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Frederiksen KS, Lanctôt KL, Weidner W, Hahn-Pedersen JH, Mattke S. A Literature Review on the Burden of Alzheimer's Disease on Care Partners. J Alzheimers Dis 2023; 96:947-966. [PMID: 37980660 DOI: 10.3233/jad-230487] [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: 11/21/2023]
Abstract
BACKGROUND Many individuals with Alzheimer's disease (AD) are dependent on nonprofessional care partners. Providing informal care can result in emotional, physical, and financial burdens; however, there is a need for a better understanding of the impact of AD on care partners to support the clinical and economic assessment of potential new treatments. OBJECTIVE We conducted a literature review to evaluate the burden experienced by care partners of individuals with AD. METHODS Electronic screening and supplementary searches identified studies published from 2011 to 2022 describing the association between AD and the quality of life (QoL) and physical health of care partners, and the economic or financial burden of AD. RESULTS Following electronic screening, 62, 25, and 39 studies were included on care partner burden, cost, and healthcare resource use in AD, respectively. Supplementary searches identified an additional 32 studies, resulting in 149 unique studies. These studies showed that care partners of individuals with AD report moderate to severe burden. Higher burden and lower QoL were observed in those caring for individuals with more severe AD. Care partners of individuals with AD experience higher burden, lower QoL, and higher levels of stress, depression, and anxiety than those without caring responsibilities. Informal care costs increased with AD severity and accounted for the greatest proportion of overall societal cost. CONCLUSIONS Care partners of individuals with AD experience emotional and economic burden, which increases with AD severity. These impacts should be quantified comprehensively in future studies and captured in economic evaluations of AD interventions.
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Affiliation(s)
- Kristian Steen Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | - Soeren Mattke
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, US
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O’Caoimh R, Calnan M, Dhar A, Molloy DW. Prevalence and Predictors of Caregiver Burden in a Memory Clinic Population. J Alzheimers Dis Rep 2021; 5:739-747. [PMID: 34755048 PMCID: PMC8543373 DOI: 10.3233/adr-201003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although caregiver burden is common among carers of people with dementia, little is known about its prevalence and predictors among caregivers of patients attending memory clinics. OBJECTIVE To examine carer and patient-specific characteristics associated with caregiver burden across the cognitive spectrum in a memory clinic population. METHODS Consecutive patients referred to a university hospital geriatric memory clinic were included. Caregiver burden was scored using the Caregiver Burden Score (CBS), (modified Zarit), with scores≥15/30 suggesting burden. BPSD were measured with the dysfunctional behaviour rating instrument (DBRI). Cognition was screened using the Montreal Cognitive Assessment (MoCA) and Quick Mild Cognitive Impairment (Qmci) screen. RESULTS In all, 351 patients were included, median age 77 (±11) years; 65.5% were female. The prevalence of caregiver burden was 33.6% overall, increasing from 10.8% in subjective cognitive decline (SCD), to 15% in mild cognitive impairment (MCI) and 43% in dementia; CBS scores were significantly higher in dementia (p < 0.001). Caregivers with burden were significantly younger (p = 0.045) and were more likely to be adult children (p = 0.007). The CBS weakly correlated with the stage of cognitive impairment (r = 0.16) but had moderate correlation with MoCA (r = -0.54) and Qmci scores (r = -0.60). After adjustment for co-variates, DBRI scores alone independently predicted burden (odds ratio 1.23;1.11-1.35, p < 0.001). CONCLUSION Caregiver burden is associated with the stage of cognitive impairment, with higher prevalence proportions in those with dementia compared with MCI and SCD. Only the severity of neuropsychiatric symptoms independently predicted caregiver burden in this population and its presence should prompt assessment for burden.
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Affiliation(s)
- Rónán O’Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork City, Ireland
- Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork City, Ireland
| | - Mareeta Calnan
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork City, Ireland
| | - Arup Dhar
- Baker Heart and Diabetes Institute, Melbourne VIC, Australia
- NeuroCentrix, Noble Park, VIC, Australia
| | - D. William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork City, Ireland
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3
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Kasper S, Bancher C, Eckert A, Förstl H, Frölich L, Hort J, Korczyn AD, Kressig RW, Levin O, Palomo MSM. Management of mild cognitive impairment (MCI): The need for national and international guidelines. World J Biol Psychiatry 2020; 21:579-594. [PMID: 32019392 DOI: 10.1080/15622975.2019.1696473] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: To review available evidence of pharmacological and non-pharmacological treatment for MCI and analyse information and limitations in national and international guidelines.Methods: Experts from several European countries conducted a qualitative review of the literature on MCI and treatments for MCI, as well as respective chapters in national and international guidelines on dementia/MCI. Psychotherapeutic/psychosocial treatments were excluded from the review.Results: Consensus diagnostic criteria for MCI are available, making early recognition and accurate classification of MCI subtypes possible. MCI can be identified in a primary care setting. Further corroboration and differential diagnosis should be done at specialist level. Mixed pathologies are the rule in MCI, thus a multi-target treatment approach is a rational strategy. Promising evidence has been generated for multi-domain interventions. Limited evidence is available for different pharmacological classes that have been investigated in MCI clinical trials (e.g. acetylcholinesterase inhibitors). EGb 761® improved symptoms in some clinical trials; it is the only pharmacological treatment recommended in existing guidelines for the symptomatic treatment of MCI.Conclusions: MCI is recognised as an important treatment target and some recent national guidelines have considered symptomatic treatment recommendations for MCI. However, more needs to be done, especially at an international level.
