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van Haeften-van Dijk AM, Meiland FJ, Hattink BJ, Bakker TJ, Dröes RM. A comparison of a community-based dementia support programme and nursing home-based day care: Effects on carer needs, emotional burden and quality of life. DEMENTIA 2020; 19:2836-2856. [PMID: 31315451 DOI: 10.1177/1471301219861767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Within an implementation study, we investigated the effectiveness of a combined community-based day care programme for persons with dementia and their carers versus traditional psychogeriatric nursing home-based day care. The effects on needs, sense of competence, burden and quality of life of the family carers were studied. METHODS A pretest-posttest control group design among family carers of people with dementia who joined community-based day care centres (n = 67) or nursing home-based day care centres (n = 64). RESULTS After six months, family carers using community-based day care more often expressed an unmet need for support regarding psychological distress than carers utilising nursing home-based day care. No effect of community-based day care on sense of competence was found. However, carers with a low sense of competence at baseline using community-based compared to nursing home-based day care became less emotionally burdened by behaviour and mood problems of their relative.Conclusion and discussion: Overall, no added value of community-based day care on needs, sense of competence, burden and quality of life was found. Increased unmet needs on psychological distress may have been caused by the increased awareness of carers participating in the carer programme of community-based day care regarding their own unmet support needs. For carers with a low sense of competence, community-based day care proves to decrease the impact of behaviour and mood problems of their relative. A larger controlled follow-up study is recommended to understand the long-term effects of community-based day care over nursing home-based day care.
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Affiliation(s)
| | - Franka J Meiland
- Department of Psychiatry and Department of General Practice and Elderly Care Medicine, Amsterdam UMC, the Netherlands
| | | | - Ton Jem Bakker
- Rotterdam University of Applied Sciences and Stichting Wetenschap Balans, the Netherlands
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Tough H, Brinkhof MWG, Siegrist J, Fekete C. Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability. Int J Equity Health 2019; 19:3. [PMID: 31892324 PMCID: PMC6938621 DOI: 10.1186/s12939-019-1112-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/13/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Socioeconomic position (SEP) is an important contextual factor in the Stress Process Model of caregiving. However, the basic assumption that low SEP is associated with greater caregiver burden has so far lacked empirical support. The objective of this study was to investigate social inequalities in the caregiver burden among caregiving partners of persons with a physical disability, i.e., spinal cord injury (SCI), applying a dyadic approach. More specifically, we investigated 1) the association of the caregivers' SEP with caregiver burden ('actor effect'); 2) the association of the care-receivers' SEP with caregiver burden ('partner effect'), and 3) potential mediators of the association between SEP and caregiver burden. METHODS Cross-sectional survey data from 118 couples of persons with SCI and their partners living in Switzerland was used. We firstly employed logistic regression to investigate the actor and partner effects of SEP on objective (hours of caregiving) and subjective caregiver burden (Zarit Burden Interview). We additionally used structural equation modelling to explore whether unfulfilled support needs, psychosocial resources and the care-receivers health status mediated the association between SEP and caregiver burden. SEP was operationalized by household income, education, subjective social position, financial strain and home ownership. RESULTS We observed a consistent trend towards higher objective and subjective burden in lower SEP groups. Caregivers with higher subjective social positon and home ownership indicated lower subjective burden, and caregivers with higher education and absence of financial strain reported lower objective burden. Further evidence suggested a partner effect of SEP on caregiver burden, whereby objective caregiver burden was reduced in couples where the care-receiver had a higher educational level. The negative association between SEP and subjective burden was partially mediated by the unfulfilled support needs and deprived psychological resources of the caregiver, and the poor health status of the care-receiver. Similar mediation effects were not supported for objective burden. CONCLUSIONS Our study, in the context of SCI, provides support for the contextual role of SEP in the Stress Process Model of caregiving. To reduce subjective caregiver burden, policy programs may target the strengthening of psychosocial resources, or the improvement of access to support services for caregivers with low SEP.
