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Gallagher VT, Reilly SE, Rossetti MA, Mattos M, Manning C. Factors associated with reduced sleep among spouses and caregivers of older adults with varying levels of cognitive decline. Psychogeriatrics 2024; 24:223-232. [PMID: 38098187 DOI: 10.1111/psyg.13064] [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: 05/10/2023] [Revised: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 03/04/2024]
Abstract
BACKGROUND Caregivers of persons with cognitive decline (PWCD) are at increased risk of poor sleep quantity and quality. It is unclear whether this is due to factors in the caregiver versus in the PWCD. METHODS This secondary data analysis using Aging, Demographics, and Memory Study data from the Health Retirement Study examined factors contributing to reduced sleep/rest among spouses and caregivers of older adults with varying levels of cognitive decline (cognitively normal (CN), cognitive impairment but not dementia (CIND), or dementia). RESULTS In our preliminary analysis, among N = 218 spouses (not necessarily caregivers) (mean age (SD) = 73.77 (7.30); 70.64% female) of older adults with varying levels of cognitive decline, regression revealed that frequency of sleep complaints was lowest among spouses with CN partners, second highest with CIND partners, and highest with dementia-partners, X2 = 26.810, P = 0.002. PRIMARY AIM among n = 136 caregivers of PWCD (mean age (SD) = 59.27 (13.97); 74.26% female; 22.79% spouses), we analyzed whether caregiver reduced sleep/rest was predicted by PWCD factors (i.e., frequent nighttime waking, dementia severity) and/or caregiver factors (i.e., depression symptoms, caregiver role overload). Regression revealed that caregiver depression symptoms (d = 0.62) and role overload (d = 0.88), but not PWCD factors, were associated with reduced caregiver sleep/rest after adjusting for demographic factors, caregiving frequency, and shared-dwelling status (overall model: X2 = 31.876, P = 0.002). Exploratory analyses revealed that a caregiver was 7.901 times more likely (95% CI: 0.99-63.15) to endorse experiencing reduced sleep/rest if back-up care was not available (P = 0.023). CONCLUSION Findings highlight that the frequency of reported sleep problems among spouses increases in a stepwise fashion when partners have dementia versus CIND versus CN. The results also emphasise that caregiver mental health and burden are strongly associated with caregiver sleep disturbances and thus may be targets of intervention for caregiver sleep problems.
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Affiliation(s)
- Virginia T Gallagher
- Department of Neurology, School of Medicine University of Virginia, Charlottesville, Virginia, USA
| | - Shannon E Reilly
- Department of Neurology, School of Medicine University of Virginia, Charlottesville, Virginia, USA
| | - M Agustina Rossetti
- Department of Neurology, School of Medicine University of Virginia, Charlottesville, Virginia, USA
| | - Meghan Mattos
- Division of Geriatrics, School of Nursing and School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Carol Manning
- Department of Neurology, School of Medicine University of Virginia, Charlottesville, Virginia, USA
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Yashkin AP, Kolpakov S, Ukraintseva S, Yashin A, Akushevich I. Graves disease is associated with increased risk of clinical Alzheimer's disease: evidence from the Medicare system. Clin Diabetes Endocrinol 2024; 10:11. [PMID: 38317215 PMCID: PMC10840251 DOI: 10.1186/s40842-024-00170-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Identification of modifiable risk factors for Alzheimer's Disease (AD) onset is an important aspect of controlling the burden imposed by this disease on an increasing number of older U.S. adults. Graves disease (GD), the most common cause of hyperthyroidism in the U.S., has been hypothesized to be associated with increased AD risk, but there is no consensus. In this study, we explore the link between GD and risk of clinical AD. METHODS Cox and Fine-Grey models were applied to a retrospective propensity-score-matched cohort of 19,798 individuals with GD drawn from a nationally representative 5% sample of U.S. Medicare beneficiaries age 65 + over the 1991-2020 period. RESULTS Results showed that the presence of GD was associated with a higher risk of AD (Hazard Ratio [HR]:1.19; 95% Confidence Interval [CI]:1.13-1.26). Competing risk estimates were consistent with these findings (HR:1.14; CI:1.08-1.20) with the magnitude of associated risk varying across subgroups: Male (HR:1.25; CI:1.07-1.47), Female (HR:1.09; CI:1.02-1.16), White (HR:1.11; CI:1.03-1.19), and Black (HR:1.23; CI:1.02-1.49). CONCLUSIONS Our results indicate a robust and consistent association between a diagnosis of GD and a subsequent diagnosis of AD in later stages of life. The precise biological pathways that could potentially connect these two conditions remain unclear as is the role of treatment in this relationship. Replications of these findings on datasets with both biomarkers and laboratory test results, especially in underrepresented groups is vital.
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Affiliation(s)
- Arseniy Pavlovich Yashkin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA.
| | - Stanislav Kolpakov
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA
| | - Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA
| | - Anatoliy Yashin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA
| | - Igor Akushevich
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA
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Yashkin AP, Kolpakov S, Ukraintseva S, Yashin A, Akushevich I. Graves Disease is Associated with Increased Risk of Clinical Alzheimer's Disease: Evidence from the Medicare System. RESEARCH SQUARE 2023:rs.3.rs-2596630. [PMID: 37886578 PMCID: PMC10602068 DOI: 10.21203/rs.3.rs-2596630/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Identification of modifiable risk factors for Alzheimer's Disease (AD) onset is an important aspect of controlling the burden imposed by this disease on an increasing number of older U.S. adults. Graves disease (GD), the most common cause of hyperthyroidism in the U.S., has been hypothesized to be associated with increased AD risk, but there is no consensus. In this study, we explore the link between GD and risk of clinical AD. Methods Cox and Fine-Grey models were applied to a retrospective propensity-score-matched cohort of 15,505 individuals with GD drawn from a nationally representative 5% sample of U.S. Medicare beneficiaries age 65 + over the 1991-2017 period. Results Results showed that the presence of GD was associated with a higher risk of AD (Hazard Ratio [HR]:1.15; 95% Confidence Interval [CI]:1.07-1.23). Magnitude of associated risk varied across subgroups: Males (HR:1.19; CI:1.01-1.41), Females (HR:1.09; CI:1.02-1.18), Whites (HR:1.13; CI:1.04-1.20), Blacks (HR:1.33; CI:1.04-1.20). Competing risk estimates were consistent with these findings. Conclusions A potential mechanism connecting GD and AD may involve shared etiological factors between the two diseases. Although replication of our findings is needed, they suggest that GD prevention and treatment may contribute to reducing the burden of AD in U.S. older adults.
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Pérez-González A, Vilajoana-Celaya J, Guàrdia-Olmos J. Burden and anticipatory grief in caregivers of family members with Alzheimer's disease and other dementias. Palliat Support Care 2023:1-11. [PMID: 37795789 DOI: 10.1017/s1478951523001360] [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: 10/06/2023]
Abstract
OBJECTIVES This study aimed to analyze the different factors that intervene in the task of caring for relatives of people with Alzheimer's and other dementias. A first objective focused on assessing the relation between burden and anticipatory grief, considering the possibility of social support and the risk of psychopathology. A second objective aimed to examine whether caregiver burden modulates the relationships between anticipatory grief and psychopathology. A cross-sectional design was employed. METHODS The sample consists of 129 participants who care for a family member with Alzheimer's and other dementias. A protocol based on a battery of tests has been applied and a mediation analysis was carried out. RESULTS The results show a positive relationship between burden and anticipatory grief. Social support could have an indirect relationship with anticipatory grief, based on its effect on the level of psychopathology and caregiver burden. Finally, a modulation model reflects that the relationship between anticipatory grief and psychopathology is strong, the latter having a greater effect as a result variable than as a risk variable. However, it seems that the relationship between grief and psychopathology is better explained directly than not through the modulating effect of the caregiver burden. SIGNIFICANCE OF RESULTS The results obtained encourage us to think that an approach focused on intervening in the anticipatory grief may be an opportunity to reduce or buffer other caregiving outcomes, especially those related to the perception of caregiver burden and psychopathology.
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Affiliation(s)
- Alba Pérez-González
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- Research group of Quantitative Psychology, University of Barcelona, Barcelona, Spain
| | | | - Joan Guàrdia-Olmos
- Research group of Quantitative Psychology, University of Barcelona, Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neuroscience, University of Barcelona, Barcelona, Spain
- Institute of Complex Systems, University of Barcelona, Barcelona, Spain
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Nguyen NP, Kim SY, Yoo HB, Tran S. Work-family conflicts and pain interference among midlife adults: a longitudinal serial mediation via family strain and loneliness. Psychol Health 2023:1-17. [PMID: 37772746 DOI: 10.1080/08870446.2023.2259929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Work-family conflict has been shown to adversely affect individuals' health and function, particularly among individuals with chronic pain. The current study's longitudinal serial mediation model examined whether work-to-family conflict predicted greater pain interference through higher levels of family strain and loneliness among midlife adults with chronic pain. METHODS AND MEASURES The study consisted of 303 participants from two waves of the national longitudinal study of Midlife in the United States (MIDUS) at wave II from 2004 to 2006 (Mage = 57, SD = 11) and wave 3 from 2013 to 2014 (Mage = 66, SD = 11). Participants were employed at time 1 and had chronic pain at both time points, and 54.5% of participants identified as female. RESULTS Family strain at time 1 (T1) and loneliness at time 2 (T2), respectively, significantly mediated the association of work-to-family conflict (T1) on pain interference at T2. Participants with greater work-to-family conflict perceived more family strain, felt lonelier, and, in turn, reported experiencing higher interference from chronic pain. CONCLUSION Results suggest that unmanaged work-to-family conflict could be a risk factor that exacerbates chronic pain symptoms through worsening family relationships and loneliness among midlife adults with chronic pain.