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Affiliation(s)
- Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Christian Bancher
- Department of Neurology/Neurological Rehabilitation, Landesklinikum Horn-Allentsteig, Horn, Austria
| | - Anne Eckert
- Neurobiology Lab for Brain Aging and Mental Health, Transfaculty Research Platform Molecular & Cognitive Neuroscience (MCN), University of Basel, Psychiatric University Clinics Basel, Basel, Switzerland
| | - Hans Förstl
- Clinic and Polyclinic for Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Lutz Frölich
- Department of Gerontopsychiatry, Central Institute of Mental Health Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Jakub Hort
- Department of Neurology, Charles University, 2nd Medical Faculty, and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Centre, Brno, Czechia
| | - Amos D Korczyn
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Oleg Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Yang Y, Rushton S, Park HK, Son H, Woodward A, Mcconnell E, Hendrix CC. Understanding the Associations between Caregiver Characteristics and Cognitive Function of Adults with Cancer: A Scoping Review. Asia Pac J Oncol Nurs 2020; 7:115-128. [PMID: 32478128 PMCID: PMC7233557 DOI: 10.4103/apjon.apjon_3_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/26/2020] [Indexed: 11/04/2022] Open
Abstract
Cognitive impairment (CI) is one of symptoms that adults with cancer frequently report. Although there are known factors that contribute to a patient's CI, these factors did not sufficiently explain its variability. Several studies conducted in patients with neurocognitive disorders have reported relationships between patients' cognitive function and caregiver characteristics, which are poorly understood in the context of cancer. This scoping review aims to map the literature on caregiver characteristics associated with CI in adults with cancer. We used the framework proposed by Arksey and O'Malley and PRISMA-Sc. Studies published in English by 2019 were searched through seven electronic databases. All retrieved citations were independently screened and eligibility for inclusion was determined by two independent authors. Ten studies met inclusion for this review with all of them showing significant associations between a patient's cognitive function and caregiver characteristics. Caregiver's mental health was the most commonly associated with a patient's cognitive function followed by family functioning, adaptation to illness, attitude toward disclosure of the illness, burden, coping and resilience, and demographic characteristics. These review findings suggest that enhanced information about CI in relation to caregiver characteristics will eventually provide the foundation for multifocal interventions for patients with impaired cognitive function. This scoping review identified caregiver characteristics that are associated with patients CI. These characteristics should be also assessed when health providers assess and treat CI of adults with cancer.
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Affiliation(s)
- Yesol Yang
- Duke University School of Nursing, Durham, NC, USA
| | - Sharron Rushton
- Division of Health Systems and Analytics, Duke University School of Nursing, Durham, NC, USA
| | - Hyeyoung K Park
- University of Massachusetts Amherst College of Nursing, Amherst, MA, USA
| | - Heeyeon Son
- Duke University School of Nursing, Durham, NC, USA
| | - Amanda Woodward
- Lane Medical Library, Stanford University School of Medicine, Stanford, CA, USA
| | - Eleanor Mcconnell
- Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, NC, USA.,Durham Veterans Affairs (VA) Health Care System Geriatric Research, Education and Clinical Center (GRECC), Durham, NC, USA
| | - Cristina C Hendrix
- Division of Health Systems and Analytics, Duke University School of Nursing, Durham, NC, USA.,Durham Veterans Affairs (VA) Health Care System Geriatric Research, Education and Clinical Center (GRECC), Durham, NC, USA
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Kashimura M, Rapaport P, Nomura T, Ishiwata A, Tateno A, Nogami A, Yamashita M, Kawanishi T, Kawashima Y, Kitamura S, Livingston G. Acceptability and feasibility of a Japanese version of STrAtegies for RelaTives (START-J): A manualized coping strategy program for family caregivers of relatives living with dementia. DEMENTIA 2020; 20:985-1004. [PMID: 32326749 DOI: 10.1177/1471301220919938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The rising older population in Japan is associated with a rise in cases of dementia. Support for the increased number of family caregivers of people living with dementia is crucial, as caring may negatively affect a family caregiver's health. This study seeks to evaluate the feasibility and applicability of a recently developed Japanese version of START (STrAtegies for RelaTives). START is a psychosocial coping intervention program developed in the United Kingdom that has been shown to improve caregivers' mood and quality of life in a randomized controlled trial. We made changes to START (e.g., idioms, linguistic nuance, and providing care insurance information suited for Japan) to make it culturally appropriate. Fourteen Japanese female family caregivers of relatives with mild dementia (n = 10) or mild cognitive impairment (n = 4) were referred to the study, but six were excluded owing to illness and busyness. This single-arm study had a before-after trial evaluating psychological outcomes including depression, anxiety, quality of life, and subjective care burden. The acceptance retention and satisfaction rate suggest the feasibility and acceptability of the START program; 8/14 (>55%) eligible, prospective participants consented and were included in this study, all (8/8) of whom completed all START sessions. The mean program satisfaction score was 30.25 (standard deviation = 2.25) out of a potential 32. The results suggest that it is feasible and acceptable to deliver START in Japanese and based on the results of analysis using a linear mixed model, there is initial indication that the intervention improved family caregivers' quality of life, depressive symptoms, and care burden.
