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Levenson RW, Chen KH, Levan DT, Chen Y, Newton SL, Paul D, Yee CI, Brown CL, Merrilees J, Moss D, Wang G. Evaluating In-home Assistive Technology for Dementia Caregivers. Clin Gerontol 2024; 47:78-89. [PMID: 36732317 PMCID: PMC10394113 DOI: 10.1080/07317115.2023.2169652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Dementia caregivers (CGs) are at heightened risk for developing problems with anxiety and depression. Much attention has been directed toward developing and deploying interventions designed to protect CG health, but few have been supported by rigorous empirical evidence. Technology-based interventions that are effective, scalable, and do not add greatly to the CG burden are of particular interest. METHODS We conducted a nine-month randomized controlled trial in 63 homes evaluating People Power Caregiver (PPCg), a system of sensors in the home connected to cloud-based software that alerts CGs about worrisome deviations from normal patterns (e.g., falls, wandering). RESULTS CGs in the active condition had significantly less anxiety than those in the control condition at the six-month assessment. Greater anxiety reduction in the active condition at the six-month assessment was associated with greater interaction with PPCg via SMS text messages. There were no differences in anxiety at the three-month or nine-month assessments or in depression at any assessment. CONCLUSIONS PPCg shows promise for reducing anxiety associated with caring for a =person with dementia. CLINICAL IMPLICATIONS Technology-based interventions can help reduce CG anxiety, a major adverse consequence of caregiving that may be difficult to treat due to other demands on caregiver time and energy.
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Tan KP, Ang JK, Koh EBY, Pang NTP, Mat Saher Z. Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4232. [PMID: 36901243 PMCID: PMC10002240 DOI: 10.3390/ijerph20054232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.
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Affiliation(s)
- Khai Pin Tan
- Department of Psychiatry and Mental Health, Hospital Tengku Ampuan Afzan, Kuantan 25100, Pahang, Malaysia
| | - Jin Kiat Ang
- Department of Psychiatry, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Eugene Boon Yau Koh
- Department of Psychiatry, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Nicholas Tze Ping Pang
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
| | - Zanariah Mat Saher
- Department of Psychiatry and Mental Health, Kuala Lumpur General Hospital, Kuala Lumpur 50586, Federal Territory of Kuala Lumpur, Malaysia
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Ma KPK, Saw A. An international systematic review of dementia caregiving interventions for Chinese families. Int J Geriatr Psychiatry 2020; 35:1263-1284. [PMID: 32964577 DOI: 10.1002/gps.5400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/26/2020] [Accepted: 08/08/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Older Asians and Chinese are among the least studied populations in the dementia caregiving literature. This review seeks to critically synthesize the literature on intervention characteristics, components and tailoring strategies for dementia family caregivers in Chinese communities globally. METHODS Five electronic databases (PsychINFO, PubMed, CINAHL, ScienceDirect and Google Scholar) were searched for articles published between 1980 and July 2018. The protocol of this review was registered with PROSPERO (CRD42019132800). RESULTS Twenty-nine unique interventions across 39 papers met inclusion criteria. Results from descriptive and thematic syntheses revealed that most interventions were psychoeducational, CBT-based, multicomponent, structured, and less than a year in duration. Disease education, management of behavioral and psychological symptoms of dementia, stress coping techniques, and referral to community resources were frequently included in interventions. Community-, culture- and language-focused strategies were used to tailor interventions. The most common tailoring strategies were: (a) using community networks and media for outreach and recruitment; (b) making translations and language adaptations to the intervention materials; and (c) focusing on trust and therapeutic alliance. Most interventions produced desired outcomes, particularly reducing caregiver burden and increasing self-efficacy. CONCLUSIONS To our knowledge, this is the first review to date that systematically synthesized the characteristics and tailoring of dementia caregiving interventions for Chinese families globally. Current findings suggest that most interventions are effective, although many only superficially address Chinese culture. Future research should incorporate Chinese values and cross-cultural challenges into caregiving interventions for deep-level adaptations that could potentially be more effective to engage and support Chinese caregivers.
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Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Anne Saw
- Department of Psychology, DePaul University, Chicago, Illinois, USA
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Characteristics of the skills of caregivers of people with dementia: observational study. BMC FAMILY PRACTICE 2020; 21:149. [PMID: 32711454 PMCID: PMC7382844 DOI: 10.1186/s12875-020-01218-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/10/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Due to demographic change within an aging population as announced by the WHO, the involvement of caregivers is essential. Caregivers are required to change their roles within the family unit. Such life transitions experienced by caregivers to people confronted with dementia-type pathologies are sometimes difficult, necessitating the acquisition and development of certain skills. Few studies have shown that caregivers develop specific and essential skills to promote quality care and safety. To characterize their skills, there is a need to identify the abilities, knowledge, resources, obstacles and constraints that contribute to caregivers' transitions. The research question for this study was: What skills do caregivers use to care for their loved one with dementia? METHODS Qualitative observational research based on the epistemological paradigm of socioconstructivist knowledge was conducted. The study was carried out in the canton of Geneva and recruitment was carried out through the participation of the Alzheimer's association and the association for the support and assistance of elderly people in medical and social institutions and their families (APAF). Observations and semi-structured interviews were conducted in the homes of 14 family carers caring for their loved one with dementia. The observations were transcribed on observation grids and the interviews were recorded. Subsequently, according to the classic distinction of Denzin (Interpretive interractionism, 2001), we analysed the observation notes and verbatims, then as recommended by Miles et al. (Qualitative data analysis: a methods sourcebook, 2014), two researchers triangulated the results. RESULTS The results identified five types of situations regularly experienced by caregivers. The study characterized 11 skills that caregivers use to cope with their daily lives. The learning process and maladaptive behaviours in caring for their loved ones with dementia were also highlighted. CONCLUSION This study was able to point out that today's caregivers have developed more competency than their predecessors. This evolution can be explained by new paradigms of care requiring caregivers to be more involved. Although some caregivers need training, others through their experiences can act upon and provide knowledge. To improve the quality and safety of care for people with dementia, this expertise can be the subject of partnerships between caregivers and health care staff.
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Young HM, Bell JF, Whitney RL, Ridberg RA, Reed SC, Vitaliano PP. Social Determinants of Health: Underreported Heterogeneity in Systematic Reviews of Caregiver Interventions. THE GERONTOLOGIST 2020; 60:S14-S28. [PMID: 32057083 PMCID: PMC7019663 DOI: 10.1093/geront/gnz148] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Indexed: 01/08/2023] Open
Abstract
Background and Objectives Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health. Research Design and Methods We examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, we identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis. Results We found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented. Discussion and Implications Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognizing opportunities for common elements and strategies.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Robin L Whitney
- The Valley Foundation School of Nursing, San Jose State University, San Jose, California
| | - Ronit A Ridberg
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Sarah C Reed
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Peter P Vitaliano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
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Stoia DCM, Ștefănuț A, Moldovan R, Hogea L, Giurgi-Oncu C, Bredicean C. Effectiveness of Family Stress-Relief Interventions for Patients with Dementia: A Systematic Evaluation of Literature. Neuropsychiatr Dis Treat 2020; 16:629-635. [PMID: 32184602 PMCID: PMC7061436 DOI: 10.2147/ndt.s241150] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/30/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to evaluate the effectiveness of stress-relief interventions for family members of patients with dementia. DATA SOURCE This analysis includes peer-reviewed articles published between 1989 and 2019, selected from online databases. The introduced keywords were: stress reduction, dementia, or Alzheimer's; program, therapy, intervention, or technique; caregivers. FOR THE SELECTION OF STUDIES We utilized the following inclusion criteria: (1) studies with experimental or quasi-experimental design; (2) study samples that include adult caregivers, who take care of other family members diagnosed with various types of dementia; (3) testing one or more types of psychological inferences presented in the study has been conducted to reduce the stress of patients with dementia; (4) studies written in English and subjected to a peer-review process. RESULTS Stress-reduction interventions for patients with dementia appear to have had a statistically significant effect in most of the identified studies. CONCLUSION On a qualitative level, the results show the effectiveness of both pre-test and follow-up interventions, but these results are to be regarded cautiously, considering the heterogeneity of the evaluation tools used and the small number of studies included.
