Factors emerging from the "Zarit Burden Interview" and predictive variables in a UK sample of caregivers for people with dementia

Social Networks Effects on Spouse and Adult-Child Dementia Caregivers' Experiences: A Cross-Sectional Study

OBJECTIVES

A large body of literature addresses experiences of spouse and adult-children caregiver of individuals with dementia (IWDs) but has not examined the role and strength of social networks in associations between spouses and adult-children caregivers' experience. Based on the stress process model, we aimed to explore the strength levels of social networks and their association with spouses/adult-children caregivers for IWDs.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

A questionnaire-based survey was conducted with a total of 146 family caregivers of IWDs (78 adult-child, and 68 spouses) in China.

METHODS

Data collection comprised 4 sections: (1) care-related stressors (dementia stage, neuropsychiatric symptoms); (2) caregiver context; (3) social network, using the Lubben Social Network Scale; and (4) caregiving experience, using the short-form Zarit Burden Interview and 9-item Positive Aspects of Caregiving Scale. Linear regression, mediation model analysis, and interactive analysis were performed to explore the mechanisms of associations between variables.

RESULTS

Spouses had weaker social network strength (β = -0.294, P = .001) and reported greater positive aspects of caregiving (β = 0.234, P = .003) than adult-children caregivers; no significant difference was found between them for caregiver burden. Mediation analysis suggests that associations between caregiver type and caregiver burden are indirect-only mediation effects of social networks (β = 0.140, 95% CI = 0.066-0.228). The social network strength suppressed the association between caregiver type and positive aspects of caregiving. The caregiver type/social network interaction statistically significantly (P = .025) affected the "positive aspects": a stronger social network was associated with more positive aspects of caregiving among the spouse subgroup (β = 0.341, P = .003).

CONCLUSIONS AND IMPLICATIONS

Social networks mediate responses to caregiving experiences among different care provider types and are vital intervention targets, especially for spousal caregivers. Our results can serve as references for identifying caregivers for clinical intervention.

Does Avoiding Distressing Thoughts and Feelings Influence the Relationship between Carer Subjective Burden and Anxiety Symptoms in Family Carers of People with Dementia?

Anxiety remains understudied in family carers of people with dementia. Understanding factors that moderate the relationship between stressors and anxiety symptoms in this population is critical to inform interventions. This study examined whether generic experiential avoidance (AAQ-II) and experiential avoidance specific to caregiving-related thoughts and feelings (EACQ) moderate the relationship between subjective burden (ZBI-12) and anxiety symptoms (GAD-7) in carers of people with dementia. The first model (R2 = .66, ∆R2 = .03) exploring the moderating effect of AAQ-II demonstrated a significant interaction term between AAQ-II and subjective burden. The second model (R2 = .53, ∆R2 = .03), exploring the moderating effect of EACQ, demonstrated a significant interaction term between EACQ and subjective burden. These results provide evidence that carers with higher levels of experiential avoidance may be particularly prone to the negative effect of subjective burden on anxiety symptoms. Clinical implications for assessment of experiential avoidance and its treatment in carers of people with dementia are discussed.

Jordanian Community People's Knowledge of and Attitudes Toward Dementia

Introduction

Limited research exists on the knowledge and attitudes of Jordanian community residents toward people with dementia (PwD). As the prevalence of dementia is anticipated to increase, there is a critical need for informed knowledge and positive attitudes toward dementia in the Jordanian community.

Objectives

This study aimed to evaluate people's knowledge of and attitudes toward PwD and identify the predictors of dementia knowledge and attitudes.

Methods

The study employed a cross-sectional research design and utilized a self-administered questionnaire as the primary data collection method. The study employed the Alzheimer's Disease Knowledge Scale (ADKS) to evaluate the knowledge of the participants, and the Dementia Attitudes Scale (DAS) was utilized to assess their attitudes in the Jordanian community. Multiple regression analysis was performed to find relevant factors influencing knowledge of and attitude toward dementia.

Results

The study's 346 participants revealed limited knowledge about dementia, with an average ADKS score of 17.21 out of 30. However, participants showed a positive attitude toward dementia, as evidenced by a mean DAS score of 88 out of 140. Statistical analysis demonstrated significantly higher knowledge scores among employed individuals (P < .05), while females exhibited significantly higher attitude scores (P < .05). Participants with experience in geriatric clinical practice, dementia education or training, informal caregiving experience, and a desire to learn more about dementia also exhibited significantly higher knowledge and attitude scores (P < .05).