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Affiliation(s)
- Masami Kashimura
- Department of Medical Psychology, Nippon Medical School, Tokyo, Japan
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Toshiaki Nomura
- Department of Medical Psychology, Nippon Medical School, Tokyo, Japan; Dementia Centre, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | - Akiko Ishiwata
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Amane Tateno
- Department of Psychiatry, Nippon Medical School, Tokyo, Japan
| | - Akane Nogami
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Mari Yamashita
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tomoya Kawanishi
- Department of Clinical Psychology, Graduate School of Education, Naruto University of Education, Tokushima, Japan
| | - Yoshitaka Kawashima
- Department of Psycho-Social Studies, School of Arts and Letters, Meiji University, Tokyo, Japan
| | - Shin Kitamura
- Dementia Centre, Nippon Medical SchoolMusashi Kosugi Hospital, Kawasaki, Japan
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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Kawano Y, Terada S, Takenoshita S, Hayashi S, Oshima Y, Miki T, Yokota O, Yamada N. Patient affect and caregiver burden in dementia. Psychogeriatrics 2020; 20:189-195. [PMID: 31698515 DOI: 10.1111/psyg.12487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/05/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Numerous studies focusing on the burden of caregivers of dementia patients have been published. However, there have been few studies focusing on positive affect as an important factor affecting the caregiver burden, and only a few studies comparing the caregiver burden between different dementia diseases have been reported. METHODS Three hundred and thirty-seven consecutive caregivers of people with dementia participated in this study. The caregiver burden was evaluated by the short version of the Japanese version of the Zarit Burden Interview. RESULTS Positive affect scores had a significant relationship with the scores of the short version of the Zarit Burden Interview. Caregivers for patients with dementia with Lewy bodies or frontotemporal dementia suffered from a greater burden than those for patients with Alzheimer's disease dementia. CONCLUSIONS The caregiver burden differed between people caring for patients with different dementia diseases. Positive affect of dementia patients has a significant relationship with caregiver burden, independently from neuropsychiatric symptoms of patients.
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Affiliation(s)
- Yoshiko Kawano
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Shintaro Takenoshita
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Satoshi Hayashi
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Yoshitaka Oshima
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Tomoko Miki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Osamu Yokota
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-city, Japan
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Abstract
BACKGROUND In medical practice, a patient's loss of competency is a major obstacle when choosing a treatment and a starting treatment program smoothly. A large number of studies have revealed the lack of medical competency in patients with dementia. However, there have been only a few reports focusing on the capacity of patients with mild cognitive impairment (MCI) to make a medical choice. METHODS In this study, we evaluated the competency of 40 patients with amnestic MCI (aMCI) and 33 normal subjects to make a medical choice using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). We compared the judgement of a team conference using the recorded semi-structured interview with the clinical judgement of a chief clinician. RESULTS A team conference concluded that 12 aMCI patients had no competency, and the clinical judgement, without any special interview, judged that five aMCI patients had no competency. All subjects in the control groups were judged to be competent to consent to treatment by both clinicians and the team conference. CONCLUSIONS Without supplementary tools such as explanatory documents, not a few patients with aMCI were judged by a team conference to have no competency to consent to therapy even in a relatively simple and easy case. In contrast, clinical physicians tended to evaluate the competency of aMCI patients in a generous manner.
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8
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Connors MH, Seeher K, Teixeira-Pinto A, Woodward M, Ames D, Brodaty H. Mild Cognitive Impairment and Caregiver Burden: A 3-Year-Longitudinal Study. Am J Geriatr Psychiatry 2019; 27:1206-1215. [PMID: 31230914 DOI: 10.1016/j.jagp.2019.05.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) is common, affecting 10%-35% of people over 65, and poses unique challenges for patients and their caregivers. Comparatively little research has examined caregiver burden in this population, with longitudinal research, in particular, lacking. We examined caregiver burden in a sample of people with MCI over 3 years. DESIGN Three-year observational study. SETTING Nine memory clinics in Australia. PARTICIPANTS One-hundred-and-eighty-five people with MCI and their caregivers. MEASUREMENTS Measures of caregiver burden, cognition, function, neuropsychiatric symptoms, driving status, and medication use were completed with patients and their caregivers at regular intervals over a 3-year period. RESULTS Between 21.1% and 29.5% of caregivers reported a clinically significant level of burden over the study. Patients' higher levels of neuropsychiatric symptoms, lower functional ability, and lack of driving ability, and caregivers' employment were associated with greater caregiver burden over time. Caregiver burden did not increase over time when controlling for patient and caregiver characteristics. CONCLUSIONS High levels of caregiver burden are present in a significant proportion of caregivers of people with MCI. Clinical characteristics of patients - including severity of neuropsychiatric symptoms and functional impairment - and the employment status of caregivers predict burden. Such characteristics may help identify caregivers at greater risk of burden to target for intervention.
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Affiliation(s)
- Michael H Connors
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Katrin Seeher
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | | | | | - David Ames
- University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, Australia; National Ageing Research Institute, Melbourne, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia.
