Cross-cultural study of caregiver burden for Alzheimer's disease in Japan and Taiwan: result from Dementia Research in Kumamoto and Tainan (DeReKaT)

Comparison survey on family caregivers of older persons in Japan and Thailand

BACKGROUND

While rapid population ageing is occurring worldwide, its speed is especially prominent in Asian countries. In Asia, cultural diversity might significantly affect care burden; however, few studies have investigated the differences in care burden, and mental, physical and social conditions among Asian countries. This study aimed to clarify the situations of and differences in family caregivers (FCs) of older persons in Japan and Thailand, and evaluate the factors associated with care burden in both countries.

METHODS

A cross-national survey of 217 in-home FCs was conducted in Japan and Thailand and mainly included items regarding care burden and psychosocial conditions. Differences between the two countries were obtained, and the factors associated with care burden were analysed by multiple regression analyses.

RESULTS

The FCs' and care receivers' mean ages (64.8 ± 11.1 and 84.8 ± 8.6 years, respectively) in Japan were significantly higher than the mean ages (49.1 ± 13.3 and 77.1 ± 9.5 years) in Thailand. In Japan, FCs had more severe care burden, loneliness, and stress compared to those in Thailand. In Thailand, FCs had more social connections and informal support than those in Japan. The factors associated with care burden were different in each country; thus, severe stress, low emotional care preparation, and low willingness to continue care at home were significantly associated with severe care burden in Japan, whereas poor relationships with care receivers, few social connections, low confidence in providing care, low emotional care preparation, and lack of informal support were significantly associated with severe care burden in Thailand.

CONCLUSIONS

Despite there being a long-term care insurance system in Japan, which is absent in Thailand, care burden and psychosocial conditions of FCs might be worse in Japan. There was a clear difference in the factors associated with care burden between Japan and Thailand.

Combining a variable-centered and a person-centered analytical approach to caregiving burden - a holistic approach

Background

Informal caregivers of persons with dementia often experience elevated levels of caregiving burden. However, existing studies tend to use a variable-centered approach to explore it. This study aims to understand the caregiving burden of informal caregivers of persons with dementia in Singapore through a combination of variable-centered and person-centered analytical approaches, and explore the correlates of identified factors and latent classes of caregiving burden.

Methods

Zarit Burden Interview was used to gauge the caregiving burden of 282 primary informal caregivers of persons with dementia recruited through convenience sampling in Singapore. Factor analysis and latent class analysis were conducted to identify the latent factors and the latent classes of Zarit Burden Interview, followed by multiple linear regression and multinomial logistic regression to explore their significant correlates.

Results

The analyses suggested a 17-item 3-factor structure for Zarit burden interview and three mutually exclusive caregiving burden classes. Regression analyses found that caregiving related variables especially care recipients’ memory and behaviour problems were correlated with both the factors and latent classes of caregiving burden.

Conclusions

The combination of these two approaches suggests that caregivers experiencing higher burden on one domain are likely to experience higher burden on the other two domains. This further supports the point that more attention should be given to caregivers who experience an overall high burden. Future research could explore the generalizability of our findings among caregivers elsewhere and explore the type of support needed by caregivers, especially those experiencing high burden.

Personal Determinants of Burden Among Indonesian Female Caregivers of Older Adults in Taiwan

INTRODUCTION

Families increasingly employ foreign domestic workers (FDWs) to care for older loved ones. Caregiver burden reflects FDWs' difficulty adapting to work demands. We test hypothesized associations between burden and six personal characteristics: children, marriage, education, Chinese proficiency, eldercare experience, and non-eldercare experience.

METHOD

In total, 299 Indonesian FDWs in Taiwan completed the Zarit Burden Interview. Exploratory factor analysis identified the dimensions of burden. Multiple and multinomial regressions related the variables to overall burden, burden dimensions, and burden severity.

RESULTS

Four dimensions were found: personal strain, role strain, dependency, and guilt. Children were negatively associated with burden, role strain, dependency, and guilt. Chinese proficiency was negatively associated with severity and guilt. Eldercare experience was positively associated with severity and personal strain. Marriage was non-monotonically related to severity.

CONCLUSION

Caregivers whose earnings benefit their children may be more likely to thrive in Taiwan. Language training may boost caregiver performance and host family satisfaction.

Sleep, caregiver burden, and life satisfaction in Parkinson's disease caregivers: a multinational investigation

PURPOSE

The primary aim of this study was to examine the pattern of associations among PD patient and caregiver sleep problems, caregiver burden, and caregiver life satisfaction. A secondary aim was to assess whether the pattern of associations differed between Mexican and U.S. caregivers.