Conclusion

The study offers preliminary insights into the knowledge and attitudes toward dementia in the Jordanian population. The findings underscore the importance of continuing education and training to increase knowledge and understanding of dementia. Improving dementia care and support in Jordan requires enhancing knowledge and attitudes toward dementia. The study findings were presented to policymakers, with recommendations for strategic planning and the development of awareness programs. Future research can build upon these findings and promote evidence-based practices in dementia care and community awareness programs.

Specific agitation behaviours in dementia differentially contribute to aspects of caregiver burden

BACKGROUND

Agitation is a common symptom in dementia and linked to caregiver burden, but both agitation and burden are multidimensional constructs. The current study sought to determine whether specific presentations of agitation differentially relate to aspects of caregiver burden.

METHODS

Medical record data from an outpatient memory clinic were extracted for 609 persons with dementia, including caregiver-reported burden and care recipient agitation.

RESULTS

Exploratory factor analysis yielded three domains of agitation on the Cohen Mansfield Agitation Inventory ('Physically Aggressive', 'Physically Non-Aggressive', 'Verbally Agitated') and four domains of burden on the Zarit Burden Interview ('Impact on Life', 'Guilt/Uncertainty', 'Embarrassment/Frustration', 'Overwhelm'). Regression analyses demonstrated all domains of agitation positively predicted overall burden. Regarding specific aspects of burden, Physically Aggressive behaviours predicted Embarrassment/Frustration. Physically Non-Aggressive behaviours predicted Impact on Life and Guilt/Uncertainty. Verbally Agitated behaviours predicted all burden dimensions.

CONCLUSIONS

Results suggest specific aspects of agitation may differentially contribute to facets of caregiver burden.

Caregiving concerns and clinical characteristics across neurodegenerative and cerebrovascular disorders in the Ontario neurodegenerative disease research initiative

OBJECTIVES

Caregiving burdens are a substantial concern in the clinical care of persons with neurodegenerative disorders. In the Ontario Neurodegenerative Disease Research Initiative, we used the Zarit's Burden Interview (ZBI) to examine: (1) the types of burdens captured by the ZBI in a cross-disorder sample of neurodegenerative conditions (2) whether there are categorical or disorder-specific effects on caregiving burdens, and (3) which demographic, clinical, and cognitive measures are related to burden(s) in neurodegenerative disorders?

METHODS/DESIGN

N = 504 participants and their study partners (e.g., family, friends) across: Alzheimer's disease/mild cognitive impairment (AD/MCI; n = 120), Parkinson's disease (PD; n = 136), amyotrophic lateral sclerosis (ALS; n = 38), frontotemporal dementia (FTD; n = 53), and cerebrovascular disease (CVD; n = 157). Study partners provided information about themselves, and information about the clinical participants (e.g., activities of daily living (ADL)). We used Correspondence Analysis to identify types of caregiving concerns in the ZBI. We then identified relationships between those concerns and demographic and clinical measures, and a cognitive battery.

RESULTS

We found three components in the ZBI. The first was "overall burden" and was (1) strongly related to increased neuropsychiatric symptoms (NPI severity r = 0.586, NPI distress r = 0.587) and decreased independence in ADL (instrumental ADLs r = -0.566, basic ADLs r = -0.43), (2) moderately related to cognition (MoCA r = -0.268), and (3) showed little-to-no differences between disorders. The second and third components together showed four types of caregiving concerns: current care of the person with the neurodegenerative disease, future care of the person with the neurodegenerative disease, personal concerns of study partners, and social concerns of study partners.

CONCLUSIONS

Our results suggest that the experience of caregiving in neurodegenerative and cerebrovascular diseases is individualized and is not defined by diagnostic categories. Our findings highlight the importance of targeting ADL and neuropsychiatric symptoms with caregiver-personalized solutions.

Caregiver Burden in a Culturally Diverse Memory Clinic Population: The Caregiver Strain Index-Expanded

INTRODUCTION

Although qualitative studies have highlighted substantial barriers to dementia diagnosis and care in culturally diverse populations in Europe, quantitative studies examining the level of caregiver burden in these populations have been lacking thus far and are urgently needed.

METHODS

We compared the caregiver burden levels on the Caregiver Strain Index (CSI)-Expanded of 63 culturally diverse patient-caregiver dyads from a multicultural memory clinic with 30 native Dutch patient-caregiver dyads and examined the association between caregiver burden and determinants of burden.

