for by their spouses (52%), and mostly lived with their caregiver (66%). In contrast, women (60.5%) were more likely cared for by their child/child-in-law (60%), less likely to live with caregivers (47%), and received less care. Caregivers of men were more likely to be distressed at baseline (27.7% versus 20.4% of women caregivers) and remain distressed (74.6% versus 69.5%) or become distressed (19.3% versus 14.3%) throughout the year. In logistic regression modelling, the effect of care-receiver's gender on caregiver distress is reduced from an unadjusted odds ratio of 1.49 (95% CI: 1.47-1.51) to 1.17 (95% CI: 1.15-1.19) when care-receiver's health and caregiving factors are controlled for. CONCLUSION Older men and women differed in health and care needs. Caregivers, especially those caring for men, were often distressed and remained so through time. These results highlight the need for policies that account for the differential care needs and caregiver profiles of men and women in order to offer targetted and appropriate support.
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Affiliation(s)
- Wenshan Li
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, Ottawa, ON Canada ,ICES uOttawa, Ottawa, ON Canada
| | - Douglas G. Manuel
- ICES uOttawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Sarina R. Isenberg
- grid.418792.10000 0000 9064 3333Bruyère Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, Ottawa, ON Canada ,ICES uOttawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
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Hedman R, Hillerås P, Tyrrell M. Living in uncertainty while a spouse is undergoing a cognitive assessment: Voices of women care partners. DEMENTIA 2022; 21:2631-2646. [PMID: 36131252 PMCID: PMC9583288 DOI: 10.1177/14713012221128448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Women often support partners with cognitive symptoms during the assessment process and when they are receiving a cognitive diagnosis. Living with a partner with cognitive symptoms can be stressful; however, there is limited insights into the specific experiences of older women during the assessment process. Previous research indicates that there are gender differences in the experiences of spousal caregiving; however, further research is needed in regard to the experiences of men and women as care partners. Therefore, the aim of the present study was to describe women's experiences of living with a partner undergoing a cognitive assessment. METHODS Semi-structured interviews were conducted with seven women when their male partners commenced a cognitive assessment and after the assessment had been completed. The interviews were analysed with abductive content analysis. FINDINGS Uncertainty permeated the women's experiences. Antecedents, attributes and strategies to manage the uncertainty were described. CONCLUSION The participants expressed informational and existential uncertainty when their partner underwent a cognitive assessment. A lack of knowledge regarding the assessment process and cognitive diagnoses, especially mild cognitive impairment, was identified. Further, there was a need to process existential uncertainty evoked by the situation.
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Affiliation(s)
- Ragnhild Hedman
- Department of Nursing Science, 25548Sophiahemmet University, Stockholm, Sweden
| | - Pernilla Hillerås
- Red Cross University College, Huddinge, Sweden.,Department of Neurobiology, Care Sciences and Society, 97092Karolinska Institutet, Stockholm, Sweden
| | - Marie Tyrrell
- Department of Nursing Science, 25548Sophiahemmet University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, 97092Karolinska Institutet, Stockholm, Sweden
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Longstreth M, McKibbin C, Steinman B, Slosser Worth A, Carrico C. Exploring Information and Referral Needs of Individuals with Dementias and Informal Caregivers in Rural and Remote Areas. Clin Gerontol 2022; 45:808-820. [PMID: 31920164 DOI: 10.1080/07317115.2019.1710735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: The provision of information and referral (I&R) and connection to support services is crucial for individuals with Alzheimer's disease and related dementias (ADRD) and their informal caregivers, especially in rural and remote regions where care and support resources may be limited. The purpose of this study was to develop a deeper understanding of needs for I&R from community stakeholders across a rural and remote state.Methods: A series of town hall meetings were conducted across ten communities in a frontier state.Results: Participants were 175 adults with a mean age of approximately 60 years (SD = 15 years); a majority were non-Hispanic white, female, and self-identified as informal caregivers. Three themes emerged as primary areas of need: (1) to address stigma related to ADRD; (2) to improve the availability of dementia-related I&R; and (3) to efficiently disseminate dementia-related I&R.Conclusions: Findings suggest the importance of a single point of access for I&R with presence in local communities as well as initial and ongoing assessment and provision of appropriate I&R throughout the course of ADRDs.Clinical Implications: Existing community resources and funding support should be leveraged for multiple points and means of access to reliable I&R.
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Affiliation(s)
- Morgan Longstreth
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | | | - Bernard Steinman
- Department of Family and Consumer Sciences, University of Wyoming, Laramie, Wyoming, USA
| | | | - Catherine Carrico
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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da Rocha CG, Perrenoud B, Ramelet AS. Perceptions of Burden and Preparedness for Caregiving among the Family Caregivers of Hospitalised Older Adults: A Cross-Sectional Study. Geriatrics (Basel) 2022; 7:19. [PMID: 35200524 PMCID: PMC8872519 DOI: 10.3390/geriatrics7010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND Due to the increasing care needs of older adults, family caregivers are more and more solicited. This can have a negative impact on their quality of life related to a lack of preparedness for caregiving and feelings of burden. OBJECTIVES To measure perceptions of burden and preparedness for caregiving among the family caregivers of hospitalised older adults, and to explore their possible associations. METHODS A cross-sectional study conducted in two university hospital geriatrics wards in Switzerland. Principal family caregivers of hospitalised older adults were invited to complete sociodemographic, the Zarit Burden Interview, and the Preparedness for Caregiving Scale questionnaires. Descriptive and correlational data analyses were performed. RESULTS Of the 38 responding caregivers, 80% provided informal care to their spouse or parent; 45% reported a lack of preparedness to provide care and 61% reported substantial levels of burden. There was no statistically significant correlation between preparedness and burden (ρ ≤ -0.30, p = 0.07). CONCLUSIONS A significant proportion of caregivers reported burden and a lack of preparedness. Healthcare professionals should provide adequate support to help informal caregivers to fulfil their roles.
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Affiliation(s)
- Carla Gomes da Rocha
- Acute Geriatric Care Unit, Lausanne University Hospital, Avenue Pierre Decker 5, CH-1011 Lausanne, Switzerland
| | - Béatrice Perrenoud
- Nursing Directorate, Lausanne University Hospital, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland;
- La Source Institute and School of Nursing, University of Applied Sciences and Arts Western Switzerland, Avenue Vinet 30, CH-1004 Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Biopôle 2, Route de la Corniche 10, CH-1010 Lausanne, Switzerland;
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Bruinsma J, Peetoom K, Bakker C, Boots L, Verhey F, de Vugt M. 'They simply do not understand': a focus group study exploring the lived experiences of family caregivers of people with frontotemporal dementia. Aging Ment Health 2022; 26:277-285. [PMID: 33325262 DOI: 10.1080/13607863.2020.1857697] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Frontotemporal dementia (FTD) has a profound impact on the spouse and other family caregivers involved. While caregivers have a need for support, it is difficult for healthcare providers to respond to their specific needs. This qualitative study explores the lived experiences and needs of caregivers of persons with FTD to facilitate the development of support. METHODS Three focus group discussions were organized to explore the lived experiences of Dutch FTD caregivers. The included caregivers (n = 24) were aged 16 years or older and were involved in the care of a relative with FTD. Two researchers independently performed an inductive content analysis using open and axial coding. RESULTS The main category emerging from the data was a lack of recognition, acknowledgment, and understanding experienced by caregivers. This was linked to caregivers' experiences with (1) complex emotional and behavioral symptoms in the person with FTD, (2) the trivializing responses of family and friends, (3) a perceived lack of knowledge and support from healthcare professionals, and (4) the bureaucratic procedures that accompany caregiving. As a result, caregivers felt lonely and solely responsible for the caregiving role. CONCLUSION Caregivers of persons with FTD experience a lack of understanding in caring for their relative with FTD, which contributes to feelings of loneliness. A specialized support approach is needed to address the specific needs of caregivers of persons with FTD. Support should address strategies that caregivers can use to inform and involve family and friends in the caregiving situation to prevent loneliness in FTD caregivers.