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Affiliation(s)
| | - Adelina Ștefănuț
- Department of Psychology, West University of Timișoara, Timișoara, Romania
| | - Romina Moldovan
- "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Lavinia Hogea
- Discipline of Psychology, Department of Neuroscience, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Cătălina Giurgi-Oncu
- Discipline of Psychiatry, Department of Neuroscience, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Cristina Bredicean
- Discipline of Psychiatry, Department of Neuroscience, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
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Estrada Fernández ME, Gil Lacruz AI, Gil Lacruz M, Viñas López A. Informal care. European situation and approximation of a reality. Health Policy 2019; 123:1163-1172. [PMID: 31606144 DOI: 10.1016/j.healthpol.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/21/2019] [Accepted: 09/16/2019] [Indexed: 01/29/2023]
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García-Mochón L, Peña-Longobardo LM, del Río-Lozano M, Oliva-Moreno J, Larrañaga-Padilla I, García-Calvente MDM. Determinants of Burden and Satisfaction in Informal Caregivers: Two Sides of the Same Coin? The CUIDAR-SE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224378. [PMID: 31717484 PMCID: PMC6888600 DOI: 10.3390/ijerph16224378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 12/14/2022]
Abstract
The aim of this study conducted in Spain was to analyze and compare burden, severe burden, and satisfaction among informal caregivers in relation to health-related quality of life (HRQoL), type and duration of caregiving, perceived social support, and use of social and health care services. We performed multivariate analyses to identify variables associated with caregiver burden, severe burden, and satisfaction with caregiving, stratified by gender. The results showed that secondary or third-level education, performance of ungratifying tasks, negative coping with caregiving, and more years providing care were associated with greater burden. Variables with protective effect were better perceived health of the person being cared for, better caregiver HRQoL, and high perceived social support. Women were 75% more likely to experience severe burden compared with male caregivers. Burden was reduced by high perceived social support in the case of women and by high caregiver HRQoL in the case of men. The main determinant of caregiving satisfaction for both men and women was perceived social support (OR = 3.11 and OR = 6.64). This study shows the need for interventions that promote gender equality and social support as a means of relieving burden and severe burden and improving satisfaction in both male and female caregivers.
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Affiliation(s)
- Leticia García-Mochón
- Escuela Andaluza de Salud Pública (EASP), 18080 Granada, Spain; (L.G.-M.); (M.d.M.G.-C.)
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, 18012 Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Luz María Peña-Longobardo
- Departamento de Análisis Económico y Seminario de Investigación en Economía y Salud (SIES), Universidad de Castilla-La mancha, 45071 Toledo, Spain; (L.M.P.-L.); (J.O.-M.)
| | - María del Río-Lozano
- Escuela Andaluza de Salud Pública (EASP), 18080 Granada, Spain; (L.G.-M.); (M.d.M.G.-C.)
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, 18012 Granada, Spain
- Correspondence: ; Tel.: +34-958-027-400
| | - Juan Oliva-Moreno
- Departamento de Análisis Económico y Seminario de Investigación en Economía y Salud (SIES), Universidad de Castilla-La mancha, 45071 Toledo, Spain; (L.M.P.-L.); (J.O.-M.)
| | | | - María del Mar García-Calvente
- Escuela Andaluza de Salud Pública (EASP), 18080 Granada, Spain; (L.G.-M.); (M.d.M.G.-C.)
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, 18012 Granada, Spain
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Wilz G, Weise L, Reiter C, Reder M, Machmer A, Soellner R. Intervention Helps Family Caregivers of People With Dementia Attain Own Therapy Goals. Am J Alzheimers Dis Other Demen 2018; 33:301-308. [PMID: 29660988 PMCID: PMC10852505 DOI: 10.1177/1533317518769475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Caregiver intervention studies typically assess whether participants attain general goals (eg, improved mental/physical health) but not their own individual goals. We used goal attainment scaling to evaluate whether participants of a telephone intervention based on cognitive behavioral therapy (CBT) attained their personal goals. We also evaluated treatment compliance and implementation. METHODS A sample of 139 family caregivers of people with dementia received 12 telephone sessions over 6 months. Participants personal goals were specified during the first and second sessions. Participants and therapists assessed goal attainment at the end of the intervention. RESULTS Nearly all participants reported meaningful improvements with regard to their personal goals. Specifically, 20.9% exceeded, 56.4% completely attained, and 21.8% partially attained at least one of their personal goals. There was high agreement between self- and therapist ratings. Treatment compliance and implementation were highly satisfactory. CONCLUSIONS The CBT telephone intervention successfully helped participants attain their personal goals.
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Affiliation(s)
- Gabriele Wilz
- Department of Counseling and Clinical Intervention, Friedrich Schiller University of Jena, Jena, Germany
| | - Lisette Weise
- Department of Counseling and Clinical Intervention, Friedrich Schiller University of Jena, Jena, Germany
| | - Christina Reiter
- Department of Counseling and Clinical Intervention, Friedrich Schiller University of Jena, Jena, Germany
| | - Maren Reder
- Department of Research Methods and Evaluation, University of Hildesheim, Hildesheim, Germany
| | - Anna Machmer
- Department of Research Methods and Evaluation, University of Hildesheim, Hildesheim, Germany
| | - Renate Soellner
- Department of Research Methods and Evaluation, University of Hildesheim, Hildesheim, Germany
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Gilmore-Bykovskyi A, Johnson R, Walljasper L, Block L, Werner N. Underreporting of Gender and Race/Ethnicity Differences in NIH-Funded Dementia Caregiver Support Interventions. Am J Alzheimers Dis Other Demen 2018; 33:145-152. [PMID: 29281895 PMCID: PMC5809319 DOI: 10.1177/1533317517749465] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Women and racial/ethnic minority dementia caregivers have unique caregiving experiences and support needs. To ensure the identification of potentially important differences in outcomes within these groups, the amended National Institutes of Health (NIH) Policy on Inclusion of Women and Minorities mandates reporting by gender and race/ethnicity. The objective of this study was to determine the inclusion and reporting rates among NIH-funded dementia caregiver support interventions. A focused systematic literature review of studies published from 1994 to 2015 located 48 articles meeting inclusion criteria. The majority of studies included women and racial/ethnic minorities; however, 67% did not report results by gender or racial/ethnic group. Acknowledgment of underreporting was more common for race/ethnicity than gender. Our findings suggest limited NIH guideline compliance that may reflect a lack of awareness regarding potential gender disparities in caregiving roles. Ensuring NIH guideline compliance necessitates shared investments from researchers, editors, and reviewers to ensure group differences are systematically identified and reported.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
- Department of Medicine, Division of Geriatrics, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, United States Department of Veterans Affairs, Overlook Terrace, Madison, WI, USA
| | - Rachel Johnson
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
| | - Lily Walljasper
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Laura Block
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Nicole Werner
- Department of Medicine, Division of Geriatrics, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, United States Department of Veterans Affairs, Overlook Terrace, Madison, WI, USA
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Center for Quality and Productivity Improvement, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Living Environments Lab, Wisconsin Institutes for Discovery, University of Wisconsin-Madison, Madison, WI, USA
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Abstract
In this issue of Psychosomatic Medicine, Mausbach and colleagues report that Alzheimer's disease caregivers who engage in more pleasant leisure activities had lower blood pressure for 5 years compared with those who engage in fewer leisure activities. This novel finding suggests that something as simple as taking more walks in the park or more time for reading books could protect the physical health of caregivers. In this editorial, we review possible mechanisms linking pleasant leisure activities with lower blood pressure in caregivers and discuss potential barriers that prevent caregivers from engaging in pleasant leisure activities. One possibility is that caregivers may not give themselves "permission" to take time away from caregiving, or feel guilty or selfish for doing so. Another impediment may be lack of outside assistance or support that would be needed to take time for leisure activities. Primary health care providers may play an important role in helping caregivers overcome these obstacles. In addition, public policy innovations are needed to meet the increasing societal demands on the psychological and medical consequences of caregiver burden.
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Wilz G, Meichsner F, Soellner R. Are psychotherapeutic effects on family caregivers of people with dementia sustainable? Two-year long-term effects of a telephone-based cognitive behavioral intervention. Aging Ment Health 2017; 21:774-781. [PMID: 26954588 DOI: 10.1080/13607863.2016.1156646] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Evaluation of long-term effects of an individualized short-term telephone intervention (seven sessions), based on a comprehensive cognitive behavioral therapy (CBT) approach. The study goal was to evaluate the maintenance of intervention effects regarding well-being, quality of life, and health at two years post treatment. METHOD Participants (n = 105) were (partly) randomized after baseline assessment in a two-arm study (intervention, control group/usual care). Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale (CES-D). Caregivers' physical complaints were measured with the Gießener Beschwerdebogen (GBB-24), and quality of life with the World Health Organization quality of life -BREF (WHOQOL-BREF). Emotional well-being and perceived health status were assessed using thermometer scaling. Data were analyzed by intention-to-treat analyses, including for those who terminated the intervention prematurely but still delivered data, using ANCOVAs. RESULTS Long-term intervention effects were found for emotional well-being (p = 0.019). For the subgroup of caregivers who were still caring at home at follow-up, the intervention led to an increased health status (p = 0.023), fewer bodily complaints (global measure p= 0.014, rheumatic pain p = 0.027, heart trouble p = 0.042), and a higher quality of life (overall p = 0.044 and subscale environment p = 0.030). CONCLUSION The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being, health status, bodily complaints, and quality of life.