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Yang Y, Rushton S, Woodward A, Hendrix C. Understanding on the association between informal caregiver characteristics and cognitive function of adults with cancer: a scoping review protocol. BMJ Open 2019; 9:e031842. [PMID: 31537575 PMCID: PMC6756403 DOI: 10.1136/bmjopen-2019-031842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Adults with cancer frequently report symptoms such as decline in cognitive function throughout the trajectory of illness. Patients with cognitive deficits need support and assistance from their informal caregivers and often rely on them to manage their symptoms based on their degree of deficits. Patients spend a significant amount of time with their informal caregivers and become interdependent with each other. In spite of their interdependence, it is unclear whether patients' cognitive outcomes (ie, cognitive function) are associated with their informal caregivers. Therefore, the body of literature related to the association between caregiver characteristics and cognitive function of adults with cancer needs to be fully mapped with assessment for knowledge gaps. METHODS AND ANALYSIS Methods for this scoping review was informed by the framework proposed by Arksey and O'Malley. Seven electronic databases will be searched: (1) PubMed (MEDLINE), (2) CINAHL, (3) Embase, (4) PsycINFO, (5) Scopus, (6) Sociological Abstracts and (7) ProQuest dissertation abstracts. In addition, the search for grey literature will include the conference abstracts available through Embase, Scopus and Sociological abstracts as well as dissertations available in ProQuest dissertations. All retrieved citations will be independently screened by two authors and eligibility will be determined based on inclusion and exclusion criteria at title and abstract level. Studies meeting inclusion criteria, will be screened at full text level by two reviewers followed by abstraction of included studies. Eligible studies will be collated, summarised and reported using the data charting form that research team developed. ETHICS AND DISSEMINATION This scoping review does not require ethics approval. Results of this scoping review will be disseminated via conference presentation and/or publication in a scientific journal.
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Affiliation(s)
- Yesol Yang
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Sharron Rushton
- Division of Health Systems and Analytics, Duke University School of Nursing, Durham, North Carolina, USA
| | - Amanda Woodward
- Duke University Medical Center Library, Durham, North Carolina, USA
| | - Cristina Hendrix
- Division of Health Systems and Analytics, Duke University School of Nursing, Durham, North Carolina, USA
- GRECC, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
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Voutilainen A, Ruokostenpohja N, Välimäki T. Associations Across Caregiver and Care Recipient Symptoms: Self-Organizing Map and Meta-analysis. THE GERONTOLOGIST 2018; 58:e138-e149. [PMID: 28329837 DOI: 10.1093/geront/gnw251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study The main objective of this study was to reveal generalizable associations across caregiver burden (CGB), caregiver depression (CGD), care recipient cognitive ability (CRCA), and care recipient behavioral and psychological symptoms of dementia (BPSD). Design and Methods Studies published between 2004 and 2014 and reporting CGB and/or CGD together with CRCA and/or BPSD were included. Only 95 out of 1,955 studies provided enough data for data clustering with the Self-Organizing Map (SOM) and 27 of them for meta-analyses based on correlation coefficients. Results Caregiver and care recipient symptoms were not tightly associated with each other, except for the CGB-BPSD interaction at the individual level. SOM emphasized the cluster comprising studies reporting low CGB, low CGD, high CRCA, and few BPSD. Meta-analyses indicated high heterogeneity between the original studies. Implications Relationships between caregiver and care recipient symptoms should be treated as situation-specific phenomena, at least when the symptoms are moderate at most. Dementia caregiving per se should not be understood as a source of stress and mental health problems. More systematic and coherent use of measures is necessary to enable a comprehensive analysis of caregiving.
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Affiliation(s)
- Ari Voutilainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Nora Ruokostenpohja
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Carlozzi NE, Sherman CW, Angers K, Belanger MP, Austin AM, Ryan KA. Caring for an individual with mild cognitive impairment: a qualitative perspective of health-related quality of life from caregivers. Aging Ment Health 2018; 22:1190-1198. [PMID: 28699777 PMCID: PMC6141353 DOI: 10.1080/13607863.2017.1341468] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Little is known regarding the effect that caring for an individual with Mild Cognitive Impairment (MCI) has on health-related quality of life (HRQOL). We sought to identify the most important aspects of HRQOL related to caring for an individual with MCI. METHODS Six focus groups were conducted with caregivers of individuals with MCI (n = 32). Qualitative frequency analysis was used to analyze the data. RESULTS Findings indicated that caregivers most frequently discussed social health, including changes in social roles and an increased need for social support (51.2% of the total discussion). This was followed by mental health concerns (37.9%) centering on anger/frustration, and a need for patience in the caregiving role, as well as caregiver-specific anxiety. Other topics included physical health (10.0%; including the impact that stress and burden have on medical heath), and caregivers' cognitive health (0.9%; including memory problems in relation to caregiver strain, sleep disruption, and cognitive fatigue). CONCLUSIONS Findings illustrate the multiple domains of HRQOL that are affected in individuals providing care for someone with MCI. Moreover, the findings highlight the need for extending support services to MCI caregivers, a group that is typically not offered support services due to the 'less severe' nature of an MCI diagnosis.