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Affiliation(s)
- Jeroen Bruinsma
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,Centre for Specialized Geriatric Care, Groenhuysen, Roosendaal, the Netherlands
| | - Lizzy Boots
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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15
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Francis N, Hanna P. Informal carer experiences of UK dementia services-A systematic review. J Psychiatr Ment Health Nurs 2022; 29:116-129. [PMID: 33047451 DOI: 10.1111/jpm.12698] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/07/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Dementia affects an increasing number of people and a person with dementia requires significant levels of care. Dementia care is often delivered by family members. Caring for someone with dementia places significant demand on the carer and support for the carer is often needed. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Research has been conducted into caregivers' experiences of caring for someone with dementia, but a synthesis of findings for studies from the UK is needed to collate the research evidence and provide an account of the common trends within the existing research. This paper adds to existing knowledge by highlighting the key difficulties experienced by carers of a person with dementia in their caring role and their experiences with support services across the existing research evidence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Improvements to the process of dementia assessment and the process of receiving a dementia diagnosis are needed. Information and support needs to be more accessible for the carer of a person with dementia Cultural differences need to be acknowledged in the support and information offered to carers of a person with dementia. ABSTRACT: Aim To understand the experiences of informal carers' of individuals with dementia in the UK when engaging with services for support in their caring role. Methods Following the PRISMA guidelines, a qualitative systematic literature review was carried out. Six Internet databases were searched. Results were screened, and eligible studies were appraised using Critical Appraisal Skills Programme (CASP, 2019) and data synthesized using Evan & Pearson (2001) and Evans (2002). Results The search returned 231 records, 11 were selected for critical appraisal and data synthesis. Four main themes (information for carers, process of diagnosing dementia, difficulties accessing support and cultural differences of experiences of services) were extracted. Discussion Carers experience services as providing inadequate support for the Person with Dementia (PwD) and themselves for support relating to dementia. Difficulties in receiving information and support were experienced from before diagnosis to end-of-life (EoL) care. Additionally, cultural differences were found in carers' experiences. Implications for practice The provision of and access to dementia support should be improved; more information for carers about dementia and dementia services is needed; cultural differences need to be appreciated in the support and information offered.
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Affiliation(s)
- Nick Francis
- School of Psychology, University of Surrey, Guildford, UK
| | - Paul Hanna
- School of Psychology, University of Surrey, Guildford, UK
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16
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Enhancing psychological resilience at the cusp of older ages: the role of social networks. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x2100180x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Prior research has established a positive association between social support and psychological resilience. In this study, we seek to examine whether and to what extent aspects of individuals’ social network – specifically size (how many relatives and friends one has) and strength (how often did one communicate with close network members and at the time of important decisions) – are related to greater psychological resilience. We use data pertaining to 1,609 respondents from the Panel on Ageing and Transitions in Health Survey (PATHS), 2016–2017, a national study of 1,654 older midlife adults, aged 50–59, in Singapore. We estimate the relationship between social networks and psychological resilience, using inverse probability weighted regression adjustment to account for the possibility of a selection bias whereby individuals with larger or stronger social networks may be more resilient at the outset. We find that strong social networks are associated with greater psychological resilience among older midlife adults, regardless of the size of the network. Having a large social network is associated with greater resilience only if it is also a strong network. Maintaining stronger, even if small, social networks may enable individuals at the cusp of older ages to be better prepared to deal with stressful life events and challenges associated with older midlife.
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17
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Ravona-Springer R, Sharvit-Ginon I, Ganmore I, Greenbaum L, Bendlin BB, Sternberg SA, Livny A, Domachevsky L, Sandler I, Ben Haim S, Golan S, Ben-Ami L, Lesman-Segev O, Manzali S, Heymann A, Beeri MS. The Israel Registry for Alzheimer's Prevention (IRAP) Study: Design and Baseline Characteristics. J Alzheimers Dis 2021; 78:777-788. [PMID: 33044181 DOI: 10.3233/jad-200623] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Family history of Alzheimer's disease (AD) is associated with increased dementia-risk. OBJECTIVE The Israel Registry for Alzheimer's Prevention (IRAP) is a prospective longitudinal study of asymptomatic middle-aged offspring of AD patients (family history positive; FH+) and controls (whose parents have aged without dementia; FH-) aimed to unravel the contribution of midlife factors to future cognitive decline and dementia. Here we present the study design, methods, and baseline characteristics. METHODS Participants are members of the Maccabi Health Services, 40-65 years of age, with exquisitely detailed laboratory, medical diagnoses and medication data available in the Maccabi electronic medical records since 1998. Data collected through IRAP include genetic, sociodemographic, cognitive, brain imaging, lifestyle, and health-related characteristics at baseline and every three years thereafter. RESULTS Currently IRAP has 483 participants [mean age 54.95 (SD = 6.68) and 64.8% (n = 313) women], 379 (78.5%) FH+, and 104 (21.5%) FH-. Compared to FH-, FH+ participants were younger (p = 0.011), more often males (p = 0.003) and with a higher prevalence of the APOE E4 allele carriers (32.9% FH+, 22% FH-; p = 0.040). Adjusting for age, sex, and education, FH+ performed worse than FH-in global cognition (p = 0.027) and episodic memory (p = 0.022). CONCLUSION Lower cognitive scores and higher rates of the APOE E4 allele carriers among the FH+ group suggest that FH ascertainment is good. The combination of long-term historical health-related data available through Maccabi with the multifactorial information collected through IRAP will potentially enable development of dementia-prevention strategies already in midlife, a critical period in terms of risk factor exposure and initiation of AD-neuropathology.
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Affiliation(s)
- Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Memory Clinic, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Sharvit-Ginon
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ithamar Ganmore
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Memory Clinic, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | - Lior Greenbaum
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Abigail Livny
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Israel Sandler
- Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Simona Ben Haim
- Department of Medical Biophysics and Nuclear Medicine, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.,Institute of Nuclear Medicine, University College London and UCL Hospitals, NHS Trust, London, UK
| | - Sapir Golan
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Liat Ben-Ami
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Orit Lesman-Segev
- Department of Diagnostic imaging, Seba Medical Center, Tel Hashomer, Israel
| | - Sigalit Manzali
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Department of Pathology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Anthony Heymann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Healthcare Services, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Wang S, de Almeida Mello J, Declercq A. Development and evaluation of an intervention on suPpoRting infOrmal cAregivers of older people with early CogniTIVe declinE (PROACTIVE): a study protocol based on the Medical Research Council framework. BMJ Open 2021; 11:e047529. [PMID: 33495265 PMCID: PMC7839908 DOI: 10.1136/bmjopen-2020-047529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Caring for people with cognitive problems can have an impact on informal caregivers' health and well-being, and especially increases pressure on healthcare systems due to an increasing ageing society. In response to a higher demand of informal care, evidence suggests that timely support for informal caregivers is essential. The New York University Caregiver Intervention (NYUCI) has proven consistent effectiveness and high adaptability over 30 years. This study has three main objectives: to develop and evaluate the Flemish adaptation of the NYUCI in the context of caregiving for older people with early cognitive decline; to explore the causal mechanism of changes in caregivers' health and well-being and to evaluate the validity and feasibility of the interRAI Family Carer Needs Assessment in Flanders. METHODS AND ANALYSIS Guided by Medical Research Council framework, this study covers the development and evaluation phases of the adapted NYUCI, named PROACTIVE-suPpoRting infOrmal cAregivers of older people with early CogniTIVe declinE. In the development phase, we will identify the evidence base and prominent theory, and develop the PROACTIVE intervention in the Flemish context. In the evaluation phase, we will evaluate the PROACTIVE intervention with a pretest and posttest design in 1 year. Quantitative data will be collected with the BelRAI Screener, the BelRAI Social Supplement and the interRAI Family Carer Needs Assessment at baseline and follow-up points (at 4, 8 and 12 months). Qualitative data will be collected using counselling logs, evaluation forms and focus groups. Quantitative data and qualitative data will be analysed with SAS 9.4 software and NVivo software, respectively. Efficacy and process evaluation of the intervention will be performed. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of KU Leuven with a dossier number G-2020-1771-R2(MAR). Findings will be disseminated through community information sessions, peer-reviewed publications and national and international conference presentations.
