The oldest carers: A narrative review and synthesis of the experiences of carers aged over 75 years

Mental health and self-rated health of older carers during the COVID-19 pandemic: evidence from England

OBJECTIVES

Older carers play a vital role supporting population health and protecting health and social care systems, yet there has been little research on understanding the effect of the pandemic on this group. In this paper, we investigate caring as a factor contributing to mental and self-rated health.

METHODS

We investigate cross-sectional and longitudinal associations between provision of family care and mental health and wellbeing using longitudinal data from 5,149 members of the English Longitudinal Study of Ageing who responded to Wave 9 (2018/2019) and two COVID-19 sub-studies (June/July 2020; November/December 2020). We use logistic or linear regression models depending on outcome measures, controlling for pre-pandemic socioeconomic, demographic, and health-related variables.

RESULTS

Before the pandemic, 21% of respondents cared for family or friends. Older people caring for someone inside the household mostly continued to provide care during the pandemic, with more than a quarter reporting an increase in the amount of care provided. Co-resident carers were disproportionately female, older, in the lowest wealth quintile, and more likely to report disability and chronic conditions. Both cross-sectional and longitudinal analyses suggest that, compared to those caring for people living outside the household, co-resident carers were significantly more likely to report poorer mental health and self-rated health.

CONCLUSION

The health of older carers worsened disproportionately in the first year of the pandemic, a period also characterised by disruptions to support and closure of respite services. Support for carers' mental and physical health requires greater policy attention, especially in pandemic conditions.

Who cares for the carer? Codesigning a carer health and wellbeing clinic for older care partners of older people in Australia

INTRODUCTION

Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well-being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well-being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context.

METHODS

Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus-based summaries, arriving at a preferred service model.

FINDINGS

This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well-being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia.

PUBLIC CONTRIBUTION

This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions.

The use of Acceptance and Commitment Therapy (ACT) in informal caregivers of people with dementia and other long-term or chronic conditions: A systematic review and conceptual integration

Informal caregivers are the primary source of support for adults with chronic conditions and disabilities. Empirical research highlights chronic stress and other risks of adverse outcomes of caregiving. Acceptance and Commitment Therapy (ACT) is an emerging evidenced-based practice that shows promise in improving an array of outcomes, theoretically by increasing psychological flexibility as the primary process of change. Research has begun to evaluate ACT among informal caregivers of adult populations, and a systematic review is now needed to summarise this evidence base. Electronic searches from five databases, including PubMed, PsycInfo, Embase, CINAHL, and Cochrane Library, yielded an initial 7896 hits, which after screening for inclusion criteria, resulted in 21 clinical trials. Studies were coded to synthesise the feasibility, effectiveness, and quality of evidence. Findings show that ACT was reported to be largely feasible and acceptable. However, the efficacy of ACT was mixed, with a more consistent pattern for informal caregivers of people with dementia. Several methodological quality issues limited the findings. However, theoretical synthesis and preliminary evidence support the promising effect of ACT in subgroups of informal caregivers. Research on the process of change, as well as larger-scale, methodologically rigorous trials, are needed to consolidate these findings.

The Vulnerability of Older Informal Caregivers with Care Needs: Significance of Multidimensional Frailty

OBJECTIVES

To improve our understanding of older informal caregivers' (ICs) health, this paper aimed to compare multidimensional frailty and sociodemographic and economic characteristics between (subgroups of) older ICs and non-caregivers.

METHODS

Using data originating from the Belgian Ageing studies (n = 6054), intergroup differences between older ICs and non-caregivers and between care-dependent and -independent older ICs/non-caregivers were conducted. In addition binary logistic regressions were carried out to determine which variables were related to caregiver status and need of assistance.

RESULTS

Among all respondents, 14.3% were ICs reporting care needs themselves. Informal and non-caregivers with care needs, relative to those without, more often only (partially) completed primary education, were significantly older, more likely to be female and widowed, found it more difficult to make ends meet, and reported higher levels of frailty in each domain. Moreover, environmental and psychological frailty were associated with an increase in the likelihood of reporting need of assistance among older non-caregivers and ICs, respectively.

CONCLUSIONS

This study revealed a particular vulnerable subpopulation of older ICs with care needs.

CLINICAL IMPLICATIONS

It is essential for clinicians to be observant for unrecognized frailty and care needs in older ICs and to develop targeted intervention and prevention strategies.

