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Russell AM, Bonham M, Lovett R, Pack A, Wolf MS, O’Conor R. Characterizing Caregiver Roles and Conflict in Health Management Support to Older People With Multiple Chronic Conditions. J Appl Gerontol 2024; 43:386-395. [PMID: 37982673 PMCID: PMC10922419 DOI: 10.1177/07334648231211456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Caregivers provide critical support for older adults managing multiple chronic conditions (MCCs), but few studies describe the assistance caregivers provide or identify factors influencing their provision of support. We conducted qualitative interviews with 25 caregivers to older adults with MCCs to describe caregivers' roles and identify the factors that influence caregivers' ability to carry out these roles. Transcripts were analyzed using the Framework Method. Caregivers supported the management of MCCs in several ways, including monitoring conditions, communicating with clinicians, and tracking health information. Disagreement, or conflicted relationships, between caregivers and older adults over health and behaviors influenced the provision of support, resulting in less involved and less effective caregivers. Caregivers in conflicted relationships were more challenged by resistance from older adults. Greater agreement, or collaboration, between caregivers and older adults resulted in more involved and effective caregivers. Addressing health-related conflict may enhance caregivers' capacity to support older adults with MCCs.
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Affiliation(s)
- Andrea M. Russell
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Morgan Bonham
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rebecca Lovett
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Allison Pack
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S. Wolf
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rachel O’Conor
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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2
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Labbé D, Yao DG, Miller WC, Routhier F, Rushton PW, Demers L, Mortenson WB. Positive and negative experiences of caregivers helping power wheelchair users: a mixed-method study. Disabil Rehabil Assist Technol 2024:1-12. [PMID: 38341650 DOI: 10.1080/17483107.2024.2313080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE This study aimed to better understand how the powered wheelchair (PWC) impacts the experiences of family caregivers of PWC users, and explore the strategies and resources used by caregivers to cope with their role. MATERIALS AND METHODS This mixed-methods study was part of a larger cross-sectional research study conducted in four Canadian cities. Twenty-three family caregivers of PWC users, who provided at least 2 h of support per week, completed the Power Mobility Caregiver Assistive Technology Outcome (PM-CATOM), an 18-item measure assessing PWC-related and overall burden experienced by family caregivers. We also conducted semi-structured interviews and analysed them using inductive content analysis. RESULTS From the quantitative PM-CATOM results, the caregivers perceived low level of burden for the wheelchair-related items, (Median:4.5; Range 3 to 5). Most perceived burden when physically helping the wheelchair user and when providing verbal hints. In terms of overall help, the caregivers experienced some level of burden (Median 3.5: Range 3 to 5). Most caregivers identified burden associated with the limitation to their recreational and/or leisure activities (52.2%) and feeling that they have more to do than they can handle. We identified 3 themes in the interviews: the burden experiences of caring for PWC users, the positive experiences of caregiving, and the coping strategies and resources used by caregivers of PWC users. CONCLUSION Our study showed that understanding the experiences of caregivers of AT users is central as they are directly and indirectly impacted by the PWC in their lives and caregiving roles.
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Affiliation(s)
- Delphine Labbé
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Lab, Vancouver, British Columbia, Canada
| | - Daryl G Yao
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois, USA
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Lab, Vancouver, British Columbia, Canada
- ICORD Research Center, Vancouver, British Columbia, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS), Québec, Québec, Canada
| | - Paula W Rushton
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte Justine Research Center, Montréal, Québec, Canada
| | - Louise Demers
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Lab, Vancouver, British Columbia, Canada
- ICORD Research Center, Vancouver, British Columbia, Canada
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3
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Wang F, Irani E, Tian MC, Yi Lau MM. The Mediating Effect of Caregiving Relationship Quality on the Association Between Caregiving Stressors and Mental Health Problems Among Older Spousal Caregivers. Int J Aging Hum Dev 2023; 97:435-455. [PMID: 36518012 DOI: 10.1177/00914150221143959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Providing care to a spouse can be especially challenging for older adults given their compounding stressors resulting from aging and caregiving. This cross-sectional study examines the relationships between caregiving stressors and caregiver mental health problems and the potential mediator (i.e., caregiving relationship quality) of these associations. A total of 431 Americans (≥65 years) were selected from the National Study of Caregiving. Path analysis shows that care assistance was positively associated with caregiver mental health problems, and this association was mediated by negative relationship quality (Indirect effect = .14, p = .016). Moreover, role overload was positively associated with caregiver mental health problems, which was mediated by negative relationship quality (indirect effect = .13, p = .002). Findings suggest that caregiving stressors can adversely affect mental health by exacerbating negative relationship quality. Interventions that limit negative exchanges and increase compassionate communications between older spousal caregivers and their care-receiving partners are needed.