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Affiliation(s)
- Shanshan Wang
- Centre for Care Research & Consultancy(LUCAS), KU Leuven, Leuven, Belgium
| | | | - Anja Declercq
- Centre for Care Research & Consultancy(LUCAS) and Centre for Sociological Research (CeSO), KU Leuven, Leuven, Belgium
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19
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Luiu AL, Favez N, Betrancourt M, Szilas N, Ehrler F. Family Relationships and Alzheimer's Disease: A Systematic Review. J Alzheimers Dis 2020; 76:1595-1608. [PMID: 32716359 DOI: 10.3233/jad-200125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family caregivers of people with Alzheimer's disease are the most important support in concrete personal and economic terms. Family dynamics play a fundamental role in the provision of informal caregiving benefits. OBJECTIVE This review aims to identify factors related to the family caregiving of relatives with Alzheimer's disease, taking specifically into account the construct of coping and expressed emotion. METHODS This is a systematic review including articles selected using search terms including "caregivers," "Alzheimer's," "family," and "relationship" in research databases. Findings were synthesized and categorized into themes. RESULTS A total of 454 abstracts were identified. Following screening, lateral searches, and quality appraisal, 36 studies were included for synthesis. A total of 5 themes were identified: burden; demographics; coping strategies; caregiver mental health; and family dynamics and expressed emotions. CONCLUSION The quality and level of evidence supporting each theme varied. We need further research into family dynamics ameliorating the caregiving and how to measure it.
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Affiliation(s)
- Anna Laura Luiu
- Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland.,TECFA, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
| | - Nicolas Favez
- Clinical Psychology Units, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
| | - Mireille Betrancourt
- TECFA, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
| | - Nicolas Szilas
- TECFA, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
| | - Frederic Ehrler
- Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland
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20
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Sex and gender differences in caregiving burden experienced by family caregivers of persons with dementia: A systematic review. PLoS One 2020; 15:e0231848. [PMID: 32310969 PMCID: PMC7170244 DOI: 10.1371/journal.pone.0231848] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/01/2020] [Indexed: 01/29/2023] Open
Abstract
Objectives Much is known about the demands of caregiving for persons with dementia (PWD) and its effects on family caregivers, however sex and gender aspects have received less attention. We synthesized the evidence on sex and gender distinctions in: (1) the caregiving burden and (2) the impact of caregiving on the physical and mental health of family caregivers of PWD. Design Systematic review. Data sources Medline, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature between January 2007 and October 2019 were searched. Eligibility criteria for selecting studies Included studies met the following criteria: (1) examine experiences and/or impacts of caregiving among family caregivers of individuals with any form of dementia; (2) report sex and/or gender distribution of study population and/or report results stratified by sex and/or gender, and (3) include both male and female family caregivers. Data extraction and synthesis Two independent reviewers extracted the data and assessed risk of bias using the Critical Appraisal Skills Program checklist and National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. Data were synthesized using a narrative synthesis approach. Results A total of 22 studies were included. Caregiving burden was measured using various methods. A majority of studies reported higher burden among females. All studies that did not report a sex and gender difference in caregiving burden accounted for confounders. Findings on sex and gender differences on physical and mental health conditions were inconsistent with most studies failing to account for confounders in their analyses. Conclusions Current evidence on sex and gender differences in caregiving burden, mental and physical health is limited. Findings suggest presence of sex and gender differences in caregiving burden. Given the variety of mental and physical health constructs that were examined, further research is required to substantiate the evidence. PROPSERO Registration Number: CRD 42018070032.
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21
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Lee K, Puga F, Pickering CEZ, Masoud SS, White CL. Transitioning into the caregiver role following a diagnosis of Alzheimer's disease or related dementia: A scoping review. Int J Nurs Stud 2019; 96:119-131. [PMID: 30851954 DOI: 10.1016/j.ijnurstu.2019.02.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify experiences, needs, interventions and outcomes for caregivers of persons with Alzheimer's disease or related dementia as they transition into this new role following diagnosis. DESIGN Scoping review of published literature. DATA SOURCES A search for published articles was conducted in PsycINFO, Scopus, Ovid and Web of Science databases. REVIEW METHODS The Arksey and O'Malley methodological framework guided the review. Studies were screened independently for inclusion by two persons. A total of 955 studies, after duplicates removed, were found by the database search. From these, 127 full-text articles were retained through the screening of titles and abstracts by two reviewers. The two reviewers assessed 46 full-text articles for eligibility. The final 29 studies identified caregiver experiences, needs, and interventions during the period following a diagnosis of Alzheimer's disease or related dementia in the scoping review. RESULTS Twenty-nine studies were organized around three major categories: i) family caregiver experiences on receiving the diagnosis (n = 23), ii) needs during this time of transition (n = 18), and iii) interventions and outcomes to support their transition into the caregiver role (n = 5). While studies may have addressed more than one topic, 16 studies intersected categories of both caregiver experience and needs, and one study intersected categories of needs and interventions. There were several studies that focused more specifically on the caregiver's initial reactions to a diagnosis of Alzheimer's disease or related dementia (n = 9), the emotional responses to the diagnosis (n = 14), changes in personal relationships and responsibilities with a new role (n = 16). Caregiver needs following the diagnosis included knowledge and information (n = 14), emotional and psychological support (n = 11), and assistance with care planning (n = 7). Five papers examined interventions specifically tailored to caregiver needs at this juncture, which support the transition into the caregiver role. CONCLUSIONS The time of receiving a diagnosis of Alzheimer's disease or related dementia is a critical period in the process of transitioning into caregiver role. This period marks a new phase in the process of caring by family caregivers. Thus, it is important to fully understand the experiences and needs of caregivers and effective interventions in order to better support their transition into this new role.
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Affiliation(s)
- Kyungmi Lee
- School of Nursing, University of Texas Health Center San Antonio, United States
| | - Frank Puga
- School of Nursing, University of Texas Health Center San Antonio, United States
| | | | - Sara S Masoud
- School of Nursing, University of Texas Health Center San Antonio, United States
| | - Carole L White
- School of Nursing, University of Texas Health Center San Antonio, United States.
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22
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Smith L, Rooyen DV, Morton DG. Silent voices: Transition experiences of family members caring for relatives with dementia. DEMENTIA 2018; 19:2114-2127. [PMID: 30526022 DOI: 10.1177/1471301218815037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Worldwide 46.8 million persons are living with dementia and many are requiring assistance with performing daily living or instrumental functions. It is often the task of family members to provide care for their relatives with dementia. However, they are often the silent, unseen and unacknowledged figures in the lives of people living with dementia. In 2015, we used a phenomenological design utilising visual participatory methods in the form of collages and interviews to explore and describe the transition experiences of eight family members (seven females and one male) living in a South African city regarding how they became caregivers of their relatives with dementia. They often entered their caregiving roles unexpectedly, often not having much choice regarding whether or not to take on the caregiving role. Family members caring for relatives with dementia have unique support needs as they transition into the caregiving role.
