Ambivalent Feelings and Relationship Quality in Dementia Family Caregivers: Associations with Depressive Symptomatology

OBJECTIVES

Ambivalent feelings in dementia family caregivers have been found to be related to caregivers´ stress associated with the behavioral and psychological symptoms of dementia (BPSD-related stress), and depressive symptoms. Ambivalent feelings may also affect caregivers´ perceived quality of the relationship with the person living with dementia (PLwD), but this variable has been scarcely studied. This study analyzes the role of ambivalent feelings in the association between caregivers' BPSD-related stress, perceived quality of the relationship with the PLwD, and depressive symptomatology.

METHODS

A theoretical model was developed and tested in a sample of 390 family caregivers.

RESULTS

The obtained tested model had an excellent fit to the data, explaining 24% of the variance of depressive symptomatology. A significant association was found between caregivers' BPSD-related stress, ambivalent feelings, and depressive symptomatology. Also, an indirect effect in the association between ambivalent feelings and depressive symptomatology was found through the perceived quality of the relationship.

CONCLUSIONS

Ambivalent feelings in dementia family caregivers are associated with caregivers' BPSD-related stress, perception of a lower relationship quality, and higher depressive symptomatology.

CLINICAL IMPLICATIONS

Targeting caregivers' ambivalent feelings and the quality of the relationship in interventions for dementia family caregivers may decrease their distress.

Resilience as a protective factor against depression in informal caregivers

Introduction

Although previous research has demonstrated that resilience can be protective against various mental health conditions such as depression, existing studies examining the relationship between resilience and depression have limitations. To our knowledge, the moderators of the relationship have not been examined. The aim of this study was to determine whether resilience acts as a protective factor against depression in informal caregivers and to examine potential moderators of the relationship between these variables.

Methods

In this cross-sectional study, 554 randomly selected informal caregivers participated (86.8% women, average age = 55.3 years). Major depressive episode, depressive symptomatology, resilience, positive environmental reward, negative automatic thoughts, self-efficacy, and personality were assessed.

Results

A total of 16.1% of informal caregivers met criteria for a depressive episode and 57.4% were at risk of developing depression. The average resilience score was 26.3 (SD = 7.6); 62.6% of participants were in the lower quartile of the resilience scale. The gender of the informal caregiver and self-efficacy acted as moderating variables in the relationship between resilience and depression. The impact of resilience on depressive symptoms was more pronounced in female informal caregivers, and increased as self-efficacy increased.

Discussion

Based on these findings, programs aimed at preventing depression in informal caregivers should focus on promoting resilience, especially in women, and introduce strategies to enhance self-efficacy to increase their impact.

Effectiveness of interventions to prevent abuse in people living with dementia in community settings: A systematic review

OBJECTIVES

This review examined the evidence for interventions to prevent the abuse of people living with dementia in the community.

METHODS

The articles were retrieved from 2000 to 2023 from six databases, including MEDLINE via PubMed, CINAHL Plus via EBSCO, EMBASE, ProQuest Medical Library, Web of Science, and Scopus. The research articles that focused on finding the effectiveness of interventions for preventing abuse of people living with dementia in community settings were included in this review. The review included randomized controlled trials and pre-test post-test trials only. The quality appraisal of the eligible studies was done using ROB 2 and ROBINS II. The findings were tabulated and narratively synthesised.

RESULTS

Out of 1831 articles, only three were included in this review. Only two RCTs were included in this efficacy review. Both the studies showed that the interventions were not effective in reducing abuse. The studies utilised family caregiver interventions like psychological interventions and online supportive education. The review identified psychological interventions with some evidence. Another study was a quasi-experimental study that used dialectical behaviour therapy as an intervention to reduce abuse occurrence. The study showed low evidence and focused only on reporting of elder abuse as an outcome.