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Affiliation(s)
- Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Mandy Man Yi Lau
- Department of Social Work, Chinese University of Hong Kong, Hong Kong, SAR, China
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Kraun L, van Achterberg T, Vlaeyen E, Fret B, Briké SM, Ellen M, De Vliegher K. Transitional care decision-making through the eyes of older people and informal caregivers: An in-depth interview-based study. Health Expect 2023; 26:1266-1275. [PMID: 36919194 PMCID: PMC10154836 DOI: 10.1111/hex.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Older people with multifaceted care needs often require treatment and complex care across different settings. However, transitional care is often inadequately managed, and older people and their informal caregivers are not always sufficiently heard and/or supported in transitional care decision-making. OBJECTIVE To explore older people's and informal caregivers' experiences with, views on, and needs concerning empowerment in transitional care decision-making. METHODS A qualitative descriptive study was conducted in the TRANS-SENIOR consortium's collaborative research using semistructured in-depth interviews between October 2020 and June 2021 in Flanders, Belgium. A total of 29 people were interviewed, including 14 older people and 15 informal caregivers who faced a transition from home to another care setting or vice versa. Data were analysed according to the Qualitative Analysis Guide of Leuven. FINDINGS Five themes were identified in relation to the participant's experiences, views and needs: involvement in the decision-making process; informal caregivers' burden of responsibility; the importance of information and support; reflections on the decision and influencing factors. CONCLUSIONS Overall, older people and informal caregivers wished to be more seen, recognised, informed and proactively supported in transitional care decision-making. However, their preferences for greater involvement in decision-making vary and are affected by several factors that are both intrinsic and extrinsic. Therefore, healthcare systems might seek out age-tuned and person-centred empowerment approaches focusing on older people's and informal caregivers' empowerment. For future studies, we recommend developing specific strategies for such empowerment. PATIENT OR PUBLIC CONTRIBUTION Older persons' representatives were involved in designing the TRANS-SENIOR programme of research, including the current study. Healthcare professionals and nursing care directors were involved in the study design and the selection and recruitment of participants.
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Affiliation(s)
- Lotan Kraun
- Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Theo van Achterberg
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Bram Fret
- Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium
| | - Sarah Marie Briké
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.,Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kristel De Vliegher
- Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
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5
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O’Neil E, Ngan J, Miller WC, Mohammadi S. Family Caregivers’ Experiences and Education When Caring for Individuals after Joint Arthroplasty. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2023. [DOI: 10.1080/02703181.2023.2172125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Erin O’Neil
- Department of Occupational Science & Occupational Therapy, University of British Columbia; Vancouver, Canada
| | - Joanne Ngan
- Department of Occupational Science & Occupational Therapy, University of British Columbia; Vancouver, Canada
| | - William C. Miller
- GF Strong Rehabilitation Research Program, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British ColumbiaVancouver, Canada
| | - Somayyeh Mohammadi
- GF Strong Rehabilitation Research Program, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British ColumbiaVancouver, Canada
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Sun L, Liu JE, Ji M, Wang Y, Chen S, Wang L. Coping with multiple chronic conditions among Chinese older couples: A community of shared destiny. Geriatr Nurs 2022; 48:214-223. [PMID: 36279804 DOI: 10.1016/j.gerinurse.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
Multiple chronic conditions (MCCs) affect patients and their spouses. We explored the experience of Chinese older couples living with MCCs to gain deeper understanding of how they cope with MCCs as dyads. A qualitative research design using semi-structured in-depth interviews was conducted. Sixteen couples (≥60 years) were included and a thematic analysis was undertaken using NVivo software. Four themes under an overarching theme "A community of shared destiny" were identified: (i) various changes and impacts in normal life; (ii) perceived dynamic stress and dyadic challenges of MCCs; (iii) acceptance and reflection on MCCs influenced by aging and fatalism; (iv) mutual support and dyadic adjustment based on a shared destiny. Coping with MCCs was a dyadic and periodic journey for older couples. They perceived themselves as a community of shared destiny. Our findings are important for healthcare professionals to develop targeted interventions for older couples living with MCCs.
