Quality of the caregiver--care recipient relationship: does it offset negative consequences of caregiving for family caregivers?

Examining the Influence of Social Interactions and Community Resources on Caregivers' Burden in Stroke Settings: A Prospective Cohort Study

Since the introduction of the integrated care model, understanding how social interactions and community resources can alleviate caregivers’ burden is vital to minimizing negative patients’ outcomes. This study (n = 214) examined the associations between these factors and caregivers’ burden in stroke settings. It used 3-month and 1-year post-stroke data collected from five tertiary hospitals. Subjective and objective caregivers’ burdens were measured using Zarit burden interview and Oberst caregiving burden scale respectively. The independent variables examined were quality of care relationship, care management strategies for managing patients’ behaviour, family caregiving conflict, formal service usage and assistance to the caregiver. Significant associations were determined using mixed effect modified Poisson regressions. For both types of burden, the scores were slightly higher at 3 months as compared to 1 year. Poorer care-relationship (relative risk: 0.81, 95% confidence interval (CI): 0.70–0.94) and adopting positive care management strategies (relative risk: 1.05, 95% CI: 1.02–1.07) were independently associated with a high subjective burden. Providing assistance to caregivers (relative risk: 2.45, 95% CI: 1.72–3.29) and adopting positive care management strategies (relative risk: 1.03, 95% CI: 1.02–1.04) were independently associated with a high objective burden. Adopting positive care management strategies at 3 months had a significant indirect effect (standardised β: 0.11, 95% CI: 0.01 to 0.20) on high objective burden at one year. Healthcare providers should be aware that excessive care management strategies and assistance from family members may add to caregivers’ burden.

Relations of Mindfulness and Illness Acceptance With Psychosocial Functioning in Patients With Metastatic Breast Cancer and Caregivers

OBJECTIVES

To examine relationships in mindfulness and illness acceptance and psychosocial functioning in patients with metastatic breast cancer and their family caregivers.

SAMPLE & SETTING

33 dyads from an academic cancer center in the United States.

METHODS & VARIABLES

Participants completed questionnaires on mindfulness, illness acceptance, relationship quality, anxiety, and depressive symptoms. Dyadic, cross-sectional data were analyzed using actor-partner interdependence models.

RESULTS

Greater nonjudging, acting with awareness, and illness acceptance among caregivers were associated with patients' and caregivers' perceptions of better relationship quality. Higher levels of these processes were associated with reduced anxiety and depressive symptoms in patients and caregivers.

IMPLICATIONS FOR NURSING

Aspects of mindfulness and illness acceptance in dyads confer benefits that are primarily intrapersonal in nature. Nurses may consider introducing mindfulness and acceptance-based interventions to patients and caregivers with adjustment difficulties.

Moderators of the relationship between frequent family demands and inflammation among adolescents

OBJECTIVE

Frequent demands from others in relationships are associated with worse physiological and health outcomes. The present research investigated 2 potential moderators of the relationship between frequency of demands from one's family and inflammatory profiles among adolescents: (a) closeness of adolescents' relationships with their families, and (b) the frequency with which adolescents provided help to their families.

METHOD

Two hundred thirty-four adolescents, ages 13-16 (Mage = 14.53; 47.83% male), completed a daily dairy in which they reported on the frequency of demands made by family members. They were also interviewed about the closeness of their family relationships and reported in the daily diary on how frequently they provided help to their families. Adolescents also underwent a blood draw to assess low-grade inflammation and proinflammatory cytokine production in response to bacterial stimulation.

RESULTS

More frequent demands from family predicted higher levels of low-grade inflammation and cytokine production in response to bacterial stimulation in adolescents. Family closeness moderated the relationship between frequent demands and stimulated cytokine production such that more frequent demands predicted higher cytokine production among adolescents who were closer to their families. Furthermore, frequency of providing help moderated the relationship between frequent demands and both low-grade inflammation and stimulated cytokine production, such that more frequent demands predicted worse inflammatory profiles among adolescents who provided more help to their families.

CONCLUSIONS

These findings build on previous work on family demands and health to show under what circumstances family demands might have a physiological cost. (PsycINFO Database Record

Elder mistreatment in a community dwelling population: the Malaysian Elder Mistreatment Project (MAESTRO) cohort study protocol

INTRODUCTION

Despite being now recognised as a global health concern, there is still an inadequate amount of research into elder mistreatment, especially in low and middle-income regions. The purpose of this paper is to report on the design and methodology of a population-based cohort study on elder mistreatment among the older Malaysian population. The study aims at gathering data and evidence to estimate the prevalence and incidence of elder mistreatment, identify its individual, familial and social determinants, and quantify its health consequences.