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Affiliation(s)
- Lourett Smith
- Department of Nursing Science, Faculty of Health Sciences, School of Clinical Care Sciences, Nelson Mandela University, South Africa
| | | | - David G Morton
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, South Africa
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23
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Moral-Fernández L, Frías-Osuna A, Moreno-Cámara S, Palomino-Moral PA, Del-Pino-Casado R. The start of caring for an elderly dependent family member: a qualitative metasynthesis. BMC Geriatr 2018; 18:228. [PMID: 30253750 PMCID: PMC6157059 DOI: 10.1186/s12877-018-0922-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/16/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The family often takes care of an elderly person who suddenly becomes dependent. This greatly affects different aspects of the caregivers' lives. The aim of this study is to explore the initial experiences, during the first year of care, of persons who suddenly become caregivers for elderly dependent relatives. METHODS A search in CINAHL, PsycINFO, WOS, Medline, and Scopus and a metasynthesis of qualitative research were conducted including 19 articles. RESULTS Three categories were developed to explain the process of becoming a caregiver 'taking on the role' (life changes, uncertainty and confusion, and acceptance or resistance); 'beginning to realise' (new needs, impact, and appraisal); and 'implementing strategies' (seeking help and self-learning, reordering family and social relationships, solving problems, and devising strategies to decrease negative emotions and stress). CONCLUSIONS The synthesis provides a comprehensive understanding of the experience of becoming a caregiver in order to help health-care professionals to adapt care plans to this situation.
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Affiliation(s)
- Lourdes Moral-Fernández
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Antonio Frías-Osuna
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Sara Moreno-Cámara
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Pedro A. Palomino-Moral
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Rafael Del-Pino-Casado
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
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Abstract
In many countries around the world, owing to the lack of specialists and equipment, delay up to a few years in help-seeking and getting diagnostic examinations for dementia is not uncommon (Sayegh and Knight, 2013), and this situation is considerably more serious in "atypical dementias" due to the challenge they present for differential diagnosis. For instance, a survey in the USA showed that misdiagnosis was common in patients with Lewy body dementia who, on average, saw at least three physicians over a year's time or more before getting the proper diagnosis (Lewy Body Dementia Association, 2010). Furthermore, in multiethnic communities, cultural and language barriers between practitioners and patients may lead to substantial delay as well (Sayegh and Knight, 2013).
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25
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The assessment experience of spousal dementia care-givers: ‘It's made me realise that I am a person also’. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis article is based on a study that used a validated care-giver assessment instrument known as ‘The C.A.R.E. (Caregivers’ Aspirations, Realities, and Expectations) Tool’ to understand its usefulness in working with older adults caring for a spouse with cognitive impairment. It draws on data collected as part of a larger, quasi-experimental pre- and post-test study examining the impact of a care-giver assessment on older spousal care-givers of a partner with cognitive impairment. One hundred community-living individuals (average age of 74) participated in the study. Participants met with a third-year nursing student who administered The C.A.R.E. Tool. Within three to seven days following this, a research team member conducted a semi-structured interview by telephone. This interview provided participants with the opportunity to comment on their experience and the usefulness of The C.A.R.E. Tool. Transcriptions of the interviews were analysed using a thematic analysis. Results indicate that the assessment experience was evaluated positively by most participants. Two broad themes emerged: assessment encourages care-givers to take stock of their situation, and it provides a relationship with a caring professional. In particular, the assessment experience gave these care-givers to have the opportunity to reflect, while expressing emotions and developing awareness, and provided them with an appreciated relationship with a caring professional who helped to validate and normalise their situation. For care-givers, the results suggest that assessment may serve as a catalyst for taking action in their care-giving situation or turning to services for help. For practitioners, assessment may increase awareness of the experience of spousal care-givers, potentially leading to interventions to support them. This study found that the attitudes and knowledge of practitioners play a role in care-givers’ experience of the assessment as positive. However, the goal of assessment must be clarified, as outcomes of other tools will differ depending on the aims.
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Tatangelo G, McCabe M, Macleod A, Konis A. I just can't please them all and stay sane: Adult child caregivers' experiences of family dynamics in care-giving for a parent with dementia in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e370-e377. [PMID: 29322577 DOI: 10.1111/hsc.12534] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 06/07/2023]
Abstract
Family caregivers of people with dementia who live within the community often experience stress and poor quality of life due to their care-giving role. While there are many factors that affect this, one influential factor is the family context. This study focussed on adult child caregivers. It examined the specific ways that family dynamics contribute to adult child caregivers' distress in the context of caring for a parent with dementia. Semi-structured interviews were conducted with 17 participants who were adult child primary caregivers for a parent with dementia who was living within the community. Interviews were audiotaped and transcribed verbatim. Transcripts were analysed using thematic analysis. Four themes were identified that represented areas of particular concern and distress for the caregivers: family expectations and caregivers' lack of choice in adopting the care-giving role; denial and differential understandings of dementia among family members; differential beliefs and approaches to care-giving among family members; and communication breakdown between family members. The findings demonstrate several avenues for further research including the development of interventions to support adult child caregivers and address problematic family dynamics within the context of caring for a parent with dementia.
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Affiliation(s)
- Gemma Tatangelo
- The Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia
| | - Marita McCabe
- The Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia
| | - Ashley Macleod
- The Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia
| | - Anastasia Konis
- The Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia
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Ying J, Wang Y, Zhang M, Wang S, Shi Y, Li H, Li Y, Xing Z, Sun J. Effect of multicomponent interventions on competence of family caregivers of people with dementia: A systematic review. J Clin Nurs 2018; 27:1744-1758. [DOI: 10.1111/jocn.14326] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Jie Ying
- Basic Nursing Department; School of Nursing; Jilin University; Changchun China
| | - Yonghong Wang
- Basic Nursing Department; School of Nursing; Jilin University; Changchun China
- Department of Neurology; The First Hospital of Jilin University; Changchun Jilin China
| | - Meiling Zhang
- Basic Nursing Department; School of Nursing; Jilin University; Changchun China
| | - Shouqi Wang
- Basic Nursing Department; School of Nursing; Jilin University; Changchun China
| | - Ying Shi
- Basic Nursing Department; School of Nursing; Jilin University; Changchun China
| | - Huanhuan Li
- Basic Nursing Department; School of Nursing; Jilin University; Changchun China
| | - Yuan Li
- Basic Nursing Department; School of Nursing; Jilin University; Changchun China
| | - Zhuangjie Xing
- Basic Nursing Department; School of Nursing; Jilin University; Changchun China
| | - Jiao Sun
- Basic Nursing Department; School of Nursing; Jilin University; Changchun China
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Steffen AM, Gallagher-Thompson D, Arenella KM, Au A, Cheng ST, Crespo M, Cristancho-Lacroix V, López J, Losada-Baltar A, Márquez-González M, Nogales-González C, Romero-Moreno R. Validating the Revised Scale for Caregiving Self-Efficacy: A Cross-National Review. THE GERONTOLOGIST 2018; 59:e325-e342. [DOI: 10.1093/geront/gny004] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Indexed: 01/15/2023] Open
Abstract
AbstractBackground and ObjectivesThis article reviews an instrument used in cross-national research with dementia family caregivers—the Revised Scale for Caregiving Self-Efficacy (RSCSE). Although the RSCSE has been translated into multiple languages, few studies have examined scale performance across samples. We examine congruence of psychometric, reliability, and validity data to inform research and practice.MethodsWe conducted citation searches using Scopus, Google Scholar, Web of Science, and PsycINFO. Identified dementia caregiving studies cited the original RSCSE article and described results of English and/or non-English translations of the scale.ResultsPeer-reviewed published studies (N = 58) of dementia family caregivers included data for Arabic, Chinese, English, French, Italian, and Spanish translations of the RSCSE; the majority (72%) reported use of non-English translations. Studies utilizing confirmatory factor analytic approaches reported findings consistent with the original development study. Internal consistency, convergent/discriminant validity, and criterion validity indices were congruent across diverse cross-national caregiving samples assessed with different translations. Data supported the RSCSE’s sensitivity to change following specific psychosocial caregiving interventions.DiscussionThe reliability and validity of different translations of the RSCSE support continued use with cross-national samples of dementia family caregivers. Limitations of the scale point to the need for further self-efficacy measurement development within caregiving domains. Consistent with Bandura’s discussion of social cognitive theory in cultural contexts, personal agency for caregiving challenges remains generalizable to cross-national populations. This review discusses the implications for cross-cultural research and practice.