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Affiliation(s)
- Liu Sun
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China
| | - Jun-E Liu
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China.
| | - Meihua Ji
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China
| | - Yanling Wang
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China
| | - Shaohua Chen
- School of Nursing, Capital Medical University, 10(#), Xitoutiao, You An Men Wai, Feng Tai District, Beijing 100069, China
| | - Lingyun Wang
- Desheng Community Health Service Center, Capital Medical University, 34(#), De Wai street, Beijing, China
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7
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Garnett A, Northwood M, Ting J, Sangrar R. Mobile Health Interventions to Support Caregivers of Older Adults: An Equity-Focused Systematic Review. JMIR Aging 2022; 5:e33085. [PMID: 35616514 PMCID: PMC9308083 DOI: 10.2196/33085] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 12/31/2022] Open
Abstract
Background Informal caregivers, hereafter referred to as caregivers, provide support to older adults so that they can age safely at home. The decision to become a caregiver can be influenced by individual factors, such as personal choice, or societal factors such as social determinants of health, including household income, employment status, and culture-specific gender roles. Over time, caregivers’ health can be negatively affected by their caregiving roles. Although programs exist to support caregivers, the availability and appropriateness of services do not match caregivers’ expressed needs. Research suggests that supportive interventions offered through mobile health (mHealth) technologies have the potential to increase caregivers’ access to supportive services. However, a knowledge gap remains regarding the extent to which social determinants of health are considered in the design, implementation, and evaluation of mHealth interventions intended to support the caregivers of older adults. Objective This study aimed to conduct a systematic review to determine how health equity is considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane Equity’s PROGRESS-Plus (place of residence, race, ethnicity, culture, language, occupation, gender, religion, education, social capital, socioeconomic status–plus age, disability, and sexual orientation) framework and synthesize evidence of the impacts of the identified caregiver-focused mHealth interventions. Methods A systematic review was conducted using 5 databases. Articles published between January 2010 and June 2021 were included if they evaluated or explored the impact of mHealth interventions on the health and well-being of informal caregivers of older adults. mHealth interventions were defined as supportive services, for example, education, that caregivers of older adults accessed via mobile or wireless devices. Results In total, 28 articles met the inclusion criteria and were included in the review. The interventions evaluated sought to connect caregivers with services, facilitate caregiving, and promote caregivers’ health and well-being. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of the included studies. Some PROGRESS-Plus factors such as sexual orientation, religion, and occupation, received little to no consideration across any phase of the intervention design, implementation, or evaluation. Overall, the findings of this review suggest that mHealth interventions were positively received by study participants. Such interventions have the potential to reduce caregiver burden and positively affect caregivers’ physical and mental health while supporting them as caregivers. The study findings highlight the importance of making support available to help facilitate caregivers’ use of mHealth interventions, as well as in the use of appropriate language and text. Conclusions The successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for the inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and evaluation.