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Affiliation(s)
- Gabriele Wilz
- a Department of Clinical Intervention , Friedrich Schiller University Jena , Institute of Psychology , Jena , Germany
| | - Franziska Meichsner
- a Department of Clinical Intervention , Friedrich Schiller University Jena , Institute of Psychology , Jena , Germany
| | - Renate Soellner
- b Department of Methodology and Evaluation Research , University of Hildesheim , Institute of Psychology , Hildesheim , Germany
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13
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Simoneau TL, Kilbourn K, Spradley J, Laudenslager ML. An evidence-based stress management intervention for allogeneic hematopoietic stem cell transplant caregivers: development, feasibility and acceptability. Support Care Cancer 2017; 25:2515-2523. [PMID: 28283805 DOI: 10.1007/s00520-017-3660-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/06/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Caregivers of cancer patients face challenges impacting their physical, psychological and social well-being that need attention in the form of well-designed and tested interventions. We created an eight-session individual stress management intervention for caregivers of allogeneic hematopoietic stem cell transplant (Allo-HSCT) recipients. This intervention, tested by randomized control trial, proved effective in decreasing distress. Herein, we describe the intervention including theoretical framework, development, and elements of fidelity. Implementation challenges along with recommendations for refinement in future studies are discussed with the goal of replication and dissemination. METHODS Seventy-four of 148 caregivers received stress management training following randomization. The intervention occurred during the 100-day post-transplant period when caregivers are required. The training provided integrated cognitive behavioral strategies, psychoeducation, and problem-solving skills building as well as use of a biofeedback device. RESULTS Seventy percent of caregivers completed all eight sessions indicating good acceptability for the in-person intervention; however, most caregivers did not reliably use the biofeedback device. The most common reason for drop-out was their patient becoming gravely ill or patient death. Few caregivers dropped out because of study demands. The need for flexibility in providing intervention sessions was key to retention. CONCLUSION Our evidence-based stress management intervention for Allo-HSCT caregivers was feasible. Variability in acceptability and challenges in implementation are discussed and suggestions for refinement of the intervention are outlined. Dissemination efforts could improve by using alternative methods for providing caregiver support such as telephone or video chat to accommodate caregivers who are unable to attend in-person sessions.
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Affiliation(s)
- Teresa L Simoneau
- VA Eastern Colorado Healthcare System, 1020 Johnson Rd., Golden, CO, 80401, USA.
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Janet Spradley
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark L Laudenslager
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Zegwaard MI, Aartsen MJ, Grypdonck MHF, Cuijpers P. Trust: an essential condition in the application of a caregiver support intervention in nursing practice. BMC Psychiatry 2017; 17:47. [PMID: 28148235 PMCID: PMC5288942 DOI: 10.1186/s12888-017-1209-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 01/18/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The recent policy of deinstitutionalization of health care in Western countries has resulted in a growing number of people - including elderly - with severe mental illness living in the community where they rely on families and others for support in daily living. Caregiving for partners, parents, children, and significant others can be a stressful experience and has been associated with psychosocial problems and poorer physical health. To support caregivers, a new, complex, nurse-led caregiver - centered intervention was developed. The intervention focuses on preventing deterioration in the wellbeing of caregivers. The objective of this study is to obtain a better understanding of the potentials of this new intervention. METHODS We applied an interpretative qualitative field study at two Dutch mental health care institutes. Thirteen caregivers participated in a one-time semi-structured interview. RESULTS From the caregivers' perspective, a trusting relationship between caregivers and the mental health nurse is an essential condition for the depth and hence the effectiveness of the caregiver-centered counseling intervention. In this trusting relationship three overlapping and mutually reinforcing phases were identified (1) phase of engagement, (2) recognition of personal needs and (3) hope and optimism. Each phase encompasses key experiences that enhanced trust in that phase. CONCLUSIONS Collaborative relationships between caregivers and mental health nurses provide a framework in which the mental health nurse can assess and help not only patients but also caregivers to gain insight into their situation and take on new roles and responsibilities in ways that promote their wellbeing.
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Affiliation(s)
- Marian I. Zegwaard
- Altrecht Mental Health Care, Gedachtengang 1, 3705 WH Zeist, The Netherlands
| | - Marja J. Aartsen
- 0000 0000 9151 4445grid.412414.6NOVA Norwegain Social Research, Oslo and Akershus University College, Postbox 4, St. Olavs plass, Oslo, 0130 Norway
| | - Mieke HF Grypdonck
- 0000 0001 2069 7798grid.5342.0University Centre for Nursing and Midwifery, Ghent University, De Pintelaan 185, block 5K3, 9000 Ghent, Belgium
| | - Pim Cuijpers
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Van der Boechorststraat 1, Amsterdam, 1081, BT The Netherlands
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Brown KW, Coogle CL, Wegelin J. A pilot randomized controlled trial of mindfulness-based stress reduction for caregivers of family members with dementia. Aging Ment Health 2016; 20. [PMID: 26211415 PMCID: PMC5070659 DOI: 10.1080/13607863.2015.1065790] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The majority of care for those with Alzheimer's disease and other age-related dementias is provided in the home by family members. To date, there is no consistently effective intervention for reducing the significant stress burden of many family caregivers. The present pilot randomized controlled trial tested the efficacy of an adapted, eight-week mindfulness-based stress reduction (MBSR) program, relative to a near structurally equivalent, standard social support (SS) control condition for reducing caregiver stress and enhancing the care giver-recipient relationship. METHOD Thirty-eight family caregivers were randomized to MBSR or SS, with measures of diurnal salivary cortisol, and perceived stress, mental health, experiential avoidance, caregiver burden, and relationship quality collected pre- and post-intervention and at three-month follow-up. RESULTS MBSR participants reported significantly lower levels of perceived stress and mood disturbance at post-intervention relative to SS participants. At three-month follow-up, participants in both treatment conditions reported improvements on several psychosocial outcomes. At follow-up, there were no condition differences on these outcomes, nor did MBSR and SS participants differ in diurnal cortisol response change over the course of the study. CONCLUSION Both MBSR and SS showed stress reduction effects, and MBSR showed no sustained neuroendocrine and psychosocial advantages over SS. The lack of treatment condition differences could be attributable to active ingredients in both interventions, and to population-specific and design factors.
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Affiliation(s)
| | - Constance L. Coogle
- Virginia Center on Aging, Virginia Commonwealth University 730 East Broad St., 2nd floor, Richmond, VA 23219
| | - Jacob Wegelin
- Department of Biostatistics, Virginia Commonwealth University Medical Center One Capitol Square, Room 732, 830 East Main St., Richmond, VA 23219
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16
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Acceptance and efficacy of interventions for family caregivers of elderly persons with a mental disorder: a meta-analysis. Int Psychogeriatr 2016; 28:1615-29. [PMID: 27268305 DOI: 10.1017/s1041610216000806] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of the present study was to conduct an extended meta-analysis of the efficacy and acceptance of supportive interventions for alleviating depressive symptoms in family caregivers of elderly relatives with a mental disorder, including dementia. The second aim was to analyze intervention characteristics as potential moderators of the efficacy and acceptance of these interventions. METHODS We searched electronic databases for randomized controlled trials (RCTs) published between 2005 and 2014. Thirty-three studies were included in the meta-analysis with a total of 5,980 participants. RESULTS No RCTs that tested interventions for caregivers of elderly patients with mental disorders other than dementia were found. The weighted pooled effect size of the interventions for caregivers of dementia patients was positive but small (standardized mean difference = 0.13; CI0.95 [0.03; 0.23], p = 0.01). Meta-regression analysis revealed higher effect sizes for interventions that were individually customized. Intervention discontinuation rates were low (mean 11%, SD = 6.3) and independent of most intervention characteristics. If the intervention was delivered via telecommunication intervention discontinuation rates tended to be higher (r = -0.39, p = 0.07). CONCLUSIONS Comparative research for caregivers of elderly patients with mental disorders other than dementia is lacking. RCTs of interventions for family caregivers of dementia patients of the last decade show good acceptance among intervention participants, but there is still a need to improve the efficacy of these interventions. Individual customization of intervention components might enhance efficacy. More research is needed on the acceptance of telecommunication interventions for family caregivers.
