Spouse and adult child differences in caregiving burden

Impact of caregiving on mental, self-rated, and physical health: evidence from the China health and retirement longitudinal study

OBJECTIVES

Given the escalating demand for care services, understanding the impact of informal caregiving, providing unpaid care for family members, on own health is essential. This study longitudinally analyzed the association of caregiving (and different caregiver types) with mental, physical, and self-rated health. Urban-rural, gender, and employment heterogeneity were further investigated.

METHOD

Based on three-wave data (2011, 2013, and 2018) from the China Health and Retirement Longitudinal Study, we used growth curve models to assess the impact of informal caregiving (providing care to family members) and caregiver types (caregivers to grandchildren, parents, spouses, or multiple family members) on three health outcomes (depressive symptoms, self-rated health, and activities of daily living limitations).

RESULTS

Our study included 13,377 individuals. Results showed a negative correlation of caregiving with mental, physical, and self-rated health. Compared to noncaregivers, spousal caregivers and multiple caregivers were both associated with worsening mental, self-rated, and physical health. In contrast, adult child caregivers were only negatively associated with mental health, and grandparent caregiving did not significantly affect any health outcomes. Further heterogeneity analysis showed that gender did not moderate the relationship between caregiving and health, whereas the negative association between caregiving and health was more pronounced among the rural population and those employed in agriculture.

DISCUSSION

Findings from the present study suggest that caregiving is detrimental to health, and recommend considering caregiver type when examining caregiving and health. These findings have vital implications for policymakers in addressing the challenges of structuring and implementing a sustainable informal care system.

Proximal Discourses in Residential Facility Care Providers' Sense-Making of Their Communication with Family Members of a Loved One with Alzheimer's Disease

Families often stay involved in the care of a loved one with Alzheimer's disease even after relocation to a residential care facility, and through this transition, communication between the residential care providers and families becomes integral to keeping family informed and providing good care to the patient. However, care providers of people with Alzheimer's living in residential facilities find themselves overwhelmed by expectations related to their caregiving role and struggle with making sense of their experiences. Fifteen care providers of people with Alzheimer's disease living in a residential facility participated in qualitative, semi-structured interviews. Using relational dialectics theory as the framework through which to examine how residential facility care providers make sense of their communication with families of patients with Alzheimer's, analysis revealed three sets of competing proximal discourses: family inclusion and exclusion, reality and positivity, and expert and layperson provision of care. We address conclusions for scholars, implications for care providers and facilities, limitations, and suggestions for future research.

Duet playing in dementia care: a new therapeutic music technology

PURPOSE

Supporting the relational worlds of people living with dementia, especially the spousal dyad, is a growing focus in dementia care as is advancing the therapeutic use of music in dementia care. This paper describes a mixed-methods, multi-phase, iterative research study designed to develop the Music Memory Makers (MMM) Duet System, a novel therapeutic music technology, that allows non-musicians to play a personalized repertoire of songs arranged as duets.

METHODS

Following a pilot phase to iteratively assess and refine the MMM Duet System for recreational and therapeutic purposes, multiple sources of data were used to investigate five older spousal dyads' experiences with the system, two couples living with dementia and three who were not. We assessed perceptions of task difficulty, joint agency, and enjoyment as well as therapeutic benefits associated with enhancing the spousal relationship and sense of couplehood.

RESULTS

Findings suggest playing meaningful songs together is an enjoyable interactive activity that prompts musical reminiscence, involves joint agency, and supports relationship continuity within a relational, positive approach to dementia care. All couples mastered the task, none evaluated it as "very challenging," and positive couple interactions were evoked, commonly before and after playing the duets.

CONCLUSIONS

The MMM Duet System is recommended for further research and development as an innovative way to support couples living with dementia with commercial implications, and as a new music technology suitable for use as a research tool.

Impact of Caregiving on Cognitive Functioning: Evidence From the China Health and Retirement Longitudinal Study

OBJECTIVES

Few studies have examined the association between caregiving and the cognitive functioning of caregivers. This study explored the association between caring for family members and cognition and how the link differs by caregiving intensity and caregiving types. Furthermore, rural-urban and gender heterogeneity were investigated.

METHODS

This study analyzed Waves 2011, 2013, and 2018 of the China Health and Retirement Longitudinal Study, with cognitive functioning assessed in 3 dimensions: memory, executive function, and orientation function. The cognition trajectories between caregivers and noncaregivers were compared with the growth curve model.

RESULTS

Results demonstrated a positive association between caregiving and cognitive functioning (β = 0.249, p < .001). Considering caregiving intensity, the positive association was only found in low (β = 0.335, p < .001) and moderate-intensity caregivers (β = 0.250, p < .05) but not in high-intensity caregivers. Moreover, grandparents, adult children, and multiple caregivers had a higher average cognition level at age 60 than noncaregivers (all β > 0, all p < .05), and adult child caregivers exhibited a significantly slower rate of decline in cognition across age (β = 0.040, p < .01). However, spousal caregivers showed no significant disparities with noncaregivers. Moreover, the impact of caregiving on memory function is more apparent among urban adults.

DISCUSSION

Results indicate that caregiving can benefit cognitive function. This study proposes considering caregiving intensity and caregiving types when exploring caregiving and cognition. Based on these findings, policy-makers may overcome the challenges involved in establishing and developing a supportive informal care system in China.

Caregiver strain among non-Hispanic Black and Hispanic male caregivers with self-reported chronic health conditions

OBJECTIVES

Caregiver strain often stems from unmet needs and is a risk factor for poor physical and psychological health. This study aims to identify factors associated with caregiver strain among middle-aged and older non-Hispanic Black and Hispanic male caregivers living with one or more chronic conditions.

DESIGN

Data were analyzed from 418 male caregivers collected through Qualtrics Online Panels using an internet-delivered survey instrument (55.7% non-Hispanic Black, 44.3% Hispanic). Three ordinal regression models were fitted to assess factors associated with Caregiver Strain Scale tertiles: one for all men, one for non-Hispanic Black men only; and one for Hispanic men only.

RESULTS

Similarities and differences were observed between the two groups in terms of factors associated with higher caregiver strain (i.e. lower disease self-management efficacy scores, providing ≥20 h of care per week). Uniquely for Non-Hispanic Black male caregivers, higher caregiver strain was associated with living with more children under the age of 18 (β = 0.35, P = 0.011) and feeling more socially disconnected (β = 0.41, P = 0.008). Uniquely for Hispanic male caregivers, higher caregiver strain levels were associated with experiencing lower pain levels (β = -0.14, P = 0.040) and higher fatigue levels (β = 0.23, P < 0.001).

CONCLUSION

Findings from this study suggest that non-Hispanic Black and Hispanic men with chronic conditions have differing caregiving experiences. While bolstering social connectedness and caregiver support services may offset caregiver strain, tailored mental health and disease management programming are needed to meet the specific needs of non-Hispanic Black and Hispanic male caregivers.