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Affiliation(s)
- Anna Garnett
- Western University, FIMS Nursing Building, Rm 2306, London, CA
| | | | - Justine Ting
- Western University, FIMS Nursing Building, Rm 2306, London, CA
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8
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Malmir S, Navipour H, Negarandeh R. Exploring challenges among Iranian family caregivers of seniors with multiple chronic conditions: a qualitative research study. BMC Geriatr 2022; 22:270. [PMID: 35365077 PMCID: PMC8973877 DOI: 10.1186/s12877-022-02881-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background It is believed that seniors with multiple chronic diseases are in dire need of support from their family caregivers; however, it can impose a significant burden on these caregivers. Therefore, it is imperative to take into account caregivers’ needs, as covert patients, along with the needs of patients; besides, it is necessary to develop supportive and health promotion programs for them. There is a critical gap in the knowledge about health problems related to family caregivers of the growing population of these senior citizens. The present study aimed to explain the challenges imposed on family caregivers of seniors with several chronic diseases in Iran. Methods This study was conducted based on the conventional qualitative content analysis method. For this purpose, 13 family caregivers of seniors with several chronic diseases were selected using the purposive sampling method. The study population included those referred to two health centers and outpatient clinics of two public hospitals in Khorramabad, Iran. Data were collected through semi-structured interviews. Data analysis was performed along with data collection using inductive thematic analysis proposed by Elo and Kyngäs. Besides, Guba and Lincoln’s criteria were used to ensure the trustworthiness of the data. Results The analysis of the obtained data led to the identification of challenges of family caregivers of the older patients with multiple chronic diseases; these challenges were classified into six main categories, including the impact of caregiving on family relationships, disruption of social relationships, disruption of personal and occupational plans, physical health-related issues, negative emotions, and dealing with the high costs of care. Conclusions Given that family caregivers may face several challenges while taking care of seniors with multiple chronic diseases, healthcare providers should design and plan various interventions based on such challenges using a caregiver-centered approach.
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Affiliation(s)
- Sahar Malmir
- Nursing Department, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Hassan Navipour
- Department of Nursing, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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9
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Gehr TJ, Freiberger E, Sieber CC, Engel SA. A typology of caregiving spouses of geriatric patients without dementia: caring, worried, desperate. BMC Geriatr 2021; 21:483. [PMID: 34488636 PMCID: PMC8419985 DOI: 10.1186/s12877-021-02425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background An increasing number of older people in Germany receive care at home from family members, particularly from spouses. Family care has been associated not only with subjective burden but also with negative effects on caregivers’ health. A heterogeneous group, caregivers are confronted with individual situational demands and use different available coping strategies. To date, little is known about the relationship between burden and coping by spousal caregivers, particularly in the context of geriatric patients without dementia. Objectives The aim of this study is to explore the burden and coping strategies of caregiving spouses of geriatric patients without dementia and with a hospitalization within the last year. To help explore this population, a typology is presented that has been based on reported perceptions of home care burden and individual coping strategies. Furthermore, a case study is presented for each type of spousal caregiver. Methods The study used a concurrent mixed method design with a sample of nine spousal caregivers (mean age: 78.9 years). Four women and five men were recruited in an acute hospital setting during the TIGER study. Quantitative data were collected using a self-questionnaire and qualitative data were gathered through nine problem-centered interviews with spousal caregivers. The latter were subsequently analyzed utilizing the structured content analysis method. The data were then summarized to nine individual cases. Finally, the results were clustered using the empirically grounded construction of types and typologies. Each type of spousal caregiver is presented by a case study. Results Three types of caregiving spouses were identified: “The Caring Partner”, “The Worried Manager” and “The Desperate Overburdened”. These types differ primarily in the level of subjective burden and caregiving stress, the coping strategies, the motivation for caregiving, and expressed emotions. Conclusions The development of this new typology of caregiving spouses could help health care professionals better understand caregiving arrangements and thus provide more targeted advice. Trial registration The TIGER study was registered with clinicaltrials.gov: NCT03513159. Registered on April 17, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02425-1.
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Affiliation(s)
- Thomas Johann Gehr
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany. .,Hospital of the Order of St. John of God Regensburg, Regensburg, Germany.
