Mutuality and preparedness of family caregivers for elderly women after bypass surgery

Feasibility and Preliminary Impact of a Web-Based Mind Body Intervention for Older Dementia Caregivers

BACKGROUND

Mind-body interventions focused on intentional breathing and movement have been found to mitigate the negative effects of caregiving such as such as stress, psychosocial distress, and emotional distress associated for persons living with Alzheimer's disease and related dementias.

OBJECTIVE

The objective was to assess the feasibility and acceptability and preliminary impacts of our 12-week mind body intervention "Gentle Yoga and Yogic Breathing" for caregivers of persons living with dementia on health outcomes including mutuality, depression and anxiety, loneliness and social support, quality of life, and physical function.

METHODS

We conducted a single-group cohort study in which 20 caregivers were enrolled. Data were collected at baseline and at the 12-week post-intervention endpoint.

RESULTS

The intervention was acceptable; 75% (n = 15/20) completed the study; 16 completed post-study questionnaires. Very few experienced technical issues; 31% (n = 3) most commonly reported as poor internet connectivity, 75% (n = 12/16) perceived a health benefit, 88% (n = 14/16) perceived improved day-to-day mood, and 100% (n = 16/16) would recommend the intervention to other caregivers. Although there was minimal change from baseline to 12 weeks, for health outcomes, there were very small improvements noted in anxiety and overall health. There were no reported adverse events.

CONCLUSION

The intervention was well received and is feasible and acceptable for future studies of stress and health management interventions for caregivers of persons living with dementia.Registered with https://www.ClinicalTrials.gov (NCT03853148).

A scoping review of unpaid caregivers' experiences during older adults' hospital-to-home transitions

The objective of this scoping review is to examine current evidence regarding unpaid/family caregivers' experiences during older adults' hospital-to-home transitions to identify gaps and opportunities to involve caregivers in transitional care improvement efforts. Eligible articles focused on caregiver experience, outcomes, or interventions during older adults' hospital-to-home transitions. Our review identified several descriptive studies focused on exploring the caregiver experience of older adult hospital-to-home transitions and caregiver outcomes (such as preparedness, strain, burden, health, and well-being). Qualitative studies revealed challenges at multiple levels, including individual, interpersonal, and systemic. Few interventions have targeted or included caregivers to improve discharge education and address support needs during the transition. Future work should target underrepresented and marginalized groups of caregivers, and caregivers' collaboration with community-based services, social networks, or professional services. Work remains in developing and implementing interventions to support both older adult and caregiver needs.

Influence of preparedness on caregiver burden, depression, and quality of life in caregivers of people with disabilities

Introduction

Caregiver preparedness is defined as the perceived preparation of caregivers to care for the physical and emotional needs of the patient.

Purpose

This study investigated caregiver preparedness and its influences on caregiver burden, depression, and quality of life (QoL) in caregivers of individuals with disabilities.

Methods

We conducted a multicenter cross-sectional survey study on caregivers caring for patients with disabilities. Sociodemographic characteristics were collected via questionnaires. The Preparedness for Caregiving Scale (PCS), Burden Interview (BI), Center for Epidemiologic Studies Depression Scale (CES-D), and EuroQol-Visual Analogue Scale (EQ-VAS) were administered.

Results

A total of 151 caregivers were enrolled. The mean age of caregivers was 53.7 ± 12.4 years, and 80.8% were female. The majority of participants were the main caregivers of patients with stroke, spinal cord injury, or traumatic brain injury. The mean PCS score was 2.1 ± 0.9, demonstrating significant relationships with BI (r = -0.512, p < 0.001), CES-D (r = -0.622, p < 0.001), and EQ-VAS (r = 0.441, p < 0.001). The CES-D was significantly associated with the PCS after controlling other variables. However, PCS did not show any correlation with the duration of caregiving or amount of time spent per day on caregiving.

Discussion

The clinical implications of this study are that higher caregiver preparedness is a predictor of less caregiver burden and depression, and better QoL. However, preparedness did not increase as the duration or time spent on caregiving was extended. Therefore, efforts to enhance the caregivers' preparedness are required to reduce caregiver burden and improve health outcomes for both caregivers and patients.

The perceived relationship quality with migrant domestic workers is correlated with a lower level of loneliness among community-dwelling older adults: A cross-sectional study

PURPOSE

To explore older adults' perceived relationship quality with migrant domestic workers (MDWs) and examine the correlation between older adult/MDW (O-M) relationship quality and loneliness of community-dwelling older adults.