A Narrative Inquiry Into the Lived Experiences of the Oldest-Old Caregivers and How These Are Shaped by Age and Aging

BACKGROUND AND OBJECTIVES

Oldest-old (80+) spousal caregivers of people with dementia are a fast-growing, highly vulnerable, and poorly understood population. As oldest-old individuals, these caregivers have a high likelihood of experiencing aging-related changes (e.g., frailty and multimorbidity) that result in unique caregiving experiences and support needs. Specialized interventions, sensitive to caregivers' age- and aging-related experiences and needs, may be required to provide adequate support to this group. To date, this group has received limited attention in the literature. Thus, the purpose of this study was to elucidate how age and aging shape the experiences of oldest-old spousal caregivers of people with dementia.

RESEARCH DESIGN AND METHODS

We used a narrative gerontology approach, with 2-3 semistructured interviews with 11 caregivers ages 80-89 (25 interviews in total). We analyzed narrative data thematically.

RESULTS

We identified 4 main themes representing caregivers' perceptions of age or aging: aging as decline, aging as life experience, doings in older age, and older age as perceived by others. Our results illustrate a breadth of age- and aging-related caregiving experiences stemming from each perception.

DISCUSSION AND IMPLICATIONS

This study provides insight into the particular experiences of oldest-old spousal caregivers of people with dementia and provides a foundation for critical future research that will continue to explore the experiences of this unique and fast-growing caregiving group. A more nuanced understanding of this caregiving subgroup is needed to develop age-sensitive health and social care services to meet their needs and, ultimately, improve their well-being and that of their spouses.

The Support Priorities of Older Carers of People Living with Dementia: A Nominal Group Technique Study

The aim of this study was to understand the support priorities of older (65+ years old) carers of people living with dementia. Two nominal group technique focus groups were carried out with older carers of people living with dementia. Twelve carers participated across two focus groups. Participants individually identified support priorities, and through several steps, reached a consensus to produce a ranked list of support priorities. The results consisted of two lists (one list per group), which when combined made up 15 support priorities. These priorities are presented alongside their overall and mean ranking. The authors did not refine these priorities after the focus groups, however, as there was overlap between priorities across the two liststhe results benefited from being themed. These overarching themes consisted of prioritising the carers' holistic needs; having a sense of belonging; support needs to be accessible and timely; support to meet the wellbeing and personhood of the person living with dementia; and understanding and training for the wider community. These results have highlighted support priorities, developed by older carers, that services and organisations can use to better inform the support and services that older carers receive.

Factors associated with being an older rather than younger unpaid carer of adults with a chronic health condition: Results from a population-based cross-sectional survey in South Australia

OBJECTIVE

To examine sociodemographic characteristics and caring experiences associated with being an older rather than younger carer of an adult with a chronic health condition.

METHODS

The population-based cross-sectional South Australian Health Omnibus survey was administered in 2016. Multiple logistic regression was used to identify sociodemographic characteristics and caring experiences associated with being an older (≥65 years) versus younger (<65 years) carer of one or more adult(s) with a chronic health condition.

RESULTS

Of 988 survey respondents who self-identified as carers, 198(20%) were 65 years or over. Characteristics associated with being an older carer included having a partner, having poor physical health, being born outside Australia, have no formal qualification, living in a household of 1-2 people, have an annual household income ≤$60,000, and owning one's home. Carer experiences associated with older carer status included providing ≥40 h of care per week, perceived control over caring, and caring for someone with a neurological condition, whereas caring for someone with a mental illness, reporting poor mental health of their own, and providing personal care were inversely associated.

DISCUSSION

Interventions directed at older carers should consider the increased likelihood that they may be investing large amounts of time in caring for someone with a neurological condition, and be culturally and linguistically diverse.

Variability in perceived burden and health trajectories among older caregivers: a population-based study in Sweden

BACKGROUND

The negative effects of informal caregiving are determined by the characteristics of the caregiver-care receiver dyad and the context of care. In this study, we aimed to identify which subgroups of older informal caregivers (1) experience the greatest subjective burden and (2) incur a faster decline in objective health status.

METHODS

From a total of 3363 older participants in the Swedish National study on Aging and Care in Kungsholmen (SNAC-K), we identified 629 informal caregivers (19.2%, mean age 69.9 years). Limitations to life and perceived burden were self-reported, and objective health status was quantified using the comprehensive clinical and functional Health Assessment Tool (HAT) score (range: 0-10). Ordered logistic regressions and linear mixed models were used to estimate the associations between caregiving-related exposures and subjective outcomes (cross-sectionally) and objective health trajectories (over 12 years), respectively.