CONCLUSION

This review found very few studies and was not able to draw a conclusion on the effectiveness of interventions for abuse in people living with dementia. Given the paucity of research, there is a clear need to identify how to overcome the challenges faced in elder abuse research and further refine the development of approaches to reduce elder abuse among people living with dementia in community settings.

Conceptualizing care partners' burden, stress, and support for reintegrating Veterans: a mixed methods study

Background

People who support Veterans as they transition from their military service into civilian life may be at an increased risk of psychological distress. Existing studies focus primarily on paid family caregivers, but few studies include spouses and informal non-family "care partners." We sought to identify key challenges faced by care partners of Veterans with invisible injuries.

Methods

Semi-structured interviews were conducted with 36 individuals involved in supporting a recently separated US military Veteran enrolled in a 2-year longitudinal study. CPs completed validated measures on perceived stress, caregiving burden, quality of their relationship, life satisfaction, and flourishing. Independent t-tests were used to compare cases in these groups on caregiving burden, quality of their relationship, life satisfaction, and flourishing. Care partners were categorized as reporting high and low levels of stress. Exemplar cases were used to demonstrate divergences in the experiences of CPs with different levels of stress over time.

Results

Care partners reported shifts in self-perception that occurred from supporting a Veteran, emphasizing how they helped Veterans navigate health systems and the processes of disclosing health and personal information in civilian contexts. Exemplar cases with high and low burdens demonstrated divergent experiences in self-perception, managing multi-faceted strain, and coping with stress over time. Case studies of specific care partners illustrate how multi-faceted strain shifted over time and is affected by additional burdens from childcare, financial responsibilities, or lack of education on mental health issues.

Conclusions

Findings suggest the unique needs of individuals who support military Veterans with invisible injuries, highlighting variations and diachronic elements of caregiving. This sample is younger than the typical caregiver sample with implications for how best to support unpaid care partners caring for Veterans in the early to mid-period of their use of VA and civilian health services.

The Mediating Effect of Caregiving Relationship Quality on the Association Between Caregiving Stressors and Mental Health Problems Among Older Spousal Caregivers

Providing care to a spouse can be especially challenging for older adults given their compounding stressors resulting from aging and caregiving. This cross-sectional study examines the relationships between caregiving stressors and caregiver mental health problems and the potential mediator (i.e., caregiving relationship quality) of these associations. A total of 431 Americans (≥65 years) were selected from the National Study of Caregiving. Path analysis shows that care assistance was positively associated with caregiver mental health problems, and this association was mediated by negative relationship quality (Indirect effect  =  .14, p  =  .016). Moreover, role overload was positively associated with caregiver mental health problems, which was mediated by negative relationship quality (indirect effect  =  .13, p  =  .002). Findings suggest that caregiving stressors can adversely affect mental health by exacerbating negative relationship quality. Interventions that limit negative exchanges and increase compassionate communications between older spousal caregivers and their care-receiving partners are needed.

Qualitative Evaluation of Family Caregivers' Experiences Participating in Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER): Web-Based Intervention to Improve Relationship Quality

BACKGROUND

The onset of Alzheimer disease and related dementias (AD/ADRD) can alter relationships between family caregivers and persons living with AD/ADRD, such as through the occurrence of distressful behavioral and psychological symptoms of dementia. Poorly perceived relationship quality by caregivers contributes to negative outcomes for both care partners, such as low-quality caregiving and potential mistreatment of older adults. Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER) is a new, web-based, asynchronous psychoeducational intervention with content informed by focus groups with family caregivers. The program was developed to prevent low-quality caregiving and potential mistreatment of older adults by focusing on building healthy caregiving relationships.

OBJECTIVE

The purpose of this study is to describe caregivers' experiences participating in KINDER to understand intervention acceptability. Of particular interest was learning how comfortable caregivers were viewing content addressing potential mistreatment, as well as whether asynchronous delivery created any barriers to participating in the intervention. Findings will inform future program refinements before efficacy testing.