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Affiliation(s)
- Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA, 2800 Plymouth Road, Ann Arbor, MI 48109, 734-763-8917,
| | - Carey W. Sherman
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA, 5067 ISR, Ann Arbor, MI 48109, 734-764-2561,
| | - Kaley Angers
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA, 1 Ohio University, Porter Hall 200, Athens, OH 45701,
| | - Mitchell P. Belanger
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA, 1415 Washington Heights, Ann Arbor, MI 48109,
| | - Amy M. Austin
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA, 2800 Plymouth Road, Ann Arbor, MI 48109, 734-764-0644,
| | - Kelly A. Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA, Plymouth Park Office Center, 2101 Commonwealth Blvd Ste C, Ann Arbor, MI 48105, 800-525-5188,
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12
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Montgomery W, Goren A, Kahle-Wrobleski K, Nakamura T, Ueda K. Alzheimer's disease severity and its association with patient and caregiver quality of life in Japan: results of a community-based survey. BMC Geriatr 2018; 18:141. [PMID: 29898679 PMCID: PMC6000944 DOI: 10.1186/s12877-018-0831-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/29/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) dementia, a progressive neurodegenerative disease, exerts significant burden upon patients, caregivers, and healthcare systems globally. The current study investigated the associations between AD dementia patient disease severity and health-related quality of life (HRQoL) of both patients (proxy report) and their caregivers living in Japan, as well as caregiving-related comorbidities such as depression. METHODS This cross-sectional study used self-reported data from caregivers of people diagnosed with AD dementia by a healthcare provider in Japan. Caregivers were identified via online panels and invited to participate in an online survey between 2014 and 2015. Caregivers completed survey items for themselves, in addition to providing proxy measures for patients with AD dementia for whom they were caring. Patient and caregiver HRQoL was measured using the EuroQoL 5-Dimension (EQ-5D). Additional outcomes for caregivers of AD dementia patients included the Patient Health Questionnaire (PHQ-9) of depressive symptomology, as well as comorbidities experienced since initiating caregiving for their AD dementia patients. These outcomes were examined as a function of AD dementia severity, as measured by long-term care insurance (LTCI) categories. Bivariate analyses between LTCI and outcomes were conducted using independent t-tests and chi-square tests. Multivariable analyses, controlling for potential confounders, were conducted using generalized linear models (GLMs) specifying a normal distribution. RESULTS Across 300 caregiver respondents, multivariable results revealed that increasing AD dementia severity was significantly associated with poorer patient and caregiver EQ-5D scores and a high proportion of caregivers (30.0%) reported PHQ-9 scores indicative of major depressive disorder (MDD). The most frequent comorbidities experienced after becoming caregivers of AD dementia patients included hypertension (12.7%) and insomnia (11.0%). Depression and other comorbidities did not differ significantly by patient severity. CONCLUSIONS The current study provides unique insight into the specific degree of incremental burden associated with increasing AD dementia severity among patients and caregivers alike. Importantly, greater disease severity was associated with poorer quality of life among both patients and caregivers. These results suggest that earlier detection and treatment of AD dementia may provide an opportunity to reduce the burden of disease for patients, caregivers, and society at large.
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Affiliation(s)
- William Montgomery
- Global Patient Outcomes & Real World Evidence, Eli Lilly Australia, 112 Wharf Rd, West Ryde, NSW 2114 Australia
| | - Amir Goren
- Health Outcomes Practice, Kantar Health, 11 Madison Ave, Floor 12, New York, NY 10010 USA
| | - Kristin Kahle-Wrobleski
- Global Patient Outcomes & Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Tomomi Nakamura
- Medical Development Unit, Eli Lilly Japan K.K, 4-15-1, Akasaka, Minato-ku, Tokyo, 107-0052 Japan
| | - Kaname Ueda
- Health Outcomes, Health Technology Assessment, & Real World Evidence, Medical Development Unit, Eli Lilly Japan K.K, 5-1-28, Isogami-dori, chuou-ku, Kobe, 651-0086 Japan
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Montgomery W, Goren A, Kahle-Wrobleski K, Nakamura T, Ueda K. Detection, diagnosis, and treatment of Alzheimer's disease dementia stratified by severity as reported by caregivers in Japan. Neuropsychiatr Dis Treat 2018; 14:1843-1854. [PMID: 30038495 PMCID: PMC6052934 DOI: 10.2147/ndt.s160591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dementia of Alzheimer's disease (AD) imposes burdens on patients, caregivers, and society. This cross-sectional study examined caregiver-reported history of disease onset and AD dementia to inform efforts promoting early disease detection and diagnosis. METHODS An online survey collected self-reported cross-sectional data - demographic characteristics, diagnosis, treatment experiences, and other information on disease detection, diagnosis, and treatment - from caregivers of patients with AD dementia. These characteristics were examined as a function of AD dementia severity. RESULTS Three hundred patients with AD dementia were trichotomized by long-term care insurance levels reported by caregivers: 12.3% (n=37) as low severity, 63.7% (n=191) as medium severity, and 24.0% (n=72) as high severity. The Short-Memory Questionnaire and patient dependency scores both varied significantly across severity groups. AD dementia symptoms were most frequently first detected by a caregiver (58.7%) or the patient's family (45.7%). However, in 13.7% of cases, symptoms were detected by a health care provider during a routine visit. Memory problems were the most frequent first symptoms (77.3%), followed by repetition (55.7%). Patients (73.7%) were taking symptomatic treatment such as acetylcholinesterase inhibitors or memantine. High-severity patients were older, had been diagnosed with AD dementia for a longer time, had more frequent reports of memory problems as the first symptoms detected, and required more hours of care per day, compared with low-severity patients. CONCLUSION Caregivers and families play an integral role in the identification of AD dementia patients, with memory problems being common first symptoms noticed by caregivers that led to a diagnosis of AD dementia. These results provide novel insight into the detection, diagnosis, and treatment of AD dementia in Japan and how these factors differ across the spectrum of disease severity.