RESULTS

Having a dual role (providing and receiving care simultaneously), caring for a spouse, living in the same household as the care receiver and spending more hours on caregiving were associated with more limitations and burden. In addition, having a dual role (β=-0.12, 95% CI -0.23 to -0.02) and caring for a spouse (β=-0.08, 95% CI -0.14 to -0.02) were associated with a faster HAT score decline. Being female and having a poor social network were associated with an exacerbation of the health decline.

CONCLUSIONS

Both the heterogeneity among caregivers and the related contextual factors should be accounted for by policymakers as well as in future research investigating the health impact of informal caregiving.

Factors Impacting User Engagement in Reablement: A Qualitative Study of User, Family Member and Practitioners' Views

Background

The challenges of population aging have fostered the adoption of reablement as a core pillar of older people's care in many developed economies. Aligning with wider literature on the association between "patient" engagement and outcomes, emerging evidence points to the impact user engagement may have on reablement outcomes. To date, existing research on the factors implicated in engagement with reablement is rather limited.

Objective

To identify and describe factors which impact user engagement in reablement from the perspectives of reablement staff, staff in interfacing services, service users and family members.

Sample and Methods

A total of 78 staff were recruited from five sites across England and Wales. Twelve service users and five family members were recruited from three of these sites. Data were collected via focus groups with staff and interviews with service users and families, and subject to thematic analysis.

Results

The data revealed a complex picture of factors potentially impacting user engagement, ranging from user-, family-, and staff-centered factors, the nature of the relationship between staff and users, and aspects of service organization and delivery across referral and intervention pathways. Many are amenable to intervention. As well as offering a more fine-grained understanding of factors reported by previous research, new factors impacting engagement were identified. These included staff morale, equipment provision systems, assessment and reviewing processes, and attention to social reablement needs. Aspects of the wider service context (eg, degree of integration of health and social care) played a role in determining which factors were pertinent.

Conclusion

Findings highlight the complexity of factors influencing engagement with reablement, and the need to ensure features of the wider service context (eg delivery models, referral pathways) do not work against securing and sustaining older people's engagement with reablement.

Applying a dyadic outcomes approach to supporting older carers and care-recipients: A qualitative study of social care professionals in England

There are an estimated 2 million older carers, aged 65 or over, in the UK. Older carers are more likely to care for a co-resident spouse/partner, provide high-intensity support and have their own health problems. The literature suggests that a 'dyadic outcomes approach' to social care (i.e. services and support that seek to understand and improve the quality of life of the older carer and the person they support, individually and together) may be especially beneficial for older carers. Such an approach may be applied in needs assessment and review, service evaluation, planning and delivery, or commissioning. However, there is a paucity of evidence of its effectiveness and feasibility in practice. In this qualitative study, we explored views of social care professionals in England on supporting older carers, as well as the feasibility, potential benefits and challenges of applying a dyadic outcomes approach into policy and practice. Overall, 25 professionals were interviewed between January and July 2021, including social workers, team leads, managers, commissioners and other representatives from local authorities, care providers and carer organisations. Findings indicate that there is limited focus on the specific needs of older carers in practice. Participants recognised the potential benefits of a dyadic approach, including the development of a holistic view that enables an effective response to supporting quality of life, for both carer and care-recipient, and building trust when working to support the caring dyad. Barriers to applying a dyadic approach included data protection and sharing, both within and between organisations; required workforce skills, experience and knowledge; and insufficient and competition-oriented adult social care funding that discourages collaborations between agencies. Despite the potential of the approach to improve the effectiveness of support for older caring dyads, these challenges need to be recognised and addressed if it is to be implemented.

Cutting through the intersections to care for caregivers: Secondary data analysis of a carers support service in Glasgow, Scotland

As the number of people living longer with life-limiting conditions grows, so too does the number of caregivers and the complexity of the caring role. To understand more about the role and how caregivers can be supported, local and national registers have been created that collect data on caregivers. Our objective was to undertake comparative analysis of female and male adult caregiver assessments from a caregiver database created from a carers support service running in Glasgow, Scotland. Assessments were carried out over a 12-month period (01/04/17-29/03/18). We aimed to identify the prevalence of negative consequences of caring through descriptive statistical, comparative analysis. Seven hundred and eighty-three assessments were eligible for inclusion. In our dataset, 69% were female (n = 552), and 29% were male (n = 231). Female caregivers were more likely to be of working age but unemployed (p = 0.03) and experiencing mental ill-health (p = 0.011). Male caregivers were more likely to be retired (p < 0.001), caring for a parent (p = 0.017) and living with heart disease (p = 0.0004), addiction issues (p = 0.013) or diabetes (p = 0.042) than female caregivers. For caregivers using this support service, female and male caregivers experienced, recognised or reported negative impacts from caring on their personal identity, social life, ability to self-care and relationships similarly. Furthermore, a caregiver whose relationships had been negatively impacted was 13.8 times more likely (p > 0.00) to report a reduction in psychological well-being. Sex disaggregated data are an important consideration for caregiver research due to socio-political influences that impact caring roles and expectations. Disaggregating data by sex allow researchers to understand how the caring role differs between subsets and allow for the development of more targeted, sensitive support.