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Demers L, Mortenson WB, Fuhrer MJ, Jutai JW, Plante M, Mah J, DeRuyter F. Effect of a tailored assistive technology intervention on older adults and their family caregiver: a pragmatic study protocol. BMC Geriatr 2016; 16:103. [PMID: 27177609 PMCID: PMC4866430 DOI: 10.1186/s12877-016-0269-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many older adults with mobility limitations use assistive technology to help them perform daily activities. However, little attention has been paid to the impact on their family caregivers. This neglect produces an incomplete portrayal of the outcomes of assistive technology provision. This paper describes the protocol for a study that examines the impact of a tailored assistive technology intervention that is inclusive of assistance users and their family caregivers. METHODS/DESIGN This research will use a combination of quantitative and qualitative methods. The quantitative portion will be an experimental, single-blinded study in which participants are randomly assigned to either an experimental assistive technology intervention or a standard care group. We will enroll 240 participants (120 dyads) into the study from three Canadian sites. Participants will include older adults (>55) and family caregivers who provide ≥4 h per week of assistance with daily activities and social participation. The primary outcome measure for the older adults will be the Functional Autonomy Measurement System, and the primary outcome measure for the caregivers will be the Caregiver Assistive Technology Outcomes Measure. Qualitative data will be collected through detailed records of the therapists' interventions, as well as through interviews with dyads and therapists following the interventions. Data collection will occur at baseline (T0) with follow-ups at 6 weeks (T1), 22 weeks (T2), and 58 weeks (T3) after baseline evaluation. DISCUSSION The findings from this study will help service providers and clinicians to move forward with assistive technology recommendations that are more attuned to the needs of both older adults with mobility limitations and their family caregivers. Additionally, the study's findings will enhance our conceptual understanding of the spectrum of assistive technology outcomes and set the stage for econometric studies assessing cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01640470 . Registered 11/21/2011.
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Affiliation(s)
- Louise Demers
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, PQ, Canada. .,École de réadaptation, Université de Montréal, Montréal, PQ, Canada.
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Research Program, Vancouver, BC, Canada.,International Collaboration on Repair Discovery, Vancouver, BC, Canada
| | - Marcus J Fuhrer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Michelle Plante
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, PQ, Canada
| | - Jasmine Mah
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Frank DeRuyter
- Department of Surgery/Speech Pathology and Audiology, Duke University, Durham, NC, USA
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18
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Tochimoto S, Kitamura M, Hino S, Kitamura T. Predictors of home discharge among patients hospitalized for behavioural and psychological symptoms of dementia. Psychogeriatrics 2015; 15:248-54. [PMID: 25919794 DOI: 10.1111/psyg.12114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 11/08/2014] [Accepted: 12/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Japanese government recently announced the 'Five-Year Plan for Promotion of Measures Against Dementia (Orange Plan)' to promote people with dementia living in their communities. To achieve this, it is imperative that patients hospitalized with behavioural and psychological symptoms of dementia (BPSD) are helped to return to their own homes. The aim of the present study was to identify predictors of home discharge among patients hospitalized for BPSD. METHODS A single-centre chart review study was conducted on consecutive patients hospitalized from home between April 2006 and March 2011 for the treatment of BPSD. The frequency of discharge back to home was examined in relation to a patient's active behavioural problems and demographics at the time of admission. Diagnoses of dementia were made on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies. RESULTS In all, 391 patients were enrolled in the study. Of these patients, 163 (42%) returned home. Multiple logistic regression analysis identified high Mini-Mental State Examination and Nishimura-style senile activities of daily living scores as significant independent predictors of home discharge. In contrast, living alone and manifestation of aggressiveness at the time of admission were negatively associated with home discharge. CONCLUSIONS Few patients hospitalized for BPSD are discharged home, and this number is affected by a patient's clinical and demographic characteristics at the time of admission. These findings should be considered in designing and implementing optimal management and care strategies for patients with BPSD.
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Affiliation(s)
- Shinnichi Tochimoto
- Department of Neuropsychiatry, Ishikawa Prefectural Takamatsu Hospital, Kahoku City, Japan
| | - Maki Kitamura
- Department of Neuropsychiatry, Ishikawa Prefectural Takamatsu Hospital, Kahoku City, Japan
| | - Shoryoku Hino
- Department of Neuropsychiatry, Ishikawa Prefectural Takamatsu Hospital, Kahoku City, Japan
| | - Tatsuru Kitamura
- Department of Neuropsychiatry, Ishikawa Prefectural Takamatsu Hospital, Kahoku City, Japan
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Penwell-Waines L, Goodworth MCR, Casillas RS, Rahn R, Stepleman L. Perceptions of caregiver distress, health behaviors, and provider health-promoting communication and their relationship to stress management in MS caregivers. HEALTH COMMUNICATION 2015; 31:478-484. [PMID: 26400038 DOI: 10.1080/10410236.2014.967909] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study applied the Stress/Health Model to examine a novel approach for promoting stress management among 67 caregivers of persons with multiple sclerosis, who often face unique caregiving challenges. Hierarchical regressions indicated that caregiver distress (i.e., emotional burden) and engagement in other health-promoting activities (i.e., controlling alcohol use) were the best predictors of caregiver stress management. Communication with the MS care recipient's health provider about caregiver engagement in health-promoting activities was associated with caregiver stress management, but not significantly more so than explained by the other factors (i.e., caregiver distress and engagement in health-promoting behaviors). A more controlled study would be indicated to further explain how to encourage, within the medical setting, caregiver engagement in self-care activities.
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Affiliation(s)
- Lauren Penwell-Waines
- a Department of Psychiatry and Health Behavior , Medical College of Georgia at Georgia Regents University
| | | | | | | | - Lara Stepleman
- a Department of Psychiatry and Health Behavior , Medical College of Georgia at Georgia Regents University
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20
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D'Onofrio G, Sancarlo D, Addante F, Ciccone F, Cascavilla L, Paris F, Picoco M, Nuzzaci C, Elia AC, Greco A, Chiarini R, Panza F, Pilotto A. Caregiver burden characterization in patients with Alzheimer's disease or vascular dementia. Int J Geriatr Psychiatry 2015; 30:891-9. [PMID: 25475248 DOI: 10.1002/gps.4232] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 09/27/2014] [Accepted: 10/15/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To characterize the differences of caregiver burden in patients with Alzheimer's disease (AD) and vascular dementia (VaD) in order to improve the care counselling and management plan. METHODS We included 506 patients consecutively attending the Alzheimer's Evaluation Unit of a Geriatric Unit, evaluated with Mini Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Hamilton Rating Scale for Depression, and Neuropsychiatric Inventory. To all caregivers were administered the Caregiver Burden Inventory (CBI), a 24-item multidimensional questionnaire in which 5 subscales explore 5 dimensions of caregiver burden: (1) CBI-Objective; (2) CBI-Developmental; (3) CBI-Physical; (4) CBI-Social; and (5) CBI-Emotional. RESULTS The present study included, respectively, 253 AD patients and 253 VaD patients. AD patients at baseline showed a significantly higher instruction level (p < .0001), higher grade of cognitive impairment (MMSE, p < .0001), and increased severity stage of dementia (CDR, p < .0001) than VaD patients. AD caregivers, mainly females (p = 0.010), devoted significantly more length of time care (in months, p = 0.010) and time of daily care (in hours, p = 0.011) and showed a significantly higher burden level in CBI-Objective (p = 0.047), CBI-Physical (p < .0001), CBI-Social (p = 0.003), CBI-Emotional (p < .0001), and CBI-total score (p < .0001), than VaD caregivers. In both caregiver groups, a higher presence of spouses and sons (p < .0001) compared to other relatives was observed. AD caregiver burden showed a significant association with sex of caregivers and length of time care in months. CONCLUSIONS AD caregivers showed a higher burden level than VaD caregivers, and this appeared to be associated with sex and length of time care.