METHODS

Although 23 caregivers enrolled in the KINDER parent study, only 7 of them completed the 8-week intervention. In-depth, semistructured qualitative interviews were conducted with all participants who completed the program to understand their experiences while attending KINDER and to decipher barriers to participation. We also asked participants about which program elements were most valuable and which were least valuable to them, as well as how the program could be improved. Interview transcripts were analyzed by 2 coders using thematic analysis.

RESULTS

Our findings indicate that caregivers were overall satisfied with KINDER's focus and content. Participants particularly liked how KINDER materials felt authentic and relevant to supporting healthy care relationships (Theme 1). The program's multiple components were found to be valuable, especially story-based video vignettes and readings (Theme 2). Most caregivers were comfortable viewing depictions of mistreatment and understood the importance of this content (Theme 3). Notably, while caregivers appreciated the convenience of participating in an asynchronous web-based intervention, several expressed a desire for more opportunities to speak with other caregivers (Theme 4). Technology challenges, such as a lack of clarity about automated intervention activities, deterred completion.

CONCLUSIONS

Findings from this study suggest an asynchronous web-based intervention covering sensitive topics such as mistreatment is acceptable for at least some AD/ADRD caregivers. Caregivers' comments that materials felt authentic may suggest that the integration of caregiver voices before intervention development enhanced the relevance of content. To make KINDER easier to deliver and participate in, the investigators plan to reduce the use of automation and integrate more group-based programming, as recommended by participants. Further, given the higher-than-expected dropout rate, in future studies, the investigators will collect data to determine the reasons for participants not completing study activities.

Anger and Dementia Caregiving: A Systematic Review of the Effects of Anger and Hostility on Caregivers' Physical Health

Background

Anger is commonly experienced by family caregivers of people living with dementia yet its effect on caregivers' physical health remains unknown.

Objective

The primary aim of this study was to systematically review current evidence on the effects of anger and hostility on caregivers' physical health.

Methods

We searched Medline, EMBASE, PubMed, and PsycINFO up to January 2022. Two review authors independently extracted data on study characteristics, study quality, and effect sizes of associations of anger and hostility with caregiver health outcomes.

Results

We found eight studies examining the effects of anger and hostility on caregivers' physical health reporting on a total of 937 participants, of which four were cross-sectional and four were longitudinal. Overall findings indicated that higher levels of anger and hostility exerted a negative effect on caregivers' physical health. Higher anger control was longitudinally associated with increased weight gain (β= 1.13, p < 0.001), whereas higher anger out predicted higher glucose dysregulation at long-term follow-up (r = 0.27, p < 0.05). Higher levels of caregiver hostility were associated with increased risk of chronic low-grade inflammation long-term (r = 0.18, p < 0.05), and increased risk of cognitive decline over time (r = -0.16, p < 0.05).

Conclusion

Our review provides the first systematic synthesis of the evidence demonstrating the harmful effects of anger and hostility on dementia caregivers' health and highlights the need for preventative interventions to support family caregivers experiencing high levels of anger.

Conceptualizing How Caregiving Relationships Connect to Quality of Family Caregiving within the Stress Process Model

Family caregivers provide the majority of care for older and disabled family members living with an illness or disability. Although most caregivers want to provide high-quality care, many report providing care that is potentially harmful. We apply the Stress Process Model to review the preponderance of literature implicating quality of the relationship between caregivers and care recipients as a factor contributing to quality of family caregiving. In drawing together literature on caregiving relationships and caregiving quality, this commentary identifies potentially modifiable intervention targets to develop programs to support high-quality caregiving to older adults living with a chronic illness or disability.

Caring for a loved one with Parkinson's disease: the role of coping styles and relationship quality

OBJECTIVE

Informal carers play an essential role in the care of individuals with Parkinson's disease (PD). This role, however, is often fraught with difficulties, including emotional, physical, and financial. Coping styles and relationship quality have been hypothesized to influence the impact of stressors. The aim of this study is to examine the relationship between carers' coping style, relationship quality, and carer burden.