Carers using assistive technology in dementia care at home: a mixed methods study

Introduction

Informal carers support persons with dementia to live at home, even with deteriorating physical, social and cognitive issues. This study aims to examine the experiences and impact of Assistive Technology (AT) on carers, providing care for a person with dementia.

Methods

This is an explanatory sequential mixed methods study. The quantitative phase was an online and postal survey using the Carers Assistive Technology Experience Questionnaire and Short Form-12 (SF-12) questionnaire, with carers of persons with dementia in the UK, who used AT. The qualitative phase involved in-depth telephone interviews with a purposive sample of survey respondents and was analysed using hermeneutic phenomenology to develop, compare and explain the findings of the survey.

Results

The survey included data from 201 carers. Smartphones (45.5%) and tablet computers (45.0%) were the most frequently used AT. Multiple AT were used in the care of persons with dementia predominantly for safety (78.5%), communication (66.0%), and reminders (62.5%). The SF-12 indicated that carers in the 46–65 age group and carers who were not extremely satisfied with AT had lower mental component scores whilst carers who lived with the person with dementia and older carers had lower physical component scores. Twenty-three carers participated in the interviews, and 5 themes with 14 sub-themes were identified. The interviews helped confirm data from the survey on the impact of AT on the physical, mental and social wellbeing of the carers. It helped describe reasons for satisfaction with AT; how AT was used in daily life and strengthened caring relationships and how wider support systems enhanced the care of a person with dementia using AT.

Conclusions

This study describes the use of AT in the real-world context. AT supplements the care provided to people with dementia in the community. Appropriate use, access to AT and abilities of the carer can enhance the support provided through AT to both carers and the person with dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03167-4.

Aged 70 and still a child: complexities, strains and gains of older children caring for their (near) centenarian mothers

BACKGROUND

Longer lives increase the possibility of caring duties, which means that older adults looking after their ageing parents-as well as their own partners-is becoming an increasingly common scenario in developed countries.

OBJECTIVE

To explore the caregiving demands of very old caregiving dyads and the experience of maintaining the identity of a child at such an advanced age.

DESIGN

Qualitative study.

SUBJECTS

15 participants (four males), all aged 70 or over and caring for their mothers, aged between 95 and 105 years old.

METHODS

Semi-structured interviews analysed thematically.

RESULTS

Caregivers are willing to care for their mothers 'until death tears them apart', despite the double strains they face, that is more self-limitations and added care receiver need. On a positive side, they feel 'happy, thankful and proud' for still having their mothers alive. They also describe that maintaining the identity of a child at such an advanced age was somewhat unthought of and unexpected but an important source of pride.

CONCLUSIONS

These findings suggest that these oldest-old caregiving dyads are characterised by a relationship shaped by strong feelings of extended filial love, constituting a family feature that needs further understanding. Findings also underscore the challenges these carers face in dealing with several agents (secondary caregivers) and entities in the care provision.

The Caregiver Support Ratio in Europe: Estimating the Future of Potentially (Un)Available Caregivers

The caregiver support ratio (CSR) is defined as the number of potential caregivers aged 45-64 years, the most common caregiving age range, for each person aged 80+, the subgroup of older adults most at risk of needing long-term services and support. This study uses data from the CENSUS HUB database and from the UN database to calculate the current (last year available: 2011) and projected (2020, 2030, 2040 and 2050) CSR for a group of European countries. Mediterranean countries, France, Belgium, and Sweden presented the lowest CSR (5:1) in 2011. The countries with the highest CSR were Slovakia (9:1) and Ireland, Poland, Cyprus, and Malta (8:1). The estimated CSR is expected to progressively decline from 6:1 (2011) to 2:1 (2050) for all countries. Although differences in the CSR exist between countries, the number of people aged 45-64 who are available to care for each person aged 80+ will decrease uniformly in the coming decades. Cross-national challenges for gerontological social policies and healthcare provision are expected due to the increasing demand for long-term care among the oldest population.