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Affiliation(s)
- Nguyen P Nguyen
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Shin Ye Kim
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Hannah B Yoo
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sophia Tran
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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De Wit L, Levy SA, Kurasz AM, Amofa P, DeFeis B, O'Shea D, Chandler MJ, Smith GE. Procedural learning, declarative learning, and working memory as predictors of learning the use of a memory compensation tool in persons with amnestic mild cognitive impairment. Neuropsychol Rehabil 2023; 33:1278-1303. [PMID: 35749375 DOI: 10.1080/09602011.2022.2089697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 06/09/2022] [Indexed: 09/30/2022]
Abstract
Persons with amnestic Mild Cognitive Impairment (aMCI) are at risk for experiencing changes in their daily functioning due to their memory impairment. The Memory Support System (MSS), a compensatory calendaring system, was developed to support functional independence in persons with aMCI (pwaMCI). This cross-sectional study examined procedural learning, declarative learning, and working memory as predictors of MSS learning efficiency in pwaMCI. Sixty pwaMCI participated in MSS training. The Serial Reaction Time Test and Mirror Tracing Test were used to assess procedural learning. The Rey Auditory Verbal Learning Test and CogState One Card Learning were used to assess declarative learning and the CogState One Back task was used to assess working memory. Multiple regression analyses were conducted to assess if procedural learning, declarative learning, and working memory predicted MSS learning efficiency. This study showed that declarative learning predicted MSS learning efficiency in pwaMCI, with less consistent results for procedural learning and non-significant results for working memory. Findings suggest that success in teaching compensatory tools is greater when training is offered in early aMCI before declarative learning skill is fully lost. Future studies should assess additional strategies to facilitate MSS learning in advanced aMCI.
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Affiliation(s)
- Liselotte De Wit
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shellie-Anne Levy
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Andrea M Kurasz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Priscilla Amofa
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Brittany DeFeis
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Deirdre O'Shea
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Melanie J Chandler
- Department of Psychiatry and Psychology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Glenn E Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Henderson JT, Martin A, Patnode CD, Henrikson NB. A synthesis of qualitative studies on patient and caregiver experiences with cognitive impairment screening and diagnosis. Aging Ment Health 2022:1-12. [PMID: 36193565 DOI: 10.1080/13607863.2022.2126431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To understand patient and caregiver perspectives on the experience of being screened or diagnosed with cognitive impairment to inform preventive clinical care. METHODS Systematic review and synthesis of qualitative studies with searches in Ovid MEDLINE ALL, EBSCOHost CINAHL, and Scopus in February 2021. Included studies were assessed for quality and coded with descriptive, deductive, and inductive codes and findings were rated using GRADE-CER-qual. RESULTS We included 15 qualitative studies representing 153 patients and 179 caregivers. Most studies involved in-depth interviews. No studies examined screening experiences for older adults presenting without cognitive function concerns; nearly all patients received a diagnosis of cognitive impairment. Seven themes emerged with moderate to high confidence. Findings showed the role of caregivers in pursuing assessment and its benefits in validating concerns and for future planning. Patients were less inclined to be evaluated, fearing judgements or social consequences from the diagnostic label. Caregivers and patients were at times frustrated with the assessment process yet believed it might result in treatments to cure or slow disease progression. CONCLUSION Clinicians and care systems can support caregivers and patients by providing timely and informative resources to support their shared and separate motivations, needs, and concerns.
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Affiliation(s)
- Jillian T Henderson
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Portland, Oregon, USA
| | - Allea Martin
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Portland, Oregon, USA
| | - Carrie D Patnode
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Portland, Oregon, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Lu Y, Liu C, Yu D, Wells Y. Conditions required to ensure successful detection and management of mild cognitive impairment in primary care: A Delphi consultation study in China. Front Public Health 2022; 10:943964. [PMID: 36211650 PMCID: PMC9540221 DOI: 10.3389/fpubh.2022.943964] [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] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Objective Detection and management of mild cognitive impairment (MCI) in primary care has been recognized internationally as one of the strategies that can be employed to delay the development of dementia. However, little is known about what role primary care should play. This study aimed to develop a checklist of conditions necessary for successfully detecting and managing mild cognitive impairment in primary care in China. Methods This study employed the Delphi method to establish expert consensus on the conditions required for successfully detecting and managing MCI in primary care in China. Twenty-four experts who specialized in general practice, public health, neuropsychology, or community health service management rated the importance of pre-defined conditions (44 items measuring providers' preparedness, patient engagement, and system support in line with the Chronic Care Model). The degree of consensus among the experts was measured using four indicators: median ≥ 4, mean ≥3.5, Co-efficient of Variance < 0.25, and retention in the checklist required ≥ 80% agreement with a rating of important or essential. The checklist and descriptions of the conditions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. Consensus was achieved after the second round of consultations, which was completed by 22 of the experts. Results The experts endorsed a checklist of 47 conditions required for successful detection and management of MCI in primary care in China. These conditions were categorized into four domains: prepared general practitioners (17 items), engaged patients (15 items), organizational efforts (11 items), and environmental support (4 items). Conclusions Successful detection and management of MCI in primary care in China requires a dedicated and competent workforce of general practitioners, as well as the engagement of patients and family caregivers. Adequate support from healthcare organizations, health system arrangements, and the broader society is needed to enable effective interactions between general practitioners and patients and efficient delivery of the services required to detect and manage MCI.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Academic Department of General Practice, Tongji University School of Medicine, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
- Academic Department of General Practice, Tongji University School of Medicine, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Yvonne Wells
- Lincoln Center for Research on Aging, La Trobe University, Melbourne, VIC, Australia
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Fang L, Dong M, Fang W, Zheng J. Relationships between care burden, resilience, and depressive symptoms among the main family caregivers of stroke patients: A cross-sectional study. Front Psychiatry 2022; 13:960830. [PMID: 36203823 PMCID: PMC9530984 DOI: 10.3389/fpsyt.2022.960830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aims to explore the potential mediating role of resilience between care burden and depressive symptoms in family caregivers of stroke patients. METHODS A cross-sectional study was conducted with a convenience sample involving 245 main family caregivers of stroke patients recruited from the neurology department of a Tertiary A hospital in China. Mediation analyses were conducted using the PROCESS macro (Model 4) for SPSS, applying the Bootstrap analysis with 5,000 samples and a 95% confidence interval. RESULTS The results showed that with constant hemiplegia side, Barthel Index, education level, monthly income, care time per day, and living with patients in regression equations, the resilience partially mediated the correlation of care burden and depressive symptoms with a mediation effect ratio of 26.32%. CONCLUSIONS Resilience plays a mediating role in the correlation between care burden and depressive symptoms. IMPACT The findings indicated a protective effect of resilience in alleviating the negative influences of care burden on depressive symptoms, suggesting that resilience-training intervention may be developed to mitigate depressive symptoms of the main family caregivers of stroke patients.
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Affiliation(s)
- Linlin Fang
- Department of Nursing, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Mengyuan Dong
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Wenbo Fang
- School of Civil and Hydraulic Engineering, Tibet Agriculture and Animal Husbandry University, Linzhi, China
| | - Jin Zheng
- Department of Nursing, The First Affiliated Hospital of China Medical University, Shenyang, China
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Fear about Alzheimer's disease among Israeli and German laypersons, persons with Mild Neurocognitive Disorder and their relatives: a qualitative study. Int Psychogeriatr 2021; 33:1019-1034. [PMID: 33046144 DOI: 10.1017/s1041610220003397] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Alzheimer's disease (AD), the most common type of dementia, is one of the most feared diseases, obstructing help-seeking, and leading to discrimination. While research interest in fear of developing AD is increasing, little is known about its characterization, triggers, and consequences, especially among different cultures. In this study, we aimed at exploring and characterizing AD fear as experienced by laypersons (LP), persons with Mild Neurocognitive Disorder (MND), and their relatives, in Israel and Germany. DESIGN A qualitative study using focus groups (FGs) and semi-structured interviews was used. Thematic content analysis was conducted to extract key themes. SETTING Israeli and German not yet diagnosed people. PARTICIPANTS The study included a total of 130 participants (63 Israeli and 67 German participants) representing 3 groups: LP (n = 82), persons with MND (n = 28), and relatives of persons with MND (n = 20). RESULTS Two overarching themes were identified across groups and countries: fear of developing AD and fear of stigmatization. Other types of fear, such as fear of a person with AD, fear about the impact of a diagnosis of AD on family members, fear of becoming a caregiver, and fear of losing one's self-determination because of developing AD, were specific to a group type or country. Different types of fear were awakened by different triggers, and were dealt with different coping strategies.
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A Tale of Two Solitudes: Loneliness and Anxiety of Family Caregivers Caring in Community Homes and Congregate Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910010. [PMID: 34639311 PMCID: PMC8508318 DOI: 10.3390/ijerph181910010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022]
Abstract
We surveyed 604 family caregivers residing in the province of Alberta to better understand the impact of the COVID-19 pandemic on anxiety, loneliness, and care work. We assessed anxiety with the Six-Item State Anxiety Scale and loneliness with the DeJong-Gierveld Loneliness Scale. The COVID-19 pandemic created two contexts giving rise to feelings of solitude for family caregivers. Family caregivers of Albertans living in private community homes were overwhelmed with caregiving needs while those caring for Albertans living in congregate settings were restricted from caregiving. The results indicated that before the COVID-19 pandemic, 31.7% of family caregivers were anxious and 53.5% were lonely. The proportions of those who were anxious rose to 78.8% and lonely to 85.9% during the pandemic. The qualitative responses of family caregivers connected being overwhelmed with care work either in community homes or as the designated essential caregiver in congregate living settings, as well as being unable to care in congregate care settings, with anxiety and loneliness. The caregivers reporting improvements in their health and relationships with care-receivers credited spending time with the receiver doing pleasant activities together, rather than purely performing onerous care tasks. Policymakers need to consider organizing health and community services to ensure family caregivers are not overwhelmed with care tasks or excluded from caring in congregate care.