DESIGN

Cross-sectional.

PARTICIPANTS

Thirty-nine PD patient carer dyads were included in the study.

MEASUREMENTS

Participants completed self-rated questionnaires including the Dyadic Adjustment Scale, Zarit Burden Interview, and Brief Coping Orientation to Problems Experienced Inventory.

RESULTS

Correlational analyses found significant and positive correlation between carer burden and all three coping styles (problem-focused, emotion-focused, and dysfunctional). There was also a moderate association between carers' perceived relationship quality and satisfaction and carer burden. Regression analyses found that carer's gender, severity of PD, relationship quality, emotion-focused, and dysfunctional coping styles did not predict carer burden. Conversely, problem-focused coping style predicted carer burden.

CONCLUSION

The results highlight that there is no perfect way to react and care for a loved one and serves as important information for practitioners who design and implement interventions.

Travesty of Life Elders Abuse an Inquiry of Physical and Psychological Abuse

Elder abuse is evil in human society. The present paper unveils this social issue from two major factors psychological and physical abuse. The study sensitizes the subject matter of study by examining the effects of demographic variables like gender and age on elders. For achieving the purpose of the study the research is a design by exploring and validating the factors of measuring elder abuse through the mix method approach, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). To test the established hypotheses of the effects of the demographic variable on elders the two-way ANOVA was applied. The present study verdicts the development of a sound measurement scale with two influence factors. The separate and composite effect of aging and gender type on elder abuse was evidenced. These findings are crucial especially when the prevalence of elder abuse is higher during COVID-19. The limited novel understudied variable opens an avenue for further research in behavioral and demographic variables like marital status. The present study has practical insinuation for caring the elders in any human society like physical and psychological treatment of elders to avoid abusive situations. In addition, the study attempts to validate the novel issues like psychological and physical abuse of elders in the dimensions of demographic variables. Some rare studies in the Indian continent established the motivation of conducting the research on this dimension.

The Role of Preparedness for Caregiving on the Relationship Between Caregiver Distress and Potentially Harmful Behaviors

This work extends research suggesting a link between indicators of distress among informal caregivers (CG) (e.g., depression and burden), and potentially harmful behaviors (PHB), including feeling like yelling or screaming at the care recipient (CR). We tested three hypotheses regarding the role of a novel predictor, CG preparedness for caregiving, which were: 1) a direct effect between CG preparedness and PHB, 2) CG distress mediates the relationship between the direct effect of CG preparedness on PHB, and finally, 3) CG preparedness is only related to PHB through their shared associations with indicators of caregiver distress, an indirect effects model. Examining two indicators of PHB and CG depression and CG burden, results supported the indirect effects model. Higher CG preparedness was associated with lower CG distress, which in turn was associated with lower risk of PHB. These findings highlight the importance of CG preparedness as a target for caregiver intervention research.

Care Recipient Controlling and Manipulative Behavior and Caregiver Depressive Symptoms: The Role of Race, Caregiver Resentment, and Mutual Communal Behavior

BACKGROUND AND OBJECTIVES

We explored whether relationship quality, as measured by mutual communal behavior, would serve as a buffer against caregiver resentment and, consequently, depressive symptoms when care recipients (CRs) engage in problem behavior (i.e., controlling and manipulative behavior [CMB]). Using the common core model of caregiver distress, we hypothesized that caregiver resentment would explain why caregivers were depressed when their CRs engage in CMB. We predicted that the indirect effect of CRCMB on depressive symptoms via resentment would depend on the strength of the communal bond between the caregiver and CR. Resentment was expected to play a significant role in explaining the association between CRCMB and depressive symptoms for caregivers in less communal relationships, but a small or nonexistent role for those in highly communal relationships. We also investigated whether these effects were different for Black and White caregivers.

RESEARCH DESIGN AND METHODS

Data were obtained from 187 Black and 247 White caregivers from the second Family Relationships in Late Life Project. Before testing our model, we confirmed the measurement equivalence/invariance of the four scales used in this study.