‘The care circle consists of me.’ Loneliness and social isolation for older male spousal care-givers. A qualitative study

Whilst loneliness and social isolation amongst older care-givers are becoming increasingly recognised, little is known about how these concepts impact on specific sub-groups of care-givers, such as older males. In the current study, we aimed to gain a better understanding of the experiences of loneliness and social isolation amongst older spousal male care-givers. Semi-structured interviews were undertaken with 24 participants, caring for a spouse/partner with a long-term chronic condition. After thematic analysis of the data, three themes were identified: dwindling social interactions, loneliness in the spousal relationship, and living with loneliness and social isolation. Study findings suggest that opportunities for social interactions gradually ‘dwindled’ due to a reluctance by older male care-givers to leave their spouse/partner at home alone, to accept offers of help or respite, or to attend social events without their spouse/partner. Consequently, social isolation increased. Feelings of physical and emotional loneliness were evident, and the loss of spousal companionship (such as loss of conversation and shared interests) increased loneliness. Individualised coping strategies were adopted including focusing on moments of positivity, talking to others and using prescribed medication. Findings provide insight into the experience of loneliness and social isolation for many older male spousal care-givers. This may facilitate a better understanding of older male care-givers’ support needs in addressing loneliness and social isolation, and should help to inform the development of targeted support services for this population.

The experience of being a father of a son or daughter with an intellectual disability: Older fathers' perspectives

BACKGROUND

As life expectancy for people with an intellectual disability increases, there is a growing cohort of older father carers. This study aimed to gain a more in-depth understanding of older father carers' experiences of parenting.

METHODS

Semi-structured interviews were conducted with 7 older fathers (M = 63.9 years) and analysed using constructivist grounded theory.

RESULTS

Three conceptual categories were identified. "Wearing different hats: how fathers' sense of identity had altered over the years. "Family comes first": importance placed on the family unit. "Getting on in years": the challenges faced by ageing fathers parenting their son/daughter.

CONCLUSIONS

Fathers re-evaluated their priorities and found a new identity in their parenting role, although they continued to see themselves as secondary carers. Fathers worried about the future as their health declined but drew strength from the benefits they had derived and the challenges that they had overcome to do their best for their son/daughter and their family.

Experiences of oldest-old caregivers whose partner is approaching end-of-life: A mixed-method systematic review and narrative synthesis

Population ageing has rapidly increased the number of people requiring end-of-life care across the globe. Governments have responded by promoting end-of-life in the community. Partly as a consequence, older spouses are frequently providing for their partner's end-of-life care at home, despite potentially facing their own health issues. While there is an emerging literature on young-old caregivers, less is known about spouse carers over 75 who are likely to face specific challenges associated with their advanced age and relationship status. The aim of this review, therefore, is to identify and synthesise the literature concerning the experiences of caregiver's aged 75 and over whose partner is approaching end-of-life. We conducted a mixed-method systematic review and narrative synthesis of the empirical literature published between 1985 and May 2019, identified from six databases: Medline, PsychINFO, Cumulative Index to Nursing and Allied Health Literature, Embase, Sociological Abstracts and Social Service Abstracts. Hand searching and reference checking were also conducted. Gough's Weight of Evidence and Morgan's Feminist Quality Appraisal tool used to determine the quality of papers. From the initial 7819 titles, 10 qualitative studies and 9 quantitative studies were included. We identified three themes: 1) "Embodied impact of care" whereby caring was found to negatively impact carers physical and psychological health, with adverse effects continuing into bereavement; 2) "Caregiving spouse's conceptualisation of their role" in which caregiver's navigated their self and marriage identities in relation to their partner's condition and expectations about gender and place; 3) "Learning to care" which involved learning new skills and ways of coping to remain able to provide care. We identified a recent up-surge in published papers about very old spousal caregivers, which now comprise a small, medium-quality evidence base. This review outlines a range of potential lines of inquiry for future research including further clarification of the impact of caregiving on the likelihood of mortality, the incidence of men and women providing end-of-life care amongst this age group, and the role of anticipatory grief in shaping their perceptions of their relationship and their own longevity.

A Scoping Review of Literature on Sex and Gender Differences Among Dementia Spousal Caregivers

BACKGROUND AND OBJECTIVES

Sex and gender differences among dementia spousal caregivers have been investigated, but never systematically reviewed or synthesized. A synthesis of findings can help facilitate specificity in practice and in health policy development. As a first step towards such a synthesis, this scoping review reports the available evidence, identifies research gaps, and suggests possible directions for future research.