MATERIALS AND METHODS

In this cross-sectional study, older adults living with MDWs were conveniently recruited from neighbourhood elderly centers in Hong Kong. Loneliness and O-M relationship quality were assessed by the 6-item De Jong Gierveld Loneliness Scale and the mutuality scale, respectively. Older adults' demographic and functional characteristics, and MDW's nationality, spoken language and years of service in the dyad were also collected. Hierarchical multiple regression analyses were conducted to examine the contributions of 1) demographic variables and functional status, 2) MDW characteristics, 3) perceived social network and 4) perceived O-M relationship quality on loneliness.

RESULTS

The 178 participants [mean age 83.44 (SD 7.05 years); 155 (87.1%) women and 23 men (22.9%)] were socially lonely (1.07 ± 1.15) and close to being lonely overall (1.90 ± 1.68), and emotionally (0.84 ± 0.97). The mean O-M relationship quality was poor (1.42 ± 0.79), which was significantly correlated with overall (β= -0.33, 95% CI: -0.65 to -0.01, P value = 0.045), and social (β= -0.24, 95% CI: -0.46 to -0.01, P value = 0.04) loneliness, but not significantly correlated to emotional loneliness.

CONCLUSION

Better perceived O-M relationship quality is correlated with a lower level of loneliness among older adults. Strategies to improve O-M relationship quality may alleviate loneliness among older adults.

Relationship between mutuality and depression in patients with chronic heart failure and caregivers in China: An actor-partner interdependence model analysis

Background

Patients with chronic heart failure and their family caregivers may experience adverse emotional problems, such as depression. Mutuality, which refers to the relationship between caregivers and those they care for, is an important factor affecting depression in the dyads. The purpose of this study was to investigate the relationship between mutuality and depression in patients with CHF and their caregivers in China.

Methods

In this cross-sectional study, we used the Mutuality Scale and the Self-Rating Depression Scale to measure mutuality and depression of patients and caregivers. We used SPSS version 26.0 and AMOS version 21.0 to analyze the data. An APIM was established to analyze the actor-partner effects of patient-caregiver mutuality and depression.

Results

A total of 250 dyads of patients and caregivers were included in the study. There were statistically significant differences in mutuality and depression between CHF patients and caregivers. The 4 dimensions of patients' mutuality all have the actor effect on depression. There were 3 partner effects of caregivers' "pleasurable activities", "shared values", and "reciprocity" on depression. Regarding caregiver depression, we only found an actor effect of caregivers' "shared values" on depression.

Conclusion

The relationship between patients and caregivers should be evaluated in the clinical setting, and it is very important to develop intervention measures to improve the adverse emotional problems affecting both patients and their caregivers.

Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden

(1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer–care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.

Exploring Factors Associated With Family Caregivers' Preparedness to Care for an Older Family Member Together With Home Care Nurses: An Analysis in a Swiss Urban Area

Introduction:

Home-dwelling older people with chronic diseases often need the support of informal and formal caregivers in order to continue living at home. Family members, however, need to be willing and prepared for caregiving together with home care nurses.

Objectives:

The purpose of this study was to explore factors associated with family caregivers’ preparedness to care for older home-dwelling adults who also receive home care nursing services.

Methods:

For this cross-sectional correlational study, a structured questionnaire was sent to family caregivers of adults aged 65 years or older receiving services from a community care agency. A total of 243 participants returned the questionnaire, of which 199 could be analyzed.

Results:

The stepwise backward regression model explained 29.1% of the variance of family caregivers’ preparedness. Mutuality was the most strongly associated factor with family caregivers’ preparedness whereas professional involvement of family caregiver in care process was important as well. Care intensity showed no significant impact.

Conclusion:

Nurses should support the whole family emotionally, and appreciate, admire, reinforce, and respect the caregivers’ situation. Home care nurses need to invest in helping families to find solutions, to strengthen their relationships between family members and the older person dwelling at home.

The Influence of Caregiver Preparedness on Caregiver Contributions to Self-care in Heart Failure and the Mediating Role of Caregiver Confidence

BACKGROUND

Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process.

OBJECTIVES

We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence.

METHODS

This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients' informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects.

RESULTS

Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management.

CONCLUSIONS

Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.

Transitional care from skilled nursing facilities to home: study protocol for a stepped wedge cluster randomized trial

Background

Skilled nursing facility (SNF) patients are medically complex with multiple, advanced chronic conditions. They are dependent on caregivers and have experienced recent acute illnesses. Among SNF patients, the rate of mortality or acute care use is over 50% within 90 days of discharge, yet these patients and their caregivers often do not receive the quality of transitional care that prepares them to manage serious illnesses at home.