RESULTS

Resentment mediated the association between CRCMB and depressive symptoms. However, the indirect effect was larger among highly communal caregivers. Caregiver race did not moderate the moderated mediation.

DISCUSSION AND IMPLICATIONS

The communal bond between the caregiver and CR does not entirely protect the caregiver from depressive symptoms, particularly among highly communal caregivers. Interventions aimed at improving caregiver outcomes should acknowledge the unique vulnerabilities of caregivers in close relationships.

The Moderating Effects of Personal Resources on Caregiver Burden in Carers of Alzheimer's Patients

Caring for persons with Alzheimer's disease can be an extremely difficult experience. To date, there has been a lack of research into the role of intermediary variables in the relationship between caregiver personality and psychosocial functioning. The growing numbers of dementia patients worldwide mean that more people are involved in their care, making research into this area a pressing concern. Both a caregiver's personality and personal resources play a key role in their capacity to cope with stressful situations. In order to determine how personal resources moderate the relationship between personality and burden of care, a total of 100 caregivers of Alzheimer's patients (78 women and 22 men) were asked to complete a set of questionnaires to assess personality, personal resources (sense of coherence, generalized self-efficacy, and perceived social support), as well as their levels of stress, depression, and commitment to care. Structural equation modeling and latent growth analysis suggest that personal resources explain the mechanisms underlying burden of care and moderate its relationship with personality. Our findings indicate that personal resources are a critical predictor of burden of care. Therefore, caregivers must be provided with appropriate support, taking into account their resources and personality profiles.

Daily Context for Abusive and Neglectful Behavior in Family Caregiving for Dementia

BACKGROUND AND OBJECTIVES

The purpose of this study was to identify risk and protective factors for abusive and neglectful behavior in the context of daily caregiving.

RESEARCH DESIGN AND METHODS

Family caregivers who co-reside with a care recipient with Alzheimer's disease and related dementia, recruited from social media, completed 21-days of diaries. Multilevel modeling with days (n = 831) nested within caregivers (N = 50) was used to evaluate relationships between hypothesized risk and protective factors and the odds of an abusive or neglectful behavior on a given day.

RESULTS

Disruptions in the daily routine and stress of the caregiver related to behavioral symptoms of the care recipient are significant risk factors for abusive and neglectful behavior. Participating in a meaningful activity with the care recipient when it occurs twice in a day is a significant protective factor against use of a neglect behavior (OR = 0.19; CI 0.06-0.64; p = .01), but not for abusive behavior. Hypotheses that spending the full day together would increase risk, and that receipt of instrumental support and caregiver participation in self-care would decrease risk, were not supported.

DISCUSSION AND IMPLICATIONS

Findings demonstrate that risk of an abusive or neglectful behavior varies from day-to-day in the presence and absence of contextual factors, and that the majority of the variance in the odds an abusive or neglectful behavior occurring is related to day-level factors. Findings demonstrate that diary surveys are critical to identifying ecologically valid modifiable risk and protective factors for abusive and neglectful behaviors that can be targeted in future interventions.

Brief Psychological Intervention Through Mobile App and Conference Calls for the Prevention of Depression in Non-Professional Caregivers: A Pilot Study

Despite its potential, no intervention aimed at non-professional caregivers administered through a smartphone app has been proven to prevent depression. The objective of this pilot study was to evaluate the efficacy and feasibility of an indicated depression-prevention intervention for non-professional caregivers administered through an app with the addition of conference-call contact. The intervention was administered to 31 caregivers (Mean age = 54.0 years, 93.5% women). An independent evaluation determined the incidence of depression, depressive symptoms, risk of developing depression, and the variables in the theoretical model (positive environmental reinforcement, negative automatic thoughts) at the pre-intervention and post-intervention, as well as the one- and three-month follow-ups. The incidence of depression at 3 months of follow-up was 6.5%. There was a significant reduction in depressive symptoms (p < 0.001) and in the risk of developing depression (p < 0.001) at the post-intervention and at the one- and three-month follow-ups. The model’s variables improved significantly after the intervention and were associated with post-intervention depressive symptoms. The intervention was more effective in caregivers who had a lower level of depressive symptoms at the pre-intervention. Adherence and satisfaction with the intervention were high. The results encourage future research using a randomized controlled clinical trial.