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Affiliation(s)
- Grazia D'Onofrio
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Daniele Sancarlo
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Filomena Addante
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Filomena Ciccone
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Leandro Cascavilla
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Francesco Paris
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Michele Picoco
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Claudia Nuzzaci
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Anna Chiara Elia
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Greco
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Ramona Chiarini
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Geriatrics Unit, Azienda ULSS 16, Padova, Italy
| | - Francesco Panza
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alberto Pilotto
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Geriatrics Unit, Azienda ULSS 16, Padova, Italy
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21
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de Labra C, Millán-Calenti JC, Buján A, Núñez-Naveira L, Jensen AM, Peersen MC, Mojs E, Samborski W, Maseda A. Predictors of caregiving satisfaction in informal caregivers of people with dementia. Arch Gerontol Geriatr 2015; 60:380-8. [DOI: 10.1016/j.archger.2015.03.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
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Lund DA, Utz RL, Caserta MS, Wright SD, Llanque SM, Lindfelt C, Shon H, Whitlatch CJ, Montoro-Rodriguez J. Time for living and caring: an intervention to make respite more effective for caregivers. Int J Aging Hum Dev 2015; 79:157-78. [PMID: 25536704 DOI: 10.2190/ag.79.2.d] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article presents the rationale for and description of a promising intervention, Time for Living and Caring (TLC), designed to enhance the effectiveness of respite services for family caregivers. It is guided by the theoretical principles of the Selective Optimization with Compensation (SOC) model, which individually coaches caregivers on how to assess their personal circumstances, identify their greatest needs and preferences, and engage in goal setting and attainment strategies to make better use of their respite time. Focusing on respite activities that match caregivers' unique needs is likely to result in improved well-being. We report on a pilot study examining TLC's feasibility and potential benefits and how caregivers viewed their participation. While additional research is needed to test and refine the intervention, we need to find more creative ways to enhance respite services.
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23
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Martin AC, Keats MR. The impact of yoga on quality of life and psychological distress in caregivers for patients with cancer. Oncol Nurs Forum 2014; 41:257-64. [PMID: 24769590 DOI: 10.1188/14.onf.257-264] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess the effects of a six-week Vinyasa yoga (VY) intervention on caregivers' overall quality of life (QOL) and psychological distress. DESIGN A single-group, pre- and post-test pilot study. SETTING University public recreational facility. SAMPLE 12 informal caregivers for patients with cancer. METHODS Caregivers participated in a six-week VY intervention and completed measures of QOL and psychological distress pre- and postintervention. Program satisfaction was measured with open-ended survey questions. MAIN RESEARCH VARIABLES QOL, psychological distress, and program satisfaction. FINDINGS Significant improvements were found in the mental component score of overall QOL and in overall psychological distress. Several subdomains of QOL and psychological distress were also improved significantly. Open-ended survey question responses revealed participants perceived physical and mental benefit from the intervention, highlighting improvements in flexibility, core and upper-body strength, balance, breathing, and energy. CONCLUSIONS Informal caregivers may benefit mentally and physically from participating in VY. IMPLICATIONS FOR NURSING Caregivers of patients with cancer characterize a group worthy of attention, research, and interventions focusing on their healthcare needs.
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Affiliation(s)
- Andi Céline Martin
- Faculty of Kinesiology and Health Studies, University of Regina, Saskatchewan, Canada
| | - Melanie R Keats
- School of Health and Human Performance and the School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
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Custodio N, Lira D, Herrera-Perez E, Del Prado LN, Parodi J, Guevara-Silva E, Castro-Suarez S, Mar M, Montesinos R, Cortijo P. Informal caregiver burden in middle-income countries: Results from Memory Centers in Lima - Peru. Dement Neuropsychol 2014; 8:376-383. [PMID: 29213929 PMCID: PMC5619187 DOI: 10.1590/s1980-57642014dn84000012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective The aim of this study was to evaluate caregiver burden based on Zarit Burden Interview (ZBI) and depression in caregivers on the Beck Depression Inventory-II (BDI-II). Methods Literate individuals, 18 years or older, who spoke Spanish as their native language were included. Demographic characteristics: Age, sex, education, relationship to person with dementia, length of time caregiving, other sources of help for caring, impact on the household economy, family support, and perception of impaired health; and Clinical data on care-recipients: type of dementia, time since diagnosis, treatment, and Global Deterioration Scale (GDS); the ZBI and BDI-II. Descriptive and analytical statistics were employed to assess caregiver burden and predictors of higher burden in caregivers. Results A total of 92 informal caregivers were evaluated. Regarding care-recipients, 75% were 69 years old or over, 75% had at least one year since diagnosis, 73.9% had Alzheimer's disease, 84.8% received treatment, 75% scored 5 or over on the GDS. For caregivers, 75% were 55.5 years old or over, predominantly female (81.5%), married (83.7%), the spouse of care-recipients (60.87%), had at least 10 years of education (75.0%) and one year of caregiving (75%), reduced entertainment time (90.2%) and self-perception of impaired health (83.7%). Median score on the ZBI was 37.5 (minimum value = 3; and maximum value = 74). The coefficient of BDI was 1.38 (p-value <0.001). Conclusion This sample of Peruvian informal caregivers showed elevated ZBI values. Self-perception of worsened health, repercussion on the family economy and time caregiving were the main determinants of ZBI, although only BDI was a consistent predictor of ZBI.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Clínica Internacional, Lima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Clínica Internacional, Lima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Diseño y Elaboración de Proyectos de Investigación, Lima, Peru.,Centro de Investigación para el Desarrollo Integral y Sostenible (CIDIS), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Liza Nuñez Del Prado
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Clínica Maisson de Sante, Lima, Peru
| | - José Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina Humana, Universidad San Martín de Porres, Lima, Peru
| | | | - Sheila Castro-Suarez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Marcela Mar
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Medicina Física y Rehabilitación, Clínica Internacional, Lima, Peru
| | - Patricia Cortijo
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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George NR, Steffen A. Physical and Mental Health Correlates of Self-Efficacy in Dementia Family Caregivers. J Women Aging 2014; 26:319-31. [DOI: 10.1080/08952841.2014.906873] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Hou RJ, Wong SYS, Yip BHK, Hung ATF, Lo HHM, Chan PHS, Lo CSL, Kwok TCY, Tang WK, Mak WWS, Mercer SW, Ma SH. The effects of mindfulness-based stress reduction program on the mental health of family caregivers: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:45-53. [PMID: 24281411 DOI: 10.1159/000353278] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/27/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Caregivers of people with chronic conditions are more likely than non-caregivers to have depression and emotional problems. Few studies have examined the effectiveness of mindfulness-based stress reduction (MBSR) in improving their mental well-being. METHODS Caregivers of persons with chronic conditions who scored 7 or above in the Caregiver Strain Index were randomly assigned to the 8-week MBSR group (n = 70) or the self-help control group (n = 71). Validated instruments were used to assess the changes in depressive and anxiety symptoms, quality of life, self-efficacy, self-compassion and mindfulness. Assessments were conducted at baseline, post-intervention and at the 3-month follow-up. RESULTS Compared to the participants in the control group, participants in the MBSR group had a significantly greater decrease in depressive symptoms at post-intervention and at 3 months post-intervention (p < 0.01). The improvement in state anxiety symptoms was significantly greater among participants in the MBSR group than those of the control group at post-intervention (p = 0.007), although this difference was not statistically significant at 3 months post-intervention (p = 0.084). There was also a statistically significant larger increase in self-efficacy (controlling negative thoughts; p = 0.041) and mindfulness (p = 0.001) among participants in the MBSR group at the 3-month follow-up compared to the participants in the control group. No statistically significant group effects (MBSR vs. control) were found in perceived stress, quality of life or self-compassion. CONCLUSIONS MBSR appears to be a feasible and acceptable intervention to improve mental health among family caregivers with significant care burden, although further studies that include an active control group are needed to make the findings more conclusive.
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Affiliation(s)
- Rebecca Jing Hou
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Evans BC, Coon DW, Belyea MJ. Worry Among Mexican American Caregivers of Community-Dwelling Elders. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2014; 36:344-365. [PMID: 27228120 DOI: 10.1177/0739986314536684] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This mixed methods, multi-site, National Institute of Nursing Research (NINR)-funded, interdisciplinary, descriptive study aimed to identify expressions of worry in qualitative data obtained from caregiving Mexican American (MA) families assisting older adults. The purpose of this portion of the inquiry was to determine how worry is expressed, what happens to caregivers when they worry, and what adaptive strategies they used. We examined semi-structured interviews completed during six in-home visits with 116 caregivers. We identified 366 worry quotations from 639 primary documents in ATLAS.ti, entered them into matrices, and organized findings under thematic statements. Caregivers expressed cultural and contextual worries, worried about transitions and turning points in care, and identified adaptive strategies. Despite these strategies, worry persisted. Constant worry may be an allied, important aspect of caregiver burden. We need additional longitudinal research to better understand the experience of MA caregivers for older adults and to provide empirically supported interventions, programs, and services that reduce worry.