Methods

The study will test the efficacy of Connect-Home, a successfully piloted transitional care intervention targeting seriously ill SNF patients discharged to home and their caregivers. The study setting will be SNFs in North Carolina, USA, and, following discharge, in patients’ home. Using a stepped wedge cluster randomized trial design, six SNFs will transition at randomly assigned intervals from standard discharge planning to the Connect-Home intervention. The SNFs will contribute data for patients (N = 360) and their caregivers (N = 360), during both the standard discharge planning and Connect-Home time periods. Connect-Home is a two-step intervention: (a) SNF staff create an individualized Transition Plan of Care to manage the patient’s illness at home; and (b) a Connect-Home Activation RN visits the patient’s home to implement the written Transition Plan of Care. A key feature of the trial includes training of the SNF and Home Care Agency staff to complete the transition plan rather than using study interventionists. The primary outcomes will be patient preparedness for discharge and caregiver preparedness for caregiving role. With the proposed sample and using a two-sided test at the 5% significance level, we have 80% power to detect a 18% increase in the patient’s preparedness for discharge score. We will employ linear mixed models to compare observations between intervention and usual care periods to assess primary outcomes. Secondary outcomes include (a) patients’ quality of life, functional status, and days of acute care use and (b) caregivers’ burden and distress.

Discussion

Study results will determine the efficacy of an intervention using existing clinical staff to (a) improve transitional care for seriously ill SNF patients and their caregivers, (b) prevent avoidable days of acute care use in a population with persistent risks from chronic conditions, and (c) advance the science of transitional care within end-of-life and palliative care trajectories of SNF patients and their caregivers. While this study protocol was being implemented, the COVID-19 pandemic occurred and this protocol was revised to mitigate COVID-related risks of patients, their caregivers, SNF staff, and the study team. Thus, this paper includes additional material describing these modifications.

Trial registration

ClinicalTrials.gov NCT03810534. Registered on January 18, 2019.

Development and psychometric testing of the Spanish version of the Caregiver Preparedness Scale

AIM

To psychometrically test the Spanish version of the Caregiver Preparedness Scale (CPS) and document the preparedness level of caregivers.

DESIGN

A descriptive and validation study.

METHOD

Purposive sampling method was used to select 171 family caregivers Spain. The scale was cross-culturally adapted through a process that included translation, comparison with versions in other languages and back-translation, review, pre-testing and validity, and reliability tests.

RESULTS

The Spanish family caregivers are mainly female (79%) and married (75%). The Spanish version of the CPS presents changes with respect to the original. Confirmatory factor analysis supported the single-factor model. Analysis of internal consistency yielded a Cronbach's α of 0.89. Significant correlations (p < .01) with other scales supported convergent validity. A descriptive analysis of the validated scale showed average levels of preparation (2.16 out of 4). Caregivers felt better prepared to attend to the patient's physical needs than emotional or spiritual needs.

The influence of relational mutuality on dyadic coping among couples facing breast cancer

OBJECTIVE

The study examined how a couple's capacity for mutuality as conceptualized by the Relational-Cultural Theory plays a role in their managing the stresses accompanying breast cancer.

METHODS

Eighty-six women treated for a primary, non-metastatic breast cancer and their partners completed measures of quality of life, relational mutuality, and dyadic coping. Demographic and clinical factors were self-reported. The relationship between mutuality and dyadic coping was evaluated using the Actor-Partner Interdependence Model (APIM).

RESULTS

Relational mutuality was positively associated with both the patients' and the caregivers' scores on common and positive dyadic coping. Similarly, relational mutuality was associated with both patients' and caregivers' reduced scores on avoidance of dyadic coping.

CONCLUSIONS

Relational mutuality emerges as a significant factor in our understanding about dyadic coping in the context of cancer and this study highlights the role it plays in dyadic coping behaviors.

IMPLICATIONS

The promotion of relational mutuality in couples coping with cancer-related stress should be a major focus in couple-based interventions.

'Who Cares?' The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease and coronary artery disease: a mixed methods systematic review

OBJECTIVE

To assess the experiences of unpaid caregivers providing care to people with heart failure (HF) or chronic obstructive pulmonary disease (COPD) or coronary artery disease (CAD). Design Mixed methods systematic review including qualitative and quantitative studies. Data sources Databases searched: Medline Ebsco, PsycInfo, CINAHL Plus with Full Text, Embase, Web of Science, Ethos: The British Library and ProQuest. Grey literature identified using: Global Dissertations and Theses and Applied Sciences Index and hand searches and citation checking of included references. Search time frame: 1 January 1990 to 30 August 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion was limited to English language studies in unpaid adult caregivers (>18 years), providing care for patients with HF, COPD or CAD. Studies that considered caregivers for any other diagnoses and studies undertaken in low-income and middle-income countries were excluded. Quality assessment of included studies was conducted by two authors.