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Affiliation(s)
- Hannah Tough
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Johannes Siegrist
- Senior Professorship 'Work Stress Research', Faculty of Medicine, University of Düsseldorf, Life-Science-Center, Merowingerplatz 1A, 40225, Düsseldorf, Germany
| | - Christine Fekete
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.
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Meyer OL, Liu X, Nguyen TN, Hinton L, Tancredi D. Psychological Distress of Ethnically Diverse Adult Caregivers in the California Health Interview Survey. J Immigr Minor Health 2017; 20:784-791. [PMID: 28748300 DOI: 10.1007/s10903-017-0634-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined factors associated with psychological distress for culturally diverse family caregivers using a population-based sample. Data were analyzed from the 6634 caregivers of adults (i.e. elderly as well as non-elderly) who self-reported as non-Hispanic White, Mexican, Chinese, or Vietnamese in the 2009 California Health Interview Survey. Simple and multiple regression analyses were conducted to assess the potential influence of race/ethnicity, caregiving context, and social contextual variables on psychological distress. Analyses that included moderators showed that while more education was associated with less distress for White caregivers, it was associated with more distress for Vietnamese and Chinese caregivers. Identifying the caregiving and contextual variables associated with psychological distress is critical for tailoring interventions towards those who need the most help-in this case, possibly less educated White caregivers and more educated Asian American caregivers.
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Affiliation(s)
- Oanh L Meyer
- Department of Neurology, University of California, Davis, School of Medicine, 4860 Y Street, Sacramento, CA, 95817, USA.
| | - Xiaoyan Liu
- University of California, Davis, Biostatistics, Davis, CA, USA
| | - Thuc-Nhi Nguyen
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Daniel Tancredi
- Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, CA, USA
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Hamid AARM, Musa SA. The mediating effects of coping strategies on the relationship between secondary traumatic stress and burnout in professional caregivers in the UAE. J Ment Health 2016; 26:28-35. [PMID: 27929700 DOI: 10.1080/09638237.2016.1244714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Professional caregivers dealing with traumatized victims or mental health clients are at increased risk for developing the same symptoms as persons who are exposed directly to the trauma. AIMS This research was aimed at examining the relationship between secondary traumatic stress, burnout and coping strategies in 502 professional caregivers who work in schools, hospitals, charity institutes and welfare centers in the United Arab Emirates (UAE). A further aim was to test the mediating effect of coping on the relationship between burnout and secondary traumatic stress. METHODS Measures used in this study were the Professional Quality of Life Questionnaire (ProQOL), The General Health Questionnaire (GHQ-28), The Maslach Burnout Inventory: Human Services Survey (MBI-HSS) and Endler and Parker's Coping Inventory. RESULTS Task-focused coping, personal accomplishment and compassion satisfaction were negatively associated with secondary traumatic stress. Burnout, emotion-focused and distraction coping were positively related to secondary traumatic stress. Coping partially mediated the relationship between burnout and secondary traumatic stress. There were also significant gender differences in depersonalization and distraction coping. CONCLUSIONS Efforts need to focus on improvement of caregivers' work environments, enhancing their coping skills and professional development.
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Affiliation(s)
- Abdalla A R M Hamid
- a Department of Psychology & Counseling , United Arab Emirates University , Al Ain , United Arab Emirates and
| | - Saif A Musa
- b Department of Sociology and Social Work , Sultan Qaboos University , Masqat , Sultanate of Oman
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Abstract
Context Family members of liver transplant patients continue caregiving activities for a lengthy period after transplantation. Objectives To assess the effect of stress-related factors on psychological distress and perceived health of family caregivers of liver transplant recipients. Setting and Participants Twenty-four caregivers of liver transplant recipients treated at a liver unit serving the northern part of Israel. Main Outcome Measures Pearlin's caregiving stress questionnaire was administered to assess the subscales of patients' symptoms as perceived by caregivers, caregiving activities, perceived overload, relational deprivation, personal gain, and social support; also, a depression questionnaire and a perceived caregivers' health questionnaire were administered to participants. Results Caregivers experienced considerable caregiving overload. Women reported performing more caregiving activities, higher perceived overload, and higher level of depression than men. Increasing passage of time since transplantation, higher perceived overload, higher sense of relational deprivation, and lower sense of personal gain were significantly associated with higher level of depression and worse perceived health. Perceived support and level of depression were not significantly associated with perceived health. Conclusions Caregiving stress endures after transplantation. Professional intervention is needed to improve caregivers' quality of life and, consequently, that of transplant recipients as well.