RESULTS

Informal caregivers in the multicultural memory clinic cohort experienced a high level of caregiver burden (mean CSI-score multicultural cohort: 6.1 [SD: 3.3]; mean CSI-score native Dutch cohort: 4.8 [SD: 3.2]). Burden was significantly associated with impairment on proxy-rated and objective measures of cognitive functioning, such as the Informant Questionnaire on Cognitive Decline and the Rowland Universal Dementia Assessment Scale, and with instrumental activities of daily living. Burden was the highest in spousal caregivers. The positive subscale of the CSI-Expanded provided limited additional information.

CONCLUSION

Caregivers of culturally diverse patients experience a high level of caregiver burden, in particular at more advanced disease stages. This study highlights the need to screen culturally diverse caregivers in European memory clinics on caregiver burden to identify those in need of caregiver support.

Validation of the Chinese Version of the Relevant Outcome Scale for Alzheimer's Disease (CROSA)

OBJECTIVES

To examine the psychometric properties of the Chinese version of the Relevant Outcome Scale for Alzheimer's disease (CROSA) among persons with AD (PWAD) and their caregivers in China.

DESIGN

A single-arm, open-label, multi-center study.

SETTING

Two tertiary general hospitals in Shanghai.

PARTICIPANTS

A total of 336 PWAD and their family caregivers.

INTERVENTION

The PWAD completed a 12-week treatment with memantine after a baseline assessment.

MEASUREMENTS

The CROSA and the Chinese versions of the Mini-Mental State Examination, the Alzheimer's Disease Assessment Scale-Cognitive Subscale, the Disability Activity of Dementia, the Neuropsychiatric Inventory Questionnaire, the Zarit Caregiver Burden Interview and the Self-Efficacy Questionnaire for Chinese Family Caregivers.

RESULTS

The Cronbach's alpha for the total scale was 0.900, and the intraclass correlation coefficient and Pearson's correlation coefficient were 0.910 (P < 0.001) and 0.836 (P < 0.001), respectively. Confirmatory factor analysis revealed the two-factor model to be consistent with the original version. For the known-group validity, the total score of the CROSA classified the PWAD into three stages and three MMSE score groups. Moderate to large correlations with the validated scales confirmed the criteria validity of the CROSA, and the convergent validity was confirmed via testing a hypothesized caregiving model; however, only minimal responsiveness was found among the deterioration group after 12 weeks of treatment with memantine.

CONCLUSIONS

The reliability and validity of the CROSA was good or acceptable for use in daily clinical settings. Further studies are needed to examine the psychometric properties of the scale.

Evaluating the Positive Experience of Caregiving: A Systematic Review of the Positive Aspects of Caregiving Scale

BACKGROUND AND OBJECTIVES

As attention to positive caregiving experience increases, there is growing evidence concerning how the identification of the positive aspects of caregiving can be beneficial in supporting caregivers. The purpose of the current study is to review the literature where the Positive Aspects of Caregiving Scale (PACS) was used, identify the ways studies have used the PACS, and summarize the relationship between PACS and the contextual factors as well as outcomes of caregiving.

RESEARCH DESIGN AND METHODS

A systematic literature review was conducted. Electronic databases were searched, and empirical research studies written in English that were published in a peer-reviewed journal after 2004 were identified. After a careful review of the 194 abstracts yielded from the databases and the reference lists of the associated articles, 52 eligible studies were identified, and relevant findings were extracted.

RESULTS

Some commonality in terms of how studies have used the PACS emerged. The literature reviewed was further grouped into three categories depending on whether the study tested the PACS as a valid and reliable measurement, examined the PACS as outcomes of caregiving, or as a predictor of certain outcomes.

DISCUSSION AND IMPLICATIONS

This review suggests that PACS is utilized for multiple purposes and yields considerable evidence supporting the importance of understanding the positive experience of caregiving. However, there is limited adaptation of the PACS in a large survey, and studies were heavily focused in the U.S. with little evidence from other countries. Further studies to address these limitations will be needed.

Support care needs of people with hearing and vision impairment in dementia: a European cross-national perspective

PURPOSE

Aging-related sensory impairments are among the most common and disabling comorbidities in people with dementia (PwD). This study explored the unmet support care needs (SCNs) from the perspectives of people with hearing and/or vision impairment in dementia (PwD), and their care partners in Europe.