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Affiliation(s)
- Bronwynne C Evans
- Arizona State University College of Nursing and Health Innovation, Phoenix, USA
| | - David W Coon
- Arizona State University College of Nursing and Health Innovation, Phoenix, USA
| | - Michael J Belyea
- Arizona State University College of Nursing and Health Innovation, Phoenix, USA
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O'Connor MF, Arizmendi BJ, Kaszniak AW. Virtually supportive: a feasibility pilot study of an online support group for dementia caregivers in a 3D virtual environment. J Aging Stud 2014; 30:87-93. [PMID: 24984911 DOI: 10.1016/j.jaging.2014.03.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 03/10/2014] [Accepted: 03/10/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Caregiver support groups effectively reduce stress from caring for someone with dementia. These same demands can prevent participation in a group. The present feasibility study investigated a virtual online caregiver support group to bring the support group into the home. While online groups have been shown to be helpful, submissions to a message board (vs. live conversation) can feel impersonal. METHOD By using avatars, participants interacted via real-time chat in a virtual environment in an 8-week support group. RESULT Data indicated lower levels of perceived stress, depression and loneliness across participants. Importantly, satisfaction reports also indicate that caregivers overcame the barriers to participation, and had a strong sense of the group's presence. DISCUSSION This study provides the framework for an accessible and low cost online support group for a dementia caregiver. The study demonstrates the feasibility of interactive group in a virtual environment for engaging members in meaningful interaction.
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Affiliation(s)
| | - Brian J Arizmendi
- Department of Psychology, University of Arizona, Tucson, AZ 85750, USA
| | - Alfred W Kaszniak
- Department of Psychology, University of Arizona, Tucson, AZ 85750, USA
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Use of the Tailored Activities Program to reduce neuropsychiatric behaviors in dementia: an Australian protocol for a randomized trial to evaluate its effectiveness. Int Psychogeriatr 2014; 26:857-69. [PMID: 24507481 PMCID: PMC4091660 DOI: 10.1017/s1041610214000040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are often considered to be the greatest challenge in dementia care, leading to increased healthcare costs, caregiver burden, and placement into care facilities. With potential for pharmacological intervention to exacerbate behaviors or even lead to mortality, the development and rigorous testing of non-pharmacological interventions is vital. A pilot of the Tailored Activities Program (TAP) for reducing problem behaviors in people with dementia was conducted in the United States with promising results. This randomized trial will investigate the effectiveness of TAP for reducing the burden of BPSD on persons with dementia and family caregivers within an Australian population. This trial will also examine the cost-effectiveness and willingness to pay for TAP compared with a control group. METHODS This randomized trial aims to recruit 180 participant dyads of a person with dementia and their caregivers. Participants will have a diagnosis of dementia, exhibit behaviors as scored by the Neuropsychiatric Inventory, and the caregiver must have at least 7 h per week contact. Participants will be randomly allocated to intervention (TAP) or control (phone-based education sessions) groups, both provided by a trained occupational therapist. Primary outcome measure will be the revised Neuropsychiatric Inventory - Clinician rating scale (NPI-C) to measure BPSD exhibited by the person with dementia. CONCLUSIONS This trial investigates the effectiveness and cost-effectiveness of TAP within an Australian population. Results will address a significant gap in the current Australian community-support base for people living with dementia and their caregivers.
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Hatch DJ, DeHart WB, Norton MC. Subjective stressors moderate effectiveness of a multi-component, multi-site intervention on caregiver depression and burden. Int J Geriatr Psychiatry 2014; 29:406-13. [PMID: 23983230 DOI: 10.1002/gps.4019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 07/22/2013] [Accepted: 07/30/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The present study assessed whether caregiving contextual factors moderated outcomes of a caregiver intervention. METHODS Extant data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II study, a randomized-control trial of a multi-component, multi-site intervention for dementia caregivers was utilized. 498 caregivers {83.1% women; mean [standard deviation (SD)] age = 60.3 (13.1)}, and their care recipients [58.6% women, mean (SD) age = 78.5 (9.6)] were randomly assigned to intervention or control group. Multiple regression was used to regress Center for Epidemiological Studies of Depression Scale (CES-D) and Zarit burden scores on the interaction between group membership and various factors reflecting the caregiving context. RESULTS Lower follow-up CES-D scores in the intervention group were found only for those: in the fourth quartile of baseline CES-D (β = -0.13, p = 0.05; overall interaction p = 0.009), with high Revised Memory and Behavior Problems Checklist (RMBPC) stress (β = -0.16, p = 0.03) and with a home health aide (β = -0.29, p = 0.009). Diminished burden was found in the intervention group only for the following: those in the fourth quartile of baseline burden (β = -0.16, p = 0.01), and in the fourth quartile (β = -0.16, p = 0.05) of Mini Mental State Examination, and with high RMBPC stress (β = -0.18, p = 0.008), with a trend for diminished burden among those with a paid homemaker (β = -0.19, p = 0.075). CONCLUSION Results suggest greater intervention efficacy among caregivers experiencing subjective stress.
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Affiliation(s)
- Daniel J Hatch
- Department of Psychology, Utah State University, Logan, Utah
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31
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Paun O, Farran CJ, Fogg L, Loukissa D, Thomas PE, Hoyem R. A chronic grief intervention for dementia family caregivers in long-term care. West J Nurs Res 2014; 37:6-27. [PMID: 24510968 DOI: 10.1177/0193945914521040] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dementia caregivers do not relinquish their role after placing family members in long-term care and they experience increased chronic grief. The Chronic Grief Management Intervention (CGMI) is a12-week group-based program that uses guided discussion to deliver knowledge of Alzheimer's or a related dementia and teach skills in communication, conflict resolution, and chronic grief management in dementia caregivers who placed their family members in long-term care. Using a quasi-experimental design, 83 caregivers from 15 long-term care facilities received either the CGMI (n = 34) or a comparison condition consisting of two check-in calls (n = 49). In this pilot study, we examined the feasibility of implementing the CGMI and evaluated the effects of the intervention on caregivers' knowledge and skill and their chronic grief and depression. The intervention was feasible and resulted in significant improvement in caregivers' heartfelt sadness and longing at 3 months and a significant drop in their guilt at the 6-month follow-up.
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Affiliation(s)
- Olimpia Paun
- Rush University College of Nursing, Chicago, IL, USA
| | | | - Louis Fogg
- Rush University College of Nursing, Chicago, IL, USA
| | | | | | - Ruby Hoyem
- Rush University College of Nursing, Chicago, IL, USA
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Abstract
BACKGROUND Depression is well documented as a key outcome variable for dementia caregivers; however, guilt has been under-researched, which may be in part due to the lack of an appropriate measure. The Caregiver Guilt Questionnaire (CGQ) was originally developed and piloted with a Spanish population but has not yet been tested in an English-speaking population. METHODS A cross-sectional postal survey was undertaken with a sample of 221 dementia caregivers in the UK, as part of a larger study of dementia caregiver outcome measures. RESULTS The five-factor structure identified for the CGQ in the Spanish sample was replicated in this study. The five factors, "guilt about doing wrong by the care recipient," "guilt about failing to meet the challenges of caregiving," 'guilt over experience of negative emotions in relation to caregiving," "guilt about self-care," and "guilt about neglecting other relatives" accounted for 60% of the variance. Internal consistencies for the whole scale and factors were acceptable, and convergent validity was established with the Zarit Burden Interview guilt factor. A higher score on the CGQ was associated with a higher score on the Center for Epidemiological Studies Depression scale (CES-D) and a new cut-off score of 22 was established, which predicted a clinical score on the CES-D with 80.0% sensitivity and 61.5% specificity. CONCLUSIONS The replication of the five-factor structure suggests that these are relevant themes within the feelings of guilt to both Hispanic and British dementia caregivers. The CGQ has been demonstrated to be a valid measure for use with British dementia caregivers and is likely to be of use in clinical and research settings.