Unpaid caregiving and stress among older working-age men and women in Sweden

Many individuals are experiencing the potentially stressful combination of providing care while still employed. In this study, the association between unpaid caregiving to another adult and self-reported stress among men and women aged 45-74 is investigated, using nationally representative time use diary data for Sweden (2000-01 and 2010-11, N = 6689). Multivariate regression analyses established that women were overall more stressed than men with the largest gender stress gap observed among intensive caregivers, providing >60 min of daily care and employed caregivers. The association between unpaid caregiving, employment, and self-reported stress is gendered. Among men, there is no caregiver effect regarding stress, but for women there is a net effect of 6-9%. Combining employment and unpaid caregiving (especially if intensive) is stressful for women but not for men. There are two potential mechanisms for this: less time for leisure and sleep. Unpaid caregiving is positively associated with stress among women when seen in relation to the way caregivers trade off time, not least to aid their recovery. These findings provide a more nuanced understanding of the time trade-offs carers make and uncover gender differences in the association between caregiving and stress that add to an existing gender stress gap. Given that unpaid caregivers are an important source of long-term care services, policymakers should consider that caregiving may be stressful and that stress impacts are gendered when designing and evaluating policies for longer working lives.

Heterogeneity in the mental health cost of caring for others

Drawing on the stress process, gender theory, and social roles theories, this study examines whether the associations between caregiving and mental health reflect the heterogeneity in caregiving experiences. It explores whether differences in care circumstances (location and intensity of care) and caregiver characteristics (gender and relation to care recipient) impact caregivers' health. While previous research has looked at these factors individually, this study uses longitudinal estimation methods to examine their combined associations with mental health. Using British data from the nationally representative panel survey Understanding Society (N = 366,907), fixed-effect models are used to assess the associations between the location and intensity of care, the caregiver's gender, and the relation to the care recipient and mental health. I report differences in mental health between non-caregivers and caregivers, as well as among caregivers across different care circumstances. While the results highlight the somewhat unique nature of each care circumstance and its relation to mental health, they uncover some general patterns. First, caregiving is a stressful social role. Second, care intensity is a crucial dimension of variation in the relationship between caregiving and mental health. Third, the location of care interacts with care relations only for less intensive caregivers. Fourth, there is a gradation in the negative association between caregiving activities and mental health by care relations. Finally, female caregivers are more susceptible to role overload and role captivity. When the care act is more expected and normative, such as when caring for a spouse, there is no difference by gender in mental health. Yet, differences by gender are evidenced when the intensive care act is less normative. This study unveils nuanced patterns in the joint and unique relations between care circumstances, caregiver characteristics, and mental health, and underscores the importance of effective care support especially for spousal and female parental caregivers.

Caring for parents with end-stage renal disease: What do adult children face and how do they cope?

AIM

This study aimed to explore the stressors and coping strategies of adult children who care for their parents with end-stage renal disease (ESRD) undergoing in-centre haemodialysis.

BACKGROUND

Given the growing number of older patients with ESRD, adult children are increasingly providing more care and assistance to their parents with this condition. However, little is still known about the experiences of caring for a parent undergoing haemodialysis.

DESIGN

A qualitative exploratory study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

METHODS

Semi-structured face-to-face interviews with nineteen adult children (44.9 ± 11.7 years old) were carried out. Data were transcribed verbatim and subjected to thematic analysis.

RESULTS

Four stressors (managing disease and treatment-related requirements, patients' reaction to treatment, lack of support from family members, and additional challenges to personal and family life) and five coping strategies (active coping and planning, seeking social support for emotional use, accepting the situation as it is, venting emotions, and maintaining interests outside caring) were identified.

CONCLUSION

Caring for a parent undergoing haemodialysis is an experience with several challenges, marked by educational needs, emotional distress, lack of support from close relatives and the need to manage multiple responsibilities.

RELEVANCE TO CLINICAL PRACTICE

Findings highlight the importance of developing interdisciplinary educational and supportive interventions to support this group of caregivers. These interventions should facilitate access to disease and treatment-related information, provide emotional support, and train coping skills to prevent burden and promote healthy adjustment to the demands of ESRD care.

Trends in long-term care use among Dutch older men and women between 1995 and 2016: is the gender gap changing?

This study examines whether the gender gap in long-term care use in the Netherlands has changed between 1995 and 2016. Previous research has shown that women use more formal care services than men, while men use more informal care. In the past decades, there have been changes in the individual determinants of care use, such as health and social resources, and care provision. This raises the question of whether gender differences in care use have also changed over time. The Longitudinal Aging Study Amsterdam (LASA) involved respondents aged 70–88 in seven waves: 1995/96, 1998/99, 2002/03, 2005/06, 2008/09, 2011/12 and 2015/16 (N = 6,527 observations). Generalised estimating equations (GEE) were used to analyse changes in the impact of gender on the use of informal and formal home care, residential care and private home care, and the non-use of care. Men used more informal care provided by a partner than women, but women used other sources of care more than men. Individual social resources explained the gender gap in informal and formal home care use, and health and social resources explained the gap in residential care. In the non-use of care and, to some extent, in residential care use, the gender gap widened over the years to the disadvantage of men and was not explained by health and social resources. The persistent and even increasing gender gap in the non-use of care over time warrants an exploration of the role of gender in seeking care and access to care, and a closer examination of the role of long-term care policies in maintaining this gap.

Explaining caregiver burden in a large sample of UK dementia caregivers: The role of contextual factors, behavioural problems, psychological resilience, and anticipatory grief

OBJECTIVES

Dementia caregiver burden is a significant public health concern, affecting both the wellbeing of caregivers and their care-recipients. This study investigated a range of variables associated with caregiver burden in a large sample of UK dementia caregivers. Clinical characteristics and novel psychological constructs were used - including anticipatory grief and psychological resilience. Anticipatory grief refers to the process of experiencing loss prior to the death of a significant person.

METHOD

Caregivers of persons with dementia (N = 530) completed a survey obtaining the Zarit-Burden Interview (ZBI-SF) and other psychological and demographic/caregiving-related factors.

RESULTS

Findings illustrate that 71% of the sample experienced high levels of caregiver burden and around 95% met the criteria for clinically significant levels of burden. A regression model explained 49% of the variance in subjective caregiver burden; contextual factors (care-recipients living situation, frequency of caregiving), behavioural challenges in the care-recipient (memory-related problem behaviours), caregiver psychological resilience and caregiver anticipatory grief (heartfelt long & sadness, worry & felt isolation) were all significant variables. Caregiver anticipatory grief, followed by psychological resilience, had the strongest association with burden.

CONCLUSION

Caregiver anticipatory grief and psychological resilience, have a significant interaction with the clinical presentation of the dementia sufferer in explaining subjective caregiver burden. More grief and resilience-focused interventions targeting both the practical and emotional challenges are imperative to reduce burden and thus to ensure caregiver wellbeing.

Beyond instrumental support: Mobile application use by family caregivers of persons living with dementia

In recent years, there has been a rapid increase in technology use in dementia caregiving, particularly the use of mobile applications (apps) which are highly accessible, cost-effective and intuitive. Yet, little is known about the experiences of family caregivers of persons living with dementia who use apps to support caregiving activities. This is of particular concern given that limited understandings of the user experience in designing technology have often led to end-users experiencing barriers in technology adoption and use. Using a qualitative descriptive approach, the purpose of the study was to explore the experiences of family caregivers of persons living with dementia on using apps in their caregiving roles. A purposive sample of five family caregivers in Ontario, Canada participated in two interviews each, with the second interview informed by photo-elicitation methods. Thematic analysis of the collected data revealed a central overarching theme, Connecting to support through apps in my, your and our lives, which explicated how apps played an important role in the lives of the caregiver, the care recipient and both together as a dyad. Three core themes also emerged: Adapting apps to meet individual needs of the dyad, Minimising the impact of the condition on the person and the family and Determining the effectiveness of apps. The findings highlighted that the value of apps extends beyond their mere functionality and their ability to help with care provision as they are also able to promote richer interpersonal connections, enhance personhood and sustain family routines. This research advances our understanding of the impact of app use in caregiving and provides direction for future research, policy, education, practice and app development.