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Affiliation(s)
- William Montgomery
- Global Patient Outcomes & Real World Evidence, Eli Lilly Australia, NSW, Australia
| | - Amir Goren
- Real World Evidence, Kantar Health, New York, NY, USA
| | - Kristin Kahle-Wrobleski
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Tomomi Nakamura
- Bio-Medicines, Medical Development Unit, Eli Lilly Japan K.K., Tokyo, Japan
| | - Kaname Ueda
- Health Outcomes, Health Technology Assessment, & Real World Evidence, Medical Development Unit, Eli Lilly Japan K.K., Kobe, Japan,
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Ramsay SC, Montayre J, Egli V, Holroyd E. Migrant caregiving for family members with mild cognitive impairment: an ethnographic study. Contemp Nurse 2017. [PMID: 28643615 DOI: 10.1080/10376178.2017.1346480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Migrant families caring for family members with mild cognitive impairment (MCI) face considerable socioeconomic burden and isolation. AIM To examine the cultural needs, beliefs and health seeking behaviours of migrant Turkish family member caregivers. DESIGN An ethnographic approach was used employing in depth interviews. METHODS Turkish caregivers residing in Melbourne, Australia were purposively sampled. Ten participants undertook face-to-face interviews in Turkish and English, followed by coding, transcription and thematic analysis. RESULTS Common themes were: (i) characteristics of MCI; (ii) care complicates our lives; (iii) beneficial coping strategies; (iv) adherence to cultural beliefs; (v) an uncertain future; (vi) interfacing with community health providers: need to understand Turkish culture (vii) need for long-term support. Migrant caregivers voiced undergoing considerable stress exacerbated by their cultural obligations. CONCLUSIONS Establishing ethnically appropriate community support groups and advocating for a health workforce tier of representative migrant health care workers is recommended as a new role for community nurses.
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Affiliation(s)
- Siena C Ramsay
- a Faculty of Science , The University of Melbourne , Parkville , VIC 3010 , Australia
| | - Jed Montayre
- b School of Clinical Sciences , AUT University , 90 Akoranga Drive, Northcote, Auckland , New Zealand
| | - Victoria Egli
- c Faculty of Health and Environmental Sciences , AUT University , Auckland , New Zealand
| | - Eleanor Holroyd
- d Professorial Fellow , School of Global and Population Health, University of Melbourne , Melbourne , Australia.,e Visiting Professor , National University of Singapore , Singapore , Singapore.,f CUHK Public Health, School of Clinical Sciences , AUT University , 90 Akoranga Drive, Northcote, Auckland , New Zealand
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Kim BJ, Nakaoka S, Underwood C. The Impacts of Social Support and Cognitive Function on Depression among Community-Dwelling Older Japanese Americans. SOCIAL WORK IN PUBLIC HEALTH 2017; 32:82-93. [PMID: 27662114 DOI: 10.1080/19371918.2016.1188747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research has demonstrated a relationship between social support, cognitive function, and depression among older adults, yet fewer studies have explored this association with Japanese American elders. This study aims to examine depression and describe its relationship with social support, cognitive function, and socioeconomic condition among Japanese American elders. A cross-sectional study of 205 Japanese American elders was conducted in Honolulu and Los Angeles County. A hierarchical regression model was used with depression as a dependent variable and with independent variables such as social support, cognitive function, and socioeconomic status. The study found that social support and cognitive function were significantly associated with depression for Japanese American elders. Also age and education were significantly associated with depression. Based on the findings, the study indicates the importance of developing preventive strategies to reduce the depression issue using culturally tailored programs to the study population.
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Affiliation(s)
- Bum Jung Kim
- a School of Social Work, University of Hawaii at Manoa , Honolulu , Hawaii , USA
| | - Susan Nakaoka
- a School of Social Work, University of Hawaii at Manoa , Honolulu , Hawaii , USA
| | - Charna Underwood
- a School of Social Work, University of Hawaii at Manoa , Honolulu , Hawaii , USA
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Abstract
The Zarit Burden Interview allows caregiver burden to be interpreted from a total score. However, recent studies propose a multidimensional Zarit Burden Interview model. This study aims to determine the agreement between unidimensional (UD) and multidimensional (MD) classification of burden, and differences in predictors among identified groups. We studied 165 dyads of dementia patients and primary caregivers. Caregivers were dichotomized into low-burden and high-burden groups based upon: (1) UD score using quartile cutoffs; and (2) MD model via exploratory cluster analysis. We compared UD versus MD 2×2 classification of burden using κ statistics. Caregivers not showing agreement by either definition were classified as "intermediate" burden. We performed binary logistic regression to ascertain differences in predictive factors. The 2 models showed moderate agreement (κ=0.72, P<0.01), yielding 104 low, 20 intermediate (UD "low burden"/MD "high burden"), and 41 high-burden caregivers. Neuropsychiatric symptoms [odds ratio (OR)=1.27, P=0.003], coresidence (OR=6.32, P=0.040), and decreased caregiving hours (OR=0.99, P=0.018) were associated with intermediate burden, whereas neuropsychiatric symptoms (OR=1.21, P=0.001) and adult children caregivers (OR=2.80, P=0.055) were associated with high burden. Our results highlight the differences between UD and MD classification of caregiver burden. Future studies should explore the significance of the noncongruent intermediate group and its predictors.