METHODS AND ANALYSIS

This is a community-based prospective cohort study using randomly selected households from the national census. A multistage sampling method was employed to obtain a total of 2496 older adults living in the rural Kuala Pilah district. The study is divided into two phases: cross-sectional study (baseline), and a longitudinal follow-up study at the third and fifth years. Elder mistreatment was measured using instrument derived from the previous literature and modified Conflict Tactic Scales. Outcomes of elder mistreatment include mortality, physical function, mental health, quality of life and health utilisation. Logistic regression models are used to examine the relationship between risk factors and abuse estimates. Cox proportional hazard regression will be used to estimate risk of mortality associated with abuse. Associated annual rate of hospitalisation and health visit frequency, and reporting of abuse, will be estimated using Poisson regression.

ETHICS AND DISSEMINATION

The study has been approved by the Medical Ethics Committee of the University of Malaya Medical Center (MEC Ref 902.2) and the Malaysian National Medical Research Register (NMRR-12-1444-11726). Written consent was obtained from all respondents prior to baseline assessment and subsequent follow-up. Findings will be disseminated to local stakeholders via forums with community leaders, and health and social welfare departments, and published in appropriate scientific journals and presented at conferences.

Psychological distress in spouses of somatically Ill: longitudinal findings from the Nord-Trøndelag Health Study (HUNT)

BACKGROUND

Studies of caregiver burden and somatic illness tend to be based on relatively small, clinical samples. Longitudinal, population based studies on this topic are still scarce and little is known about the long-term impact of partner illness on spousal mental health in the general population. In this study we investigate whether spouses of partners who either have become somatically ill or cured from illness in an 11 year period - or who have long-term illness - have different mental health scores compared to spouses of healthy partners.

METHODS

Approximately 9000 couples with valid self-report data on a Global Mental Health (GMH) scale and somatic illness status were identified. The diagnoses stroke, angina pectoris, myocardial infarction and severe physical disability, were transformed into a dichotomous 'any illness'-scale, and also investigated separately. Analyses of variance (ANOVA) stratified by sex were conducted with spousal GMH score at follow-up (1995-97, T2) as the outcome variable, adjusting for spousal GMH score at baseline (1984-86, T1) and several covariates.

RESULTS

Results showed that male and female spouses whose partners had become somatically ill since T1 had significantly poorer mental health than partners in the reference category, comprising couples healthy at both time points. Further, female spouses of partners who had recovered from illness since T1 had significantly better mental health than controls. Of the somatic conditions, physical disability had the most significant contribution on spousal GMH, for both sexes, in addition to stroke on male spouses' GMH. The effect sizes were small. Some of the loss of spousal mental health seems to be mediated by the ill persons' psychological distress.

CONCLUSION

The occurrence of partner illness during the follow-up period affect the mental health of spouses negatively, while partner recovery appeared to be associated with improved mental health scores for female spouses. Of the measured conditions, physical disability had the largest impact on spousal distress, but for some conditions the distress of the ill person mediated much of the loss of mental health among spouses.

The influence of relationships on personhood in dementia care: a qualitative, hermeneutic study

BACKGROUND

In dementia personhood can be understood as increasingly concealed rather than lost. The sense of being a person evolves in relationships with others. The aim of this study was to increase the understanding of the nature and quality of relationships between persons with dementia, family carers and professional caregivers and how these relationships influenced personhood in people with dementia.

METHODS

This Norwegian study had a qualitative hermeneutical design based on ten cases. Each case consisted of a triad: the person with dementia, the family carer and the professional caregiver. Inclusion criteria for persons with dementia were (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2 ie. moderate dementia (4) able to communicate verbally.A semi-structured interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day care centre. Data were analysed in two steps: (1) inductive analysis with an interpretive approach and (2) deductive analysis, applying a theoretical framework for person-centred care.

RESULTS

Relationships that sustained personhood were close emotional bonds between family carers and persons with dementia and professional relationships between caregivers and persons with dementia.Relationships that diminished personhood were task-centred relationships and reluctant helping relationships between family carers and persons with dementia and unprofessional relationships between caregivers and persons with dementia.

CONCLUSIONS

A broad range of relationships was identified. Understanding the complex nature and quality of these relationships added insight as to how they influenced the provision of care and the personhood of persons with dementia. Personhood was not only bestowed upon them by family carers and professional caregivers; they themselves were active agents who gained a sense of self by what they said and did.

Health behaviors and weight status of childhood cancer survivors and their parents: similarities and opportunities for joint interventions

Childhood cancer survivors are at increased risk for chronic health conditions that may be influenced by their cancer treatment and unhealthy lifestyle behaviors. Despite the possibility that interventions targeting the survivor-parent dyad may hold promise for this population, a clearer understanding of the role of family factors and the lifestyle behaviors of both survivors and parents is needed. A mailed cross-sectional survey was conducted in 2009 to assess weight status (body mass index), lifestyle behaviors (eg, diet, physical activity), and the quality of the parent-child relationship among 170 childhood cancer survivors who were treated at MD Anderson Cancer Center and 114 of their parents (80% mothers). Survivors were more physically active and consumed more fruits and vegetables than their parents. However, fewer than half of survivors or parents met national guidelines for diet and physical activity, and their weight status and fat intakes were moderately correlated (r=.30-.57; P<0.001). Multilevel models showed that, compared with survivors with better than average relationships, those with poorer than average relationships with their parents were significantly more likely to consume high-fat diets (P<0.05). Survivors and their parents may thus benefit from interventions that address common lifestyle behaviors, as well as issues in the family environment that may contribute to an unhealthy lifestyle.