Comparing adult-child and spousal caregiver burden and potential contributors

BACKGROUND

Adult-children caring for a parent with cancer comprise a significant segment of caregivers. Yet less is known about adult-child caregivers, their burden, or caregivers' and patients' gender's impact, which may differ from the well-studied spousal caregiver. This knowledge gap may hinder efforts to ameliorate adult-children's caregiver burden.

METHODS

We analyzed caregiver surveys from the Cancer Care Outcomes Research and Surveillance Consortium, a multi-regional population-based study of patients with colorectal or lung cancer. Using t tests and multivariate regression models, we assessed whether adult-child and spousal caregivers' caregiving responsibilities and social/emotional and financial burdens differed and used structural equation models (SEMs) to examine mediating factors.

RESULTS

Compared with spouses/partners (N = 1007), adult-children (N = 227) spent less time caregiving (14 vs 23 hours/week; P < .001), but experienced higher social/ emotional burden (P < .01). In models adjusted for objective caregiving burden measures and demographics, adult-children's social/emotional (P < .05) and financial burdens (P < .01) were greater than spouses'. Poor communication quality was associated with greater social/emotional burden for both groups (P < .05). SEMs indicated that gender concordance between caregivers and patients (eg, daughters caring for mothers) and caregiver employment increased the difference between adult-child and spouses' social/emotional burden, whereas caregiver-patient relationship quality reduced it.

CONCLUSIONS

Adult-children spend less time caregiving than spouses/partners, but have higher social/emotional and financial caregiving burdens, partially due to adult-children's employment, caregiver-patients' gender concordance, and relationship quality. Gender concordance's contribution to greater social/emotional burden adds important context to prior findings, indicating female caregivers experience the most burden. Interventions that improve caregiver-patient communication may reduce both adult-child and spousal caregiver burden.

The Burden of Caring for Dependent Older People and the Resultant Risk of Depression in Family Primary Caregivers in Italy

Long-Term Care (LTC) for older people in need of care is a critical issue affecting the quality of life of family caregivers (as well as older people), encompassing both negative and positive caregiving experiences. Providing support to family caregivers is essential because they play a crucial role in sharing the societal burden of LTC for the growing frail older population. By presenting the results of a survey carried out in 2019–2020 in Central Italy, this study aims to describe the characteristics and estimate by a multivariate logistic model the correlates of depressive symptoms in 369 primary caregivers of dependent older people. Caregivers are mostly women who provide a high amount of care in terms of weekly hours as a result of insufficient assistance from public or private care services. More than half of the sample show depressive symptoms, indicating a fairly serious situation. Perceived burden is a strong predictor of depression. The findings offer suggestions and policy implications. The fragmentation of the care context should be addressed by allocating sufficient funding to expand the supply of public in-kind services and integrate cash-for-care schemes, thus alleviating the burden and mitigating the negative consequences of care on physical and mental health.

Psychotic experiences among informal caregivers: findings from 48 low- and middle-income countries

PURPOSE

Informal caregivers may be at high risk for psychotic experiences (PE) due to caregiving related stress, sleep issues, or other potential mechanisms, but this has not been previously investigated in the general adult population. Thus, we examined the association between caregiving and PE, and its mediators, in a large sample of adults from 48 low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data from the World Health Organization (WHO) World Health Survey were analyzed. Informal caregivers referred to those who provided help to a relative or friend (adult or child) in the past year, because this person has a long-term physical or mental illness or disability, or is getting old and weak. PE were assessed using the WHO Composite International Diagnostic Interview psychosis screen. Multivariable logistic regression and mediation analyses were conducted.

RESULTS

Data on 224,842 individuals were analyzed. The mean (SD) age was 38.3 (16.0) years (range 18-120 years) and 50.7% were females. After adjustment for age, sex, and country, in the overall sample, caregiving was associated with 1.67 (95%CI = 1.56-1.79) times higher odds for PE. Sleep/energy explained the largest proportion of the association between caregiving and PE (13.9%), followed by pain/discomfort (11.5%), perceived stress (7.6%), depression (6.2%), and cognition (3.5%).

CONCLUSION

Caregivers in LMICs are at higher risk of PE. Future studies are warranted to gain a further understanding of the underlying mechanisms, and to assess whether addressing the identified mediators can lead to lower risk for PE among caregivers.

A qualitative exploration of how gender and relationship shape family caregivers' experiences across the Alzheimer's disease trajectory

Caregiving experiences are not static. They change across the disease trajectory and care continuum. However, it is not clear how caregiver gender or relationship type is related to evolving caregiver experiences over time. This qualitative study informed by constructivist grounded theory and framework analysis explored the experiences over time of men and women who were adult children and spousal caregivers to persons with Alzheimer's disease. Forty spousal (10 husbands and 10 wives) and adult children (10 sons and 10 daughters) caregivers to persons with Alzheimer's disease were interviewed using a semi-structured interview guide. Our findings suggest the experiences of caregiving, examined through a gender and relationship type lens, are complex and variable. The caregiving experience was not related to gender or relationship type alone, but often to a combination of the two. For instance, spousal caregivers did not immediately accept the diagnosis, with wives being more optimistic than husbands about a slow progression of the disease. Adult children caregivers were concerned about the ways the caregiving role would impact their personal and career obligations and sought ways to mitigate the changes to their daily lives. Sons and husband caregivers largely utilized home and community health services to assist with personal care tasks, whereas daughters and wives utilized the same services to allow them to complete other caregiving tasks (e.g., housekeeping). Recognition of the complex inter-relationships among gender and relationship type on caregiving experiences supports the need for family-centered interventions. This article also extends sex and gender research as it highlights that an in-depth understanding of the caregiving experience cannot be understood by gender alone and relationship type must also be considered.

Impact of an educational programme on Alzheimer's disease patients' quality of life: results of the randomized controlled trial THERAD

BACKGROUND

Although educational interventions are recommended in Alzheimer's disease (AD), studies assessing the impact of interventions such as "therapeutic patient education" are scarce. Indeed, the intrinsic nature of the disease is considered a barrier to patients' involvement in such approaches. We aimed to evaluate an intervention by using a "dyadic" approach (patient and caregiver) in both intervention and assessment.

METHODS

THERAD is a monocentric, randomized, controlled trial assessing the effects of a 2-month educational programme in mild to moderately severe AD patients among 98 dyads (caregiver/patient) on caregiver-reported patient quality of life (QOL) at 2 months. Community-dwelling patients and their caregivers were recruited in ambulatory units of the French Toulouse University Hospital. Self-reported patient QOL, autonomy, behavioural and psychological symptoms and caregiver QOL and burden were collected at 2, 6 and 12 months. Linear mixed models were used in modified intention-to-treat populations. We also performed sensitivity analysis.