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O’Caoimh R, Calnan M, Dhar A, Molloy DW. Prevalence and Predictors of Caregiver Burden in a Memory Clinic Population. J Alzheimers Dis Rep 2021; 5:739-747. [PMID: 34755048 PMCID: PMC8543373 DOI: 10.3233/adr-201003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although caregiver burden is common among carers of people with dementia, little is known about its prevalence and predictors among caregivers of patients attending memory clinics. OBJECTIVE To examine carer and patient-specific characteristics associated with caregiver burden across the cognitive spectrum in a memory clinic population. METHODS Consecutive patients referred to a university hospital geriatric memory clinic were included. Caregiver burden was scored using the Caregiver Burden Score (CBS), (modified Zarit), with scores≥15/30 suggesting burden. BPSD were measured with the dysfunctional behaviour rating instrument (DBRI). Cognition was screened using the Montreal Cognitive Assessment (MoCA) and Quick Mild Cognitive Impairment (Qmci) screen. RESULTS In all, 351 patients were included, median age 77 (±11) years; 65.5% were female. The prevalence of caregiver burden was 33.6% overall, increasing from 10.8% in subjective cognitive decline (SCD), to 15% in mild cognitive impairment (MCI) and 43% in dementia; CBS scores were significantly higher in dementia (p < 0.001). Caregivers with burden were significantly younger (p = 0.045) and were more likely to be adult children (p = 0.007). The CBS weakly correlated with the stage of cognitive impairment (r = 0.16) but had moderate correlation with MoCA (r = -0.54) and Qmci scores (r = -0.60). After adjustment for co-variates, DBRI scores alone independently predicted burden (odds ratio 1.23;1.11-1.35, p < 0.001). CONCLUSION Caregiver burden is associated with the stage of cognitive impairment, with higher prevalence proportions in those with dementia compared with MCI and SCD. Only the severity of neuropsychiatric symptoms independently predicted caregiver burden in this population and its presence should prompt assessment for burden.
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Affiliation(s)
- Rónán O’Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork City, Ireland
- Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork City, Ireland
| | - Mareeta Calnan
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork City, Ireland
| | - Arup Dhar
- Baker Heart and Diabetes Institute, Melbourne VIC, Australia
- NeuroCentrix, Noble Park, VIC, Australia
| | - D. William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork City, Ireland
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Seike A. [How can the well-being of family caregivers of people with dementia be identified?]. Nihon Ronen Igakkai Zasshi 2021; 58:353-362. [PMID: 34483157 DOI: 10.3143/geriatrics.58.353] [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: 11/11/2022]
Abstract
This paper discusses what well-being means to caregivers and how it can be measured to confirm its acquisition by using previous research on theoretical and practical aspects.Within the field of psychology, the two types of well-being (subjective and psychological well-being) are combined to form "feeling good and functioning well", which refers to "pleasant subjective experiences, meaningful activities and the realization of human potential in an individual's life".On the other hands, a review study reported on the Global Measure of well-being, that is, depressive symptoms, mental health, QOL, satisfaction with life and health, also on caregiver-specific well-being measures that are burden, role strain, personal strain, stress, competence and self-efficacy. The majority of measures focused on the negative aspects of well-being.If there is no simple measurement tool that captures both the positive and negative aspects of well-being, a comprehensive and quantitative evaluation of dementia care, so for the present there is no alternative but to using multiple tools for evaluation.The Eco-map of the Ecological Social Work method, which was used in a psycho-educational intervention for caregivers, was shown to provide a hint as to how to take a macroscopic and comprehensive view of dementia care and how to easily grasp an understanding of the well-being of caregivers.
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Affiliation(s)
- Aya Seike
- Kokoro Research Center, Kyoto University.,Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology
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14
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Chang J, Zhu W, Zhang J, Yong L, Yang M, Wang J, Yan J. The Effect of Chinese Square Dance Exercise on Cognitive Function in Older Women With Mild Cognitive Impairment: The Mediating Effect of Mood Status and Quality of Life. Front Psychiatry 2021; 12:711079. [PMID: 34305689 PMCID: PMC8298898 DOI: 10.3389/fpsyt.2021.711079] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
The present study aimed to assess the effects of square dance exercise on the cognitive function and quality of life in older women with mild cognitive impairment and to investigate the mediating role of a depressed mood and reduced quality of life in the relationship between square dance exercise and cognition. The study design was a single-blind whole-group controlled trial. A total of 136 eligible participants were divided according to their nursing home into either an experimental or control group. The nursing home grouping was determined by the drawing of lots. The Montreal Cognitive Assessment (MoCA), Quality of Life (SF-12) and Geriatric Depression Scale (GDS-15) were used to assess participants at baseline, week 9, and week 18, respectively. Generalized estimating equations (GEE) were used to compare the results at baseline with mid-test and post-test changes in cognitive function and quality of life. Maximum likelihood estimation (ML) and robust standard errors were used to perform the mediation model. The study results indicated that the experimental group (compared to the control group) had a significant improvement in cognitive function, quality of life, and mood state at baseline in the mid-test and post-test results. The results of this 18-week experiment showed that the exercise-cognition relationship was significantly mediated by a reduction in depressive symptoms (indirect effect: β = -0.375; 95% CI = -0.864 to -0.069) and an improvement in quality of life (indirect effect: β = -0.678; 95% CI = -1.222 to -0.290). This study revealed the effects of moderate-intensity square dance exercise on cognitive function and quality of life in older Chinese women with mild cognitive impairment and explored the potential mediating mechanisms. These findings can be used to inform the development of public health policies to promote brain health in older adults with mild cognitive impairment.
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Affiliation(s)
- Jindong Chang
- School of Physical Education, Southwest University, Chongqing, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Wenbing Zhu
- College of Physical Education and Health Science, Chongqing Normal University, Chongqing, China
| | - Jia Zhang
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Liming Yong
- School of Physical Education, Southwest University, Chongqing, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Ming Yang
- School of Physical Education, Southwest University, Chongqing, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Jibing Wang
- International College of Football, Tongji University, Shanghai, China
| | - Jiagao Yan
- Editorial Department, the Journal of Shandong Sports University, Shandong Sports University, Jinan, China
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15
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Gathercole R, Bradley R, Harper E, Davies L, Pank L, Lam N, Davies A, Talbot E, Hooper E, Winson R, Scutt B, Montano VO, Nunn S, Lavelle G, Lariviere M, Hirani S, Brini S, Bateman A, Bentham P, Burns A, Dunk B, Forsyth K, Fox C, Henderson C, Knapp M, Leroi I, Newman S, O'Brien J, Poland F, Woolham J, Gray R, Howard R. Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT. Health Technol Assess 2021; 25:1-156. [PMID: 33755548 DOI: 10.3310/hta25190] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Assistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness. OBJECTIVES This trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated. DESIGN This was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis. SETTING This trial was set in 12 councils in England with adult social services responsibilities. PARTICIPANTS Participants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare. INTERVENTIONS Participants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package). MAIN OUTCOME MEASURES The primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview. RESULTS Of 495 participants, 248 were randomised to receive full assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01; p = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12; p = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group - control group difference: mean -£909, 95% confidence interval -£5336 to £3345) or in societal costs (intervention group - control group difference: mean -£3545; 95% confidence interval -£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval -0.204 to -0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks. LIMITATIONS Compliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events. CONCLUSIONS A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants' health and social care or societal costs. Quality-adjusted life-years based on participants' EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire. FUTURE WORK Future work could examine whether or not improved assessment that is more personalised to an individual is beneficial. TRIAL REGISTRATION Current Controlled Trials ISRCTN86537017. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Rosie Bradley
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Emma Harper
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Lucy Davies
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Lynn Pank
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Natalie Lam
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Anna Davies
- School of Health Sciences, City, University of London, London, UK.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Emma Talbot
- Norfolk and Suffolk NHS Foundation Trust, Stowmarket, UK
| | - Emma Hooper
- Lancashire Care NHS Foundation Trust, Preston, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rachel Winson
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Bethany Scutt
- Department of Old Age Psychiatry, King's College London, London, UK
| | | | - Samantha Nunn
- Cambridgeshire Community Services NHS Trust, Cambridge, UK
| | - Grace Lavelle
- Department of Old Age Psychiatry, King's College London, London, UK
| | - Matthew Lariviere
- Centre for International Research on Care, Labour and Equalities, University of Sheffield, Sheffield, UK
| | | | - Stefano Brini
- School of Health Sciences, City, University of London, London, UK
| | - Andrew Bateman
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Peter Bentham
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Alistair Burns
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Barbara Dunk
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Stanton Newman
- School of Health Sciences, City, University of London, London, UK
| | - John O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - John Woolham
- National Institute for Health Research (NIHR) Health & Social Care Workforce Research Unit, King's College London, London, UK
| | - Richard Gray
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
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16
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Beatie BE, Mackenzie CS, Funk L, Davidson D, Koven L, Reynolds KA. Caregiver identity in care partners of persons living with mild cognitive impairment. DEMENTIA 2021; 20:2323-2339. [PMID: 33595336 PMCID: PMC8564256 DOI: 10.1177/1471301221994317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on caregiver identity in the context of memory impairment has focused primarily
on more advanced stages of the cognitive impairment trajectory (e.g., dementia
caregivers), failing to capture the complex dynamics of early caregiver identity
development (e.g., MCI; mild cognitive impairment caregivers). The aim of this study was
to develop a nuanced understanding of how caregiver identity develops in family and
friends of persons living with MCI. Using constructivist grounded theory (ConGT), this
study explored caregiver identity development from 18 in-depth interviews with spouses
(n = 13), children (n = 3), and friends
(n = 2) of persons recently diagnosed with MCI. The overarching themes
influencing MCI caregiver identity development included MCI changes, care-related
experiences, “caregiver” interpretation, and approach/avoidance coping. These themes
influenced how participants primarily identified, represented as I am a caregiver,
I am not a caregiver, or liminality (i.e., between their
previous identity and a caregiver identity). Irrespective of their current
self-identification, all conveyed thinking about their “future self,” as providing more
intensive care. MCI caregiver identity development in family and friends is a fluid and
evolving process. Nearly all participants had taken on care tasks, yet the majority of
these individuals did not clearly identify as caregivers. Irrespective of how participants
identified, they were engaging in care, and would likely benefit from support with
navigating these changes and their new, ambiguous, and evolving roles.