MATERIALS AND METHODS

Analyses were performed on data obtained from 253 caregivers (M age = 59.92). A composite score was produced for caregiver and patient sleep problems. The Zarit Burden Interview and Satisfaction with Life Scale measured caregiver burden and life satisfaction, respectively. A structural equation model with an invariance design was developed to examine and compare the pattern of associations.

RESULTS

The model was generally invariant across U.S. and Mexican caregivers. Three significant indirect effects were found: caregiver sleep problems were negatively associated with life satisfaction via caregiver burden (p = 0.003); PD patient sleep problems were positively related to caregiver burden via caregiver sleep problems (p = 0.005) and life satisfaction via caregiver burden and caregiver sleep problems (p = 0.002).

CONCLUSIONS

PD patient sleep problems were associated with caregiver sleep problems, leading to increased burden in caregivers and poorer life satisfaction. The findings highlight a potential opportunity for empirically supported sleep interventions.Implications for rehabilitationParkinson's disease is a progressive neurological condition that impacts patient and caregiver quality of life.Patient sleep problems contribute to greater caregiver burden, sleep problems, and reduced life satisfaction.The findings suggest patient and caregiver sleep may be a worthwhile target for intervention in order to reduce risk of caregiver burden and improve life satisfaction.

Can drawings help assessing dementia caregivers' burden? A preliminary study

The use of quantitative self-report methods for assessing the stress associated with dementia caregiving, especially among minority groups, has been lately criticized. The aim of this study was to examine whether Human Figures Drawings might provide a tool for assessing caregivers' burden. Sixty Israeli Arabs – 30 family caregivers of a person with dementia and 30 gender and age-matched non-caregivers – were asked to draw a caregiver of an elderly person with dementia and a caregiver of an elderly person with a physical disability. While no differences were found between the drawings of caregivers and non-caregivers, statistically significant differences were found between all the characteristics of the drawings depicting a caregiver of an elderly person with dementia and a caregiver of an elderly person with a physical disability, as drawn by caregivers. Several of the drawings' characteristics were significantly associated with caregiver burden. By introducing a nonverbal form of expression, Human Figures Drawings might add utility to the assessment of dementia caregivers' burden.

Stigmatic beliefs towards persons with dementia: comparing Israeli and Greek college students

OBJECTIVES

Increasing Alzheimer's Disease (AD) awareness and decreasing stigmatic beliefs among the general public are core goals of National Dementia Strategy programs. College students are one of the most important targeted populations for achieving this goal. The aim of the current study was to examine AD public stigma among Israeli and Greek college students.

DESIGN

A cross-sectional survey was conducted among college students in Israel and Greece using vignette methodology.

PARTICIPANTS

Seven hundred and fifty three college students - 213 Israeli and 540 Greek - participated in the study.

MEASUREMENTS

Three dimensions of stigma were assessed (cognitive, emotional, and behavioral) together with health beliefs regarding AD and socio-demographic characteristics.

RESULTS

Low levels of stigma were found in both samples, with Israeli students reporting statistically significant higher levels of stigmatic beliefs than Greek students in all the dimensions, except with willingness to help. Similar to stigma in the area of mental illness, the findings in both countries supported an attributional model for AD public stigma, i.e. positive correlations were found among cognitive attributions, negative emotions, and discriminatory behaviors in both countries. Differences between the countries emerged as a significant determinant of cognitive, as well as of negative emotions and willingness to help.

CONCLUSION

Our findings might help researchers and clinicians to apply the knowledge gained in the area of mental illness to the development of effective ways of reducing AD public stigma. Moreover, they allowed us to frame the understanding of AD public stigma within a socio-cultural context.

Mental health of working-age populations in Japan who provide nursing care for a person at home: A cross-sectional analysis

OBJECTIVES

This study investigated potential associations between having a person in need of nursing care at home and psychological distress amongst the Japanese working population, using a nationally representative sample.

METHODS

We extracted data from the 2013 Comprehensive Survey of Living Conditions conducted by the Ministry of Health, Labour and Welfare of Japan. The original survey was conducted amongst 295,367 households in 5,530 randomly selected municipalities. We analyzed participants aged 25-65 years who headed a household. The original questionnaire included questions about the specific qualifications required to receive long-term care insurance benefits, about psychological distress (measured using the K6 scale), and other covariates. If a family contained a member in need of nursing care at home, the person who headed that household was recognized as the participant who had a person in need of nursing care at home. Multiple logistic regression analysis was conducted to investigate the association between having a person in need of nursing care at home and psychological distress.

RESULTS

A total of 36,193 men and 2,765 women were included in the analysis, 2.9% of whom had a person in need of nursing care at home. Statistical analysis revealed an association between having a care-requiring older relative at home and psychological distress (odds ratio: 1.40, 95% confidence interval: 1.01-1.93).

CONCLUSIONS

Having a person in need of nursing care at home appears to be positively correlated with worsening mental health of working populations in Japan.