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Affiliation(s)
- Ann M Steffen
- Department of Psychological Sciences, University of Missouri—St. Louis
| | | | | | - Alma Au
- Department of Applied Social Sciences, Hong Kong Polytechnic University, China
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, China
| | - María Crespo
- Department of Clinical Psychology, Universidad Complutense de Madrid, España
| | - Victoria Cristancho-Lacroix
- Department of Clinical Gerontology, Assistance Publique des Hôpitaux de Paris, Pôle de Gériatrie, France
- Research Unit EA 4468, University of Paris Descartes, France
| | - Javier López
- Department of Psychology, Universidad San Pablo-CEU, Madrid, España
| | | | - María Márquez-González
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Campus de Cantoblanco, España
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Laparidou D, Middlemass J, Karran T, Siriwardena AN. Caregivers’ interactions with health care services – Mediator of stress or added strain? Experiences and perceptions of informal caregivers of people with dementia – A qualitative study. DEMENTIA 2018; 18:2526-2542. [DOI: 10.1177/1471301217751226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background There are an estimated 46.8 million people worldwide living with dementia in 2015, being cared for usually by family members or friends (informal caregivers). The challenges faced by informal caregivers often lead to increased levels of stress, burden and risk of care-recipient institutionalisation. Aim The overarching aim of this study was to explore the experiences and perceptions of informal caregivers of people with dementia when interacting with the health care system, and whether the support received acted as a mediator of caregiver stress. The secondary aim was to investigate healthcare professionals’ views and current practice regarding people with dementia and their interactions with informal caregivers. Method We employed a qualitative research design, using focus groups and one face-to-face interview with a purposive sample of informal caregivers and healthcare professionals in Lincolnshire, UK. Data were collected between March and July 2015. We used the stress-process model of stress in caregivers as a theoretical framework. Results We interviewed 18 caregivers and 17 healthcare professionals. Five themes, mapped to the stress-process in caregivers’ model, captured the main challenges faced by caregivers and the type of support they wanted from health care services. Primary stressors included the challenge of diagnosing dementia; caregivers’ needs and expectations of an in-depth knowledge and understanding of dementia from healthcare professionals; and need for carer education. Secondary role strain included lack of support and mismatch of communication and expectations. Caregiver involvement in monitoring care and disease was a potential mediator tool. Conclusions Fragmentation of dementia care services, lack of training for healthcare professionals and the dearth of information for caregivers means health care services are only partially fulfilling a support role. In turn, lack of support may be intensifying caregiver stress leading to worsening in their health and well-being; thus, potentially increasing the risk of institutionalisation of their care-recipient.
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Affiliation(s)
| | - Jo Middlemass
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln UK
| | | | - A Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, UK
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Ayalon L, Levkovich I. A Systematic Review of Research on Social Networks of Older Adults. THE GERONTOLOGIST 2018; 59:e164-e176. [DOI: 10.1093/geront/gnx218] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liat Ayalon
- The Louis and Gaby Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Inbar Levkovich
- The Division of Family Medicine, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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White CL, Overbaugh KJ, Pickering CEZ, Piernik-Yoder B, James D, Patel DI, Puga F, Ford L, Cleveland J. Advancing Care for Family Caregivers of persons with dementia through caregiver and community partnerships. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:1. [PMID: 29387453 PMCID: PMC5776762 DOI: 10.1186/s40900-018-0084-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/08/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND There are currently 15 million Americans who provide over 80% of the care required by their family members with Alzheimer's disease and other dementias. Yet care for caregivers continues to be fragmented and few evidence-based interventions have been translated into routine clinical care and therefore remain inaccessible to most family caregivers. To address this gap, the Caring for the Caregiver program is being developed at UT Health San Antonio, School of Nursing to improve support services and health outcomes for family caregivers. Our purpose is to describe the engagement process undertaken to assess caregiver and community needs and how findings are informing program development. METHODS We are using a model of public engagement that consists of communication of information, collection of information from stakeholders, and collaboration where stakeholders are partners in an exchange of information to guide program activities. An assessment of the community was undertaken to identify resources/services for family caregivers. Subsequently, stakeholders were invited to a community-academic forum to discuss strategies to build on existing strengths for family caregiving and to identify gaps in care. Detailed notes were taken and all discussions were recorded and transcribed for analysis. Data were analyzed using thematic content analysis. RESULTS We conducted site visits with 15 community agencies, interviewed 13 family caregivers, and attended community events including support groups and health and senior fairs. Fifty-three diverse stakeholders attended the community-academic forum. Participants identified existing assets within our community to support family caregivers. Consistent among groups was the need to increase awareness in our community about family caregivers. Themes identified from the discussion were: making the invisible visible, you don't know what you don't know, learning too late, and anticipating and preparing for the future. CONCLUSIONS Incorporating caregiver and community stakeholders was critical to ensure that the priorities of our community are addressed in a culturally responsive accessible program for family caregivers. The forum served as important mechanism to partner with the community and will be an annual event where we can continue to work with our stakeholders around needs for practice, education, and research.
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Affiliation(s)
- Carole L. White
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Kristen J. Overbaugh
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | | | - Bridgett Piernik-Yoder
- School of Health Professions, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Debbie James
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Darpan I. Patel
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Frank Puga
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Lark Ford
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - James Cleveland
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
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Michalowsky B, Flessa S, Eichler T, Hertel J, Dreier A, Zwingmann I, Wucherer D, Rau H, Thyrian JR, Hoffmann W. Healthcare utilization and costs in primary care patients with dementia: baseline results of the DelpHi-trial. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:87-102. [PMID: 28160100 DOI: 10.1007/s10198-017-0869-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/10/2017] [Indexed: 05/18/2023]
Abstract
The objectives of this cross-sectional analysis were to determine healthcare resource utilization and cost for community-dwelling patients with dementia (PWD) from a payer's and societal perspective, and to analyze the associations between costs and sociodemographic and clinical variables. Analysis of healthcare costs from a payer's perspective was based on a sample of 425 PWD, analysis of healthcare costs from societal perspective on a subsample of 254 PWD and their informal caregivers. Frequency of healthcare resource utilization was assessed by means of questionnaires. Informal care and productivity losses were assessed by using the Resource Utilization in Dementia questionnaire (RUD). Costs were monetarized using standardized unit costs. To analyze the associations, multiple linear regression models were used. Total annual costs per PWD valued 7016€ from a payer's and 25,877€ from a societal perspective, meaning that societal cost is approximately three and a half times as much as payer's expenditures. Costs valuated 5456 € for medical treatments, 1559 € for formal care, 18,327€ for informal care. Productivity losses valued 1297€ for PWD caregivers. Informal care could vary substantially (-21%; +33%) concerning different valuation methods. Medical care costs decreased significantly with progression of dementia and with age. Costs of care double over the stages of dementia. Formal care costs were significantly higher for PWD living alone and informal care costs significantly lower for PWD with an employed caregiver. For all cost categories, deficits in daily living activities were major cost drivers.