Research protocol of the NeedYD-study (Needs in Young onset Dementia): a prospective cohort study on the needs and course of early onset dementia

BACKGROUND

Early onset dementia has serious consequences for patients and their family members. Although there has been growing attention for this patient group, health care services are still mainly targeted at the elderly. Specific knowledge of the needs of early onset dementia patients and their families is limited but necessary for the development of adequate health care services and specific guidelines. This research project is mainly targeted at delineating the course of early onset dementia, the functional characteristics and needs of early onset dementia patients and their caregivers, the risk factors for institutionalization and the interaction with the caring environment.

METHODS/DESIGN

The NeedYD-study (Needs in Young Onset Dementia) is a longitudinal observational study investigating early onset dementia patients and their caregivers (n = 217). Assessments are performed every six months over two years and consist of interviews and questionnaires with patients and caregivers. The main outcomes are (1) the needs of patients and caregivers, as measured by the Camberwell Assessment of Needs for the Elderly (CANE) and (2) neuropsychiatric symptoms, as measured by the NeuroPsychiatric Inventory (NPI). Qualitative analyses will be performed in order to obtain more in-depth information on the experiences of EOD patients and their family members. The results of this study will be compared with comparable data on late onset dementia from a historical cohort.

DISCUSSION

The study protocol of the NeedYD-study is presented here. To our knowledge, this study is the first prospective cohort study in this research area. Although some limitations exist, these do not outweigh the strong points of this study design.

Experience and perspectives of caregivers of spouse with mild cognitive impairment

The purpose of this paper is to describe commonalities of the lived experience of being a spouse caregiver of a person with mild cognitive impairment (MCI). The Colaizzi method of empirical phenomenology was used for inter-viewing and analyzing data obtained from 10 spouse caregivers of persons with MCI. Four major themes were found and labeled: (a) Putting the Puzzle Pieces Together-There Really is Something Wrong; (b) A Downward Spiral into a World of Silence; (c) Consequences to Caregivers of Living in a World of Silence; (d) Taking Charge of Care. The findings of this study provided rich data to guide interventions to help caregivers to improve their awareness of MCI, gain new information and skills to deal more effectively with and adjust to the caregiving of their spouse with MCI over the long-term.

Psychosocial Moderators the Effects of Transitioning Into Filial Caregiving on Mental and Physical Health

A life-course theoretical perspective guided this study to examine how effects on mental and physical health (depressive symptoms, hostility, global happiness, self-esteem, personal mastery, psychological wellness, self-rated physical health) of transitioning into filial caregiving for a sole surviving parent are moderated by prior relationship quality, filial obligation, race or ethnicity, education, income, employment status, marital status, and parental status. Results from models estimated using longitudinal data from 1,060 adults aged 25 to 65 years at baseline (National Survey of Families and Households, 1987 to 1994) suggested that life-course and contextual factors do contribute to patterning health risks of caregiving, often in different ways for men and women: For example, low income puts daughter caregivers at greater risk for decline in physical health, combining employment with filial caregiving is more problematic for daughters' mental health, and being an unmarried filial caregiver is more problematic for men. Heterogeneity in the experience of filial care needs further attention in future research.

Marital quality in the context of mild cognitive impairment

Profound behavioral changes in persons with dementia often negatively affect the quality of marital relationships. Yet, little is known about the extent to which the marital relationship may be affected when the care recipient has milder degrees of cognitive impairment. This study characterizes marital quality among 27 adults who live with a spouse with mild cognitive impairment (MCI). This study demonstrates that at mild levels of cognitive impairment, specific behaviors in the affected person are distressing and may degrade the quality of the marital relationship. These results have implications for clinical practice and the delivery of health care and social services to these families. It is important to develop interventions to address the needs of these individuals and their caregivers. Results of this study suggest the need for mental health interventions designed to preserve the quality of these marital relationships.

An exploratory qualitative analysis of the emotional impact of breast cancer and caregiving among older women

Using in-depth qualitative interviews, this exploratory analysis evaluated the emotional impact of breast cancer on seven older women caring for others at the time of their breast cancer diagnosis. Stress--not depression as hypothesized--was identified as a primary issue for the women in their struggle to balance caregiving responsibilities and health needs. Modified by the caregiver-care recipient relationship and the type and amount of care provided, participants' experience with stress was influenced by a host ofphysical emotional, economic, and environmental factors. Life course pattern similarities represented another compelling emergent theme in the study. Participants shared similar characteristics and experiences during their lives, leading them through common pathways to the dual status of caregiver and breast cancer patient. Findings from this preliminary analysis support the need for more extensive research in this area as well as heightened awareness among social workers and care managers of the unique stressors experienced by older women breast cancer patients caring for others.