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Kelleher M, Tolea MI, Galvin JE. Anosognosia increases caregiver burden in mild cognitive impairment. Int J Geriatr Psychiatry 2016; 31:799-808. [PMID: 26643996 PMCID: PMC8483618 DOI: 10.1002/gps.4394] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our aim is to determine the clinical correlates of impaired insight in patients with mild cognitive impairment (MCI) by examining its impact on cognition, functional status, neuropsychiatric symptoms, and caregiver burden. METHODS The study involved 75 patients with MCI and their caregivers. Patients and caregivers underwent a comprehensive evaluation including the Clinical Dementia Rating, memory tests, and the Functional Assessment Questionnaire. Behavioral symptoms were assessed by the Neuropsychiatric Inventory, caregiver burden by the Zarit Burden Inventory, and insight by comparing self-report on the AD8 dementia screening tool to informant collateral. Patients were asked about their perceptions of their memory, and answers were compared with informants' responses. Patient mood was assessed with the Hospital Anxiety Depression Scale. RESULTS There was a significant difference in AD8 scores among patients who retained versus lacked insight. Zarit Burden Inventory scores showed a significant rise as patient insight declined; the burden appeared greater on spouse versus non-spouse caregivers. Patients with poor insight had significantly worse ratings in Clinical Dementia Rating domains of personal care and judgment, while patients who retained insight had significantly higher depression and anxiety. Insight impairment was associated with worse caregiver mood. CONCLUSIONS Decreased patient awareness for cognitive problems was significantly associated with higher caregiver burden, independent of neuropsychiatric symptoms, functional abilities, and cognition. Personal care, judgment, and problem-solving skills could contribute to caregiver burden. Increased awareness seemed a source of patient depression and anxiety. The research highlights the need to focus on the needs of MCI caregivers and to incorporate psychosocial assessments of caregiver-patient dyads into office visits.
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Affiliation(s)
- Mary Kelleher
- Center for Cognitive Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Magdalena I. Tolea
- Center for Cognitive Neurology, NYU Langone Medical Center, New York, NY, USA,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - James E. Galvin
- Center for Cognitive Neurology, NYU Langone Medical Center, New York, NY, USA,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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van den Dungen P, Moll van Charante EP, van de Ven PM, van Marwijk HWJ, van der Horst HE, van Hout HPJ. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care. PLoS One 2016; 11:e0156958. [PMID: 27310616 PMCID: PMC4910994 DOI: 10.1371/journal.pone.0156958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 05/22/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. METHODS In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. RESULTS Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326) of persons in the intervention, and in 30.5% (98/321) in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60-3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%), there were no differences in mental health between the intervention and control group. CONCLUSIONS We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude a clinically relevant effect, a larger study is warranted to replicate ours. TRIAL REGISTRATION Nederlands Trial Register NTR3389.
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Affiliation(s)
- Pim van den Dungen
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Eric P. Moll van Charante
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Harm W. J. van Marwijk
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Primary Care Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Henriëtte E. van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Hein P. J. van Hout
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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Goren A, Montgomery W, Kahle-Wrobleski K, Nakamura T, Ueda K. Impact of caring for persons with Alzheimer's disease or dementia on caregivers' health outcomes: findings from a community based survey in Japan. BMC Geriatr 2016; 16:122. [PMID: 27287238 PMCID: PMC4903014 DOI: 10.1186/s12877-016-0298-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/03/2016] [Indexed: 11/26/2022] Open
Abstract
Background This study assessed how family caregivers for patients with Alzheimer’s disease (AD) or dementia in Japan differed from non-caregivers in characteristics and health outcomes (i.e., comorbidities, health-related quality of life [HRQoL], productivity, and resource use). Caregivers were hypothesized to experience significantly poorer outcomes than non-caregivers. Methods Data were combined from the 2012 and 2013 National Health and Wellness Survey in Japan (n = 60000). Caregivers for adult relatives with AD or dementia were compared with non-caregivers on: comorbidities (including Patient Health Questionnaire (PHQ-9) cutoff scores suggesting presence/absence of major depressive disorder (MDD)), Work Productivity and Activity Impairment (WPAI), SF-36v2-based HRQoL, and healthcare resource utilization. Sociodemographic characteristics, health characteristics and behaviors, and Charlson comorbidity index (CCI) scores were compared across groups. Propensity matching, based on scores generated from a logistic regression predicting caregiving, was used to match caregivers with non-caregivers with similar likelihood of being caregivers. Bivariate comparisons across matched groups served to estimate outcomes differences due to caregiving. Results Among 55060 respondents, compared with non-caregivers (n = 53758), caregivers (n = 1302) were older (52.6 vs. 47.5 years), more frequently female (53 % vs. 49 %), married/partnered, frequent alcohol drinkers, current smokers, exercisers, and not employed, and they averaged higher CCI scores (0.37 vs. 0.14), all p < 0.05. Propensity scores incorporated sex, age, body mass index (BMI), exercise, alcohol, smoking, marital status, CCI, insured status, education, employment, income, and children in household. A greedy matching algorithm produced 1297 exact matches, excluding 5 non-matched caregivers. Health utilities scores were significantly lower among caregivers (0.724) vs. non-caregivers (0.764), as were SF-36v2 Physical and Mental Component Summary scores. Caregivers vs. non-caregivers had significantly higher absenteeism, presenteeism-related impairment, overall work impairment (25.8 % vs. 20.4 %, respectively), and activity impairment (25.4 % vs. 21.8 %), more emergency room and traditional provider visits (7.70 vs. 5.35) in the past six months, and more frequent MDD (14 % vs. 9 %), depression, insomnia, anxiety, and pain. Conclusions Those providing care for patients with AD or dementia in Japan experienced significantly poorer HRQoL and greater comorbid risk, productivity impairment, and resource use. These findings inform the need for greater support for caregivers and their patients.