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Mackenzie CS, Wiprzycka UJ, Khatri N, Cheng J. Clinically significant effects of group cognitive behavioral therapy on spouse caregivers' mental health and cognitive functioning: a pilot study. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 56:675-692. [PMID: 24116878 DOI: 10.1080/01634372.2013.834857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of this pilot study was to investigate whether group cognitive behavioral therapy (CBT) resulted in clinically meaningful improvements in caregiver mood, burden, and cognition. We screened 97 caregivers in Toronto, Canada, of whom 25 with DSM-IV disorders began the 13-week CBT intervention, and 12 completed therapy and the 3-month follow-up. Each caregiver experienced clinically significant improvement on at least 2 of the following outcomes: diagnostic criteria, mood, attention, memory, and caregiver burden. Despite effectiveness, the challenges of recruiting distressed caregivers for therapy suggest that CBT might be most useful as part of a stepped care model of treatment.
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Affiliation(s)
- Corey S Mackenzie
- a Department of Psychology , University of Manitoba , Winnipeg , Canada
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Abstract
Elder abuse is a pervasive problem that can have lasting emotional and physical consequences, increasing its victims’ risk of mortality. Healthcare providers are frequently involved in the detection and intervention of elder abuse. Because of the complexity of these cases, applying treatment interventions within an interdisciplinary care team has been recommended to ensure older adults’ safety and welfare. Psychologists in particular are frequently relied upon in these situations because of their expertise in cognitive, psychiatric, and capacity assessment, as well as their ability to intervene in a variety of difficult situations. The following is a report examining the case of Mr. B, who was a victim of elder abuse involving financial exploitation and undue influence. Assessment and treatment interventions were used within the context of an interdisciplinary care team, using a bio-psychosocial approach. A decision-tree model describing the steps to take in assessing and treating financial elder abuse is proposed.
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Affiliation(s)
| | - Stacy S. Wilkins
- VA Greater Los Angeles Healthcare System, CA, USA
- University of California, Los Angeles, USA
| | - Shawkat Dhanani
- VA Greater Los Angeles Healthcare System, CA, USA
- University of California, Los Angeles, USA
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35
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Altpeter M, Gwyther LP, Kennedy SR, Patterson TR, Derence K. From evidence to practice: using the RE-AIM framework to adapt the REACHII caregiver intervention to the community. DEMENTIA 2013; 14:104-13. [PMID: 24339092 DOI: 10.1177/1471301213494499] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article describes how the multi-step mid-course assessment of the REACH II community translation project in North Carolina was guided by the RE-AIM framework, and summarizes adaptations made to enhance the feasibility of adoption and maintenance while at the same time assuring fidelity to program core elements. The two-stage assessment involved both quantitative (survey) and qualitative (discussion group) components. Results indicated a need to focus primarily on tailoring pre-intervention training, streamlining and clarifying intervention guides and tools, targeting specific participant recruitment messages, addressing issues of session length, and clarifying what flexibilities family consultants could exercise in terms of specific session content addressed and other supportive materials used. The use of the RE-AIM framework and the mixed-method process allowed the program staff to thoroughly assess program satisfaction and areas of concern, and ultimately ensured that the family consultants implementing the intervention had a voice in the adaptation process.
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Affiliation(s)
- Mary Altpeter
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA
| | - Lisa P Gwyther
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA
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36
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Towards a Healthier 2020: Advancing Mental Health as a Global Health Priority. Public Health Rev 2013. [DOI: 10.1007/bf03391692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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McGhan G, Loeb SJ, Baney B, Penrod J. End-of-life caregiving: challenges faced by older adult women. J Gerontol Nurs 2013; 39:45-54. [PMID: 23641930 DOI: 10.3928/00989134-20130402-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 08/22/2012] [Indexed: 11/20/2022]
Abstract
In the United States, the number of people older than 60 is expected to triple over the next 50 years, and as the population ages so do family caregivers. Increased levels of depression and low ratings of subjective well-being in caregivers are consistently associated with older age, the spousal relationship, and female caregiver gender. Less well known is the effect care delivery models have on the older adult as his or her spouse approaches the end of life. The purpose of this study was to explore the challenges faced by older adult spousal caregivers providing end-of-life care across different life-limiting illness trajectories in distinctive care delivery models. An instrumental case study using purposive sampling identified the following themes for older spousal caregivers: balancing multiple morbidities; feeling overwhelmed and exhausted; dealing with personal health issues; feeling isolated; and coordinating care. Implications for health care providers are also examined.
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Affiliation(s)
- Gwen McGhan
- School of Nursing, The Pennsylvania State University, University Park, PA, USA.
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Kitamura T, Kitamura M, Hino S, Kurata K. Predictors of time to discharge in patients hospitalized for behavioral and psychological symptoms of dementia. Dement Geriatr Cogn Dis Extra 2013; 3:86-95. [PMID: 23637701 PMCID: PMC3638926 DOI: 10.1159/000350028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS In Japan, more than 50,000 patients with dementia are housed in psychiatric facilities, a trend precipitated by prolonged hospitalizations. This study aimed to determine predictors for the time to discharge in patients hospitalized for behavioral and psychological symptoms of dementia (BPSD). METHODS Medical charts of patients admitted to an acute psychogeriatric ward for treatment of BPSD were reviewed. Cox's proportional hazards model was used to evaluate relationships between active behavioral problems and/or demographics at the time of admission, and the time until favorable discharge (FD), defined as discharge to the patient's own home or a care facility. RESULTS For the 402 study patients included in this study, median time to FD was 101 days. In addition to family and residential factors, multivariate analysis identified higher Mini-Mental State Examination scores as independent clinical predictors for a shorter hospital stay, whereas male gender and combative behavior as the primary reason for hospital admission were predictors for a longer hospital stay. CONCLUSION Clinical characteristics can be predictive of the time to discharge for patients with BPSD. Earlier interventions and enhanced care strategies may be needed for patients with a lower likelihood of FD.
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Affiliation(s)
- Tatsuru Kitamura
- Department of Neuropsychiatry, Ishikawa Prefectural Takamatsu Hospital, Kahoku City, Japan
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39
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Janevic MR, Rosland AM, Wiitala W, Connell CM, Piette JD. Providing support to relatives and friends managing both chronic physical illness and depression: the views of a national sample of U.S. adults. PATIENT EDUCATION AND COUNSELING 2012; 89:191-198. [PMID: 22748757 PMCID: PMC3462282 DOI: 10.1016/j.pec.2012.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/20/2012] [Accepted: 05/18/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To describe how comorbid depression in chronically ill adults affects the willingness of their family and friends to provide them with illness management support. METHODS We identified a national sample of U.S. adults (n = 1027), all of whom had a close relative or friend with a chronic physical illness. We examined whether respondents were less willing to help their relatives/friends with disease management when they reported that these relatives/friends were also diagnosed with depression. RESULTS In multivariate models, the odds of respondents being willing to provide disease-management support doubled when the relative/friend was depressed (adjusted odds ratio (AOR) = 1.99; 95% C.I. = 1.31, 3.02). Respondents were willing to perform an equal number of illness support tasks for relatives/friends with and without depression. However, respondents reported 30% more difficulties discussing health issues (incidence rate ratio (IRR) = 1.30; 95% C.I. = 1.11, 1.53), and 44% more barriers to providing support (IRR = 1.44; 95% C.I. = 1.18, 1.75) to depressed relatives/friends. CONCLUSION U.S. adults are more willing to provide disease-management support for chronically ill relatives/friends with depression. However, helping depressed relatives/friends is also more challenging. PRACTICE IMPLICATIONS By providing resources for potential supporters, health providers could mobilize an important source of disease-management support for patients with chronic illness and depression.
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Affiliation(s)
- Mary R Janevic
- University of Michigan School of Public Health, Center for Managing Chronic Disease and Department of Health Behavior and Health Education, Ann Arbor, MI 48103-2029, USA.
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Ji J, Zöller B, Sundquist K, Sundquist J. Increased risks of coronary heart disease and stroke among spousal caregivers of cancer patients. Circulation 2012; 125:1742-7. [PMID: 22415143 DOI: 10.1161/circulationaha.111.057018] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spousal caregivers of cancer patients suffer psychological and physical burdens that may affect their risk of subsequently developing coronary heart disease and stroke. METHODS AND RESULTS Cancer patients were identified in the Swedish Cancer Registry, and information on their spouses was retrieved from the Swedish Multi-Generation Register. Follow-up of caregivers was performed from the date of the first diagnosis of cancer in their spouses through 2008. Standardized incidence ratios were calculated for spousal caregivers of cancer patients compared with those without an affected spouse. After the cancer diagnosis in wives, the risks of coronary heart disease, ischemic stroke, and hemorrhagic stroke in husbands were 1.13 (95% confidence interval [CI], 1.10-1.16), 1.24 (95% CI, 1.21-1.27), and 1.25 (95% CI, 1.18-1.32), respectively. The corresponding risks in wives with an affected husband were 1.13 (95% CI, 1.10-1.16), 1.29 (95% CI, 1.26-1.32), and 1.27 (95% CI, 1.19-1.34). The increases were consistent over time and were more pronounced if the spouse was affected by a cancer with a high mortality rate, such as pancreatic and lung cancers. CONCLUSIONS Spousal caregivers of cancer patients have increased risks of coronary heart disease and stroke that persist over time. Clinical attention should be paid to spousal caregivers, especially those caring for cancer patients with high mortality rates.