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany.,Department of Internal Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Sabine Alexandra Engel
- Department of Social Services, Catholic University of Applied Sciences of North Rhine-Westphalia, Campus Paderborn, Paderborn, Germany.,Private Institute for Gerontological Intervention and EduKation at Dementia GmbH, Buckenhof, Germany
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10
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Cheng C, Bai J. Coping with Multiple Chronic Conditions in the Family Context: A Meta-Synthesis. West J Nurs Res 2021; 44:972-984. [PMID: 34433327 DOI: 10.1177/01939459211041171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was to collect, synthesize, and interpret the current qualitative evidence from studies that investigated family coping among people with multiple chronic conditions (MCCs). A meta-synthesis approach was used to report this study. A systematic search was performed in five electronic databases, including CINAHL, EMBASE, PsycINFO, Web of Science, and PubMed from January 2000 to December 2020. The PRISMA flow chart and Joanna Briggs Institute Qualitative Assessment and Review Instrument checklist are integrated into the meta-synthesis. A total of ten eligible studies including data from 381 participants were identified. Three meta-themes were identified in the synthesis: (1) family role maintenance in MCCs management, (2) coping as a family, and (3) be frustrated with family interactions. This meta-synthesis indicated the importance of maintaining social roles and family support within family interactions for coping with MCCs. It also demonstrated the frustrations in the family coping process experienced by people with MCCs. Health care professionals should understand the interactions between people with MCCs and their family members that may impact people's coping. Such an understanding may contribute to the development of supportive programs such as family-based interventions for people with MCCs.
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Affiliation(s)
- Cheng Cheng
- School of Nursing, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jie Bai
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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11
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Ellis KR, Cuthbertson CC, Carthron D, Rimmler S, Gottfredson NC, Bahorski SG, Phillips A, Corbie-Smith G, Callahan L, Rini C. A Longitudinal Observational Study of Multimorbidity and Partner Support for Physical Activity Among People with Osteoarthritis. Int J Behav Med 2021; 28:746-758. [PMID: 33797056 DOI: 10.1007/s12529-021-09985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physical activity can improve osteoarthritis-related symptoms; however, many people with osteoarthritis (PWOA) are insufficiently active. Social support for physical activity from an intimate partner can help PWOA increase activity, but managing multiple, chronic physical or mental health conditions (i.e., multimorbidity) may influence provision and receipt of that support. METHOD Data from a 1-year longitudinal observational study was used to examine associations between multimorbidity and three dimensions of partner support for physical activity-companionship partner support (doing activity together), enacted partner support, and social support effectiveness-in 169 insufficiently active PWOA and their partners. RESULTS Multivariable-adjusted multi-level models indicated baseline differences in support by multimorbidity status: when partners had multimorbidity, PWOA reported receiving less companionship support and less effective support from partners; when PWOA had multimorbidity, partners reported providing less enacted support and both partners and PWOA reported less effective partner support. Broad trends (p < .05) indicate initial increases and subsequent decreases in companionship and enacted partner support when PWOA had multimorbidity, and among partners with and without multimorbidity. When PWOA had multimorbidity, an initial increase in support effectiveness was followed by no significant change; a similar trend was seen among partners with and without multimorbidity. CONCLUSION Multimorbidity may generally contribute to less partner support for physical activity or less effective support, although influences on support over time are less clear. Physical activity interventions for couples experiencing multimorbidity would likely benefit from attention to the impact of multiple chronic health conditions on physical activity and physical activity-related partner support.
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Affiliation(s)
- Katrina R Ellis
- School of Social Work, University of Michigan, 1080 South University, Ann Arbor, MI, 48109, USA.
| | - Carmen C Cuthbertson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dana Carthron
- College of Nursing & Division of Public Health, Michigan State University, East Lansing, MI, USA
| | - Shelby Rimmler
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nisha C Gottfredson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie G Bahorski
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Giselle Corbie-Smith
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leigh Callahan
- University of North Carolina Division of Rheumatology, Allergy and Immunology, Department of Medicine, Thurston Arthritis Research Center, Chapel Hill, NC, USA
| | - Christine Rini
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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12
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Pel-Littel RE, Snaterse M, Teppich NM, Buurman BM, van Etten-Jamaludin FS, van Weert JCM, Minkman MM, Scholte Op Reimer WJM. Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review. BMC Geriatr 2021; 21:112. [PMID: 33549059 PMCID: PMC7866443 DOI: 10.1186/s12877-021-02050-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/25/2021] [Indexed: 01/11/2023] Open
Abstract
Background The aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals. Methods A structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy. Results Our search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important. Conclusions Although poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02050-y.