RESULTS

A total of 196 dyads were included, 98 in each group. The mean age of the patients was 82 years, 67.7% were women, diagnosed with AD (+/- cerebrovascular component) (mean MMSE =17.6), and 56.9% lived with a partner. The mean age of the caregivers was 65.7 years, and 64.6% were women (52.3% offspring/42.6% spouses), with a moderate burden (mean Zarit score = 30.9). The mean caregiver-reported patient QOL was lower than the self-reported QOL (28.61 vs. 33.96). We did not identify any significant difference in caregiver-reported patients' QOL (p = 0.297) at 2 months, but there was a significant difference in self-reported patients' QOL at 2 months (p = 0.0483) or 6 months (p = 0.0154). No significant difference was found for the secondary outcomes. The results were stable in the sensitivity analyses.

CONCLUSIONS

This randomized controlled trial assessing an educational intervention in 196 dyads (Alzheimer's disease affected patient/caregiver) highlights the need to better consider the patient's point of view, since only the self-reported QOL was improved. Additional studies using this dyadic approach are necessary in targeted subpopulations of caregivers (spouse vs. child, gender) and of patients (severity of cognitive impairment or behavioural disturbances) TRIAL REGISTRATION: THERAD study NCT01796314 . Registered on February 19, 2013.

The Trajectory of Caregiver Burden and Risk Factors in Dementia Progression: A Systematic Review

Background:

Caring for patients with dementia at home is often a long-term process, in which the independence of the patient declines, and more responsibility and supervision time is required from the informal caregiver.

Objective:

In order to minimize and reduce caregiver burden, it is important to explore its trajectory and the accompanying risk factors as dementia progresses; the objective of this systematic review.

Methods:

PRISMA guidelines were followed in this systematic review. Three databases, PubMed, PsycINFO, and EMbase, were systematically searched in November 2019 using specific keywords.

Results:

1,506 hits emerged during the systematic search but only eleven articles actually met the inclusion criteria for this review. The trajectory of caregiver burden is highly variable and depends on multiple factors. Important risk factors included: patients’ behavioral and neuropsychiatric symptoms, and their decline in functioning in (I)ADL; the caregiver’s age, gender, and physical and mental health; and, within the dyads (patient/caregiver), cohabitation and kinship.

Conclusion:

There is no one-size-fits-all for predicting how caregiver burden will change over time, but specific factors (like being a spouse and increased behavioral impairment and decline in functional status in the patient) may heighten the risk. Other factors, not yet comprehensively included in the published studies, might also prove to be important risk factors. Future research in the field of reducing caregiver burden is recommended to integrate the patient, caregiver, and context characteristics in the trajectory of caregiver burden, and to assess more clearly the phase of the dementia progression and use of external resources.

Social Isolation Among Spousal and Adult-Child Caregivers: Findings From the Canadian Longitudinal Study on Aging

OBJECTIVES

The caregiving outcomes of spousal and adult-child caregivers are widely studied since they are the most common source of support provided to adults. However, the literature on social isolation among spousal and adult-child caregivers is very limited. In order to further elaborate and specify unique caregiving outcomes, this study focuses on social isolation, both longitudinally and comparatively between spousal and adult-child caregivers.

METHODS

This study was based on the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 5,226 participants (1,293 spousal caregivers and 3,933 adult-child caregivers) were selected. The Linear mixed models were used to examine the effect of caregiver type and caregiving intensity on social isolation over the course of survey.

RESULTS

Spousal and adult-child caregivers reported greater social isolation over time, and spousal caregivers exhibited a steeper increase in social isolation from Baseline to Follow-up 1 than adult-child caregivers. Also, an increase in caregiving hours resulted in greater social isolation. Finally, male spousal or adult-child caregivers were more likely to be socially isolated over time than their female counterparts.

DISCUSSION

The findings of this study contribute to the existing literature on caregiving outcomes by demonstrating an association between family caregiving and social isolation. The results indicate a strong need for intervention programs that aim to enhance social connectedness among family caregivers, and especially for those who perform intensive caregiving, are older age, and are from a lower socioeconomic status.

Gender Differences in Caregiver Burden Among Family Caregivers of Persons With Dementia

The current study aimed to identify gender-dependent factors that influence caregiver burden among family caregivers of persons with dementia through secondary data analysis. We used a nationally representative survey of 379 family caregivers of persons with dementia completed in 2014. We examined factors affecting the burden experience of male and female caregivers, guided by the stress process model, using hierarchical regression. The analytic sample included 159 males (42%) and 220 females (58%). For males, age of care recipient, being an adult child, social support, instrumental activities of daily living performed, and caregiving impact on caregivers' health influenced burden. For females, co-residence, social support, caregivers' current health, and caregiving impact on caregivers' health impacted burden. Understanding gender differences related to caregiving burden is beneficial for developing effective targeted interventions that support the caregiving role and improve the quality of life of caregivers. [Journal of Gerontological Nursing, 47(7), 33-42.].

Differences in Burden Severity in Adult-Child Family Caregivers and Spousal Caregivers of Persons with Dementia

Researchers are continuing to focus on the nature and sources of burden of family caregivers of persons living with dementia. Caregiving stress and burden are assessed and addressed by social workers, including at high-risk times such as hospitalization. This study tested whether adult-child family caregivers experience greater perceived burden than spousal caregivers, accounting for risks of acute stress which can accompany hospitalization for their care recipient, where social workers may be meeting with family caregivers for the first time. Family caregivers (N = 76; n = 42 adult-child; n = 34 spouse) were recruited during care-recipient clinical treatment. The settings of care included an outpatient memory care program and an inpatient geriatric psychiatry service. Results showed that adult-child caregivers reported greater burden as compared with spousal caregivers, but no differences regarding depressive symptoms, perceived stress, or grief. After controlling for demographics and location of care, being an adult-child caregiver remained a predictor of greater burden severity. Being an adult-child family caregiver may place an individual at increased risk for experiencing high burden. These findings suggest socials workers should consider how adult-child caregivers may benefit from strategies to address and reduce burden, beyond those typically offered to spousal caregivers.

The Impact of Caregiving Burden on Mental Well-Being in Coronary Artery Bypass Graft Surgery Caregivers: The Mediatory Role of Perceived Social Support

An increase in caregiver burden and a decrease in social support have both been identified as predictors of poor caregiver psychological distress. However, little is known about the role of these factors in coronary artery bypass graft (CABG) caregivers. The purpose of this study was to investigate whether change in perceived social support from pre to post surgery mediated the relationship between change in caregiver burden and caregiver depressive symptoms and subjective well-being post surgery. A sample of 101 caregivers of elective CABG patients were assessed 28 days before and 62 days after patients' surgery. Caregivers completed the Oberst Burden Scale, the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, the Beck Depression Inventory, and the Control, Autonomy, Self-Realisation, and Pleasure (CASP-19) scale. Simple mediation analyses showed that change in social support significantly mediated both the relationship between change in caregiver burden and post-surgery depressive symptoms (unstandardised β = 0.041, 95% CI (0.005, 0.112)) and the relationship between change in caregiver burden and post-surgery subjective well-being (unstandardised β = 0.071, 95% CI (0.001, 0.200)). Psychological interventions aimed at the CABG caregiver population should promote social support to deal with the increase of caregivers' tasks and demands after the patients' surgery.

An analysis of carer burden among family carers of people with and without dementia in Ireland

OBJECTIVE

Despite the policy relevance of carer burden, limited research focuses on family carers' experience of carer burden among different disease groups. This study aimed to examine differences in carer burden among family carers of people with and without dementia.