DATA ANALYSIS/SYNTHESIS

A results-based convergent synthesis was conducted.

RESULTS

Searches returned 8026 titles and abstracts. 54 studies-21 qualitative, 32 quantitative and 1 mixed method were included. This totalled 26 453 caregivers who were primarily female (63%), with median age of 62 years. Narrative synthesis yielded six concepts related to caregiver experience: (1) mental health, (2) caregiver role, (3) lifestyle change, (4) support for caregivers, (5) knowledge and (6) relationships. There was a discordance between paradigms regarding emerging concepts. Four concepts emerged from qualitative papers which were not present in quantitative papers: (1) expert by experience, (2) vigilance, (3) shared care and (4) time.

CONCLUSION

Caregiving is life altering and complex with significant health implications. Health professionals should support caregivers who in turn can facilitate the recipient to manage their long-term condition. Further longitudinal research exploring the evolution of caregiver experiences over time of patients with chronic cardiopulmonary conditions is required.

TRIAL REGISTRATION NUMBER

CRD42016053412.

Variances in family carers' quality of life based on selected relationship and caregiving indicators: A quantitative secondary analysis

AIMS AND OBJECTIVES

To determine subgroups of family carers based on family relational and caregiving variables and to explore group differences in relation to selected carer outcomes.

BACKGROUND

Family caregiving in later life holds a myriad of positive and negative outcomes for family members' well-being. However, factors that constitute family carers' experience and explain variances are less well understood.

DESIGN

A secondary data analysis using cross-sectional data from a controlled randomised trial with community-dwelling people 80 years or older and their families.

METHODS

A total of 277 paired data sets of older persons and their family carers were included into the analysis. Data were collected via mailed questionnaires and a geriatric nursing assessment. A two-step cluster analysis was performed to determine subgroups. To discern group differences, appropriate tests for differences with Bonferroni correction were used.

RESULTS

Two family carer groups were identified. The low-intensity caregiver group (57% of carers) reported high relationship quality and self-perceived ease of caregiving. In contrast, the high-intensity caregiver group (43% of carers) experienced significantly lower relationship quality, felt less prepared and appraised caregiving as more difficult, time intensive and burdensome. The latter cared for older, frailer and more dependent octogenarians and had significantly lower levels of quality of life and self-perceived health compared to the low-intensity caregiver group.

CONCLUSIONS

A combination of family relational and caregiving variables differentiates those at risk for adverse outcomes. Family carers of frailer older people tend to experience higher strain, lower relationship quality and ability to work together as a family.

IMPLICATIONS FOR PRACTICE

Nurses should explicitly assess family carer needs, in particular when older persons are frail. Family carer support interventions should address caregiving preparedness, demand and burden, as well as concerns situated in the relationship.

Spousal Caregivers of Coronary Artery Bypass Surgery Patients: Differences between Caregivers with Low vs. High Caregiving Demands

PURPOSE

Compared to non-caregivers, caregivers have higher rates of depressive symptoms, caregiver strain, less mutuality, and health care visits. However, few investigators have examined family caregivers after coronary artery bypass (CAB) surgery. The purpose of this study was to examine differences in caregiving difficulties, mutuality (i.e., open communication; avoiding sad thoughts), and depressive symptoms based on low vs. high caregiving demands among spousal caregivers.

DESIGN

A descriptive, comparative design was used to examine 33 spousal caregivers of CAB surgery patients (16 in low and 17 in high caregiving demand groups).

METHODS

Measures included: Caregiving Burden Scale, Mutuality and Interpersonal Sensitivity Scale, and Patient Health Questionnaire-9. Groups were compared using Mann-Whitney U statistics.

FINDINGS

It was found that caregivers with high caregiving demands reported more caregiving difficulties and more open communication about the surgery compared to caregivers with low demands.

CONCLUSION

Caregivers with greater caregiving demands may need additional support to assist them with the caregiving situation.

CLINICAL RELEVANCE

Priority should be given to family caregivers, who take care of patients in cardiac rehabilitation, with higher caregiving demand.

Formal and informal support of family caregivers managing medications for patients who receive end-of-life care at home: a cross-sectional survey of caregivers

BACKGROUND

Managing medications is a complex responsibility of family caregivers caring for end-of-life patients. This study characterizes caregivers with and without formal/informal support managing medications for patients who receive end-of-life care at home.

AIM

To explore factors related to caregivers' support with managing medications for end-of-life home hospice patients.