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Affiliation(s)
- Bernhard Michalowsky
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany.
| | - Steffen Flessa
- Department of General Business Administration and Health Care Management, Ernst Moritz Arndt University Greifswald, 17489, Greifswald, Germany
| | - Tilly Eichler
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Johannes Hertel
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Adina Dreier
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Ina Zwingmann
- Department Interventional Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Diana Wucherer
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Henriette Rau
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Jochen René Thyrian
- Department Interventional Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Wolfgang Hoffmann
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
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Moral-Fernández L, Frías-Osuna A, Moreno-Cámara S, Palomino-Moral PA, Del-Pino-Casado R. [The first moments of the carer: The process of becoming a caregiver of a dependent elderly relative]. Aten Primaria 2017; 50:282-290. [PMID: 28735721 PMCID: PMC6837060 DOI: 10.1016/j.aprim.2017.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/27/2017] [Accepted: 05/03/2017] [Indexed: 12/02/2022] Open
Abstract
Objetivo Describir el proceso inicial por el que pasan las personas que se convierten inminentemente en cuidadores de algún familiar mayor en situación de dependencia. Diseño Estudio cualitativo cuyo análisis se ha regido por los principios de la teoría fundamentada. Emplazamiento El estudio se ha realizado en los distritos sanitarios de Jaén, durante 2015 y 2016, a nivel comunitario. Participantes y/o contextos La captación se realizó mediante los enfermeros gestores de casos de los Centros de Salud de cada distrito sanitario, los cuales localizaron participantes que cumpliesen los criterios de inclusión y los invitaban a participar en el estudio. Método Se han llevado a cabo 11 entrevistas en profundidad a personas que llevan cuidando menos de un año a un familiar mayor con dependencia hasta la saturación de la información. Resultados Tres fases han sido descritas durante este proceso. Una fase inicial de cambios, en los que la persona cuidadora asume nuevas actividades; una segunda fase atestada de emociones, en la que emergen necesidades y consecuencias en las personas cuidadoras; y una tercera fase donde destaca la aceptación como estrategia de afrontamiento y la incertidumbre como expectativa de futuro. Discusión La descripción de este proceso proporciona una mejor comprensión de la experiencia de convertirse en persona cuidadora familiar, con el fin de ayudar a los profesionales de la salud a adaptar los planes de atención a esta situación inicial.
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Clemmensen TH, Busted LM, Søborg J, Bruun P. The family's experience and perception of phases and roles in the progression of dementia: An explorative, interview-based study. DEMENTIA 2016; 18:490-513. [PMID: 27927946 PMCID: PMC6376601 DOI: 10.1177/1471301216682602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper examines how the relatives of a person with dementia experience challenges in everyday life. A model of phases is developed on the basis of interviews with 14 relatives from eight families. Data were subjected to a thematic content analysis, which found that the progression of dementia - from the perspective of the family - had three phases. These phases involved small changes in everyday life, adaptations to everyday life, and the loss of everyday life. The analysis further identified the following two archetypes of relatives that develop throughout the progression of dementia: the protective relative and the decisive relative. The study found that the two types of relatives experience different challenges during the three phases. It is important for health professionals to be familiar with these changes, when they evaluate whether the relatives of a person with dementia require help.
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Affiliation(s)
- Trine H Clemmensen
- Department of Physiotherapy, University College Lillebaelt, Denmark; Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Laila M Busted
- Department of Nursing, University College Lillebaelt, DK Health Sciences Research Centre, University College Lillebaelt, Vejle, Denmark
| | - Jane Søborg
- Department of Occupational Therapy, University College Lillebaelt, DK Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Poul Bruun
- Health Sciences Research Centre, University College Lillebaelt, Vejle, Denmark
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Pozet A, Lejeune C, Bonnet M, Dabakuyo S, Dion M, Fagnoni P, Gaimard M, Imbert G, Nerich V, Foubert A, Chotard M, Bonin M, Anota A, Bonnetain F. Evaluation of efficacy and efficiency of a pragmatic intervention by a social worker to support informal caregivers of elderly patients (The ICE Study): study protocol for a randomized controlled trial. Trials 2016; 17:531. [PMID: 27881145 PMCID: PMC5122007 DOI: 10.1186/s13063-016-1622-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical progress and the lifestyle modification have prolonged life expectancy, despite the development of chronic diseases. Support and care for older subjects are often provided by a network of informal caregivers composed of family, friends and neighbors, who are essential in helping older persons to continue living at home. It has been shown that the extent and diversity of informal tasks may jeopardize the physical, mental and social wellbeing of caregivers. METHODS/DESIGN The aim of the Informal Carers of Elderly cohort is to define, through a longitudinal study, profiles of caregivers of older patients with a diagnosis of one of the following diseases: cancer (breast, prostate, colorectal), neurodegenerative diseases (Parkinson's disease, Alzheimer's disease and similar diseases), neurovascular diseases (stroke), sensory diseases (age-related macular degeneration (AMD)) and heart disease (heart failure). Patients must be at least 60 years old and living in the region of Burgundy-Franche-Comte (France). By following the different phases of the caregiving relationship from the announcement of the diagnosis, it will be possible to assess the quality of life of caregivers, coping strategies, levels of anxiety and depression, social support and the extent of their burden. We will also evaluate the efficacy and efficiency of the implementation of a pragmatic intervention by a social worker to help informal caregivers, through a randomized interventional trial nested in the cohort. Qualitative approaches aimed at studying the caregiver/patient relationship, and situations leading to breakdown of the caregiver relationship will be also undertaken. DISCUSSION Through an analytical and longitudinal definition of profiles of informal caregivers, this study will gather detailed information on their life courses and their health trajectory by identifying consequences associated with the concept of their role as carers. In addition, the randomized interventional trial will explore the relevance of the implementation of a supportive intervention by a social worker to help caregivers. These data will help to identify strategies that could be used to improve the existing sources of aid and to propose new approaches to help caregivers. This study will provide the opportunity to identify the most relevant means of support adapted to caregivers, and provide an impulse for new health care policies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02626377 . Retrospectively registered on 9 December 2015. Protocol date/version: 23 October 2014/version 2.
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Affiliation(s)
- Astrid Pozet
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France. .,Methodology and Quality of Life in Oncology Unit, University Hospital Jean Minjoz, Boulevard Fleming, 25030, Besançon, France.
| | - Catherine Lejeune
- INSERM U866 Epidémiologie et Recherche Clinique en Oncologie Digestive, University of Burgundy, Dijon, France
| | - Magalie Bonnet
- UFR Sciences du Langage de l'Homme et de la Société, University of Franche-Comté, Besançon, France
| | | | - Michèle Dion
- Centre Georges Chevrier, UMR CNRS 7366, UFR Sciences Humaines et Sociales, Dijon, France
| | - Philippe Fagnoni
- EA 4184, Faculty of Pharmacy, University of Burgundy, Dijon, France
| | - Maryse Gaimard
- Centre Georges Chevrier, UMR CNRS 7366, UFR Sciences Humaines et Sociales, Dijon, France
| | - Geneviève Imbert
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
| | - Virginie Nerich
- INSERM U1098. Interaction Hôte-Greffon et Ingénierie Cellulaire et Génique, Besançon, France
| | - Audrey Foubert
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
| | - Morgane Chotard
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France
| | - Marie Bonin
- Pôle de Gérontologie Interrégional Bourgogne et Franche-Comté (PGI), Besançon, France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France.,The French National Platform Quality of Life and Cancer, Besançon, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale UMR 1098, Besançon, France.,The French National Platform Quality of Life and Cancer, Besançon, France
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Michalowsky B, Thyrian JR, Eichler T, Hertel J, Wucherer D, Flessa S, Hoffmann W. Economic Analysis of Formal Care, Informal Care, and Productivity Losses in Primary Care Patients who Screened Positive for Dementia in Germany. J Alzheimers Dis 2016; 50:47-59. [PMID: 26639964 DOI: 10.3233/jad-150600] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The majority of people with dementia (PwD) live at home and require professional formal care and informal care that is generally provided by close relatives. OBJECTIVE To determine the utilization and costs of formal and informal care for PwD, indirect costs because of productivity losses of caregivers, and the associations between cost, socio-demographic and clinical variables. METHODS The analysis includes the data of 262 community-dwelling PwD and their caregivers. Socio-demographics, clinical variables, and the utilization of formal care were assessed within the baseline assessment. To evaluate informal care costs, the Resource Utilization in Dementia (RUD) questionnaire was used. Costs were calculated from a social perspective. Associations were evaluated using multiple linear and logistic regression models. RESULTS Formal care services were utilized less (26.3%) than informal care (85.1%), resulting in a cost ratio of one to ten(1,646 €; 16,473 €, respectively). In total, 29% of caregivers were employed, and every seventh (14.3%) experienced productivity losses, which corresponded to 1,258 € annually. Whereas increasing deficits in daily living activities were associated with higher formal and higher informal costs, living alone was significantly associated with higher formal care costs and the employment of a caregiver was associated with lower informal care costs. CONCLUSION Informal care contributes the most to total care costs. Living alone is a major cost driver for formal costs because of the lower availability of potential informal care. The availability of informal care is limited and productivity losses are increased when a caregiver is employed.