DESIGN

Secondary data analysis was conducted on a national cross-sectional dataset. Multivariable ordered logistic regression was used to analyze four levels of carer burden (low, mild, moderate, high). The main independent variable was dementia diagnosis, and controls included variables relating to the care recipient, family carer, and context of care.

SETTING

The original survey was funded by Irish Health Service Executive and undertaken by the National Centre for the Protection of Older People in Ireland.

PARTICIPANTS

The original dataset consisted of 2,311 family carers of older people in Ireland. Approximately, one-fifth of this sample had a diagnosis of dementia.

MEASUREMENTS

Carer burden was measured using the standardized 22-item Zarit Burden Interview. Care-recipient dependency was measured using the Activities for Daily Living Scale. Sociodemographic details and information about the context of caring were collected using self-report scales.

RESULTS

In our model, dementia diagnosis and dependency level were significantly associated with carer burden. Family carer and context of care variables including gender, marital status, education, residence, co-residence, and perceived support showed significant relationships with carer burden. Our results highlighted significant differences in carer burden distribution; in particular, family carers of people with dementia were less likely to report low or mild carer burden (-6.95 ppts and -3.64 ppts, respectively) and more likely to report moderate or high carer burden (8.46 ppts and 2.13 ppts, respectively).

CONCLUSION

Our findings suggest that family carers of people with dementia may experience additional challenges associated with caring. Therefore, family carers of people with dementia may require tailored social supports to maintain good health and well-being.

The Impact of Risk and Resistance Factors on Quality of Life in Caregivers of Individuals with Dementia

OBJECTIVES

The present study investigates the effect of caregiver and care recipient risk and resistance factors on caregiver quality of life (QOL). Risk factors are those characteristics that contribute to psychosocial maladjustment of the caregiver and reduce QOL, while resistance factors promote caregiver adjustment and improve QOL.

METHODS

One-hundred and three caregiver/care recipient dyads were recruited from a memory assessment clinic in Midwestern United States. Caregivers completed questionnaires estimating perceived social support, spirituality, social problem-solving, and care recipient functional dependence. Care recipients' results from the Mini-Mental State Examination and Animal Naming task were also collected.

RESULTS

In the final model, caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence each accounted for a significant portion of variance in caregiver QOL. The final model accounted for 46.1% of the variance in caregiver QOL.

CONCLUSION

Caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence are important contributors to caregiver QOL. Further research is needed to specify which caregiver and care recipient characteristics are most important to caregiver QOL.

CLINICAL IMPLICATIONS

Health professionals should assess caregiver problem-solving skills, social support, and care recipient functional dependence, as these may provide important information about caregiver QOL. Study results also suggest that caregiving has more of a negative impact on caregiver QOL for midlife adult caregivers compared to older adult caregivers, and appears to have a greater negative effect on spouses than on children.

Effects of Transitions to Family Caregiving on Well-Being: A Longitudinal Population-Based Study

BACKGROUND/OBJECTIVES

Few studies have rigorously examined the magnitude of changes in well-being after a transition into sustained and substantial caregiving, especially in population-based studies, compared with matched noncaregiving controls.

DESIGN

We identified individuals from a national epidemiological investigation who transitioned into caregiving over a 10- to 13-year follow-up and provided continuous in-home care for at least 18 months and at least 5 hours per week. Individuals who did not become caregivers were individually matched with caregivers on age, sex, race, education, marital status, self-rated health, and history of cardiovascular disease at baseline. Both groups were assessed at baseline and follow-up.

SETTING

REasons for Geographic And Racial Differences in Stroke study.

PARTICIPANTS

A total of 251 incident caregivers and 251 matched controls.

MEASUREMENTS

Perceived Stress Scale (PSS), 10-Item Center for Epidemiological Studies-Depression (CES-D), and 12-item Short-Form Health Survey quality-of-life mental (MCS) and physical (PCS) component scores.

RESULTS

Caregivers showed significantly greater worsening in PSS, CES-D, and MCS, with standardized effect sizes ranging from 0.676 to 0.796 compared with changes in noncaregivers. A significant but smaller effect size was found for worsening PCS in caregivers (0.242). Taking on sustained caregiving was associated with almost a tripling of increased risk of transitioning to clinically significant depressive symptoms at follow-up. Effects were not moderated by race, sex, or relationship to care recipient, but younger caregivers showed greater increases in CES-D than older caregivers.

CONCLUSION

Persons who began substantial, sustained family caregiving had marked worsening of psychological well-being, and relatively smaller worsening of self-reported physical health, compared with carefully matched noncaregivers. Previous estimates of effect sizes on caregiver well-being have had serious limitations due to use of convenience sampling and cross-sectional comparisons. Researchers, public policy makers, and clinicians should note these strong effects, and caregiver assessment and service provision for psychological well-being deserve increased priority.

A cross-sectional study on spouse and parent differences in caregiving experiences of people living with schizophrenia in rural China

BACKGROUND

Conflicting evidence exists on whether parent or spouse caregivers experience better outcomes when caring for family members with schizophrenia. The current study aims to examine relative caregiving experiences and impacts of spouse and parent caregivers for people living with schizophrenia (PLS) in China.

METHODS

A cross-sectional study was conducted in a sample of 264 community-dwelling primary family caregivers of PLS. Face-to-face interviews were conducted to collect information on family caregiving activities; negative caregiving impacts including objective and subjective burden, and caregiver psychological distress such as depression and anxiety; positive caregiving impacts including caregiving rewarding feelings, and family functioning for spouse and parent caregivers.

RESULTS

Both types of caregivers report engaging in similar caregiving activities and report comparable levels of objective burden. However, parent caregivers report significantly higher subjective burden than spouse caregivers (b = 7.94, 95%CI:2.08, 13.80, P < 0.01), which is also reflected in significantly higher depression (b = 3.88, 95%CI:1.35, 6.41, P < 0.01) and anxiety (b = 2.53, 95%CI: 0.22, 4.84, P < 0.05), and lower family functioning (b = - 1.71, 95%CI: - 2.73, - 0.49, P < 0.01). Despite these differences, both groups of caregivers report comparable rewarding feelings about caregiving.

CONCLUSIONS

Our findings have implications for family caregivers globally, but especially for countries that adhere to Confucian cultural values and provide guidance for future family intervention programs. Such programs may do well to incorporate cultural values and beliefs in understanding caregiving and kinship family dynamics so as to support family caregivers, and in particular, the specific vulnerabilities of parent caregivers.

An evaluation study of caregiver perceptions of the Ontario's Health Links program

Introduction

In 2012, the Ontario government launched Health Links (HL), which was designed to integrate care for patients with multimorbidity and complex needs who are high users of health services. This study evaluated perceptions of family and friend caregivers of patients enrolled in the HL program. Research questions included: What are (a) characteristics of caregivers of patients enrolled in HL (b) caregivers’ perceptions of the program in relation to HL’s guiding principles (patient and family-centred care, accessibility, coordination of services, and continuity of care and care provider) and (c) caregivers’ perceptions of the impact of HL on themselves and their care recipient?

Methods

This study involved a survey and qualitative, semi-structured interviews. HL guiding principles (patient and family-centered care, accessibility, coordination of services, and continuity) guided the analysis.