DESIGN

A convenience-sampled, cross-sectional telephone survey.

SETTING/PARTICIPANTS

Computer-assisted telephone interviews were administered to 120 caregivers managing medications, who were referred by five Chicago-based home hospice services. We measured caregivers' additional formal (paid) and informal (unpaid) support with managing medications, and caregiver/patient socio-demographic, relational, and health characteristics.

RESULTS

While 47 (39%) had no additional support with managing medications, 27 (22.5%) had formal support, 37 (31%) informal, and 9 (7.5%) both. Seven caregivers (19%) with formal and 13 (31%) with informal support reported disagreements concerning treatment plans. Caregivers lacking formal support tended to be racial/ethnic minorities, live with the patient in their home, or report greater emotional burden. Caregivers with formal support tended to report higher education/income, lower mutuality, or care for a patient with over 6 months' hospice enrollment. Caregivers lacking informal support tended to be spousal caregivers, live with the patient, or have experience caring for another dying person.

CONCLUSION

Our study suggests that high proportions of caregivers may not have support managing medications for patients receiving hospice care at home. More research should examine whether the observed variations in obtaining support indicate disparities or unmet needs among caregivers. Disagreement about treatment with formal/informal support also warrants further investigation.

Psychometric properties of the Caregiver Preparedness Scale in caregivers of stroke survivors

OBJECTIVE

To evaluate the psychometric characteristics of the Caregiver Preparedness Scale (CPS) in caregivers of stroke survivors.

BACKGROUND

Caregiver preparedness can have an important impact on both the caregiver and the stroke survivor. The validity and reliability of the CPS has not been tested for the stroke-caregiver population.

METHODS

We used a cross-sectional design to study a sample of 156 caregivers of stroke survivors. Construct validity of the CPS was evaluated by confirmatory factor analysis (CFA). Internal consistency and test-retest reliability were also evaluated.

RESULTS

Caregivers were, on average, 54 year old (SD = 13.2) and most were women (64.7%). CFA supported the unidimensionality of the scale (comparative fit index = 0.98). Reliability was also supported: item-reliability index and item-total correlations above 0.30; composite reliability index = 0.93; Cronbach's alpha = 0.94; factor score determinacy = 0.97; and test-retest reliability = 0.92.

CONCLUSION

The CPS is valid and reliable in caregivers of stroke survivors. Scores on this scale may assist health-care providers in identifying caregivers with less preparedness to provide specific interventions.

Long-term health-related quality of life of stroke survivors and their spousal caregivers

Because treatment for stroke has improved, individuals are living longer with the effects of a stroke. The resulting long-term impairment can affect both stroke survivors' and their caregivers' health-related quality of life (HRQOL). Few studies have examined the HRQOL of stroke survivors and their caregivers greater than 2 years poststroke. The stroke survivors and their spousal caregivers (n = 30 dyads) who had previously completed a 12-month study after discharge from inpatient rehabilitation were assessed at 3-5 years poststroke. The HRQOL and related outcomes were measured for stroke survivors and caregivers. Data from baseline to 12 months were used in conjunction with data from this study. Linear mixed models were used to analyze the change in repeated measures over time. Multiple linear regression was used to analyze the relationship of generic HRQOL to related psychosocial outcomes. The stroke survivors were an average of 4.68 years poststroke. The mean age for stroke survivors and caregivers was 70.8 and 64.9 years, respectively. Most stroke survivors were men (80%) and non-Hispanic White (70%). Among stroke survivors, depression decreased from baseline to 12 months (p = .04) but increased from 12 months to the end of follow-up (p = .003). The caregivers' depression decreased from baseline to all time points (p = .015). Stroke-specific HRQOL showed statistically significant (p < .03) decreases between 12 months and end of follow-up. Increased number of illnesses and older age were associated with caregivers' lower physical HRQOL score (p = .004). Higher depression was associated with lower mental HRQOL score for both caregivers and stroke survivors (p = .003 and p = .011, respectively). Both stroke survivors and caregivers continue to experience negative stroke-related health outcomes for many years after the initial stroke; some of these outcomes even worsen over time. These findings illustrate the need for ongoing psychological and medical evaluation for both long-term stroke survivors and caregivers. Development and testing of targeted behavioral interventions are also warranted.

The longitudinal and dyadic effects of mutuality on perceived stress for stroke survivors and their spousal caregivers

OBJECTIVE

Functional impairment resulting from a stroke frequently requires the care of a family caregiver, often the spouse. This change in the relationship can be stressful for the couple. Thus, this study examined the longitudinal, dyadic relationship between caregivers' and stroke survivors' mutuality and caregivers' and stroke survivors' perceived stress.