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Affiliation(s)
- Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Steffen Flessa
- Department of General Business Administration and Health Care Management, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
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Erol R, Brooker D, Peel E. The impact of dementia on women internationally: An integrative review. Health Care Women Int 2016; 37:1320-1341. [DOI: 10.1080/07399332.2016.1219357] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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How does dementia onset in parents influence unmarried adult children's wealth. Soc Sci Med 2016; 152:156-65. [PMID: 26859082 DOI: 10.1016/j.socscimed.2016.01.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 11/21/2022]
Abstract
There is a growing concern that long-term care (LTC) needs of older adults lead to negative financial consequences for their family members. This paper examines whether the onset of dementia in parents influences wealth change among unmarried adult children regardless of their status as informal caregivers. Longitudinal data from seven waves (1998-2010) of the Health and Retirement Study (1540 person-wave observations) are used to analyze this question. Unconditional quantile regressions demonstrate that as a result of parental dementia diagnosis, unmarried adult children have lower wealth accumulation above the median of the wealth change distribution. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent period as well. Both losses in labor income and nursing home expenditures may play a role in leading to wealth declines.
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Grigorovich A, Rittenberg N, Dick T, McCann A, Abbott A, Kmielauskas A, Estioko V, Kulasingham S, Cameron JI. Roles and Coping Strategies of Sons Caring for a Parent With Dementia. Am J Occup Ther 2015; 70:7001260020p1-9. [DOI: 10.5014/ajot.2016.017715] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. Little is known about sons’ roles in caring for a parent with dementia. To ensure that interventions and practices appropriately match sons’ needs, we investigated their experiences.
METHOD. A qualitative descriptive approach was used; 20 sons of a parent with dementia participated in semistructured interviews.
RESULTS. Participants reported varied paths to becoming a caregiver, primarily undertaking a care management role and managing by using their own occupational experiences and receiving support from other family members, peers, and private and public community services. They experienced negative consequences such as participation restriction and stress and positive consequences such as feelings of satisfaction. Strategies used to cope included boundary setting and practicing self-care.
CONCLUSION. This study highlights the need to consider sons’ role as care managers for their parent with dementia in community-based settings, as well as their need for education and intervention. Occupational therapy practitioners can use this information to inform their practices and support clients and their families.
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Affiliation(s)
- Alisa Grigorovich
- Alisa Grigorovich, PhD, is Postdoctoral Researcher, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nira Rittenberg
- Nira Rittenberg, BSc(OT), is an Occupational Therapist/ Case Coordinator, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Talia Dick
- Talia Dick, MSc(OT), Ashley McCann, MSc(OT), Amanda Abbott, MSc(OT), Andrea Kmielauskas, MSc(OT), Valerie Estioko, MSc(OT), and Sinthusha Kulasingham, MSc(OT), were Students, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada, at the time of the study
| | - Ashley McCann
- Talia Dick, MSc(OT), Ashley McCann, MSc(OT), Amanda Abbott, MSc(OT), Andrea Kmielauskas, MSc(OT), Valerie Estioko, MSc(OT), and Sinthusha Kulasingham, MSc(OT), were Students, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada, at the time of the study
| | - Amanda Abbott
- Talia Dick, MSc(OT), Ashley McCann, MSc(OT), Amanda Abbott, MSc(OT), Andrea Kmielauskas, MSc(OT), Valerie Estioko, MSc(OT), and Sinthusha Kulasingham, MSc(OT), were Students, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada, at the time of the study
| | - Andrea Kmielauskas
- Talia Dick, MSc(OT), Ashley McCann, MSc(OT), Amanda Abbott, MSc(OT), Andrea Kmielauskas, MSc(OT), Valerie Estioko, MSc(OT), and Sinthusha Kulasingham, MSc(OT), were Students, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada, at the time of the study
| | - Valerie Estioko
- Talia Dick, MSc(OT), Ashley McCann, MSc(OT), Amanda Abbott, MSc(OT), Andrea Kmielauskas, MSc(OT), Valerie Estioko, MSc(OT), and Sinthusha Kulasingham, MSc(OT), were Students, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada, at the time of the study
| | - Sinthusha Kulasingham
- Talia Dick, MSc(OT), Ashley McCann, MSc(OT), Amanda Abbott, MSc(OT), Andrea Kmielauskas, MSc(OT), Valerie Estioko, MSc(OT), and Sinthusha Kulasingham, MSc(OT), were Students, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada, at the time of the study
| | - Jill I. Cameron
- Jill I. Cameron, PhD, is Associate Professor, Department of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada;
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Hashemi-Ghasemabadi M, Taleghani F, Yousefy A, Kohan S. Transition to the new role of caregiving for families of patients with breast cancer: a qualitative descriptive exploratory study. Support Care Cancer 2015; 24:1269-76. [DOI: 10.1007/s00520-015-2906-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/16/2015] [Indexed: 11/28/2022]
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DiZazzo-Miller R, Pociask FD. Dementia in the Context of Disability. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2015. [DOI: 10.3109/02703181.2015.1014126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Johannessen A, Bruvik FK, Hauge S. Family carers' experiences of attending a multicomponent psychosocial intervention program for carers and persons with dementia. J Multidiscip Healthc 2015; 8:91-9. [PMID: 25709469 PMCID: PMC4334330 DOI: 10.2147/jmdh.s76093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Psychosocial interventions for persons with dementia and their primary family carers are promising approaches to reducing the challenges associated with care, but, obtaining significant outcomes may be difficult. Even though carers in general are satisfied with such interventions, few studies have evaluated the interventions by means of qualitative methods. Aim The objective of the study reported here was to investigate family carers’ experiences of a multicomponent psychosocial intervention program, and also to offer advice on how to develop the intervention program. Methods Content analyses were taken from individual qualitative interviews conducted in 2012 with 20 carers (aged 50–82 years) who participated in a psychosocial intervention program that included education, individual and family counseling, and parallel group sessions for carers and persons with dementia. Results Two main categories emerged: 1) benefits of the intervention program, which sets out the informants’ experiences for the benefits of participation, described in the subcategories “importance of content and group organization” and “importance of social support”; and 2) missing content in the intervention program, which details the informants’ suggestions for future interventions, contained in the subcategories “need for extended content” and “need for new group organization”. Conclusion The carers found the interventions useful. The importance of even earlier and more flexible interventions for the family carers, the extended family, and the persons with dementia was underscored.
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Affiliation(s)
- Aud Johannessen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Frøydis Kristine Bruvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway ; Kavli Centre, Haraldsplass Deaconess Hospital, Bergen, Norway ; Haraldsplass Deaconess University College, Bergen, Norway
| | - Solveig Hauge
- Norway Faculty of Health and Social Studies and Centre of Caring Research - Southern Norway, Telemark University College, Porsgrunn, Norway
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Gervès-Pinquié C, Bellanger MM, Ankri J. Willingness to pay for informal care in France: the value of funding support interventions for caregivers. HEALTH ECONOMICS REVIEW 2014; 4:34. [PMID: 26208934 PMCID: PMC4502075 DOI: 10.1186/s13561-014-0034-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/19/2014] [Indexed: 05/22/2023]
Abstract
OBJECTIVES This article aims to assess the relationship between the monetary value of informal care - approximated with the caregiver's willingness to pay to reduce caregiving time - and the caregiver's need of three types of support services: care training, respite care and support group. Developing such services may be the only way to provide sustainable informal care in the future, along with efficient allocation. DATA & METHODS Data used stemmed from two representative national surveys conducted by French National Institute of Statistics and Economic Studies and the French Head Office of Research, Studies, Evaluation and Statistics of the Social Affairs Ministry in 2008. The contingent valuation method was used to approximate the monetary value of informal care. The model was run on 223 informal caregivers of people with Alzheimer's Disease. Statistical analyses were performed using Heckman's two-step estimation strategy, which is known to correct selection bias. RESULTS On average, one hour of informal care was estimated at <euro>12.1. Monetary value of informal care was influenced by the caregiver's need of care training (p<0.01). No similar association was found for respite care or support group. DISCUSSION Since informal caring value increases with caregivers' need of care training, improving caring skills and capabilities through training support is likely to improve its benefits.