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Yoshioka E, Yamamoto S, Yasuda M, Saijo Y, Kishi R. Spouse caregivers and behavioral and psychological symptoms of dementia. Aging Ment Health 2014; 17:966-72. [PMID: 23621100 DOI: 10.1080/13607863.2013.790927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Only a few studies have specifically considered the role of caregiver characteristics in the presence of behavioral and psychological symptoms of dementia (BPSD). The aim of this study was to determine whether there were differences in the presence of individual BPSD between community-dwelling dementia care recipients with spouse caregivers and those with non-spouse caregivers. METHODS Care recipients (n = 109) and their primary caregivers were recruited from memory clinic outpatients at the public psychiatric hospital in Sapporo City, Japan. Data were collected by questionnaire. Relationship with the care recipient was categorized as either 'spouse' or 'non-spouse.' The frequency of BPSD occurrence observed by the caregiver was assessed using the Troublesome Behavior Scale (TBS). Logistic regression analyses were performed to examine whether there were differences with regard to each of the 14 TBS items between spouse and non-spouse caregivers. RESULTS The number of spouse caregivers was 47 (43.1%). TBS items presented by >50% care recipients were 'repetition and/or clinging' and 'ill-natured denial and/or distortion.' After adjustment for the characteristics of caregivers and care recipients, non-spouse caregivers were found to be significantly associated with the presence of 'hiding and/or losing things,' 'rummaging,' 'crying and/or screaming,' and 'interfering with a happy home circle,' compared with spouse caregivers. CONCLUSIONS Our results suggest that non-spouse caregivers need more support with regard to certain symptoms of individual BPSD compared with spouse caregivers. Identifying caregiver characteristics that are independently associated with each individual BPSD may help customize interventions for caregivers with specific characteristics.
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Affiliation(s)
- Eiji Yoshioka
- a Department of Health Science , Asahikawa Medical University , Hokkaido , Japan
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Effects of attachment quality on caregiving of a parent with dementia. Am J Geriatr Psychiatry 2014; 22:623-31. [PMID: 23642460 DOI: 10.1016/j.jagp.2012.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 12/02/2012] [Accepted: 12/10/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of the current study was to examine the moderating role of attachment quality on the relationship between dementia-specific stressors and: (a) caregiver distress and (b) caregiver satisfaction. METHOD Caregivers (N = 91) of a parent with dementia completed questionnaires that assessed caregiving stressors (parental cognitive impairment and behavioral problems), attachment (early and present-day attachment) and measures of caregiver distress and satisfaction. A series of regression analyses were conducted to test the hypothesis that better attachment quality may buffer the effects of cognitive impairment and behavioral problems on the caregiver's experience of distress and enhance caregiver satisfaction. RESULTS Results did suggest that present-day attachment moderates the effects of both cognitive impairment and behavioral problems on global distress but, contrary to our hypotheses, attachment security did not buffer the negative impact associated with these demands. Instead, secure present-day attachment was positively associated with an increased risk for emotional distress at mild levels of care-recipient cognitive impairment. Most analyses indicated no significant relationship between caregiving stressors and caregiver distress or satisfaction and few interactions based on attachment quality were found. CONCLUSIONS Our study indicates that attachment security does not always have a protective or stress-buffering function but may amplify the effect of stressors under certain conditions. Different ways of understanding the obtained pattern of findings are discussed and additional work is required to test if secure attachment may be associated with increased resilience when the disease is more advanced. Clinical implications of the present findings are discussed.