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Affiliation(s)
- Ruth E Pel-Littel
- Vilans, Centre of Expertise for Long-term Care, PO Box 8228, Utrecht, RE, 3503, the Netherlands. .,Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Marjolein Snaterse
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Nelly Marela Teppich
- Vilans, Centre of Expertise for Long-term Care, PO Box 8228, Utrecht, RE, 3503, the Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | | | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirella M Minkman
- Vilans, Centre of Expertise for Long-term Care, PO Box 8228, Utrecht, RE, 3503, the Netherlands.,University of Tilburg/TIAS School for Business and Society, Tilburg, the Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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13
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Ploeg J, Garnett A, Fraser KD, Baird LG, Kaasalainen S, McAiney C, Markle-Reid M, Dufour S. The complexity of caregiving for community-living older adults with multiple chronic conditions: A qualitative study. JOURNAL OF COMORBIDITY 2020; 10:2235042X20981190. [PMID: 33403202 PMCID: PMC7739080 DOI: 10.1177/2235042x20981190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/19/2020] [Indexed: 11/15/2022]
Abstract
Background: Older adults with multiple chronic conditions (MCC) rely heavily on caregivers for assistance with care. However, we know little about their psychosocial experiences and their needs for support in managing MCC. The purpose of this study was to explore the experiences of caregivers of older adults living in the community with MCC. Methods: This qualitative study was a secondary analysis of previously collected data from caregivers in Ontario and Alberta, Canada. Participants included caregivers of older adults (65 years and older) with three or more chronic conditions. Data were collected through in-depth, semi-structured interviews. Interview transcripts were coded and analyzed using Thorne’s interpretive description approach. Results: Most of the 47 caregiver participants were female (76.6%), aged 65 years of age or older (61.7%), married (87.2%) and were spouses to the care recipient (68.1%). Caregivers’ experiences of caring for community-living older adults with MCC were complex and included: (a) dealing with the demands of caregiving; (b) prioritizing chronic conditions; (c) living with my own health limitations; (d) feeling socially isolated and constrained; (e) remaining committed to caring; and (f) reaping the rewards of caregiving. Conclusions: Healthcare providers can play key roles in supporting caregivers of older adults with MCC by providing education and support on managing MCC, actively engaging them in goal setting and care planning, and linking them to appropriate community health and social support services. Communities can create environments that support caregivers in areas such as social participation, social inclusion, and community support and health services.
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Affiliation(s)
- Jenny Ploeg
- School of Nursing, McMaster University, Canada.,Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, McMaster University, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kimberly D Fraser
- Faculty of Nursing, University of Alberta, Canada.,Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Lisa Garland Baird
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Carrie McAiney
- Schlegel-UW Research Institute for Aging, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, Canada.,Aging, Community and Health Research Unit, McMaster University, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sinéad Dufour
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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14
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Valaitis RK, Markle-Reid M, Ploeg J, Butt ML, Ganann R, Murray N, Bookey-Bassett S, Kennedy L, Yousif C. An evaluation study of caregiver perceptions of the Ontario's Health Links program. PLoS One 2020; 15:e0229579. [PMID: 32106273 PMCID: PMC7046224 DOI: 10.1371/journal.pone.0229579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/11/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Ruta K. Valaitis
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Maureen Markle-Reid
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michelle L. Butt
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Ganann
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Murray
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sue Bookey-Bassett
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laurie Kennedy
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Claudia Yousif
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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15
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Aloweni F, Doshi K, Fook-Chong S, Malhotra R, Østbye T. The types of caregiving reactions experienced by the older spouse caregivers. J Clin Nurs 2019; 28:4538-4548. [PMID: 31466133 DOI: 10.1111/jocn.15044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/30/2019] [Accepted: 08/18/2019] [Indexed: 01/07/2023]
Abstract