RESEARCH DESIGN AND METHODS

A scoping review methodology was used to identify articles, and to chart and analyze data. Systematic searches for published, empirical studies, with an explicit goal or hypothesis related to sex or gender differences were conducted in seven databases.

RESULTS

Sixty-one studies met inclusion criteria. Most (n = 45) were quantitative, cross-sectional studies. Caregivers included in the studies were generally 61-70 years old, Caucasian, middle-class, and highly educated. The most extensively investigated differences are: depression, burden, objective physical health, and informal supports.

DISCUSSION AND IMPLICATIONS

This scoping review is the first to summarize and critique the research on sex and gender differences that are specific to dementia spousal caregivers. The review can be used by researchers to make decisions regarding future systematic reviews and primary studies. To further strengthen the evidence base, future studies may benefit from including more caregivers of ethnic minorities, using more qualitative, longitudinal, or experimental designs, and focusing on variables needed to inform caregiving models and theories. Overall, this scoping review contributes to furthering gender-sensitive practices and policies that are better tailored to the specific needs of this population.

Spouses' existential loneliness when caring for a frail partner late in life - a hermeneutical approach

Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs.

Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner.

Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other.

Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses’ existential needs visible and to provide support based on their needs.

'What happens when I can no longer care?' Informal carers' concerns about facing their own illness or death: a qualitative focus group study

OBJECTIVES

Older informal carers play an increasingly important role in supporting others with long-term health conditions. This study aimed to explore in depth the perspectives of older carers (70+ years) supporting others with a variety of conditions and disabilities focusing on their thoughts and experiences about when they are unable to continue caring.

DESIGN

Qualitative with four focus groups.

SETTING

Greater London, UK.

PARTICIPANTS

28 older carers (70+ years) recruited from the voluntary sector participated in this study. Most were women and many were spouses caring for partners with age-related conditions such as dementia, arthritis and visual impairment. Nearly a third were parents of adult children with severe physical or cognitive disabilities.

FINDINGS

Thematic analysis identified two main aspects for carers when contemplating the future-when they are unable to care in the short term or long term if they die or can no longer manage. Themes included the following: the impact of age, health conditions and relationships on future planning; anxiety about future care; carers' ambivalence and challenges in broaching the subject; interventions that might help older carers talk about and plan for the future of those they care for.

CONCLUSIONS

Services need to be open to talking about this difficult topic. Our findings suggest that frank discussions about when older carers cannot care and having plans in place, whether these are financial or address other practical issues, makes it easier for all concerned. However, this issue is not easily broached and its timing and ways to access this support must be carefully and individually gauged. Future research with more diverse demographic groups is needed to improve understanding of these carers' perspectives. Research is also needed to develop interventions to support older carers to talk about and plan for the future.

Social life characteristics in relation to adherence to the Mediterranean diet in older adults: findings from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study

OBJECTIVE

The present study aimed to explore the associations between social life and adherence to a healthy dietary pattern, the Mediterranean diet (MD), in a population-representative cohort of older people.

DESIGN

Cross-sectional study. Adherence to the MD was evaluated by an a priori score; tertiles of the score, indicating low, medium and high adherence, were used in the analyses. Social life was assessed by a questionnaire evaluating participation in leisure-time activities and the number of social contacts; primary occupation was also recorded and job characteristics were further explored.

SETTING

Community-dwelling older adults.

PARTICIPANTS

Adults from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study (n 1933; age range 65-99 years).

RESULTS

Each unit increase in the number of social contacts/month and in the frequency score of intellectual, social and physical activities was associated with a 1·6, 6·8, 4·8 and 13·7 % increase in the likelihood of a participant being in the high MD adherence group, respectively. The analysis by age group revealed that younger elderly participants had a 1·4, 8·4 and 11·3 % higher likelihood to be in the high adherence group for each unit increase in the number of social contacts/month and in the frequency score of engagement in intellectual and physical activities, respectively. Similar associations were found for older elderly participants with high compared with low MD adherence, except for the intellectual activities.

CONCLUSIONS

The present results suggest that high MD adherence is associated with good social life, suggesting a clustering of health-promoting lifestyle factors in older adults.

Motivations for being informal carers of people living with dementia: a systematic review of qualitative literature

Background

Informal, often family carers play a vital role in supporting people living with dementia in the community. With ageing populations, the part played by these carers is increasing making it important that we understand what motivates them to take on the role. This systematic review aimed to identify and synthesise qualitative literature describing what motivates people to care for someone with dementia.