METHODS

This was a two-phase mixed methods study. We administered standardized questionnaires of SCNs and quality of life (QoL) to PwD with hearing and/or vision impairment (n = 97), and their care partners (n = 97) in the UK, France, and Cyprus. Next, a purposive sub-sample of 34 participants (PwD and care partners) participated as focus groups (FGs) or semi-structured interviews to explore their SCNs in depth.

RESULTS

Over 94% of the participants reported unmet SCNs (median, 13 (range 5-23)). Nearly three-quarters reported SCNs in the moderate to high range, with the most prevalent unmet SCNs for PwD being in the psychological (>60%) and physical domains (>56%), followed by the need for health information (>46%). Emergent qualitative themes were: (1) the need for tailored support care interventions; (2) care burden, social isolation, and loneliness arising from the combined problems; (3) the need for adequate support from professionals from the different fields, including education around the use of sensory aids. Both study phases revealed that SCNs were highly individualized.

CONCLUSIONS

This cross-national study revealed that PwD with sensory impairment and their care partners experience a wide range of unmet SCNs, the interactions between sensory impairments, SCNs and QoL are also complex. A tailored intervention could address these unmet SCNs, including additional support with sensory aids, psychological support, more information about concurrent impairments, and joined up health systems providing care.Implications for rehabilitationA majority of participants with combined age-related hearing, vision, and cognitive impairment had unmet SCNs.The needs of care partners including the risk of loneliness and social isolation, need to be considered.Individually tailored, specific interventions for hearing, vision, and cognitive impairment should incorporate physical and psychological support, as well as education.

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.

Multidimensional Care Burden in Parkinson-Related Dementia

BACKGROUND AND OBJECTIVE

Providing care to people with Parkinson-related dementia (PwPRD) may result in significant stress, strain, and burden for life partners. A common measurement of life partner burden is the Zarit Burden Interview (ZBI), which considers "burden" as a unitary concept; however, burden is highly complex and most likely comprises several dimensions. This study aimed to explore the factor structure of the ZBI in life partners of PwPRD and to examine the relationships among the emerging factors and the demographic and clinical features.

METHODS

Life partners of PwPRD participated in home-based quantitative assessments and self-completed postal questionnaires. The assessment battery included ZBI, measures of relationship satisfaction, mood, stress, resilience, health, quality of life, feelings related to care provision, and sociodemographic questions. Data on PwPRDs' motor and neuropsychiatric symptom severity were also elicited in home-based assessments.

RESULTS

An exploratory factor analysis (principal axis factoring) of ZBI, conducted with 127 life partners, revealed five burden dimensions: social and psychological constraints, personal strain, interference with personal life, concerns about future, and guilt. These burden factors were associated with lower relationship satisfaction, mental health, and resilience, and higher stress, anxiety, depression, resentment, negative strain, and PwPRD motor severity. In multiple linear regression analyses, where each factor score was the dependent variable, stress, negative strain, and resentment emerged as significant predictors of specific burden dimensions.

CONCLUSIONS

Burden is a complex and multidimensional construct. Interventions should address specific types of burden among life partners of PwPRD to support couples' relationships and maintain quality of life.

Social aspects of dementia and dementia practice

Social aspects of dementia are becoming increasingly important as part of a wider shift in emphasis from cure to care. This is partly because approaches based on finding a cure have proved far more difficult and complex than originally imagined (WHO, 2016). New evidence on the effectiveness of public health measures, that while incidence is growing as the proportion of older people in society increases its prevalence amongst older adults is actually falling, has also lead to increased interest in social dimensions of prevention, lifestyle change, and practical intervention in community settings (Prince et al., 2016; Kivipelto et al., 2017). This, in turn, has led to a rediscovery of the role of supports to people living with dementia in their daily lives, the needs of informal carers, and professional activities that can maintain the social engagement of each party (Winblad et al., 2016). The expansion of practice around person-centered care, beyond traditional institutional settings, has also contributed to a socialized view of how interactions in dementia care are thought about (Bartlett et al., 2017), as has an increased awareness of the effects of the social construction of dementia in the public mind (Biggs, 2018). Most recently, people living with dementia, and particularly with respect to younger onset dementia, have begun to find a voice and to make connections to the wider disability movement (Dementia Alliance International, 2017). Each of these developments, in their different ways, have led to a re-emphasis on psycho-social elements of dementia, its experience, and how that might translate into clinical practice and service delivery.