Interdependence of physical and psychological morbidity among patients with cancer and family caregivers: Review of the literature

OBJECTIVE

Caregivers for patients with cancer have an integral role in maintaining patients' health. Although patients and caregivers experience the impact of cancer individually, studies suggest their health is interdependent. The objective of this review was to synthesize the literature on interdependent physical and psychological morbidity in patient-caregiver dyads published since 2016.

METHODS

A search of PubMed, CINAHL, Embase, and PsycInfo databases was performed using Cooper's recommendations and the Preferred Reporting Items for Systematic Reviews And Meta-Analyses Guidelines. Studies were included if they measured individual physical or psychological morbidity in cancer patient-caregiver dyads, evaluated interdependence, and were published in a peer-reviewed journal.

RESULTS

Twenty-three studies met criteria, characterized by mainly spousal dyads. Studies included a variety of cancers and methodologies. Findings were inconsistent, indicating varying interdependence. However, the studies demonstrated a stronger relationship between patients' and caregivers' psychological morbidity than between their physical morbidity.

CONCLUSIONS

This review revealed a need for continued exploration of dyadic health interdependence. Future studies should consider samples of patients with a single type of cancer, testing cultural mediators/moderators, and using longitudinal designs.

Measuring the outcomes of long-term care for unpaid carers: comparing the ASCOT-Carer, Carer Experience Scale and EQ-5D-3 L

Background

The ASCOT-Carer and Carer Experience Scale are instruments designed to capture aspects of quality of life ‘beyond health’ for family carers. The aim of this study was to compare and validate these two carer care-related measures, with a secondary aim to compare both instruments to the three-level EQ-5D (EQ-5D-3 L) measure of health-related quality of life.

Methods

An interview survey was conducted with 387 carers of adults who used long-term care (also known as social care) support in England. Construct validity by hypothesis testing was assessed using Pearson correlation coefficient. Exploratory factor analysis was also applied to investigate the dimensionality of the combined items from the ASCOT-Carer and CES (as measures of carer quality of life ‘beyond health’) and the EQ-5D (as a measure of health-related quality of life).

Results

In the construct validity analysis, hypothesised differences in correlations were observed with two exceptions. The exploratory factor analysis indicated that the ASCOT-Carer, CES and EQ-5D-3 L items loaded onto three separate factors. The first factor comprised the seven ASCOT-Carer items plus two CES items (activities outside caring, support from friends and family). The second factor comprised three of the six CES items (fulfilment from caring, control over caring and getting on with the person you care for). The third factor included four of the five EQ-5D-3 L items.

Conclusion

The findings indicate that the ASCOT-Carer, CES and EQ-5D-3 L capture separate constructs of social care-related quality of life (ASCOT-Carer) and carer experience (CES), which partially overlap in relation to activities outside caring and social support, and health-related quality of life (EQ-5D-3 L). The ASCOT-Carer and CES are both promising measures for the evaluation of social care support for carers that capture aspects of quality of life ‘beyond health’. The choice of whether to use the ASCOT-Carer or CES depends on the study objectives.

Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit

Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.

Do State and Trait Measures Measure States and Traits? The Case of Community-Dwelling Caregivers of Older Adults

Spielberger’s state and trait anxiety and anger scales are widely used and documented, but there is little or no direct evidence that they actually measure their respective state and trait aspects as was intended. We conducted latent state-trait analyses on data collected from 310 community-dwelling caregivers of older adult care recipients and found that (a) both state and trait scales reflected a mixture of state and trait aspects of their latent constructs, (b) state scales reflected more state-like variance than did corresponding trait scales, but (c) both state and trait scales were dominated by stable trait-like variance. Follow-up bivariate latent state-trait analyses indicated that correlations between trait components of anger and anxiety correlated more strongly with trait components of caregiver–care recipient mutually communal behavior and care recipient problem behavior than did state–state component correlations. Implications for the measurement of state and trait components of psychological constructs are discussed.