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Affiliation(s)
- Brooke E Beatie
- Department of Psychology, 194379University of Manitoba, Winnipeg, Manitoba, Canada
| | - Corey S Mackenzie
- Department of Psychology, 194379University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Funk
- Department of Sociology and Criminology, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dylan Davidson
- Department of Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley Koven
- Department of Clinical Health Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristin A Reynolds
- Department of Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Happich F, König H, Hajek A. Spousal care and its effect on partnership characteristics – a longitudinal analysis of spousal caregiving and care receipt in Germany. Scand J Caring Sci 2021; 36:109-119. [DOI: 10.1111/scs.12968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/22/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Fiona Happich
- Department of Health Economics and Health Services Research University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Hans‐Helmut König
- Department of Health Economics and Health Services Research University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - André Hajek
- Department of Health Economics and Health Services Research University Medical Center Hamburg‐Eppendorf Hamburg Germany
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18
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Hale L, Mayland E, Jenkins M, Buttery Y, Norris P, Butler M, Holland M, Ngocha-Chaderopa E, Mckenzie-Green B, Czuba K, Sezier A, Kayes N. Constructing Normalcy in Dementia Care: Carers' Perceptions of Their Roles and the Supports They Need. THE GERONTOLOGIST 2020; 60:905-915. [PMID: 31722390 DOI: 10.1093/geront/gnz151] [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] [Received: 06/27/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES People with dementia are critically dependent on their carers when accessing and utilizing health care. To inform health care development and delivery, we aimed to explore carers' perceptions of their role in caring for a family member with dementia and to identify carers' skills and attributes and factors impacting on care. RESEARCH DESIGN AND METHODS We used semistructured interviews to collect data from 25 carers supporting older adults with dementia. Data were thematically analyzed and the paradigm model was used to guide theory development. RESULTS "Constructing normalcy" was central to all carers did, impacted by stage of life and relationship status and driven by a holistic focus on their care-recipient's quality of life. Goals guiding care were: keeping the peace; facilitating participation, happiness and independence; and ensuring safety. Enablers included: social contact; knowledge; and quality social services. Barriers included health and legal issues; symptoms of dementia; and reduced knowledge. These goals kept the peace and reduced stress for the cared-for person, but often at the cost of unrelenting responsibility and loss of carers' original roles. Discussion and Implications: As carers are so critical to the access and uptake of health care of those with dementia, health professionals and services need to support carers in their quest to construct normalcy. Our findings provide guidance to assist in ensuring appropriate support and understanding of carers work in order to optimize dementia health care delivery.
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Affiliation(s)
- Leigh Hale
- School of Physiotherapy, Dunedin, New Zealand
| | | | | | | | - Pauline Norris
- Centre for Pacific Health, University of Otago, Dunedin, New Zealand
| | - Mary Butler
- School of Occupational Therapy, Otago Polytechnic, Dunedin, New Zealand
| | - Michelle Holland
- School of Occupational Therapy, Otago Polytechnic, Dunedin, New Zealand
| | | | | | - Karol Czuba
- Centre for Person Centred Research, Health and Rehabilitation Research Institute, Auckland University of Technology, New Zealand
| | - Ann Sezier
- Centre for Person Centred Research, Health and Rehabilitation Research Institute, Auckland University of Technology, New Zealand
| | - Nicola Kayes
- Centre for Person Centred Research, Health and Rehabilitation Research Institute, Auckland University of Technology, New Zealand
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19
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El-Hayek YH, Wiley RE, Khoury CP, Daya RP, Ballard C, Evans AR, Karran M, Molinuevo JL, Norton M, Atri A. Tip of the Iceberg: Assessing the Global Socioeconomic Costs of Alzheimer's Disease and Related Dementias and Strategic Implications for Stakeholders. J Alzheimers Dis 2020; 70:323-341. [PMID: 31256142 PMCID: PMC6700654 DOI: 10.3233/jad-190426] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
While it is generally understood that Alzheimer’s disease (AD) and related dementias (ADRD) is one of the costliest diseases to society, there is widespread concern that researchers and policymakers are not comprehensively capturing and describing the full scope and magnitude of the socioeconomic burden of ADRD. This review aimed to 1) catalogue the different types of AD-related socioeconomic costs described in the literature; 2) assess the challenges and gaps of existing approaches to measuring these costs; and 3) analyze and discuss the implications for stakeholders including policymakers, healthcare systems, associations, advocacy groups, clinicians, and researchers looking to improve the ability to generate reliable data that can guide evidence-based decision making. A centrally emergent theme from this review is that it is challenging to gauge the true value of policies, programs, or interventions in the ADRD arena given the long-term, progressive nature of the disease, its insidious socioeconomic impact beyond the patient and the formal healthcare system, and the complexities and current deficiencies (in measures and real-world data) in accurately calculating the full costs to society. There is therefore an urgent need for all stakeholders to establish a common understanding of the challenges in evaluating the full cost of ADRD and define approaches that allow us to measure these costs more accurately, with a view to prioritizing evidence-based solutions to mitigate this looming public health crisis.
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Affiliation(s)
| | - Ryan E Wiley
- Shift Health, Toronto, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center, Barcelona, Spain.,Paqual Maragall Foundation, Barcelona, Spain
| | | | - Alireza Atri
- Banner Sun Health Research Institute, Banner Health, Sun City, AZ, USA.,Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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20
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Hawkley L, Zheng B, Hedberg EC, Huisingh-Scheetz M, Waite L. Cognitive limitations in older adults receiving care reduces well-being among spouse caregivers. Psychol Aging 2020; 35:28-40. [PMID: 31985247 PMCID: PMC6989024 DOI: 10.1037/pag0000406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A large number of older adults have physical and/or cognitive challenges and require help to manage everyday activities. Many older adults receive care from a spouse. Over the long term, this has adverse consequences for caregiver health and well-being. Less is known about the outcomes associated with the early transition to becoming a spousal caregiver. Nor is it clear how mild-cognitive decline worsens caregiver outcomes. The present study uses dyadic data from 588 couples in the National Social Life, Health, and Aging Project to compare mental and social well-being in marital partners who became a spousal caregiver versus those who remained noncaregivers or became caregivers for someone other than a spouse between 2010 and 2015. Cognitive ability was assessed using a validated version of the Montreal Cognitive Assessment. Moderated Actor-Partner Independence Models revealed that becoming a caregiver was associated with an increase in perceived stress in both men and women, and an increase in anxiety among men. Partners' cognitive limitations moderated, in a dose-dependent fashion, the association between becoming a caregiver and changes in well-being. Specifically, becoming a caregiver was associated with increased support from friends for wives at lower levels of husband's cognitive ability, and with increased anxiety for husbands at lower levels of wife's cognitive ability. Associations were independent of demographic characteristics and physical limitations. We discuss the value of using population-based samples to study the transition to caregiving and implications for interventions during the early transition to a caregiving role for even modestly cognitively impaired partners. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Louise Hawkley
- Academic Research Centers, National Opinion Research Center (NORC) at the University of Chicago
| | - Boyan Zheng
- Academic Research Centers, National Opinion Research Center (NORC) at the University of Chicago
| | - E C Hedberg
- Academic Research Centers, National Opinion Research Center (NORC) at the University of Chicago
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago
| | - Linda Waite
- Department of Sociology, University of Chicago
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21
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Do D, Schnittker J. Utilization of Medications With Cognitive Impairment Side Effects and the Implications for Older Adults' Cognitive Function. J Aging Health 2020; 32:1165-1177. [PMID: 31904296 DOI: 10.1177/0898264319895842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: Many medications have cognitive impairment, memory loss, amnesia, or dementia as side effects ("cognitive side effects" hereafter), but little is known about trends in the prevalence of these medications or their implications for population-level cognitive impairment. Method: We use data from the National Health and Nutrition Examination Survey (1999-2016) to describe trends in the use of medications with cognitive side effects among adults aged 60+ (N = 16,937) and their implications for cognitive functioning (measured using word learning and recall, animal fluency, and digit symbol substitution assessments). Results: Between 1999 to 2000 and 2015 to 2016, the prevalence of older adults taking one, two, and at least three medications with cognitive side effects increased by 10.2%, 57.3%, and 298.7%, respectively. Compared to non-users, respondents who simultaneously used three or more medications with cognitive side effects scored 0.22 to 0.27 standard deviations lower in word learning and recall (p = .02), digit symbol substitution (p < .01), and the average standardized score of the three assessments (p < .001). Limitation: Dosage of medications associated with cognitive side effects was not measured. Discussion: Concurrent use of medications with cognitive side effects among older adults has increased dramatically over the past two decades. The use of such medications is associated with cognitive impairment and may explain for disparities in cognitive function across subgroups. These findings highlight the need for cognitive screenings among patients who consume medications with cognitive side effects. They also highlight the synergic effects of polypharmacy and potential drug-drug interactions that result in cognitive deficits.
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Affiliation(s)
- Duy Do
- University of Pennsylvania, Philadelphia, USA
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22
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Han Y, Jia J, Li X, Lv Y, Sun X, Wang S, Wang Y, Wang Z, Zhang J, Zhou J, Zhou Y. Expert Consensus on the Care and Management of Patients with Cognitive Impairment in China. Neurosci Bull 2019; 36:307-320. [PMID: 31792911 DOI: 10.1007/s12264-019-00444-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022] Open
Abstract
The cognitive disease consensus was prepared by panels of health and public representatives based on actual clinical practice in Geriatric Departments in Chinese hospitals and a systematic literature review. This consensus reflects the medical knowledge accumulated by those experts and provides information about professional medical care and advice. A multidisciplinary panel of specialists (neurologists, psychiatrists, and nursing specialists) reports an expert consensus on the medical knowledge accumulated from those experts and provides information about professional medical care and advice. The recommendations focus on the care and management of older adults with mild cognitive impairment, the objectives and methods of maintaining cognition and training, the assessments and measures of daily care for patients at different stages of dementia, the assessments and coping strategies for the behavioral and psychological symptoms of dementia, principles and suggestions for an appropriate living environment, arrangements for recreational activities, the care and management of patients with end-stage dementia, and suggestions for addressing stress in caregivers.