Results

Twenty-seven surveys and 16 qualitative interviews were completed. Caregivers reported high levels of strain [Modified Caregiver Strain Index (MCSI) 15.5 (SD 7.03)], mild anxiety [Generalized Anxiety Disorder (GAD 7), 9.6 (SD 6.64)] and depression [Center for Epidemiological Studies Depression Scale (CES-D 10), 11.9 (SD 8.72)]. Regarding the guiding principles, most caregivers had a copy of the HL patient’s care plan, although some caregivers noted that their needs were not included in the plan, nor were they asked for input. Caregivers found the program’s home and phone visits accessible. Despite minimum wait times for community-based services, other access barriers persisted, (i.e., out-of-pocket costs). HL provided well-coordinated patient services, although some perceived that there was poor team communication. Caregiver perceptions varied on the quality of care provided. Provider continuity provided caregiver relief and patient support: A lack of continuity was related to changes in care coordinators and weekend staff and attrition.

Conclusions

Caregivers of HL patients appreciated patient- and family-centred, accessible, consistent, coordinated and team-based approaches in care. Providers and decision-makers are urged to ensure that programs aimed at high system users address these core concepts while addressing caregivers’ needs.

Dementia and caregiver burden: A three-year longitudinal study

OBJECTIVES

Dementia, with its progressive cognitive and functional decline and associated neuropsychiatric symptoms, places a large burden on caregivers. While frequently studied, longitudinal findings about the overall trajectory of burden are mixed. The study sought to characterize caregiver burden over a 3-year period and identify predictors of this burden.

METHODS

Seven-hundred-and-eighty-one patients with dementia were recruited from nine memory clinics around Australia. Measures of caregiver burden, cognition, function, and neuropsychiatric symptoms were completed with patients and their caregivers at regular intervals over a 3-year period. Patients' level of services and medication use were also recorded.

RESULTS

Of the 720 patients with measures of caregiver burden at baseline, 47.4% of caregivers had clinically significant levels of burden. This proportion increased over time, with 56.8% affected at 3 years. Overall levels of burden increased for caregivers of patients without services, though did not change for caregivers of patients receiving services or residential care after controlling for other variables. Patient characteristics-including greater neuropsychiatric symptoms, lower functional ability, fewer medications, lack of driving ability-and female sex of caregivers were associated with greater burden.

CONCLUSIONS

High levels of caregiver burden are present in a large proportion of caregivers of people with dementia and this increases over time for those without services. Clinical characteristics of patients (including neuropsychiatric symptoms, function, overall health, driving status), level of services, and caregiver sex appear to be the best predictors of this burden. These characteristics may help identify caregivers at greater risk of burden to target for intervention.

Hearing and Cognitive Impairments Increase the Risk of Long-term Care Admissions

Background and Objectives

The objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions.

Research Design and Methods

This retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants' most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan-Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC.

Results

In this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer's dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11).

Discussion and Implications

Although CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients.

Caregiver burden: An increasing problem related to an aging cancer population

This prospective cohort study identified risk factors for the development of caregiver burden and included older cancer survivors, middle-aged cancer survivors, older patients without cancer and their caregivers. Overall, more than 16 per cent of caregivers experienced high-to-severe burden at baseline. This proportion remained stable after 1 and 3 years. Caregivers who experienced increased caregiver burden at baseline were at higher risk maintaining their caregiver burden over the following years. Caregiver burden was not related to the cancer diagnosis but rather to the baseline psychosocial well-being of both the caregiver and patient and the physical condition of the patient.

Risks Perceived by Frail Male Patients, Family Caregivers and Clinicians in Hospital: Do they Change after Discharge? A Multiple Case Study

INTRODUCTION

Up to 40% of hospitalised seniors are frail and most want to return home after discharge. Inaccurate estimation of risks in the hospital may lead to inadequate support at home. This study aimed to document convergences and divergences between risks and support needs identified before hospital discharge and perceived at home post-discharge.

METHODS

This research used a multiple case study design. Three cases were recruited, each involving a hospitalised frail patient aged 70+, the main family caregiver and most of the clinicians who assessed the patient before and after hospital discharge. Thirty-two semi-structured interviews were conducted and their transcripts analysed using a qualitative thematic analysis approach.

RESULTS

Among risks raised by participants, falls were the only one with total inter-participant/inter-time/inter-case convergence. In all cases, all participants mentioned, before and after discharge, home adaptations and use of technical aids to mitigate this risk. However, clinicians recommended professional services while patients and family caregivers preferred to rely on family members and their own coping strategies.

CONCLUSION

The divergences identified for most risks and support needs between users and clinicians, before and after discharge, provide new insights into a comprehensive and patient-centred risk assessment process to plan hospital discharge for frail elderly.

We Are Caregivers: Social Identity Is Associated with Lower Perceived Stress among Rural Informal Caregivers

ABSTRACTInformal caregivers often experience high stress levels with little support, especially in rural settings. With a mixed-methods approach, this research explored experiences of rural informal caregivers, including how social identification as a caregiver, social interactions, and formal and informal coping support related to perceived stress. Major focus group themes (n = 8) included lacking available services, balancing challenges, unmet practical needs, and strong community identity. Survey data (n = 22) revealed that perceived coping support (e.g., having someone to turn to), social interactions, and caregiver identity (e.g., perceiving the role as important to one's self-concept) were associated with lower life upset stress, but only caregiver identity was associated with managing the personal distress and negative feelings associated with caregiving stress. Results suggest that, although available rural services may fall short, other options might alleviate caregiver stress, including facilitating access to coping support, encouraging social interactions, and enhancing caregiver social identity.

Longitudinal Outcomes Among Family Caregivers of Power Mobility Users

OBJECTIVE

To examine the change over 1 year in the burden, wheelchair skills, social support, social participation, and mental health of family caregivers providing assistance to older adult powered wheelchair users.

DESIGN

Longitudinal study.

SETTING

Community.

PARTICIPANTS

Participants (N=35) included family caregivers (mean age ± SD=63.7±10.2y) who provided at least 2 hours of general care per week for a powered wheelchair user.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

The Power Mobility Caregiver Assistive Technology Outcome Measure (frequency of care and subjective burden), the Wheelchair Skills Test Questionnaire for caregivers (wheelchair skills), the Interpersonal Support Evaluation List-6 (social support), the Late-Life Function and Disability Instrument (social participation), the Hospital Anxiety and Depression Scale (mental health). Measures were taken at baseline, 1, 3, 6, and 12 months. Descriptive statistics were calculated, and a linear mixed model was used to assess changes over time in the outcomes.

RESULTS

The results showed that the caregivers helped on average with 3 powered wheelchair-related activities and 10 other caregiving activities. They also experienced moderate subjective burden and social participation and were within the normal range for depression and anxiety. Moreover, those outcomes remained stable over the 1-year study period. However, the wheelchair skills scores showed significant changes over time, as the scores improved during the first 6 months of the study.

CONCLUSION

Given that previous research indicated that subjective burden tends to decline over time among caregivers, the findings of stability in this study may reflect increasing needs among this population of caregivers, who may benefit from additional support and interventions. This would need further consideration.