Methods

The review followed the Centre for Reviews and Dissemination (CRD) guidelines. Six electronic databases were searched from their first records until August 2018. Synthesis was narrative.

Results

Twenty-six studies fitting the inclusion criteria were identified. Carers described multiple, inter-related motives for caring for someone with dementia. Caring was generally described as a reflection of long-standing family relationships between carers and the care recipients, whether by blood or marriage. Commonly offered motivations included love, reciprocity, filial piety, duty and obligation.

Conclusions

Perhaps the most striking finding was the similarity in these motivations irrespective of gender or relationship with the care recipient. Family relationship and shared history underlay most motivations. Future research should include more longitudinal studies incorporating within study comparisons between different demographic groups to give greater confidence in identifying similarities and differences between demographic groups.

Informal carers' experience of assistive technology use in dementia care at home: a systematic review

BACKGROUND

Dementia is a health and care priority globally. Caring for persons with dementia is a challenge and can lead to negative psychological, physiological and financial consequences for informal carers. Advances in technology have the potential to assist persons with dementia and their carers, through assistive technology devices such as electronic medication dispensers, robotic devices trackers and motion detectors. However, little is known about carers' experience and the impact of these technologies on them. This review aims to investigate the outcomes and experience of carers of persons with dementia, who live at home and use assistive technology.

METHODS

A systematic search in seven databases and manual searches were carried out using pre-defined inclusion and exclusion criteria to identify studies on carers of persons with dementia involving the use of assistive technology. The search identified 56 publications with quantitative, qualitative and mixed-method designs.

RESULTS

The studies reported positive and negative findings and focused on a wide variety of assistive technology devices. There were large differences in the uses of assistive technology, outcome measures used and the quality of studies. Knowledge and acceptance, competence to use and ethical issues when using assistive technology were themes that emerged from the studies. Carers generally appreciated using assistive technology and their experience of use varied.

CONCLUSIONS

The intention of this systematic review is to list and classify the various types of assistive technology used by carers of persons with dementia and explores the positive and negative aspects, knowledge, acceptance and ethical issues in the use of assistive technology by carers of persons with dementia. We recommend the use of a standard and person-centred system of classifying and naming assistive technology devices and systems and for future research efforts in assistive technology to incorporate a family/carer centred model.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO - CRD42017082268 .

A qualitative study of older informal carers' experiences and perceptions of their caring role

BACKGROUND AND AIMS

Unpaid family carers, or caregivers as they are also known, often play a vital role in supporting others with illness or disability living in the community. Overall numbers of carers are growing but numbers of older carers are increasing particularly rapidly as populations age worldwide. However, little research has focused on this important older group. This qualitative study therefore investigated older carers' experiences and their perceptions of their role.

METHODS

Five digitally recorded focus groups with carers from Greater London were undertaken. Recordings were transcribed and analysed thematically.

FINDINGS

Forty-four carers aged 70-87 years participated. Most were female and two-thirds were spouses or partners. Overall, the carers thought their experiences were similar to those of younger adult carers and included both satisfying and challenging facets. However, they thought that some of the more negative aspects of the role were more difficult for older carers. Their own declining physical and emotional health and strength were seen as making it harder to access support and maintain social contacts. Loneliness both outside and within relationships featured prominently and was perceived as especially significant for housebound carers and when caring for someone with dementia. Many of these older carers also worried about the future when they might no longer be able to be a carer due to their own ill-health or death.

CONCLUSIONS

Older carers find their role challenging and future investigations should focus on identifying means of reducing their isolation and supporting them with planning for the future.

Experiences and support needs of older carers: A focus group study of perceptions from the voluntary and statutory sectors

OBJECTIVES

Older informal carers play a vital, growing role in supporting others with long-term health conditions but their support needs and experiences are poorly understood. The aim of this study was to explore the perceptions of volunteers and professionals of the experiences and support needs of older carers (aged 70+ years).

METHODS

Thirty-five volunteers and professionals working with older carers in the voluntary and statutory sectors participated in a series of focus groups in outer London, United Kingdom. Groups were audio recorded, transcribed and subjected to thematic analysis.

FINDINGS

Five main themes were identified. These included participants' perceptions of older carers' ambivalence about asking for support, their multiple losses, often restricted lives, social isolation and loneliness and concerns for their loved ones when they can no longer care. Overall, these themes are similar to those reported for adult carers in general but older carers' experiences were regarded as more challenging primarily because of their pride, attitudes to caring and because of their age, their own health was often declining making the physical aspects of caring and leaving their homes more difficult. Concerns about the future are thought to be particularly important for older carers of adult children with disabilities because they expect to be outlived by their children, although similar concerns were voiced by spouses of partners living with dementia.