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Affiliation(s)
| | - Yuliang Han
- The 305 Hospital of People's Liberation Army, Beijing, 100017, China
| | - Jianjun Jia
- The Second Medical Center, People's Liberation Army (PLA) General Hospital, Beijing, 100853, China.
| | - Xia Li
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, 200030, China
| | - Yang Lv
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 630014, China
| | - Xuan Sun
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Shanshan Wang
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Yongjun Wang
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Zhiwen Wang
- Peking University School of Nursing, Beijing, 100191, China
| | - Jintao Zhang
- The 960th Hospital of People's Liberation Army, Taian, 271000, China
| | - Jiong Zhou
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yuying Zhou
- HuanHu Hospital of Nankai University, Tianjin, 300350, China
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23
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Diagnoseverfahren bei Patienten mit leichten kognitiven Störungen und bei Patienten mit Demenz. DER NERVENARZT 2019; 91:141-147. [DOI: 10.1007/s00115-019-00829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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24
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Connors MH, Seeher K, Teixeira-Pinto A, Woodward M, Ames D, Brodaty H. Mild Cognitive Impairment and Caregiver Burden: A 3-Year-Longitudinal Study. Am J Geriatr Psychiatry 2019; 27:1206-1215. [PMID: 31230914 DOI: 10.1016/j.jagp.2019.05.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) is common, affecting 10%-35% of people over 65, and poses unique challenges for patients and their caregivers. Comparatively little research has examined caregiver burden in this population, with longitudinal research, in particular, lacking. We examined caregiver burden in a sample of people with MCI over 3 years. DESIGN Three-year observational study. SETTING Nine memory clinics in Australia. PARTICIPANTS One-hundred-and-eighty-five people with MCI and their caregivers. MEASUREMENTS Measures of caregiver burden, cognition, function, neuropsychiatric symptoms, driving status, and medication use were completed with patients and their caregivers at regular intervals over a 3-year period. RESULTS Between 21.1% and 29.5% of caregivers reported a clinically significant level of burden over the study. Patients' higher levels of neuropsychiatric symptoms, lower functional ability, and lack of driving ability, and caregivers' employment were associated with greater caregiver burden over time. Caregiver burden did not increase over time when controlling for patient and caregiver characteristics. CONCLUSIONS High levels of caregiver burden are present in a significant proportion of caregivers of people with MCI. Clinical characteristics of patients - including severity of neuropsychiatric symptoms and functional impairment - and the employment status of caregivers predict burden. Such characteristics may help identify caregivers at greater risk of burden to target for intervention.
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Affiliation(s)
- Michael H Connors
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Katrin Seeher
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | | | | | - David Ames
- University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, Australia; National Ageing Research Institute, Melbourne, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia.
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Lara-Ruiz J, Kauzor K, Nakhala M, Banuelos D, Woo E, Apostolova LG, Razani J. The Functional Ability of MCI and Alzheimer's Patients Predicts Caregiver Burden. GEROPSYCH 2019; 32:31-39. [PMID: 31602199 PMCID: PMC6785829 DOI: 10.1024/1662-9647/a000200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sixty patients and their caregivers participated in this study. Patients completed activities of daily living tasks and several neuropsychological tests assessing memory, abstract reasoning, and language. Caregivers completed self-report measures assessing caregiver burden and psychological distress. Results revealed that the mAD caregivers endorsed greater physical burden and feelings of missing out on life compared to MCI caregivers. The mAD caregivers indicated greater depression and anxiety relative to MCI caregivers. Stepwise regression found that fewer patient neuropsychological scores predicted caregiver burden, as compared to patients' daily functioning. Overall, mAD displayed more severe types of burden and psychological distress relative to MCI caregivers and patients' daily functional abilities better predicated caregivers' burden and psychological distress than patients' neuropsychological functioning.
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Affiliation(s)
- Jose Lara-Ruiz
- UT Health Science Center at San Antonio, University of Texas at San
| | | | | | | | - Ellen Woo
- Department of Neuology, University of California, Los Angeles
| | - Liana G Apostolova
- Department of Neurology, Department of Radiology and Department of Medical and Molecular Genetics Indiana University
| | - Jill Razani
- Department of Psychology, California State University, Northridge
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Pine J, Steffen AM. Intergenerational Ambivalence and Dyadic Strain: Understanding Stress in Family Care Partners of Older Adults. Clin Gerontol 2019; 42:90-100. [PMID: 28960145 DOI: 10.1080/07317115.2017.1356894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The present study used Pearlin, Mullan, Semple & Skaff's (1990) caregiving stress process model as a framework to examine the comparative influence of two stressors: (a) intergenerational ambivalence as a unified construct and (b) dyadic strain, which is one isolated component of intergenerational ambivalence. METHODS Participants were 120 women providing healthcare and medication assistance to an earlier generation family member with physical and/or cognitive impairments. RESULTS Hierarchical regression confirmed that intergenerational ambivalence explained perceived stress in family care partners, beyond the variance accounted for by other commonly reported stressors such as length of caregiving experience, memory/cognitive and functional impairments of the care recipient, caregiver overload, family conflict and financial strain. Further analyses revealed that examining dyadic strain apart from intergenerational ambivalence may more accurately explain the influence of ambivalence scores on care partners' perceived stress. CONCLUSIONS AND CLINICAL IMPLICATIONS The comparative influence of dyadic strain versus ambivalence suggests that stress-reducing interventions may benefit from a focus on reducing care partners' experiences of negative strain in the dyadic relationship rather than managing ambivalence.
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Affiliation(s)
- Jillian Pine
- a Psychological Sciences , University of Missouri-St. Louis , St. Louis , Missouri , USA
| | - Ann M Steffen
- b Department of Psychological Services , University of Missouri-St. Louis , St. Louis , Missouri , USA
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27
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Lucero RJ, Fehlberg EA, Patel AGM, Bjarnardottir RI, Williams R, Lee K, Ansell M, Bakken S, Luchsinger JA, Mittelman M. The effects of information and communication technologies on informal caregivers of persons living with dementia: A systematic review. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 5:1-12. [PMID: 30623020 PMCID: PMC6315277 DOI: 10.1016/j.trci.2018.11.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Information and communication technology (ICT) has emerged as promising to support health care consumers, including informal caregivers. This systematic review seeks to evaluate the state of the science of ICT interventions on the health of informal dementia caregivers. Methods We searched PubMed, CINAHL, Web of Science, and PsycINFO using concepts associated with ICT, dementia, and caregiver. Studies were assessed using the Quality Assessment Tool for Quantitative Studies. Results We identified 657 full-text publications. After removal of duplicates and title, abstract, and full-text screening, the quality of 12 studies was assessed. Studies varied in technology, implementation, results, and intervention evaluation. Discussion The methodological quality of the ICT intervention studies among dementia family caregivers was moderate to strong, yet outcome measurement was not uniform. The evidence is strongest for various forms of telephone-based interventions. However, there is a need for research that includes heterogeneous participants based on gender, race, and ethnicity.
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Affiliation(s)
- Robert J Lucero
- Department of Family, Community, and Health Systems Science, University of Florida, College of Nursing, Gainesville, FL, USA
| | - Elizabeth A Fehlberg
- Division of Research on Healthcare Value, Equity, and the Lifespan, RTI International, Raleigh, NC, USA
| | - Aditi G M Patel
- Department of Health Outcomes and Biomedical Informatics, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Ragnhildur I Bjarnardottir
- Department of Family, Community, and Health Systems Science, University of Florida, College of Nursing, Gainesville, FL, USA
| | - Renessa Williams
- Department of Family, Community, and Health Systems Science, University of Florida, College of Nursing, Gainesville, FL, USA
| | - Karis Lee
- University of Central Florida, College of Nursing, Orlando, FL, USA
| | - Margaret Ansell
- Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Suzanne Bakken
- Columbia University, School of Nursing, New York, NY, USA
| | - Jose A Luchsinger
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Mary Mittelman
- Departments of Psychiatry and Rehabilitation Medicine, New York University, Langone Health, New York, NY, USA
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Carlozzi NE, Sherman CW, Angers K, Belanger MP, Austin AM, Ryan KA. Caring for an individual with mild cognitive impairment: a qualitative perspective of health-related quality of life from caregivers. Aging Ment Health 2018; 22:1190-1198. [PMID: 28699777 PMCID: PMC6141353 DOI: 10.1080/13607863.2017.1341468] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Little is known regarding the effect that caring for an individual with Mild Cognitive Impairment (MCI) has on health-related quality of life (HRQOL). We sought to identify the most important aspects of HRQOL related to caring for an individual with MCI. METHODS Six focus groups were conducted with caregivers of individuals with MCI (n = 32). Qualitative frequency analysis was used to analyze the data. RESULTS Findings indicated that caregivers most frequently discussed social health, including changes in social roles and an increased need for social support (51.2% of the total discussion). This was followed by mental health concerns (37.9%) centering on anger/frustration, and a need for patience in the caregiving role, as well as caregiver-specific anxiety. Other topics included physical health (10.0%; including the impact that stress and burden have on medical heath), and caregivers' cognitive health (0.9%; including memory problems in relation to caregiver strain, sleep disruption, and cognitive fatigue). CONCLUSIONS Findings illustrate the multiple domains of HRQOL that are affected in individuals providing care for someone with MCI. Moreover, the findings highlight the need for extending support services to MCI caregivers, a group that is typically not offered support services due to the 'less severe' nature of an MCI diagnosis.