METHOD

This secondary data analysis of 159 stroke survivors and their spousal caregivers utilized a cross-lagged, mixed models analysis with the actor-partner interdependence model to examine the dyadic relationship between mutuality and perceived stress over the first year post-discharge from inpatient rehabilitation.

RESULTS

Caregivers' mutuality showed an actor effect (β = -3.82, p < 0.0001) but not a partner effect. Thus, caregivers' mutuality influenced one's own perceived stress but not the stroke survivors' perceived stress. Stroke survivors' perceived stress showed a partner effect and affected caregivers' perceived stress (β = 0.13, p = 0.047). Caregivers' perceived stress did not show a partner effect and did not significantly affect stroke survivors' perceived stress.

CONCLUSION

These findings highlight the interpersonal nature of stress in the context of caregiving for a spouse. Caregivers are especially influenced by perceived stress in the spousal relationship. Couples should be encouraged to focus on positive aspects of the caregiving relationship to mitigate stress.

The state of the science of family caregiver-care receiver mutuality: a systematic review

This review critically examines the current state of the science on the concept of family caregiver-care receiver mutuality, summarizes accomplishments and gaps and identifies directions for future theory development and research. Mutuality between family caregivers and care receivers is of increasing interest to researchers. However, no analysis of the current state of the science of this important concept has been published. Our literature search revealed 34 research articles that met inclusion criteria. The studies were assessed in terms of conceptualization of mutuality, instrument development, populations studied, research designs and methods and findings. Significant scientific progress during the past 30 years includes the development of clear definitions and new instruments, expansion of research beyond the clinical populations in which mutuality was first studied, the use of a variety of research designs, and increasingly sophisticated methods of data analysis. Growing evidence suggests that mutuality is associated with caregiver emotional health outcomes and may decrease over time in the context of chronic illness. Directions for future research include development of new theoretical frameworks grounded in relational theory, development of theory on the dynamics of mutuality over time, exploration of mutuality in diverse cultures and populations, and intervention studies aimed at enhancing mutuality.

Adaptation and psychometric evaluation of the Preparedness for Caregiving Scale, Caregiver Competence Scale and Rewards of Caregiving Scale in a sample of Swedish family members of patients with life-threatening illness

BACKGROUND

Family members often take on many caring responsibilities, with complex issues and challenges to consider. Feelings of preparedness, competence and reward are identified as concepts that may protect caregiver wellbeing and decrease negative outcomes related to caregiving.

AIM

This study aimed to translate, adapt and psychometrically evaluate the Preparedness for Caregiving Scale, Caregiver Competence Scale and Rewards of Caregiving Scale in Swedish family members of patients with life threatening illness.

DESIGN

Correlational.

SETTING/PARTICIPANTS

The study took place in four settings including advanced palliative care. The scales were tested in a sample of 125 family members of persons with life-threatening illness. All three scales were tested in relation to distribution of item and scale scores, missing data patterns, dimensionality, convergent validity and reliability.

RESULTS

The results in this study indicate that the Swedish versions of The Preparedness for Caregiving Scale, Caregiver Competence Scale and Rewards of Caregiving Scale are valid, reliable and user-friendly scales. Confirmatory factor analysis showed that the scales were unidimensional and all demonstrated Cronbach's alpha values of ≥0.9.

CONCLUSIONS

As a result of this study it is anticipated that the Preparedness for Caregiving Scale, Caregiver Competence Scale and Rewards of Caregiving Scale could provide a basis for collaborative research between different countries and make international studies more comparable and generalizable despite differences in language and culture.

Care transition experiences of spousal caregivers: from a geriatric rehabilitation unit to home

The purpose of this study was to develop a theoretical framework about caregivers' experiences and the processes in which they engaged during their spouses' transition from a geriatric rehabilitation unit to home. We used a constructivist grounded theory methodology approach. Forty-five interviews were conducted across three points in time with 18 older adult spousal caregivers. A theoretical framework was developed within which reconciling in response to fluctuating needs emerged as the basic social process. Reconciling included three subprocesses (i.e., navigating, safekeeping, and repositioning), and highlighted how caregivers responded to the fluctuating needs of their spouse, to their own needs, and to those of the marital dyad. Reconciling was situated within a context shaped by a trajectory of prior care transitions and intertwined life events experienced by caregivers. Findings serve as a resource for scientists, rehabilitation clinicians, educators, and decision makers toward improving transitional care for spousal caregivers.