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Coping and distress among spouse caregivers to older patients with cancer: An intricate path. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Juratovac E, Morris DL, Zauszniewski JA, Wykle ML. Effort, workload, and depressive symptoms in family caregivers of older adults: conceptualizing and testing a work-health relationship. Res Theory Nurs Pract 2012; 26:74-94. [PMID: 22908429 DOI: 10.1891/1541-6577.26.2.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Increasing effort in response to a complex workload is detrimental to workers' health and may explain the negative health consequences experienced by millions of family caregivers who are the primary workforce for older adult care in the United States. This cross-sectional, descriptive correlational study used survey data from 110 family caregivers of community-dwelling older adults to theoretically explain caregiving effort (as perceived exertion) and to examine the relationship between effort and depressive symptoms, a particularly persistent adverse caregiver health outcome. Visual analog scales and exemplar quotes explicated physical, mental, emotional, and time-related effort. Notably, effort was considered too multidimensional by several caregivers to discretely categorize. Among the relationships tested, effort was statistically significantly correlated with workload proxies (time, difficulty, overload), caregiver health and depressive symptoms, and care receiver function. Using regression analysis, effort and workload did not have direct effects on depressive symptoms. Surprisingly, effort was not decreased for caregivers who had formal or informal caregiving help. These findings support an energetical conceptualization in caregiving and highlight the complexity of a caregiving workload assessment. Practice suggestions are offered toward tailored health promotion strategies to benefit the families who constitute this essential, global caregiving workforce.
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Affiliation(s)
- Evanne Juratovac
- Frances Payne Bolton School of Nursing, Case Western Reserve University, University Center on Aging and Health, Cleveland, OH 44106, USA.
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Kulhara P, Kate N, Grover S, Nehra R. Positive aspects of caregiving in schizophrenia: A review. World J Psychiatry 2012; 2:43-8. [PMID: 24175167 PMCID: PMC3782175 DOI: 10.5498/wjp.v2.i3.43] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 06/19/2012] [Accepted: 06/20/2012] [Indexed: 02/05/2023] Open
Abstract
Schizophrenia is a severe mental illness which is associated with significant consequences for both the patients and their relatives. Due to chronicity of the illness, the relatives of patients of schizophrenia have to bear the main brunt of the illness. Studies across the world have evaluated various aspects of caregiving and caregivers such as burden, coping, quality of life, social support, expressed emotions, and psychological morbidity. In general the research has looked at caregiving as a negative phenomenon, however, now it is increasingly recognised that caregiving is not only associated with negative consequences only, also experience subjective gains and satisfaction. This review focus on the conceptual issues, instruments available to assess the positive aspects of caregiving and the various correlates of positive aspects of caregiving reported in relation to schizophrenia. The positive aspect of caregiving has been variously measured as positive caregiving experience, caregiving satisfaction, caregiving gains and finding meaning through caregiving scale and positive aspects of caregiving experience. Studies suggests that caregivers of patients with schizophrenia and psychotic disorders experience caregiving gains (in the form of becoming more sensitive to persons with disabilities, clarity about their priorities in life and a greater sense of inner strength), experience good aspects of relationship with the patient, do have personal positive experiences. Some of the studies suggest that those who experience greater negative caregiving experience also do experience positive caregiving experience.