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Affiliation(s)
- Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA, 2800 Plymouth Road, Ann Arbor, MI 48109, 734-763-8917,
| | - Carey W. Sherman
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA, 5067 ISR, Ann Arbor, MI 48109, 734-764-2561,
| | - Kaley Angers
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA, 1 Ohio University, Porter Hall 200, Athens, OH 45701,
| | - Mitchell P. Belanger
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA, 1415 Washington Heights, Ann Arbor, MI 48109,
| | - Amy M. Austin
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA, 2800 Plymouth Road, Ann Arbor, MI 48109, 734-764-0644,
| | - Kelly A. Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA, Plymouth Park Office Center, 2101 Commonwealth Blvd Ste C, Ann Arbor, MI 48105, 800-525-5188,
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Landeiro F, Walsh K, Ghinai I, Mughal S, Nye E, Wace H, Roberts N, Lecomte P, Wittenberg R, Wolstenholme J, Handels R, Roncancio-Diaz E, Potashman MH, Tockhorn-Heidenreich A, Gray AM. Measuring quality of life of people with predementia and dementia and their caregivers: a systematic review protocol. BMJ Open 2018; 8:e019082. [PMID: 29602838 PMCID: PMC5884378 DOI: 10.1136/bmjopen-2017-019082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Dementia is the fastest growing major cause of disability globally and may have a profound impact on the health-related quality of life (HRQoL) of both the patient with dementia and those who care for them. This review aims to systematically identify and synthesise the measurements of HRQoL for people with, and their caregivers across the full spectrum of, dementia from its preceding stage of predementia to end of life. METHODS AND ANALYSIS A systematic literature review was conducted in Medical Literature Analysis and Retrieval System Online , ExcerptaMedicadataBASE, Cochrane Database of Systematic Reviews , Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effect, National Health Service Economic Evaluation Database and PsycINFO between January 1990 and the end of April 2017. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed with the Effective Public Health Practice Project quality assessment tool. HRQoL measurements will be presented separately for people with dementia and caregivers by instrument used and, when possible, HRQoL will be reported by disease type and stage of the disease. Descriptive statistics of the results will be provided. A narrative synthesis of studies will also be provided discussing differences in HRQoL measurements by instrument used to estimate it, type of dementia and disease severity. ETHICS AND DISSEMINATION This systematic literature review is exempt from ethics approval because the work is carried out on published documents. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. They will also contribute to the work developed in the Real World Outcomes across the Alzheimer's disease spectrum for better care: multimodal data access platform (ROADMAP). TRIAL REGISTRATION NUMBER CRD42017071416.
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Affiliation(s)
- Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Katie Walsh
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Isaac Ghinai
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Seher Mughal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elsbeth Nye
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helena Wace
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Pascal Lecomte
- Health Economic Modelling and Methodology, Novartis Pharma AG, Basel, Switzerland
| | - Raphael Wittenberg
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ron Handels
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
- Division of Neurogeriatrics, Department of Neurobiology, Care Science and Society, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Hall AK, Backonja U, Painter I, Cakmak M, Sung M, Lau T, Thompson HJ, Demiris G. Acceptance and perceived usefulness of robots to assist with activities of daily living and healthcare tasks. Assist Technol 2017; 31:133-140. [PMID: 29125804 DOI: 10.1080/10400435.2017.1396565] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
As the number of older adults living with chronic conditions continues to rise, they will require assistance with activities of daily living (ADL) and healthcare tasks to continue living independently in their homes. One proposed solution to assist with the care needs of an aging population and a shrinking healthcare workforce is robotic technology. Using a cross-sectional survey design, we purposively sampled adults (≥18 years old) to assess generational acceptance and perceived usefulness of robots to assist with ADLs, healthcare tasks, and evaluate acceptance of robotic healthcare assistance across different settings. A total of 499 adults (age range [years] 18-98, Mean = 38.7, SD = 22.7) responded to the survey. Significant differences were found among young, middle-aged, and older adults on perceived usefulness of robots for cleaning, escorting them around town, acting as companionship, delivering meals, assessing sadness and calling for help, providing medical advice, taking vital sign assessments, and assisting with personal care (p < 0.05). The majority of younger adults reported that they would like a robot to provide healthcare assistance in the hospital, compared to middle-aged and older adults (p < 0.001). Results of this study can guide the design of robots to assist adults of all ages with useful tasks.
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Affiliation(s)
- Amanda K Hall
- a Department of Biomedical Informatics and Health Education , University of Washington School of Medicine , Seattle , Washington , USA
| | - Uba Backonja
- a Department of Biomedical Informatics and Health Education , University of Washington School of Medicine , Seattle , Washington , USA
| | - Ian Painter
- b Department of Health Services, School of Public Health , University of Washington , Seattle , Washington , USA
| | - Maya Cakmak
- c Science and Engineering Department , University of Washington , Seattle , Washington , USA
| | - Minjung Sung
- d Department of Physics , University of Washington , Seattle , Washington , USA
| | - Timothy Lau
- e Information School , University of Washington , Seattle , Washington , USA
| | - Hilaire J Thompson
- f Department of Biobehavioral Nursing and Health Systems , University of Washington School of Nursing , Seattle , Washington , USA
| | - George Demiris
- a Department of Biomedical Informatics and Health Education , University of Washington School of Medicine , Seattle , Washington , USA
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Morgan S, Kellner S, Gutierrez J, Collins K, Rohl B, Migliore F, Cosentino S, Huey ED, Louis ED, Monin JK. The Experience of Essential Tremor Caregivers: Burden and Its Correlates. Front Neurol 2017; 8:396. [PMID: 28855888 PMCID: PMC5557742 DOI: 10.3389/fneur.2017.00396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/25/2017] [Indexed: 11/15/2022] Open
Abstract
Background Essential tremor (ET) is associated with physical and cognitive impairments, as well as embarrassment, avoidance of social settings, and related difficulties that negatively impact the lives of patients. In similar disease contexts, burden on friends and relatives acting as caregivers has been noted and has well-documented implications. There has been no study examining caregiver burden related to ET. Methods Data were gathered from 55 ET participants enrolled in a clinical study and their caregivers. The Zarit Burden Interview was used to assess caregiver burden. To assess clinical features that may be associated with burden, we collected several variables including the Montreal Cognitive Assessment, self-reported tremor disability, a videotaped neurological examination, questionnaires assessing ET participants’ suffering, caregivers’ perceptions of that suffering, and both caregiver and ET participant depressive symptoms. Spearman’s correlations were performed between caregiver burden and clinical features, and we created a multivariate linear regression model predicting caregiver burden. Results Many ET caregivers provide little to no care and experience little to no burden. However, some caregivers (11%) provide over 25 h of care/week, and 13% experience high levels of burden. Caregivers most commonly provided assistance with writing and cooking. Increased burden was associated with the ET participants’ decreased cognition, more caregiving tasks, more hours/week of caregiving activities, a longer duration of care, more ET participant falls/year, more medications taken by the ET participant, and more depressive symptoms in both the ET participant and the caregiver (all p < 0.05). ET participants’ suffering and their caregivers’ perceptions of suffering were both associated with increased burden. Neither tremor severity score nor self-reported tremor disability score was associated with increased caregiver burden. Using a multivariate linear regression model, we found that caregivers’ increased perception of their partners’ suffering was the best predictor of caregiver burden. Conclusion While not all relatives and friends of ET patients provide extensive care or experience high burden, there is a group reporting high levels of caregiver burden that requires the attention and counseling of clinicians. This burden is associated with primarily non-tremor symptoms of ET and with caregivers’ perception that their partners are suffering.
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Affiliation(s)
- Sarah Morgan
- Department of Neurology, Division of Movement Disorders, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Sarah Kellner
- Department of Neurology, Division of Movement Disorders, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Jesus Gutierrez
- Department of Neurology, Division of Movement Disorders, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Kathleen Collins
- Department of Neurology, Division of Movement Disorders, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Brittany Rohl
- Department of Neurology, Division of Movement Disorders, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Fanny Migliore
- Department of Neurology, Division of Movement Disorders, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Stephanie Cosentino
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Edward D Huey
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Elan D Louis
- Department of Neurology, Division of Movement Disorders, Yale School of Medicine, Yale University, New Haven, CT, United States.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Joan K Monin
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
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Hashimoto A, Matsuoka K, Yasuno F, Takahashi M, Iida J, Jikumaru K, Kishimoto T. Frontal lobe function in elderly patients with Alzheimer's disease and caregiver burden. Psychogeriatrics 2017; 17:267-272. [PMID: 28130804 DOI: 10.1111/psyg.12231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/30/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Abstract
AIM Understanding of the relationship between caregiver burden and the degree of behavioural deficits in patients with Alzheimer's disease (AD) is relatively limited. Therefore, it is worthwhile to examine the correlations between the various relevant factors to improve the efficacy of care for patients with AD. The aim of this study was to investigate the specific contributions of frontal lobe dysfunction in AD patients to caregiver burden, while controlling for other predictor variables. METHODS Participants included 30 pairs of caregivers and patients with AD. The Zarit Burden Interview and Frontal Assessment Battery were used to measure the caregiver burden and patients' frontal lobe function, respectively. To investigate the effects of frontal lobe dysfunction on caregiver burden, hierarchical regression equations with steps incorporating additional predictor variables were fitted. We also performed a correlation analysis between the individual subdomains of the Zarit Burden Interview and the predictor variables. RESULTS Our study suggests that the degree of frontal lobe dysfunction in AD patients predicts their caregiver burden, when other factors of daily functional limitations and neuropsychiatric symptoms are controlled. Daily functional limitations and neuropsychiatric symptoms affected caregivers' psychosocial burden, whereas frontal lobe dysfunction affected caregivers' burden due to the increase in the dependency of the patients. CONCLUSION Our findings indicate that to ameliorate the disabilities of patients and reduce caregiver burden, there is a need for interventions that focus on psychosocial burdens, as shown in previous studies, as well as on excessive dependency due to frontal lobe dysfunction.