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Affiliation(s)
- Chloé Gervès-Pinquié
- />Management des organisations de santé (MOS), Ecole des Hautes Etudes en Santé Publique (EHESP), Avenue du Professeur Léon-Bernard, 35043 Rennes, France
| | - Martine M Bellanger
- />Management des organisations de santé (MOS), Ecole des Hautes Etudes en Santé Publique (EHESP), Avenue du Professeur Léon-Bernard, 35043 Rennes, France
| | - Joel Ankri
- />Laboratoire Santé-Environnement-Vieillissement, Université Versailles-Saint-Quentin, Centre de gérontologie Hôpital Sainte Périne 49 rue Mirabeau, 75016 paris, France
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The journey with dementia from the perspective of bereaved family caregivers: a qualitative descriptive study. BMC Nurs 2014; 13:42. [PMID: 25435810 PMCID: PMC4247750 DOI: 10.1186/s12912-014-0042-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 11/18/2014] [Indexed: 12/05/2022] Open
Abstract
Background With increasing rates of dementia among older adults, many people will be affected by this disease; either by having the disease or by caring for a relative with dementia. Due to a shift toward home and community-based care there will be an increase in the number of family caregivers caring for persons with dementia. The caregiving experience in the dementia journey is influenced by many factors. Currently there is a paucity of research that examines the dementia caregiving experience from the perspective of bereaved caregivers or that presents the complete caregiving journey. The purpose of this study was to describe the dementia caregiving journey as revealed by bereaved family caregivers. Methods This study utilized qualitative description to describe the overall dementia caregiving journey as told by 11 bereaved caregivers. Open-ended interviews resulted in rich detailed descriptions of the caregiving journey from before a dementia diagnosis and into bereavement. Results Findings are discussed based on the following caregiving themes: (a) getting a diagnosis; (b) managing at home; (c) transition to long-term care; (d) end of life; and (e) grief in bereavement. Subthemes reflect the dementia caregiving journey using the words of the participants. Participants spoke of grieving throughout the caregiving experience. Conclusions Bereaved caregivers have similar experiences to active caregivers over comparable points in the journey with dementia. Findings from this work contribute new understanding to the literature around the unique perspective of bereaved caregivers, while presenting the overall dementia caregiving journey.
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Iavarone A, Ziello AR, Pastore F, Fasanaro AM, Poderico C. Caregiver burden and coping strategies in caregivers of patients with Alzheimer's disease. Neuropsychiatr Dis Treat 2014; 10:1407-13. [PMID: 25114532 PMCID: PMC4122550 DOI: 10.2147/ndt.s58063] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) causes considerable distress in caregivers who are continuously required to deal with requests from patients. Coping strategies play a fundamental role in modulating the psychologic impact of the disease, although their role is still debated. The present study aims to evaluate the burden and anxiety experienced by caregivers, the effectiveness of adopted coping strategies, and their relationships with burden and anxiety. METHODS Eighty-six caregivers received the Caregiver Burden Inventory (CBI) and the State-Trait Anxiety Inventory (STAI Y-1 and Y-2). The coping strategies were assessed by means of the Coping Inventory for Stressful Situations (CISS), according to the model proposed by Endler and Parker in 1990. RESULTS The CBI scores (overall and single sections) were extremely high and correlated with dementia severity. Women, as well as older caregivers, showed higher scores. The trait anxiety (STAI-Y-2) correlated with the CBI overall score. The CISS showed that caregivers mainly adopted task-focused strategies. Women mainly adopted emotion-focused strategies and this style was related to a higher level of distress. CONCLUSION AD is associated with high distress among caregivers. The burden strongly correlates with dementia severity and is higher in women and in elderly subjects. Chronic anxiety affects caregivers who mainly rely on emotion-oriented coping strategies. The findings suggest providing support to families of patients with AD through tailored strategies aimed to reshape the dysfunctional coping styles.
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Affiliation(s)
- Alessandro Iavarone
- Neurological and Stroke Unit, CTO Hospital, Naples, Italy
- Italian Association on Alzheimer’s Disease (AIMA), Naples, Italy
| | - Antonio Rosario Ziello
- Memory Clinic, Neurological Unit, AORN Cardarelli Hospital, Naples, Italy
- Clinical Research, Telemedicine and Telepharmacy Centre, University of Camerino, Camerino, Italy
| | - Francesca Pastore
- Memory Clinic, Neurological Unit, AORN Cardarelli Hospital, Naples, Italy
| | | | - Carla Poderico
- Department of Psychology, Second University of Naples, Caserta, Italy
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Suhonen R, Stolt M, Koskenniemi J, Leino-Kilpi H. Right for knowledge - the perspective of significant others of persons with memory disorders. Scand J Caring Sci 2014; 29:83-92. [DOI: 10.1111/scs.12132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Riitta Suhonen
- Department of Nursing Science; University of Turku; Turku Finland
| | - Minna Stolt
- Department of Nursing Science; University of Turku; Turku Finland
| | | | - Helena Leino-Kilpi
- Department of Nursing Science; University of Turku and Turku University Hospital; Turku Finland
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Pallant JF, Reid C. Measuring the positive and negative aspects of the caring role in community versus aged care setting. Australas J Ageing 2013; 33:244-9. [DOI: 10.1111/ajag.12046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julie F Pallant
- Rural Health Academic Centre; University of Melbourne; Shepparton Victoria Australia
| | - Carol Reid
- Carer Support Services; Family Care; Rural Health Academic Centre; University of Melbourne; Shepparton Victoria Australia
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de Vugt ME, Verhey FRJ. The impact of early dementia diagnosis and intervention on informal caregivers. Prog Neurobiol 2013; 110:54-62. [PMID: 23689068 DOI: 10.1016/j.pneurobio.2013.04.005] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 03/27/2013] [Accepted: 04/04/2013] [Indexed: 11/17/2022]
Abstract
In the absence of disease modifying therapies for dementia, the question rises what the benefits are of an early dementia diagnosis for patients and their caregivers. This paper reviews the caregiver perspective in dementia and addresses the question what the consequences are of promoting earlier dementia diagnosis. An early diagnosis offers caregivers the opportunity to advance the process of adaptation to the caregiver role. Caregivers that are better able to adapt to the changes that characterize dementia, feel more competent to care and experience less psychological problems. However, drawbacks of an early diagnosis may outweigh the benefits if people are left with a diagnosis but little support. There is convincing evidence that multicomponent caregiver interventions in the mild to moderate dementia stages are effective to improve caregiver well-being and delay institutionalization. However, there still exist a gap between the improved possibilities to diagnose people in the predementia stage versus the scarce knowledge on intervention effects in this very early stage. This stresses the urgent need for more research on early caregiver interventions that enhance role adaptation and that include long-term follow-up and cost-effectiveness evaluation. Early interventions may help caregivers in anticipating and accepting the future care role and transitions, with the increased possibility that caregivers can still involve the patient in the decision making process. As levels of stress and burden are still low in the predementia stage it provides excellent opportunities to empower the resources of caregivers.
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Affiliation(s)
- Marjolein E de Vugt
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Abstract
This article reviews the current recommendations in early diagnosis and the desires of the patients and their relatives, put in perspective with the reality of the clinical practices. More specific situations covered are: (1) the issue of young diseased patients, taking into account the psychological implications of the early occurrence of the disease in life and of the longer delay for these patients between the first observable signs and the diagnosis and (2) the issue of genetic testing, taking into account the implications of this extremely early form of bad news on the individual's existence and on the family structure.
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