Sociodemographic Disparities in Adult Child Informal Caregiving Intensity in the United States: Results from the New National Study of Caregiving

The objective of the current study was to assess socioeconomic and demographic disparities in caregiving intensity among informal caregivers. Using a randomized, nationally representative sample of 1,014 adult child informal caregivers from Medicare enrollment databases, the associations between informal caregiving intensity and age, race/ethnicity, and income were examined using binary and ordinal logistic regression. Caregiving intensity varied by demographics. Activities of daily living (ADL) caregiving was highest among Black, non-Hispanic caregivers. Instrumental ADL caregiving and number of hours spent caregiving was highest in female and non-White caregivers. Although the overall association between caregiving intensity and income was not significant, when stratified by race/ethnicity, this association was positive for White caregivers and negative for non-White caregivers. Health care providers frequently interact with informal caregivers and should be aware of trends in caregiving and the needs and supports available to ameliorate caregiver burden. To protect caregivers, policies and programs should be designed to promote well-being and mitigate the potential harms of caregiving to health. [Journal of Gerontological Nursing, 44(9), 15-20.].

Socioeconomic and demographic factors modify observed relationship between caregiving intensity and three dimensions of quality of life in informal adult children caregivers

Background

The relationship between informal caregiving intensity and caregiver health is well-established, though research suggests this may vary by caregiver demographics. The aim of this exploratory study is to assess the association between caregiving intensity and three dimensions of quality of life outcomes, and determine how caregiver sociodemographics change the nature of this relationship among informal adult children caregivers.

Methods

Using the 2011 National Study of Caregiving, associations between caregiving intensity and quality of life were examined in caregivers providing care to an aging parent (n = 1014). Logistic regression was used to model caregiver quality of life on caregiving intensity using an ordinal composite measure of caregiving activities, including Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), hours per month, and length of caregiving, stratified by race/ethnicity, gender, age, and family income. Odds ratios and corresponding 95% confidence intervals were calculated.

Results

Associations between caregiving intensity and quality of life varied substantially by race/ethnicity, gender, age, and annual family income. White caregivers were significantly more likely to experience negative emotional burden when providing high intensity care (ADL: 1.92, Hours: 3.23). Black caregivers were more likely to experience positive emotions of caregiving (ADL: 2.68, Hours: 2.60) as well as younger caregivers (Hours: 8.49). Older caregivers were more likely to experience social burden when providing high ADL, IADL, and monthly hours of care.

Conclusions

These findings demonstrate the complex and multi-dimensional nature of caregiving, and emphasize the need to develop approaches that are tailored to the specific health needs of subpopulations of informal caregivers.

Patterns of carer distress over time in mild dementia

OBJECTIVE

To study the level of carer reported distress in mild dementia, over a 3-year period.

METHODS

This study is part of the Norwegian DemVest-study and utilises data from carers of people with mild dementia (n = 223). Those diagnosed with dementia with Lewy bodies (DLB, n = 63) and Alzheimer's disease (AD, n = 97) were included together with other dementia types (n = 63). The Relatives' Stress Scale was used to assess the level of reported distress in carers. Descriptive and a linear mixed effects models including diagnosis, time, and the interaction between time and diagnosis were performed.

RESULTS

Carer distress in mild dementia increased significantly over time (P = 0.011), particularly from baseline until 2 (P = 0.001) years follow-up. Carer distress in people caring for those with AD increased significantly, from baseline until 2 (P = 0.047) and 3 (P = 0.019) years follow-up. Distress in carers of people with DLB was high at baseline and remained relatively stable across the 3-year period. However, admission to a nursing home during the first year of follow-up was associated with a significantly lower reported carer distress in those caring for a person with DLB (P = 0.002), compared with those caring for a person with DLB living at home.

CONCLUSION

Being a carer to a person with mild dementia is associated with increasing distress. However, the burden of distress changes with the diagnosis, time, and situation, which highlights the dynamic nature of the caring role. Findings have important implications for health services for people diagnosed with mild dementia and their carers.

Well-being of Sibling Caregivers: Effects of Kinship Relationship and Race

Purpose of the Study

This study examined whether caregiving has a differential effect on the well-being of sibling caregivers relative to other caregiving groups and whether race moderates this effect.

Design and Methods

Using the National Survey of Midlife Development in the United States, 631 family caregivers (including 61 sibling caregivers) and 4,944 noncaregivers were identified. Hierarchical regression analyses were conducted to estimate the effect of the caregiver-care recipient relationship and its interaction with race on caregivers' well-being (i.e., depressive symptoms, self-rated health, life satisfaction, and perceived control over life).

Results

Caregivers in general reported poorer well-being than noncaregivers, but sibling caregivers were less affected by caregiving than parent or spouse caregivers. Among sibling caregivers, caregiving took a significantly greater toll on non-Hispanic White caregivers than those from minority groups with respect to depressive symptoms and life satisfaction.

Implication

The findings suggest that the experience of sibling caregivers is significantly shaped by their cultural background.

Kinship and cohabitation in relation to caregiver burden in the context of Alzheimer's disease: a 24-month longitudinal study

OBJECTIVES

The aims of the study were to identify the clinical characteristics of three groups of caregivers: spouses, live-in adult-child or non-live-in adult-child, and their relation to the degree of perceived burden (Caregiver Burden Interview).

METHODS

The sample comprised 275 Alzheimer's disease primary caregivers, with a follow-up of 24 months. Cognitive, functional and behavioural characteristics were evaluated in persons with dementia, whilst sociodemographic data, use of socio-medical resources, physical and mental health and self-perceived burden were assessed in caregivers. Generalized estimating equations were used for longitudinal data analysis.

RESULTS

Spouse caregivers were 45.0% men, sole caregivers (>80%), used few external resources and had worse physical health. The number of female adult-child caregivers was higher (>75%). The live-in adult-child group, compared with the non-live-in adult-child group, was less likely to be married, had a lower level of education, was more commonly the sole caregiver and used fewer external resources. The greatest burden was observed in live-in adult-child caregivers, and the lowest in the non-live-in adult-child group, with no significant variation in the follow-up for both groups. Spouses had an intermediate level of perceived burden, which rose significantly during follow-up (p < 0.001).

CONCLUSIONS

Kinship and cohabitation with the persons with dementia were associated with different scores and evolution of the burden, with an increase in the follow-up of the spouses, and with more or less burden, depending on cohabitation, in the adult-child groups. Interventions to reduce the level of burden on caregivers should consider these differences. Copyright © 2017 John Wiley & Sons, Ltd.

Caregiver Experiences Across Three Neurodegenerative Diseases: Alzheimer’s, Parkinson’s, and Parkinson’s With Dementia

Objective: This article asks whether distinct caregiver experiences of Alzheimer’s disease (AD), Parkinson’s disease (PD), and Parkinson’s disease with dementia (PDD) spouses are accounted for by disease diagnosis or by a unique combination of symptoms, demands, support, and quality of life (QOL) cross disease groups. Method: One hundred five live-in spouse caregivers (71.4 ± 7 years) were surveyed for persons with AD (39%), PD (41%), and PDD (20%). A hierarchical cluster analysis organized caregivers across disease diagnosis into clusters with similar symptom presentation, care demands, support, and QoL. Results: Four clusters cut across disease diagnosis. “Succeeding” cared for mild symptoms and had emotional support. “Coping” managed moderate stressors and utilized formal supports. “Getting by with support” and “Struggling” had the greatest stressors; available emotional support influenced whether burden/depression was moderate or severe. The results remain the same when diagnostic category is added to the cluster analysis. Discussion: This study supports going beyond disease diagnosis when examining caregiver experiences.