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Affiliation(s)
- Akiko Hashimoto
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Kiwamu Matsuoka
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Fumihiko Yasuno
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Masato Takahashi
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Junzo Iida
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Kiyoko Jikumaru
- Department of Psychiatric and Mental Health Nursing, Nara Medical University, Kashihara, Japan
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Sex differences in the prevalence and incidence of mild cognitive impairment: A meta-analysis. Ageing Res Rev 2017; 35:176-199. [PMID: 27771474 DOI: 10.1016/j.arr.2016.09.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/31/2016] [Accepted: 09/26/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE More women have Alzheimer's disease (AD) than men. Understanding sex differences in mild cognitive impairment (MCI) may further knowledge of AD etiology and prevention. We conducted a meta-analysis to examine sex differences in the prevalence and incidence of MCI, which included amnestic and non-amnestic subtypes. METHOD Systematic searches were performed in July 2015 using MEDLINE/PubMed, Scopus, and PsycINFO for population-or community-based studies with MCI data for men and women. Random-effects model were used. RESULTS Fifty-six studies were included. There were no statistically significant sex differences in prevalence or incidence of amnestic MCI. There was a significantly higher prevalence (p=0.038), but not incidence, of non-amnestic MCI among women. There were no sex differences in studies that combined both subtypes of MCI. CONCLUSION The only statistically significant finding emerging from this study was that women have a higher prevalence of non-amnestic MCI. To better understand sex differences in the preclinical stages of dementia, studies must better characterize the etiology of the cognitive impairment.
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Abstract
This report describes the public health impact of Alzheimer's disease, including incidence and prevalence, mortality rates, costs of care, and the overall impact on caregivers and society. It also examines in detail the financial impact of Alzheimer's on families, including annual costs to families and the difficult decisions families must often make to pay those costs. An estimated 5.4 million Americans have Alzheimer's disease. By mid-century, the number of people living with Alzheimer's disease in the United States is projected to grow to 13.8 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops Alzheimer's disease every 66 seconds. By 2050, one new case of Alzheimer's is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year. In 2013, official death certificates recorded 84,767 deaths from Alzheimer's disease, making it the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age ≥ 65 years. Between 2000 and 2013, deaths resulting from stroke, heart disease, and prostate cancer decreased 23%, 14%, and 11%, respectively, whereas deaths from Alzheimer's disease increased 71%. The actual number of deaths to which Alzheimer's disease contributes is likely much larger than the number of deaths from Alzheimer's disease recorded on death certificates. In 2016, an estimated 700,000 Americans age ≥ 65 years will die with Alzheimer's disease, and many of them will die because of the complications caused by Alzheimer's disease. In 2015, more than 15 million family members and other unpaid caregivers provided an estimated 18.1 billion hours of care to people with Alzheimer's and other dementias, a contribution valued at more than $221 billion. Average per-person Medicare payments for services to beneficiaries age ≥ 65 years with Alzheimer's disease and other dementias are more than two and a half times as great as payments for all beneficiaries without these conditions, and Medicaid payments are 19 times as great. Total payments in 2016 for health care, long-term care and hospice services for people age ≥ 65 years with dementia are estimated to be $236 billion. The costs of Alzheimer's care may place a substantial financial burden on families, who often have to take money out of their retirement savings, cut back on buying food, and reduce their own trips to the doctor. In addition, many family members incorrectly believe that Medicare pays for nursing home care and other types of long-term care. Such findings highlight the need for solutions to prevent dementia-related costs from jeopardizing the health and financial security of the families of people with Alzheimer's and other dementias.
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Anxiety and depression symptoms among caregivers of care-recipients with subjective cognitive decline and cognitive impairment. BMC Neurol 2016; 16:191. [PMID: 27716098 PMCID: PMC5048476 DOI: 10.1186/s12883-016-0712-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 09/26/2016] [Indexed: 01/13/2023] Open
Abstract
Background Caregivers of care-recipients with mild cognitive impairment (MCI) or dementia experience high caregiver burden; however, the psychiatric burden of caregivers of care-recipients with subjective cognitive decline (SCD) has not been investigated. We aimed to explore the prevalence of and risk factors for anxiety and depression symptoms among the caregivers of care-recipients with SCD and cognitive impairment. Methods The Hospital Anxiety and Depression Scale (HADS) was used to examine the anxiety and depression symptoms among the caregivers of 343 care-recipients (84 with SCD, 120 with MCI and 139 with dementia) treated at the Memory Clinic of Huashan Hospital in Shanghai, China from May 2012 to October 2014. A logistic regression was used to explore the factors associated with caregiver’s anxiety and depression symptoms. Results In total, 26.5 % of caregivers had anxiety symptoms, and 22.4 % had depression symptoms. Totals of 17.9, 30.0 and 28.8 % of caregivers of care-recipients with SCD, MCI or dementia, respectively, had anxiety symptoms (P = 0.1140), whereas 22.6, 24.2 and 20.9 %, respectively, had depression symptoms (P = 0.8165). The risk factors for caregiver’s anxiety symptoms were increased caregiver age as well as having care-recipients who were male, had higher Cohen Mansfield Agitation Inventory (CMAI) scores, and higher Geriatric Depression Scale (GDS) scores. The risk factors for caregiver’s depression symptoms were increased caregiver age as well as caring for care-recipients with MCI or SCD, those with lower Toronto Empathy Questionnaire (TEQ) scores, and those with higher GDS scores. Conclusions Caregivers of care-recipients with SCD showed the same level of depression symptoms as those of care-recipients with MCI. Caregiver’s depression and anxiety symptoms were associated with their care-recipients’ psychiatric and behavioral syndromes.
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Lingler JH, Terhorst L, Schulz R, Gentry A, Lopez O. Dyadic Analysis of Illness Perceptions Among Persons with Mild Cognitive Impairment and Their Family Members. THE GERONTOLOGIST 2016; 56:886-95. [PMID: 26035901 PMCID: PMC5019043 DOI: 10.1093/geront/gnv029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 02/10/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THIS STUDY To characterize illness perceptions among persons with mild cognitive impairment (PWMCI) and their family care partners, and to examine whether PWMCI's and their family care partners' illness perceptions were associated with their own, as well as the other member of the dyad's, emotional reactions to MCI. DESIGN AND METHODS This cross-sectional study of PWMCI and their family care partners (n = 60 dyads) used patient and relative versions of the Revised Illness Perception Questionnaire (IPQ-R) to assess metacognitive and emotional features of illness perception in MCI along 5 dimensions of perceived: seriousness of potential consequences, personal controllability, timeline, fluctuation (cycling) of symptoms, and illness coherence (clear vs. confusing). RESULTS As compared to family members, PWMCI perceived MCI to be less potentially serious and to be more within their personal control, but dyads otherwise shared similar perceptions of MCI. Among PWMCI, perceived seriousness of the potential consequences of MCI was the only dimension to be significantly correlated with emotional distress. For family members, increased MCI-related emotional distress was significantly associated with perceptions of MCI as potentially serious, permanent, or confusing. A dyadic analysis using APIM showed that MCI-related emotional distress, in both PWMCI and family members, was linked to the PWMCI's perception of the seriousness of MCI. IMPLICATIONS MCI-related education and support should be tailored for both the PWMCI and family member audiences, while acknowledging interdependence of illness perceptions within family units. Tailored information and support will be critical in managing MCI going forward, as illness perceptions are likely key factors on which individuals will plan for the future or base medical decisions.
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Affiliation(s)
- Jennifer H Lingler
- Department of Health and Community Systems, University of Pittsburgh, School of Nursing, Pennsylvania.
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health & Rehabilitation Sciences, Pennsylvania
| | - Richard Schulz
- University Center for Social and Urban Research, University of Pittsburgh, Pennsylvania
| | - Amanda Gentry
- Department of Health and Community Systems, University of Pittsburgh, School of Nursing, Pennsylvania
| | - Oscar Lopez
- Department of Neurology, University of Pittsburgh, School of Medicine, Pennsylvania
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Shaw WS, Hartvigsen J, Woiszwillo MJ, Linton SJ, Reme SE. Psychological Distress in Acute Low Back Pain: A Review of Measurement Scales and Levels of Distress Reported in the First 2 Months After Pain Onset. Arch Phys Med Rehabil 2016; 97:1573-1587. [DOI: 10.1016/j.apmr.2016.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 01/11/2016] [Accepted: 02/04/2016] [Indexed: 11/15/2022]
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Risk Factors of Caregiver Burden Evolution, for Patients With Subjective Cognitive Decline or Neurocognitive Disorders: A Longitudinal Analysis. J Am Med Dir Assoc 2016; 17:1037-1043. [PMID: 27575984 DOI: 10.1016/j.jamda.2016.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/29/2016] [Accepted: 07/06/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND/OBJECTIVES The identification of factors used to predict caregiver burden may help preventive care. This study aimed to assess the relationship between evolution of patients with subjective cognitive decline (SCD) or progressive neurocognitive disorder (NCD) and evolution of caregiver burden. DESIGN Observational, longitudinal study. SETTING The study was conducted in the Clinical and Research Memory Center of the University Hospital of Lyon (France), between the November 1, 2011 and the June 30, 2014, with a maximum follow-up of 30 months. PARTICIPANTS The study population included outpatients with SCD or NCD at all stages, and their informal caregiver. MEASUREMENTS The caregiver burden was assessed during 2 visits of the patients and their caregiver, with the short version of the Zarit Burden Inventory (ZBI). Functional, cognitive performance, and behavioral and psychological symptoms were measured twice, concomitantly with the ZBI, using the Instrumental Activities of Daily Living (IADL) scale, the Mini-Mental State Examination (MMSE), and the Neuropsychiatric Inventory (NPI), respectively. Etiology and stage of the cognitive impairment were collected. RESULTS The population study included 222 patients (mean age at inclusion: 80 years old, 62.9% females), with an average follow-up 12.6 ± 6 months. Proportion of patients with major NCD at the second visit (62.2%) increased compared with inclusion (50.0%). MMSE and IADL decreased between the 2 visits (P < .001), whereas ZBI increased (mean ZBI: 3.2 ± 2 at baseline, mean ZBI: 3.8 ± 2 at follow-up, P < .001). In unadjusted analyses, ZBI tended to be higher for patients whose MMSE decreased of at least 3 points between the visits. ZBI increased over time when IADL decreased (P value for within-patient effect <.001), while it remained stable when the IADL increased. ZBI increased when NPI increased. After mutual adjustment for change of MMSE, IADL, NPI, and etiologies, increase of ZBI over time remained significant when MMSE decreased at least 3 points between baseline and follow-up, when IADL decreased, and when NPI increased of at least 4 points. CONCLUSIONS In a study population of patients with SCD or NCD at all stages, concomitant decrease of cognitive performance, increase of functional impairment, and increase neuropsychiatric symptoms over time were independently associated with increased caregiver burden. The identification of risk factors associated with an increased caregiver burden over time may allow a better evaluation of the impact of specific interventions on cognitive, behavioral, and functional dimensions of NCD on caregivers. TRIAL REGISTRATION ClinicalTrials.govNCT02825732.