The Perceived Caregiver Burden Among Turkish Family Caregivers Providing Care for Frail Older Adults

Purpose: The older population has reached to 8.5%, and the prevalence of frailty is reported as 39.2% in Turkey. The purpose of the study was to assess caregiver burden in families who care for frail older adults in Turkish culture. Method: This descriptive study was conducted in Turkey between June and October 2017. Frail older adults who had no severe cognitive impairment were included. Data were measured using the Older Adult Information Form, Edmonton Frailty Scale, Caregiver Information Form, and Zarit Burden Interview. Results: In total, 131 older person/caregiver dyads were analyzed; the Zarit Burden Interview mean score was 37.59 ± 18.20. Caregivers with less education and providing care more than 8 hours experienced a higher burden ( p < .05). The severity of frailty significantly correlated with the caregiver scores ( R = .36, p < .01). Conclusion: The caregiver burden in Turkish family caregivers was found mild to moderate and correlated with the degree of frailty. Policymakers should focus on culture-specific formal caregiver services.

Exploration of the Factor Structure of the Burden Experienced by Individuals Providing End-of-Life Care at Home

In Japan, the number of elderly people who require long-term care is increasing as a result of the country's aging population. Consequently, the burden experienced by caregivers who provide end-of-life care at home has become a social problem. This study aimed to confirm the factor structure of such caregiver burden by analyzing the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI). The J-ZBI was administered to 389 caregivers providing end-of-life care, and 247 answers were analyzed, with exploratory factor analysis performed on the results. Consequently, a four-factor structure emerged (sacrificing life, personal strain, severe anxiety, and captivity); these four factors, constituting 15 items, were cumulatively named “J-ZBI_15.” In regard to reliability, Cronbach's α coefficient for each factor was high; in terms of validity, a confirmatory factor analysis was conducted to examine the four-factor structure, and the goodness of model fit was determined to be satisfactory. Further, the convergent validity was also high. The care burden experienced by those providing end-of-life care at home differs from the burden of caregivers of individuals with other diseases, such as Alzheimer's. For assessing the burden felt by this population, the 15-item four-factor ZBI model is more appropriate than the single-factor 22-item ZBI, and we also determined that J-ZBI_8 is unsuitable for this task. Thus, measurement of family caregivers' burden in regard to providing end-of-life care at home should be performed using the 15-item four-factor J-ZBI model.

"I Treat Him as a Normal Patient": Unveiling the Normalization Coping Strategy Among Formal Caregivers of Persons With Dementia and Its Implications for Person-Centered Care

INTRODUCTION

Currently, 47 million people have dementia, worldwide, often requiring paid care by formal caregivers. Research regarding family caregivers suggests normalization as a model for coping with negative emotional outcomes in caring for a person with dementia (PWD). The study aims to explore whether normalization coping mechanism exists among formal caregivers, reveal differences in its application among cross-cultural caregivers, and examine how this coping mechanism may be related to implementing person-centered care for PWDs.

METHOD

Content analysis of interviews with 20 formal caregivers from three cultural groups (Jews born in Israel [JI], Arabs born in Israel [AI], Russian immigrants [RI]), attending to PWDs.

RESULTS

We extracted five normalization modes, revealing AI caregivers had substantially more utterances of normalization expressions than their colleagues.

DISCUSSION

The normalization modes most commonly expressed by AI caregivers relate to the personhood of PWDs. These normalization modes may enhance formal caregivers' ability to employ person-centered care.

Factor analyses of the Chinese Zarit Burden Interview among caregivers of patients with schizophrenia in a rural Chinese community

OBJECTIVE

This study aimed to evaluate the factor structure of the Chinese version of the 22-item Zarit Burden Interview (ZBI) among family caregivers of patients with schizophrenia in China.

METHODS

Using one-stage cluster-sampling design, 324 primary caregivers of patients with schizophrenia in Ningxiang County, Hunan Province, China, completed the Zarit Burden Interview face-to-face. Confirmatory factor analysis (CFA) was first performed based on existing models to check model fit. Owing to an unsatisfactory result of CFA, exploratory factor analysis (EFA) was then conducted to explore a new factor structure, and a subsequent CFA was run to examine its model fit.

RESULTS

The CFA results showed that none of the existing models fit the data reasonably well. The EFA results suggested five dimensions: negative emotion (10 items), interpersonal relationship (4 items), time demand (3 items), patient's dependence (2 items) and self-accusation and guilt (2 items). The following CFA confirmed the five-factor solution in this study, and the goodness-of-fit for this model fell within the acceptable range. The overall internal consistency (Cronbach's alpha) was 0.88, and the internal consistency coefficients of individual dimensions were 0.68 to 0.84.

CONCLUSION

This study supported a 22-item ZBI scale, with a five-factor structure when applied to Chinese caregivers of patients with schizophrenia.