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Affiliation(s)
- Parmanand Kulhara
- Parmanand Kulhara, Natasha Kate, Sandeep Grover, Ritu Nehra, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Coping strategies and psychological morbidity in family carers of people with dementia: a systematic review and meta-analysis. J Affect Disord 2012; 139:1-11. [PMID: 21723617 DOI: 10.1016/j.jad.2011.05.055] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/27/2011] [Accepted: 05/27/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Carers for people with dementia experience high levels of anxiety and depression. Coping style has been associated with carer anxiety and depression. METHOD We systematically reviewed studies examining the relationships between coping and anxiety or depression among carers of people with dementia. We rated study validity using standardised checklists. We calculated weighted mean correlations (WMC) for the relationships between coping and psychological morbidity, using random effects meta-analyses. RESULTS We included 35 studies. Dysfunctional coping correlated with higher levels of anxiety (WMC=0.39, 95% CI 0.28-0.50; N=688) and depression (0.46, 0.36-0.56; N=1428) cross-sectionally, and with depression 6 and 12months later (0.32, 0.10-0.54; N=143). Emotional support and acceptance-based coping correlated with less anxiety (-0.22, 95% CI -0.26 to -0.18; N=628) and depression (-0.20, -0.28 to -0.11; N=848) cross-sectionally; and predicted anxiety and depression a year later in the only study to measure this. Solution-focused coping did not correlate significantly with psychological morbidity. LIMITATIONS Just over a quarter of the identified studies provided extractable data for meta-analysis, including only two longitudinal studies. CONCLUSIONS There is good evidence that using more dysfunctional, and less emotional support and acceptance-based coping styles are associated with more anxiety and depression cross-sectionally, and there is preliminary evidence from longitudinal studies that they predict this morbidity. Our findings would support the development of psychological interventions for carers that aim to modify coping style.
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Möller-Leimkühler AM, Wiesheu A. Caregiver burden in chronic mental illness: the role of patient and caregiver characteristics. Eur Arch Psychiatry Clin Neurosci 2012; 262:157-66. [PMID: 21538092 DOI: 10.1007/s00406-011-0215-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 04/13/2011] [Indexed: 11/26/2022]
Abstract
The aim of the present study is to identify the relative contribution of patient and caregiver characteristics in a sample of primary carers of patients with chronic mental disorders living in the community. As carers were recruited from caregiver organizations, mainly mothers of an adult child suffering from schizophrenia participated in the study (n = 102). Within a comprehensive transactional stress model, burden was assessed with respect to objective and subjective burden, cognitive-emotional well-being, psychological distress and subjective quality of life. Primary stressors include illness-related characteristics of the patient, and a number of personal dispositions and resources of the caregivers were included as potential moderating variables. Multiple regression analyses were separately calculated for each dimension of burden. Interaction of carers' expressed emotion and external locus of control with the patient's problem with family communication as well as perceived social support was most predictive for objective and subjective burden, whereas carers' neuroticism appeared as the most relevant predictor of their well-being, psychological distress and subjective quality of life. Among the patients' variables, regular employment contributed significantly to reduce carers' distress and enhance their well-being. As the sample was recruited from caregiver organizations, a selection bias has to be taken into account. To reduce caregiver burden, especially mothers' burden, the patients' occupational abilities should be strongly enhanced at an early stage. Family interventions should improve dysfunctional interactions, enhance the carers' social activities and focus more intensely on the carers' own dispositions.
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Abstract
The enduring cultural image of cancer is of an acute and deadly disease that acts swiftly to end life. Although it is the case that cancer mortality rates remain obstinately high in industrial countries, cancers are now seen as a chronic disease with uncertainty in remission, new recurrence, palliation, and death. Caregivers' commitment, emotional involvement, and understanding of the patients' needs demonstrate that caring is a special way of being, thinking and growing within the experience of the illness trajectory. Caring is fundamental to human survival. It is understood to imply a distinct way of being, believing, and acting that calls for commitment, knowledge, and new coping skills. It motivates families and gives meaning and structure to life. Informal family caregivers of cancer patients are required to meet multidimensional needs, including treatment monitoring; treatment-related symptom management; emotional, financial, and spiritual support; and assistance with personal and instrumental care. Families are increasingly replacing skilled healthcare workers in the delivery of unfamiliar complex care to their ill family members despite the other obligations and responsibilities that characterize their lives.