Older Adult Spouses with Multiple Chronic Conditions: Challenges, Rewards, and Coping Strategies

There is a paucity of research exploring how spouses to older adults with multiple chronic conditions make meaning of their caregiving experience. For this study, we asked: What is the experience of spousal caregivers to persons with multiple chronic conditions? We applied Thorne's interpretive description approach, interviewing 18 spouses who provided a rich description of their caregiving experience; interviews were transcribed verbatim and thematically analysed. Themes were categorized according to challenges encountered, rewards gleaned, and sustaining strategies employed by participants in caregiving to their spouse with multiple chronic conditions. Unique findings relate to the challenges inherent in decision-making within the context of multiple chronic conditions. This article begins to address the gap in the literature regarding the caregiving experience within the context of multiple chronic conditions.

A qualitative exploration of how Canadian informal caregivers in medical tourism use experiential resources to cope with providing transnational care

Canadians travelling abroad for privately arranged surgeries paid for out-of-pocket are engaging in what has come to be known as medical tourism. They are often accompanied by friends or family members, who we call caregiver-companions. Caregiver-companions provide care in and across a variety of formal and informal settings, such as in hotels, airplanes and at home. This qualitative study examines the experiences of informal caregivers in medical tourism to learn more about the lived experiences or 'experiential resources' they draw upon to cope with providing care and avoiding caregiver burden. The care-giving literature has demonstrated that such burden can negatively impact caregivers' well-being. The unique, transnational context of care-giving in medical tourism and recent growth in popularity of this practice means that there are few supports or resources currently in place to assist informal caregivers. In this article, we report on an analysis that sought to detail how caregiver-companions draw upon their previous lived experiences to cope with providing transnational care and to minimise or avoid the onset of caregiver burden. We conducted semi-structured telephone interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery between September 2013 and January 2014. Thematic analysis revealed the ways that participants had developed practical strategies to deal with the challenges they faced in medical tourism. The interviews revealed three important experiential resources drawn upon by participants: (i) previous experiences of international travel; (ii) previous experiences of informal care-giving; and (iii) dimensions of the existing relationship with the care recipient. Differences in access to and use of these experiential resources related to participants' perspectives on medical tourism and the outcomes of the trip. By identifying the experiential resources drawn upon by informal caregivers in medical tourism, we can more effectively identify supportive interventions.

Accuracy of Caregiver Proxy Reports of Home Care Service Use

Although much of the research on service use by older adults with dementia relies on proxy reports by informal caregivers, little research assesses the accuracy of these reports, and that which does exist, does not focus on home care services. This brief report compares proxy reports by family caregivers to those with dementia with provincial Ministry of Health records collected for payment and monitoring. The four home care services examined include home nursing care, adult day care, home support, and respite care. Data come from a province-wide study of caregivers in British Columbia, Canada. Caregiver reports are largely consistent with Ministry records, ranging from 81.0% agreement for home support to 96.6% for respite care. Spouses living with the care recipient (the vast majority of the sample) are the most accurate. Others, whether living with the care recipient or not, have only a 50-50 chance of being correct.

Subjective burden among spousal and adult-child informal caregivers of older adults: results from a longitudinal cohort study

Background

Pressures on informal caregivers are likely to increase due to increasing life expectancy and health care costs, which stresses the importance of prevention of subjective burden. The present study examined the correlates of overall subjective burden and multiple burden dimensions among spousal and adult-child caregivers of Dutch older adults, both cross-sectional and longitudinal (12-months follow-up).

Methods

In 2010 and 2011 baseline and follow-up data was collected in a sample of informal caregivers and care recipients in the Northern provinces of the Netherlands. Subjective burden included 7 burden dimensions and a summary score for overall subjective burden, based on the Care-Related Quality of Life Instrument (CarerQoL-7D). Objective stressors were the time investment in caregiving (hours of household care, personal care, practical care) and the health situation of the care recipient, including multimorbidity, functional limitations (Katz Index of Independence Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), and cognitive functioning problems (EQ-5D + C). Correlates of subjective burden were evaluated with linear and logistic regression analyses.

Results

The sample consisted of 356 caregivers at baseline (43% spousal, 57% adult-child caregivers), and 158 caregivers at follow-up (45% spousal, 55% adult-child caregivers). At baseline and follow-up, spousal caregivers experienced a higher overall subjective burden, and reported more often mental health problems, physical health problems, and problems with combining daily activities, compared to adult-child caregivers. For spousal caregivers, a poorer health situation of the care recipient was associated with higher subjective burden, while adult-child caregivers reported higher levels of subjective burden when their time investment in caregiving was high. Subjective burden at follow-up was mainly explained by baseline subjective burden.

Conclusions

These results indicate that for effective caregiver support, it is crucial to take the type of care relationship into account, since the level and correlates of overall subjective burden and burden dimensions varied for spousal and adult-child caregivers. In addition, reducing subjective burden will also positively impact the subjective burden over time.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0387-y) contains supplementary material, which is available to authorized users.

Caregiving Subgroups Differences in the Associations Between the Resilience Resources and Life Satisfaction

Using a model of resilience, this study compared the direct and indirect associations between resilience resources (sense of mastery, openness to experience, emotion regulation, and social support) and life satisfaction among caregiving subgroups (spouses, adult-children, and parents). Participants were included from the survey of Midlife in the United States (MIDUS II). Estimates of direct and indirect relationships between the resources and life satisfaction were calculated for each subgroup, and differences in the relationships between subgroups were tested. The direct positive relationships between sense of mastery and life satisfaction were significant and stronger for spouses and parents than for adult-children. In contrast, an indirect relationship through social support between the two variables was stronger for adult-children than for spouses. Openness to experience had a direct positive link to life satisfaction among spouses, and emotion regulation was directly related to life satisfaction among parents. We suggested targeted interventions for caregiving subgroups.

The bereavement experience of spousal caregivers to persons with dementia: Reclaiming self

Spouses of persons living with dementia both anticipate future loss and grieve for multiple losses occurring with caregiving and this ultimately influences their bereavement experience. Little research has been conducted regarding the bereavement experience in the caregiving journey with dementia and what does exist is mostly quantitative in nature. The purpose of this study is to describe the bereavement experience of spousal caregivers ( n = 10) utilizing Thorne’s interpretive description. Thematic analysis revealed the features and facilitators of the bereavement process for spousal caregivers to persons with dementia. The unique contribution of this study to the dementia literature is the finding that the overall process of reclaiming self is significant to the bereavement journey. Future work should investigate identity as understood by spousal caregivers to persons with dementia, and further explore the processes, facilitators, and barriers to healthy bereavement in this population.

Caregiver Well-Being: Intersections of Relationship and Gender

We know much about caregiving women compared with caregiving men and caregiving spouses compared with caregiving adult children. We know less about the intersections of relationship and gender. This article explores this intersection through the well-being (burden and self-esteem) of caregivers to family members with dementia. Throughout British Columbia, Canada, 873 caregivers were interviewed in person for on average, over 1½ hours. The results reveal that daughters experience the highest burden but also the highest self-esteem, suggesting the role is less salient for their self-identities. Wives emerge as the most vulnerable of the four groups when both burden and self-esteem are considered. The data confirm the usefulness of the intersectionality framework for understanding co-occupancy of more than one status and indicate that positive cognitive well-being and negative affective well-being can be differentially related. Multivariate analyses confirm the importance of caregiver, not patient, characteristics for burden and self-esteem.