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Thyrian JR, Winter P, Eichler T, Reimann M, Wucherer D, Dreier A, Michalowsky B, Zarm K, Hoffmann W. Relatives' burden of caring for people screened positive for dementia in primary care : Results of the DelpHi study. Z Gerontol Geriatr 2016; 50:4-13. [PMID: 27534949 DOI: 10.1007/s00391-016-1119-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/14/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a lack of data describing caregiver burden in primary care where most (informal) caregiving is provided. OBJECTIVE The aims of the paper are to describe the burden of people caring for persons with dementia (PWD) in primary care in multiple dimensions and to analyze factors associated with specific dimensions of caregiver burden. MATERIAL AND METHODS Analyses are based on cross-sectional data of the general physician-based, cluster-randomized, controlled intervention trial DelpHi-MV (Dementia: life and person-centered help). A sample of n = 310 community dwelling PWD screened positive for dementia (DemTect < 9) and their caregivers provided sociodemographic and disease-related data, caregiver burden was assessed in 20 dimensions using the Berlin inventory on relatives' burden in dementia (Berliner Inventar zur Angehörigenbelastung - Demenz, BIZA-D). RESULTS Depending on the dimension of objective burden due to caring, between 71.3 % and 92.3 % of the caregivers reported an objective burden. The average burden ranged from 3.68 to 9.81 (scale range 0-16). The subjective burden due to caring ranged from 0.1 to 1.1 (scale range 0-4). Between 22.6 and 51.6 % of our sample indicated burdens due to perceived conflicts. Logistic regression models associating caregiver burden with specifics of PWD and caregivers reached statistical significance for nearly all dimensions of the BIZA-D. Functional and cognitive impairment were statistically significant factors in 12 out of 20 and 5 out of 20 dimensions, respectively. CONCLUSION This is first quantitative in-depth analysis of burden for caregiver of people screened positive for dementia in primary care in Germany. In general, caregiver burden was perceived as being low to moderate by caregivers and lower than reported from other settings.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
| | - Paula Winter
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Melanie Reimann
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Adina Dreier
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Katja Zarm
- German Center for Neurodegenerative Diseases, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Universitymedicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
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Kelleher M, Tolea MI, Galvin JE. Anosognosia increases caregiver burden in mild cognitive impairment. Int J Geriatr Psychiatry 2016; 31:799-808. [PMID: 26643996 PMCID: PMC8483618 DOI: 10.1002/gps.4394] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our aim is to determine the clinical correlates of impaired insight in patients with mild cognitive impairment (MCI) by examining its impact on cognition, functional status, neuropsychiatric symptoms, and caregiver burden. METHODS The study involved 75 patients with MCI and their caregivers. Patients and caregivers underwent a comprehensive evaluation including the Clinical Dementia Rating, memory tests, and the Functional Assessment Questionnaire. Behavioral symptoms were assessed by the Neuropsychiatric Inventory, caregiver burden by the Zarit Burden Inventory, and insight by comparing self-report on the AD8 dementia screening tool to informant collateral. Patients were asked about their perceptions of their memory, and answers were compared with informants' responses. Patient mood was assessed with the Hospital Anxiety Depression Scale. RESULTS There was a significant difference in AD8 scores among patients who retained versus lacked insight. Zarit Burden Inventory scores showed a significant rise as patient insight declined; the burden appeared greater on spouse versus non-spouse caregivers. Patients with poor insight had significantly worse ratings in Clinical Dementia Rating domains of personal care and judgment, while patients who retained insight had significantly higher depression and anxiety. Insight impairment was associated with worse caregiver mood. CONCLUSIONS Decreased patient awareness for cognitive problems was significantly associated with higher caregiver burden, independent of neuropsychiatric symptoms, functional abilities, and cognition. Personal care, judgment, and problem-solving skills could contribute to caregiver burden. Increased awareness seemed a source of patient depression and anxiety. The research highlights the need to focus on the needs of MCI caregivers and to incorporate psychosocial assessments of caregiver-patient dyads into office visits.
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Affiliation(s)
- Mary Kelleher
- Center for Cognitive Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Magdalena I. Tolea
- Center for Cognitive Neurology, NYU Langone Medical Center, New York, NY, USA,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - James E. Galvin
- Center for Cognitive Neurology, NYU Langone Medical Center, New York, NY, USA,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Lu YYF, Ellis J, Yang Z, Weaver MT, Bakas T, Austrom MG, Haase JE. Satisfaction With a Family-Focused Intervention for Mild Cognitive Impairment Dyads. J Nurs Scholarsh 2016; 48:334-44. [PMID: 27121662 DOI: 10.1111/jnu.12214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE This article describes satisfaction that persons with mild cognitive impairment (PwMCI) and their caregivers had with the Daily Enhancement of Meaningful Activity (DEMA) intervention. METHODS This randomized controlled pilot study compared satisfaction (usefulness, ease of use, and acceptability) with DEMA (n = 17 dyads) to an information support (IS) control group (n = 19 dyads). Six biweekly sessions (two in person and four by telephone) were delivered by trained nurses. Data analysis included descriptive statistics, independent-sample t tests, and content analysis. FINDINGS PwMCI receiving DEMA rated their satisfaction significantly higher (p = .033) than did the control group; there was no difference in satisfaction between caregivers across groups. Qualitative interview data supported the usefulness, ease of use, and acceptability of DEMA for both PwMCI and caregivers. CONCLUSIONS Results documented PwMCI's satisfaction with DEMA as implemented by nurses to support PwMCI-caregiver dyads' engagement in meaningful activity. DEMA may need revision to increase satisfaction for caregivers. CLINICAL RELEVANCE The DEMA intervention was evaluated as useful, easy to use, and acceptable to PwMCI and their caregivers based on positive mean ratings. The study findings provide preliminary support of DEMA as a means to improve quality of life by helping to support patient and caregiver engagement in meaningful activities and problem solving.
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Affiliation(s)
- Yvonne Yueh-Feng Lu
- Associate Professor, Department Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Jennifer Ellis
- Indiana University School of Health and Rehabilitation, Indianapolis, IN, USA
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael T Weaver
- Professor & Associate Dean for Research & Scholarship, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Tamilyn Bakas
- Professor Emeritus, Indiana University School of Nursing, Indianapolis, IN, and Professor and Jane E. Procter Endowed Chair, College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Mary Guerriero Austrom
- Wesley P Martin Professor of Alzheimer's Disease Education, Department of Psychiatry, Associate Dean for Diversity Affairs, Indiana University School of Medicine, and Director, Outreach, Recruitment and Education Core, Indiana Alzheimer Disease Center (IADC), Indianapolis, IN, USA
| | - Joan E Haase
- Holmquist Professor of Pediatric Oncology Nursing, Department Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
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Perez-Ordóñez F, Frías-Osuna A, Romero-Rodríguez Y, Del-Pino-Casado R. Coping strategies and anxiety in caregivers of palliative cancer patients. Eur J Cancer Care (Engl) 2016; 25:600-7. [PMID: 27099167 DOI: 10.1111/ecc.12507] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 01/01/2023]
Abstract
The study purpose was to determine the relationship between coping strategies and anxiety in primary family caregivers of palliative cancer patients. A cross-sectional study was carried out in a Pain and Palliative Care Unit in Spain. Data were collected through interviews from fifty primary family caregivers of palliative cancer patients. Main research variables were: (1) dependent variable: anxiety (subscale of anxiety from Goldberg's scale); (2) independent variable: coping (Brief COPE); (3) control variables: functional capacity and perceived burden. Analyses comprised descriptive statistics, correlation coefficients and multiple linear regression. Anxiety was present in the majority of caregivers surveyed (76%). Anxiety was related to the perception of perceived burden (β = 0.42, P < 0.001), the emotion-focused coping (β = -0.28, P = 0.01) and dysfunctional coping (β = 0.41, P < 0.001), after adjusting for control variables. Thus, emotion-focused coping is negatively associated with anxiety, while dysfunctional coping is positively associated with anxiety. Problem-focused coping is not related to anxiety. Assessment of coping should be done in a systematic way in caregivers of palliative cancer patients.
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Affiliation(s)
- F Perez-Ordóñez
- Unit of Pain and Palliative Care, University Hospital Virgen de las Nieves, Granada
| | - A Frías-Osuna
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Y Romero-Rodríguez
- Unit of Pain and Palliative Care, University Hospital Virgen de las Nieves, Granada
| | - R Del-Pino-Casado
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Jaén, Spain
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and (select 8682 from (select(sleep(5)))aqxj)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- rkdf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 waitfor delay '0:0:5'-- bmov] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- bcpd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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