CONCLUSIONS

Professionals and volunteers need to consider these additional challenges for older carers. Support with accessing services, for example from the voluntary sector, is important as is future exploration of how to support older carers in planning for the future care for their loved ones is needed.

Carer-related research and knowledge: Findings from a scoping review

The review discussed in this paper provides a unique synthesis of evidence and knowledge about carers. The authors adopted a scoping review methodology drawing on a wide range of material from many different sources published between 2000 and 2016. It offers key insights into what we know and how we know it; reinforces and expands evidence about carers' profile; shows knowledge is uneven, e.g. much is known about working carers, young carers and carers of people with dementia but far less is about older carers or caring for someone with multiple needs. A striking feature of much research is a focus on caring as a set of tasks, rather than a dimension of an, often dyadic, relationship. While there is substantive evidence about the negative impact of caring, the review suggests that links between caring and carer outcomes are neither linear nor inevitable and vary in depth and nature. A reliance on cross-sectional studies using standardised measures is a major weakness of existing research: this approach fails to capture the multidimensionality of the caring role, and the lived experience of the carer. Although research relating to formal support suggests that specific interventions for particular groups of carers may be effective, overall the evidence base is weak. There is a tension between cost-effectiveness and what is valued by carers. Developing robust evaluative models that accommodate this tension, and take account of the dyadic context of caring is a critical challenge. A fundamental deficit of carer-related research is its location in one of two, largely separate, paradigmatic frameworks: the "Gatherers and Evaluators" and the "Conceptualisers and Theorisers." The authors suggest that developing an integrated paradigm that draws on the strengths and methods of existing paradigms, has considerable potential to generate new knowledge and new evidence and extend understanding of care and caring.

Prevalence and predictors of psychosocial problems in informal caregivers of older cancer survivors - A systematic review: Still major gaps in current research

Despite the abundance of studies concerning caring for patients with cancer, less is known about caring for an older cancer survivor (≥65 years). We aimed to systematically gather literature about the psychosocial well-being of caregivers of older cancer survivors and to identify possible risk factors for developing psychosocial problems. Fourteen articles met the following inclusion criteria: articles about (a) cancer, (b) informal caregivers, (c) older survivors and a (d) curative setting. After critical appraisal, nearly all were considered to be of moderate-to-strong quality. This results mainly from the specific study population, the valid and reliable measurement instruments and the appropriate statistical methods used in the articles. Main outcomes were burden, depression, anxiety, self-esteem, distress, communication issues, stress and QoL. For all these outcomes, measurement instruments and timing of measurements vary. Also, the results on studied predictors vary widely or not all of them were described in the reviewed articles. There seems to be a higher prevalence of distress, lower QoL and more anxiety in informal caregivers of older cancer survivors compared with the general population, but all were understudied. Based on these results and more focused future research, specific and qualitative support for this group of caregivers can be developed.

What do we know about older former carers? Key issues and themes

Despite a significant growth in the number older former family carers, they remain largely invisible in carer-related research and literature. To begin to address this deficit, a four-stage literature review was conducted to identify existing knowledge about older former carers. Narrative synthesis of the findings yielded five themes - the concept of 'older former carer', the legacies of caring, influences on the legacies of caring, conceptualising post-caring and support services for older former carers. Critical analysis of these findings suggests that existing evidence has a number of strengths. It highlights the terminological and conceptual confusion in the field, identifies the profound financial and health-related legacies older former carers' experience, the factors which shape these legacies and some of the complexities of bereavement older former carers face. The support needs of older former carers are also illuminated. However, the field is characterised by key weaknesses. The evidence base is fragmented and uneven. In part this reflects lack of definitional consensus and in part the fact that there is much more evidence about some sub-groups, such as carers of relatives admitted to a care home, than others. Methodology-related weaknesses include small sample sizes and a focus on a single, often condition-specific, group of older former carers. An overarching criticism relates to the narrow conceptual/theoretical purview. As post-caring tends to be viewed as one of the final temporal 'stages' of the carer's 'care-giving career', a bifurcatory model of carer/former carer is created, i.e. that a carer actively provides care and a former carer is no longer caring. This constructs being a former carer - namely formerality - as a single fixed state failing to capture its dynamic and shifting nature and constrains the potential of research to generate new knowledge and extend understanding.