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Robb C, Small B, Haley WE. Gender differences in coping with functional disability in older married couples: the role of personality and social resources. Aging Ment Health 2008; 12:423-33. [PMID: 18791889 DOI: 10.1080/13607860802224326] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present study examines the impact of functional disability on subjective well-being (SWB) and the moderating effects of personal resources on a sample of 144 community-dwelling, older adult couples age 60-84 years, with emphasis on gender differences in both direct and moderating effects. Functional disability in self and in the spouse was associated with poorer well-being in both men and women, but differences were found by gender in the effects of coping resources. While high neuroticism was associated with poorer well-being for both husbands and wives, extraversion and social support had unique benefits in enhancing well-being only in husbands. Husbands were more introverted, and had fewer social resources, and individual differences in social resources may be more critical for older husbands. Results are interpreted in terms of gender differences in coping and their implications for interventions to enhance well-being in older adults.
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Affiliation(s)
- Claire Robb
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA.
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Mutuality and preparedness moderate the effects of caregiving demand on cancer family caregiver outcomes. Nurs Res 2007; 56:425-33. [PMID: 18004189 DOI: 10.1097/01.nnr.0000299852.75300.03] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Family caregiving researchers have explored the moderating or stress-buffering effects of variables such as coping and social support. However, the quality of the family caregiver-patient relationship and preparedness for caregiving have received little attention as potential moderators. OBJECTIVE To explore whether relationship quality and preparedness moderate the effects of caregiving demand on caregiver outcomes during cancer treatment. METHODS Eighty-seven family caregivers of patients receiving treatment for cancer completed the Demand and Difficulty subscales of the Caregiving Burden Scale, Mutuality and Preparedness Scales of the Family Care Inventory, and the short form of the Profile of Mood States. Using hierarchical multiple regression analyses, caregiving difficulty and total mood disturbance were regressed on two- and three-way interaction terms for demand, mutuality, and preparedness, controlling for caregiver age and gender, and the simple effect of each independent variable. RESULTS Negligible effects for two-way interactions were found. However, the three-way interaction between demand, mutuality, and preparedness explained statistically significant variance in both perceived difficulty of caregiving and total mood disturbance. High mutuality in combination with high preparedness protected caregivers from adverse outcomes when demand was high. When either mutuality or preparedness was low, caregivers were at greater risk for negative outcomes when demand was high, but not when demand was low. When both mutuality and preparedness were low, caregivers were at risk for mood disturbance even when demand was low. DISCUSSION Analysis of three-way interactions provided new theoretical insights into the protective effects of mutuality and preparedness and demonstrated conditions under which caregivers are at increased risk for negative outcomes.
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Hudson P. A conceptual model and key variables for guiding supportive interventions for family caregivers of people receiving palliative care. Palliat Support Care 2006; 1:353-65. [PMID: 16594225 DOI: 10.1017/s1478951503030426] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
According to the World Health Organization, the patient and family should be viewed as the "unit of care" when palliative care is required. Therefore family caregivers should receive optimal supportive care from health professionals. However, the impact of supporting a dying relative is frequently described as having negative physical and psychosocial sequalae. Furthermore, family caregivers consistently report unmet needs and there has been a dearth of rigorous supportive interventions published. In addition, comprehensive conceptual frameworks to navigate the family caregiver experience and guide intervention development are lacking. This article draws on Lazarus and Folkman's seminal work on the transactional stress and coping framework to present a conceptual model specific to family caregivers of patients receiving palliative care. A comprehensive account of key variables to aid understanding of the family caregiver experience and intervention design is provided.
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Affiliation(s)
- Peter Hudson
- School of Nursing and Centre for Palliative Care, University of Melbourne, Carlton, Victoria, Australia.