Compassion fatigue: an application of the concept to informal caregivers of family members with dementia

Introduction. Compassion fatigue is a concept used with increasing frequency in the nursing literature. The objective of this paper is to identify common themes across the literature and to apply these themes, and an existing model of compassion fatigue, to informal caregivers for family members with dementia. Findings. Caregivers for family members with dementia may be at risk for developing compassion fatigue. The model of compassion fatigue provides an informative framework for understanding compassion fatigue in the informal caregiver population. Limitations of the model when applied to this population were identified as traumatic memories and the emotional relationship between parent and child, suggesting areas for future research. Conclusions. Research is needed to better understand the impact of compassion fatigue on informal caregivers through qualitative interviews, to identify informal caregivers at risk for compassion fatigue, and to provide an empirical basis for developing nursing interventions for caregivers experiencing compassion fatigue.

Correlates of care relationship mutuality among carers of people with Alzheimer's and Parkinson's disease

AIM

This paper presents findings from secondary analysis of longitudinal data on correlates of care relationship mutuality collected from 91 carers of people with Alzheimer's disease and Parkinson's disease in the control group of a randomized trial of home-care skill training.

BACKGROUND

Many family members and other informal carers are reported to suffer multiple adverse social, financial, psychological and physical caregiving outcomes. High levels of mutuality, the perception that the quality of the care relationship is positive, reportedly ameliorate these negative outcomes.

METHOD

Multilevel models for change were used to explore whether care recipient functional ability, carer gender, depressive symptoms, kin relation to care recipient (spouse, non-spouse) and years of caregiving experience were related to carers' perceptions of care relationship mutuality over a 12-month period. Data collection took place between 2003 and 2008.

RESULTS

Carers who reported lower mutuality: (1) were caring for care recipients with lower functional ability, (2) had less caregiving experience and (3) had more depressive symptoms.

CONCLUSION

Informal carers who perceive little mutuality in their relationship with the care recipient may be more likely to terminate care early. Clinicians and researchers should explore the quality of the caregiving relationship as a critical factor in carer and care recipient outcomes. Home-care skill training may need to include relationship-building skills to offset adverse carer outcomes.

Understanding experiences of spousal caregivers with health as expanding consciousness

The purpose of this study was to recognize a unitary pattern within the lives of spousal caregivers following their spouses' discharge from the hospital after coronary artery bypass graft surgery. The unitary pattern emerged through four themes: dyadic relationship life patterns influenced caregivers' roles and responsibilities, life patterns of caring for self and others were altered, life patterns of certainty and knowing were limiting, awareness of life pattern gave meaning, and new perception on life left to live. The study added empirical support to the theory of health as expanding consciousness and provided a new way to examine the spousal caregiving experience.

Optimism, pessimism, mutuality, and gender: predicting 10-year role strain in Parkinson's disease spouses

PURPOSE

There is wide variability in how spouses providing care respond to their care situations. Few studies focus on the roles of both intra- and interpersonal factors in long-term spousal care, particularly in the context of Parkinson's disease (PD). The current study uses longitudinal data over a 10-year period to examine the roles of optimism, pessimism, mutuality, and spouse gender in predicting role strain in PD spouses.

DESIGN AND METHODS

A longitudinal design was used to study 255 spouses of persons with PD over a 10-year period, with data points at baseline (Year 0), Year 2, and Year 10. A series of multilevel models were used to examine four role strain variables -- global strain, strain from worry, strain from feelings of being manipulated, and strain from increased tension.

RESULTS

Female spouse gender predicted both higher Year 10 role strain and faster increases in role strain over the 10-year period. In addition, high mutuality and optimism and low pessimism at baseline played important protective roles against increased role strain at Year 10.

IMPLICATIONS

This study focused on early-stage spousal care in a primarily physical disability context. Findings suggest that gender differences place wives at greater risk for negative outcomes, even in the absence of dementia. Additionally, clinicians have opportunities to target interventions early in the care trajectory based on intra- and interpersonal risk factors.

Effects of caregiving demand, mutuality, and preparedness on family caregiver outcomes during cancer treatment

PURPOSE/OBJECTIVES

To test a model of family caregiving derived from the interactionist approach to role theory that hypothesized that three caregiving role implementation variables (caregiving demand, mutuality between caregivers and patients, and preparedness for caregiving) would predict multiple caregiving-specific and generic outcomes with different patterns of association across outcomes.

DESIGN

Descriptive, correlational.

SETTING

Surgical, radiation, and medical oncology settings.

SAMPLE

87 family caregivers of adults receiving treatment for solid tumors or lymphoma.

METHODS

Caregivers completed the Demand and Difficulty subscales of the Caregiving Burden Scale; the Mutuality, Preparedness, and Global Strain scales of the Family Care Inventory; and the 30-item short form of the Profile of Mood States. Data were analyzed with simultaneous multiple regression.