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Affiliation(s)
- Amir Goren
- Health Outcomes Practice, Kantar Health, 11 Madison Ave, Floor 12, New York, NY, 10010, USA.
| | - William Montgomery
- Global Patient Outcomes & Real World Evidence, Eli Lilly Australia, 112 Wharf Rd, West, Ryde, NSW, 2114, Australia
| | - Kristin Kahle-Wrobleski
- Global Patient Outcomes & Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Tomomi Nakamura
- Medical Development Unit, Eli Lilly Japan K.K, 7-1-5, Isogami-dori, chuou-ku, Kobe, 651-0086, Japan
| | - Kaname Ueda
- Health Outcomes, Health Technology Assessment, & Real World Evidence, Medical Development Unit, Eli Lilly Japan K.K, 7-1-5, Isogami-dori, chuou-ku, Kobe, 651-0086, Japan
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Ikeda C, Terada S, Oshima E, Hayashi S, Okahisa Y, Takaki M, Inagaki M, Yokota O, Uchitomi Y. Difference in determinants of caregiver burden between amnestic mild cognitive impairment and mild Alzheimer's disease. Psychiatry Res 2015; 226:242-6. [PMID: 25631688 DOI: 10.1016/j.psychres.2014.12.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/24/2014] [Accepted: 12/27/2014] [Indexed: 11/19/2022]
Abstract
Care for the disabled elderly can be stressful and exhausting, especially in cases of dementia. There have been a number of studies on the dementia caregiver burden, but studies focusing on differences by stages of the disease are rare. The caregiver burden of 85 caregivers of patients with amnestic mild cognitive impairment (aMCI) and 106 caregivers of patients with mild Alzheimer׳s disease (AD) was evaluated by the short version of the Japanese version of the Zarit Burden Interview (sZBI). The caregiver burden in mild AD was more severe than that in aMCI. In mild AD, the risk factors of caregiver burden were neurobehavioral symptoms and disturbances instrumental activities of daily living (IADL), whereas the risk factors in aMCI were neurobehavioral symptoms and memory dysfunction. The severity of dementing disease affects the caregiver burden, and somewhat different factors contribute to the burden at different stages. We should pay attention to different factors in evaluating and reducing the caregiver burden in aMCI and mild AD.
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Affiliation(s)
- Chikako Ikeda
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Etsuko Oshima
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Satoshi Hayashi
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuko Okahisa
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Manabu Takaki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masatoshi Inagaki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Osamu Yokota
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Uchitomi
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Seeher KM, Low LF, Reppermund S, Slavin MJ, Draper BM, Kang K, Kochan NA, Trollor JN, Sachdev PS, Brodaty H. Correlates of psychological distress in study partners of older people with and without mild cognitive impairment (MCI) - the Sydney Memory and Ageing Study. Aging Ment Health 2014; 18:694-705. [PMID: 24588692 DOI: 10.1080/13607863.2013.875123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Psychological effects of supporting someone with mild cognitive impairment (MCI) are often overlooked. We aimed to establish correlates of psychological distress in study partners of individuals with and without nonclinical MCI. METHODS Demographic, psychosocial and health measures were obtained cross-sectionally from 714 participants (39% MCI) and study partners of a longitudinal community-based study on cognitive aging. Study partners (i.e. family members/friends) were categorized as providing support with instrumental everyday activities or not. Psychological distress was measured by the Kessler psychological distress scale. Multiple hierarchical regressions examined determinants of psychological distress within Pearlin's stress process model. RESULTS Psychological distress was generally low and not associated with MCI or whether study partners provided support or not. Instead, distress was greater if participants were male irrespective of study partners' sex and if study partners reported negative reactions to participants' behavioral symptoms, felt burdened by providing support and showed worse coping abilities; overall explaining 37% variance. Self-rated disability and aspects of health-related quality of life explained additional 7%. CONCLUSION Objective impairment measures were not associated with distress in partners or supporters. However, study partners' appraisals of functional and behavioral symptoms were linked to increased distress even in this very mildly affected community cohort.
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Affiliation(s)
- Katrin M Seeher
- a Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine , University of New South Wales , Sydney , Australia
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Cheng ST, Kwok T, Lam LCW. Dimensionality of burden in Alzheimer caregivers: confirmatory factor analysis and correlates of the Zarit Burden interview. Int Psychogeriatr 2014; 26:1-9. [PMID: 24892872 DOI: 10.1017/s104161021400101x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT Background: To investigate dimensions of caregiver burden through factor analysis of the Zarit Burden Interview (ZBI), and to examine predictors of different dimensions of burden. Methods: Confirmatory factor analyses were performed on 395 Hong Kong Chinese Alzheimer caregivers to examine whether several proposed factor structures fit the data well. Subsequently, participants were split into two roughly equal subsamples, for the purpose of identifying the most optimal factor structure through exploratory factor analysis in Sample A (n = 183) and an independent verification through confirmatory factor analysis in Sample B (n = 212). ZBI subscales representing the established factors were correlated with caregiver and care-recipient variables known to be associated with burden. Results: Confirmatory factor analyses showed that factor models reported elsewhere did not fit the data well. Subsequently, exploratory factor analysis in Sample A suggested a 4-factor structure. After dropping three items due to poor factor loadings, the 4-factor structure was found to fit the data moderately well in Sample B. The four factors tapped personal strain, captivity, self-criticism, and loss of control. However, self-criticism was basically unrelated to the other three factors and showed a rather different pattern of correlations with caregiver and care-recipient variables. Self-criticism was more common among child caregivers and those who did not live with the care-recipient and was less involved in day-to-day care, yet feeling obligated and close to the care-recipient. Conclusions: The dimensions of caregiver burden may be culturally specific. More research is needed to examine cultural considerations in measuring caregiver burden.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education,Hong Kong Institute of Education,Hong Kong
| | - Timothy Kwok
- Department of Medicine & Therapeutics,Chinese University of Hong Kong,Hong Kong
| | - Linda C W Lam
- Department of Psychiatry,Chinese University of Hong Kong,Hong Kong
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