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Möller-Leimkühler AM. Burden of relatives and predictors of burden. Baseline results from the Munich 5-year-follow-up study on relatives of first hospitalized patients with schizophrenia or depression. Eur Arch Psychiatry Clin Neurosci 2005; 255:223-31. [PMID: 15549342 DOI: 10.1007/s00406-004-0550-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 09/14/2004] [Indexed: 10/26/2022]
Abstract
In the present study, part of the Munich 5-year follow-up study on key relatives of first-hospitalized schizophrenic and depressive patients, baseline results with respect to relatives' burden and predictors of burden are presented. Basing on a transactional stress model the following hypothesis was tested: the impact of the patients' illness on their relatives' stress outcome is moderated by the psychosocial resources of the relatives. Stress outcome was measured in terms of objective and subjective burden, well-being, self-rated symptoms and global satisfaction with life. Potential moderating variables included age and gender, generalized stress response and illness-related coping strategies, beliefs of control,perceived social support,personality factors, expressed emotion and life stressors. A total of 83 relatives, whose ill family members had been hospitalized in the Department of Psychiatry of the Ludwig-Maximilians-University of Munich for the first time, participated in the study. Findings did not entirely support the hypothesis. On the one hand, relatives' stress outcome was independent of the objective stressors (severity of the illness, kind of symptoms, level of psychosocial functioning at admission). On the other hand, burden was significantly associated with several psychosocial resources and dispositions of the relatives. Multivariate linear regression analyses indicated that expressed emotion, emotion-focused coping strategies and generalized negative stress response are the most relevant predictors of burden. It is argued that a multidimensional approach in burden assessment is necessary and has relevant implications for improving family intervention strategies.
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Lim JW, Zebrack B. Caring for family members with chronic physical illness: a critical review of caregiver literature. Health Qual Life Outcomes 2004; 2:50. [PMID: 15377384 PMCID: PMC521496 DOI: 10.1186/1477-7525-2-50] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 09/17/2004] [Indexed: 11/10/2022] Open
Abstract
This article reviews 19 studies (1987-2004) on quality of life for family caregivers helping those with chronic physical illness. Here we explore the concepts of and instruments used to measure caregivers' quality of life. We were particularly interested in understanding stress-related variables and documenting factors influencing quality of life based on family stress theory. Findings show that various positive and negative terms equated with quality of life were used to measure them. Results indicate that stress-related variables as possible predictors influencing caregivers' quality of life include: patient and caregiver characteristics, stressors, stress appraisal, stress coping methods, and social support. Our recommendations touch upon applying theory for intervention, developing measurement, making operable the concepts for measuring, and the need for longitudinal and comprehensive study.
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Affiliation(s)
- Jung-won Lim
- School of Social Work, University of Southern California, 669 MRF Building, West 34Street, & 102W, Los Angeles, CA 90089-0411, USA
| | - Brad Zebrack
- School of Social Work, University of Southern California, 669 MRF Building, West 34Street, & 102W, Los Angeles, CA 90089-0411, USA
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Pot AM, Deeg DJ, Knipscheer CP. Institutionalization of demented elderly: the role of caregiver characteristics. Int J Geriatr Psychiatry 2001; 16:273-80. [PMID: 11288161 DOI: 10.1002/gps.331] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Three sets of caregiver characteristics were examined with respect to their explanatory value for institutionalization of demented elderly people: commitment to the caregiving relationship, psychological distress, and personality traits. METHOD Logistic regression was used to test whether these caregiver characteristics were risk factors for institutionalization of demented elderly people in the first year after baseline measurement (N = 138). Control variables were caregivers' sex, age and education. RESULTS The results showed the importance of commitment to the caregiving relationship, indicated by type of relationship between caregiver and care recipient. Demented people cared for by non-spouses were more likely to be institutionalized as compared to those cared for by spouses. For non-spouse care-givers, being more extravert increased the likelihood of institutional placement, whereas for spouse caregivers perceiving more pressure from informal increased this likelihood. CONCLUSIONS These findings are in agreement with the assumption that non-spouses are less strongly committed to the caregiving relationship as compared to spouses. Results were independent from elders' impairment in cognitive functioning and (Instrumental) Activities of Daily Living. Caregivers' psychopathology was not a risk factor at all, which is a matter of concern, regarding the consequences for caregivers' own health and health-care utilization, but also for their treatment of the demented elder.
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Affiliation(s)
- A M Pot
- Department of General Practice, Nursing Home Medicine and Social Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
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