MAIN RESEARCH VARIABLES

Caregiving demand, mutuality, preparedness, caregiving difficulty, global caregiver strain, tension, depression, anger, fatigue, vigor, confusion, and total mood disturbance.

FINDINGS

The model explained statistically significant proportions of variance in each outcome, with different patterns of association across outcomes. Demand was associated most strongly with caregiving difficulty and global strain. Mutuality was associated most strongly with caregiver anger. Unexpectedly, preparedness was associated more strongly with mood disturbance outcomes than with the caregiving-specific variables of difficulty and strain.

CONCLUSIONS

Further research should explore models that address implementation of the caregiving role to better elucidate how family caregivers learn and carry out the important role.

IMPLICATIONS FOR NURSING

Clinical assessment should include caregiving demand, the quality of the relationship between caregiver and patient, and preparedness for caregiving. Interventions could be tailored to meet caregiver needs in each area.

Mutuality and preparedness moderate the effects of caregiving demand on cancer family caregiver outcomes

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.

Caregiver burden and outcomes of caregiving of spouses of patients who undergo coronary artery bypass graft surgery

BACKGROUND

Patients who undergo coronary artery bypass graft surgery often rely on spouses for care during recovery. Although often meaningful, caregiving may be stressful and affect spouses' ability to provide care to the patient.

OBJECTIVES

The purpose of this study was to compare burden and caregiving outcomes across three groups of spouses. Spouse groups varied by the interval of time between surgery and follow-up, which may have been 3, 6, or 12 months.

METHODS

This cross-sectional comparative study recruited a convenience sample of 166 spouses on the basis of a power analysis. A total of 166 spouses completed caregiver surveys on burden and other caregiving outcomes.

RESULTS

Total, objective, and subjective burden levels were low to moderate. Although no burden differences were found between groups, men had higher total burden but more positive caregiving outcomes. Future outlook and social activities were less positive in the 6-month group. Burden levels were not lower, nor were caregiving outcomes higher, in the 12-month group, suggesting a steady caregiving demand across the first year after coronary artery bypass graft surgery.

CONCLUSION

Longitudinal investigations are needed to understand burden and caregiving outcomes over time and the impact of burden on spousal and patient recovery outcomes.

The enduring and contextual effects of physical health and depression on care-dyad mutuality

Mutuality is a protective factor in family care situations, but little is known about changes in care-dyad mutuality. In this study, we examined mutuality in 103 care dyads over 20 months, and the enduring and contextual impact of older adult and family caregiver health on changes in mutuality. Care dyads consisted of frail older adults and their family caregiver. Older adults reported higher levels of mutuality than family caregivers, but their mutuality declined significantly faster over time. Although changes in physical health were more important than mean health for both older adults and family caregivers, mean depression was more important than changes in depression for older adults. This study shows the importance of examining time-varying covariates in the care dyad.

Measuring the psychosocial characteristics of family caregivers of palliative care patients: psychometric properties of nine self-report instruments

Researchers and clinicians have experienced substantial difficulties locating measures that are suitable for use within palliative care settings. This article details the psychometric properties of nine instruments designed to assess the following psychosocial characteristics of family caregivers: competence, mastery, self-efficacy, burden, optimism, preparedness, social support, rewards, and mutuality. Results are based on the responses of 106 primary family caregivers caring for relatives dying of cancer. Principal components extraction with varimax rotation was used to explore the underlying structure of each measure. Following the exclusion of complex variables, suggested components for most measures comprised relatively homogenous items, which were good to excellent measures of each component. Some components comprised only two items; however, Cronbach's alphas typically indicated moderate to high levels of internal consistency. Overall, the results of this study suggest that most of the measures analyzed, excepting the mastery and mutuality scales, can be recommended to examine the family caregiver experience and test supportive interventions.

Weaving the fabric of spirituality as experienced by patients who have undergone a coronary bypass surgery

When one is faced with a life-threatening event, spiritual issues become extremely important. The depth of one person's suffering is a unique experience. The relationship that developed between the interpretation of the answers of the coronary artery bypass patients and self-interpretation were the two directions in which this hermeneutic research moved forward within the hermeneutic circle. Central implications of the concept of spirituality emerging from this study are spirituality as meaning through gaining a new appreciation of life and health, spirituality as an inner strength through love and faith and in an ontological sense, spirituality as an inner strength through suffering and desire. Suffering invites one into the spiritual domain. Indeed, this concept raises important considerations for the development of caring knowledge about spirituality.