AIMS To examine factors associated with the four types of caregiver reactions according to the modified Caregiver Reaction Assessment (mCRA) and assess the differences in the narrative assessment from spouse caregivers between the high-positive and high-negative caregiver reactions. BACKGROUND There is a limited understanding of the factors contributing to positive and negative reactions among older spouse caregivers with chronic illnesses. Narrative assessment from spouse caregivers has not been studied before. DESIGN The study design was a paired-sample, mixed-method survey design. Data were collected from spouse caregivers (≥55 years old) and care-recipients in one medical institute from February 2017-December 2017. This manuscript used STROBE checklist to ensure complete reporting. METHODS Demographic, socioeconomic, Frailty Index, perceived stress, and quality of life data were gathered from caregiver dyads. mCRA, relationship, and life satisfaction data were collected from caregivers. mCRA identified the four types of caregiver reactions: (a) high-positive, low-negative; (b) high-positive, high-negative; (c) low-positive, high-negative; and (d) low-positive, low-negative. A qualitative interview was conducted to understand the differences in the narrative and choice of words used to describe caregiving experience. RESULTS Seventy-five caregiver dyads were recruited. Total perceived stress was found to be negatively associated with high-positive, low-negative caregiver reaction (baseline category: low-positive, high-negative) by multinomial logistic regression. Content analyses showed that low-positive and high-negative caregivers used words that implied a lack of volition. Caregivers with positive experience viewed caregiving as a responsibility; the opposite viewed it as having 'no choice'. CONCLUSIONS Perceived stress is an important indicator of caregiver reactions. Words used when describing caregiving experiences can potentially depict the spouse caregivers' current state of being as a caregiver. RELEVANCE TO CLINICAL PRACTICE Spouse caregiver's narrative of their caregiving experience may provide easy and quick insights if interventions are needed. Early identification of negative reactions will allow for prompt interventions in mitigating caregivers' stress.
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Affiliation(s)
- Fazila Aloweni
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Kinjal Doshi
- Department of Psychology, Singapore General Hospital, Singapore, Singapore
| | | | - Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Truls Østbye
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Community and Family Medicine, Duke University, Durham, NC, USA
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16
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Ploeg J, Northwood M, Duggleby W, McAiney CA, Chambers T, Peacock S, Fisher K, Ghosh S, Markle-Reid M, Swindle J, Williams A, Triscott JA. Caregivers of older adults with dementia and multiple chronic conditions: Exploring their experiences with significant changes. DEMENTIA 2019; 19:2601-2620. [PMID: 30841745 PMCID: PMC7925441 DOI: 10.1177/1471301219834423] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Family caregiving is considered a social transition as changes in the health of the care recipient create a process of transition for the caregiver when they are more vulnerable to threats to their own health. Family and friend caregivers take on many responsibilities and experience high levels of burden when caring for community-dwelling older adults living with dementia and multiple chronic conditions. However, little is known about the changes they experience in their caring roles or how they cope with these changes. This qualitative descriptive study was part of a larger mixed methods randomized controlled trial evaluating a web-based caregiver support toolkit. Multiple semi-structured phone interviews were conducted with caregivers of older adults with dementia and multiple chronic conditions. Content analysis was used to generate thematic descriptions. Six themes were generated and grouped into two categories. Significant changes experienced by caregivers are described by the following themes: 'everything falls on you - all of the responsibilities,' 'too many feelings' and 'no time for me.' The themes describing how caregivers coped with these changes include: seeking support, self-caring, and adapting their caregiving approach. Study results indicate that caregivers of older adults with dementia and multiple chronic conditions experienced many changes in their caregiving journey resulting in increasing complexity as they tended to the care recipients' declining health and well-being. These caregivers used several creative strategies to cope with these changes. Health care providers should consider both the caregiver and care recipient as clients in the circle of care, and facilitate their linkage with health and community support services to help address the increasing complexity of care needs.
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Affiliation(s)
- Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | - Melissa Northwood
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | - Wendy Duggleby
- Innovation in Seniors Care Research Unit, Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Carrie A McAiney
- School of Public Health and Health Systems, University of Waterloo, Schlegel-UW Research Institute for Aging, Waterloo Canada
| | - Tracey Chambers
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Kathryn Fisher
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | - Sunita Ghosh
- Department of Medical Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | | | - Allison Williams
- School of Geography & Earth Sciences, McMaster University, Hamilton, Canada
| | - Jean Ac Triscott
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, Canada
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