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Affiliation(s)
- Jianguang Ji
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
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Impact of Family Caregiving by Youth on Their Psychological Well-Being: A Latent Trait Analysis. J Behav Health Serv Res 2012; 39:245-56. [DOI: 10.1007/s11414-011-9264-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Smith GR, Williamson GM, Miller LS, Schulz R. Depression and quality of informal care: a longitudinal investigation of caregiving stressors. Psychol Aging 2012; 26:584-91. [PMID: 21417536 DOI: 10.1037/a0022263] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This research examined longitudinal associations between caregiving stressors, caregiver depression, and quality of care. Informal caregivers of elderly care recipients were interviewed at baseline (N = 310) and again one year later (N = 213). Hierarchical regression analyses indicated that increases in caregiving stressors (i.e., caregiver physical health symptoms, caregiver activity restriction, and care recipient controlling and manipulative behavior) were related to increased caregiver depression. In turn, increased caregiver depression and decreased caregiver respectful behavior predicted increases in potentially harmful behavior. These results extend previous cross-sectional findings and indicate that changes in caregiving stressors, caregiver depression, and caregiver respect over time may signal that intervention is warranted in order to forestall or prevent poor quality of care.
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Affiliation(s)
- G Rush Smith
- Department of Psychology, University of Georgia, Athens, GA 30602, USA
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LaVela SL, Johnson BW, Miskevics S, Weaver FM. Impact of a multicomponent support services program on informal caregivers of adults aging with disabilities. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2012; 55:160-174. [PMID: 22324332 DOI: 10.1080/01634372.2011.642472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A multicomponent support services program was implemented for veterans aging with disabilities and their informal caregivers (n = 42 dyads). Caregiver outcomes (satisfaction, physical and mental health status, burden, and benefits) were evaluated before and after program use. Caregivers reported significant improvements in mental health post-program. Caregivers who provided care to individuals with impaired physical health experienced meaningful improvements in burden after the support services were rendered. Supporting caregiver health status through such programs is vital to preserve noninstitutional long-term care for persons aging with disabilities, particularly when care is provided over many years to an individual with physical impairments.
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Affiliation(s)
- Sherri L LaVela
- Center for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Illinois 60141, USA.
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Guerra SRC, Demain SH, Figueiredo DMP, De Sousa LXM. Being a Volunteer: Motivations, Fears, and Benefits of Volunteering in an Intervention Program for People With Dementia and Their Families. ACTIVITIES ADAPTATION & AGING 2012. [DOI: 10.1080/01924788.2011.647538] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Paun O, Farran CJ. Chronic grief management for dementia caregivers in transition: intervention development and implementation. J Gerontol Nurs 2011; 37:28-35. [PMID: 22084962 DOI: 10.3928/00989134-20111103-04] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 08/30/2011] [Indexed: 11/20/2022]
Abstract
Research reveals that Alzheimer's disease (AD) caregivers do not relinquish their role after placing a family member in long-term care. Caregivers report increased emotional upset around the time of placement, with sustained losses over time leading to chronic grief. Chronic grief increases caregivers' risk for depression and suicide. There are no documented interventions designed to decrease caregivers' chronic grief post placement. The Chronic Grief Management Intervention (CGMI) builds on existing evidence to target caregivers' chronic grief in the transition of a family member into long-term care. The intervention is structured into three major components: (a) knowledge, (b) communication and conflict resolution skills, and (c) chronic grief management skills. The 12-week intervention was pilot tested with 34 caregivers for feasibility and preliminary effects on caregiver skill, knowledge, chronic grief, and depression. This article presents a general study description while focusing on the development and implementation of the CGMI.
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Affiliation(s)
- Olimpia Paun
- Rush University College of Nursing, Chicago, IL, USA.
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46
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Wilz G, Schinköthe D, Soellner R. Goal Attainment and Treatment Compliance in a Cognitive-Behavioral Telephone Intervention for Family Caregivers of Persons with Dementia. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2011. [DOI: 10.1024/1662-9647/a000043] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: The evaluation of effective interventions is still needed to prevent family caregivers of persons with dementia from becoming physically or mentally ill. However, in most existing intervention studies, primary outcomes are not well matched to the treatment goals. Method: A randomized controlled trial (N = 229) was conducted to compare a treatment group (CBT), a treated control group, and an untreated control group. In theses analyses we focused on the primary outcome measurement (GAS) as a perceived treatment success as well as treatment compliance and participants’ evaluation. Results: Results showed that 30.1% achieved complete goal attainment, 39.8% partial goal attainment, and 24.1% declared no change (overachievement 2.4%; deterioration 3.6%). Discussion: The intervention can be considered to have been successful.
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Affiliation(s)
- Gabriele Wilz
- Institute of Psychology, Department of Clinical Intervention, Friedrich Schiller University of Jena, Germany
| | - Denise Schinköthe
- Institute of Psychology, Department of Clinical Intervention, Friedrich Schiller University of Jena, Germany
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Abstract
Primary care settings present important opportunities for the detection and management of depression in older adults. In this article, the authors review the common barriers to effective treatment of geriatric depression, identify treatment strategies that can substantially improve the effectiveness of treatment in this setting, and highlight the opportunities for addressing health disparities in geriatric depression care. The importance of engaging and supporting family caregivers of depressed older adults and the 3 strategic areas to improve the treatment of geriatric depression in primary care are also discussed.
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Zegwaard MI, Aartsen MJ, Cuijpers P, Grypdonck MH. Review: a conceptual model of perceived burden of informal caregivers for older persons with a severe functional psychiatric syndrome and concomitant problematic behaviour. J Clin Nurs 2011; 20:2233-58. [PMID: 21332854 DOI: 10.1111/j.1365-2702.2010.03524.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIMS AND OBJECTIVES This literature review aims to delineate the determinants of perceived burden by informal caregivers and provide insight into the interrelatedness between these determinants. BACKGROUND Despite the attention given to the various determinants of perceived burden, their interrelatedness has not been unravelled. Insight into this interrelatedness is mandatory for the development of successful, complex, multivariate interventions to reduce perceived burden of informal caregivers. DESIGN; Systematic review. METHOD Four electronic databases, CINAHL, Embase psychiatry, Medline, Psychinfo and reference lists of selected articles, were searched. Publications between January 1985-2008 were included if they concerned mental illness, burden and care giving. Articles were selected according to predefined inclusion and exclusion criteria. RESULTS The results of mostly descriptive, cross-sectional and univariate research and the more process-oriented results coming from qualitative burden research are organised in a process orientated conceptual scheme or model adapted from the stress-theoretical framework by Lazarus and Folkman. The model indicates that perceived burden must be understood through the individual appraisal of stressors and the availability and use of internal and external resources. Perceived burden is the outcome of multiple, clinically overlapping psychiatric problems, problematic behaviour and functional disabilities. CONCLUSIONS So far, intervention programs to reduce perceived burden of informal caregivers have not devoted much attention to the interrelatedness of the origins of burden. The conceptual model provides an overview of the various determinants of perceived burden and a clear picture of the possible interrelatedness appears. This overview of the most important sources of burden helps to develop a complex, multivariate intervention that is comprehensive, long-term, individually tailored and has the flexibility to meet the dynamics of burden over time. RELEVANCE TO CLINICAL PRACTICE Use of the conceptual model is crucial to professional nursing and the quality of support of informal caregivers.
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Wiprzycka UJ, Mackenzie CS, Khatri N, Cheng JW. Feasibility of Recruiting Spouses With DSM-IV Diagnoses for Caregiver Interventions. J Gerontol B Psychol Sci Soc Sci 2011; 66:302-6. [DOI: 10.1093/geronb/gbr004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chien WT, Lee IY. Randomized controlled trial of a dementia care programme for families of home-resided older people with dementia. J Adv Nurs 2010; 67:774-87. [DOI: 10.1111/j.1365-2648.2010.05537.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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