The impact of both spousal caregivers' and care recipients' health on relationship satisfaction in the Caregiver Health Effects Study

This study examined, with a sample of older adult, caregiving couples, whether each spouse's health was associated with their own and their partner's relationship satisfaction. Dyads (n = 233; age = 64-99 years) in the Caregiver Health Effects Study, ancillary to the Cardiovascular Health Study, reported relationship satisfaction, depressive symptoms, disability, and self-reported health. The cross-sectional Actor-Partner Interdependence Model showed that for both caregivers and care recipients, greater depressive symptoms and lower self-reported health related to lower relationship satisfaction (actor effects). Caregivers had lower relationship satisfaction when they were more disabled (actor effect) and when care recipients were more depressed (partner effect).

The impact of support provided by close others in the emergency department on threat perceptions

Objective: Having close others present in the emergency department (ED) can cause patients significant distress. The present study tested the hypothesis that close others provide more negative support than non-close others as a potential explanation for this effect.Design: Participants were 493 patients evaluated for an acute coronary syndrome (ACS) in the ED (M_Age = 62.01, SD_Age = 13.55; 49.49% male) and who arrived with close others (i.e. spouse/partner, child) or non-close others (e.g. neighbour). Patients self-reported support from companions and threat perceptions (in-ED and at recall approximately three days later).Main outcome measures: Positive support (comfort, responsiveness); negative support (made patients anxious, required comforting); threat perceptions (feeling helpless, vulnerable).Results: Close (vs non-close) others provided patients with marginally more positive support, but also required more comfort, B = 0.32, p = .050, and caused patients more anxiety, B = 0.24, p = .009. Anxiety was associated with patients' Threat Perceptions: in-ED, B = 0.11, p = .002; recall, B = 0.14, p < .001; as was provision of comfort to support partners: recall, B = .06, p = .005.Conclusion: Negative support may be one mechanism underlying the association between close others and patient distress in the ED.

Women Coping With a Partner's Dementia-Related Violence: A Qualitative Study

PURPOSE

The aim of the present study was to differentiate between the lived experience of two groups of women caregiving for a partner with dementia. One group was coping with lifelong intimate partner violence (IPV) and dementia-related violence (Group 1); the other group was coping with dementia-related violence only (Group 2).

DESIGN

An interpretive phenomenological analysis perspective was used. Data collection was performed through in-depth, semistructured interviews with eight female spouses of men with dementia from each of the two above-mentioned groups, followed by a content analysis.

FINDINGS

Comparing the narratives of the aging women revealed their different experiences over several dimensions: (a) the identification of violence as a symptom of dementia; (b) the use of past couplehood memories; (c) feelings over time; (d) willingness to care for the partner with dementia; and (e) a prospective view of life.

CONCLUSIONS

The complexities of being old and having to cope with caregiving responsibilities for a spouse with dementia, accompanied by violent behaviors, emphasize the significance of the couple's past relationship. This notion should be taken into account in practical interventions.

CLINICAL RELEVANCE

As part of the aging process, there is an increase in people who are engaged in dementia-related violence. Nurses' education and practice should focus on the dynamics of dyads coping with violence and identify the particular needs of the caregiver spouse in this context.

Relationship Consensus and Caregiver Burden in Adults with Cognitive Impairments 6 Months Following Stroke

BACKGROUND

Caregiver burden is commonly experienced in caregivers of adults with cognitive impairment after stroke. This burden can be associated with caregiver-centered factors, including caregiver-perceived relationship quality.

OBJECTIVE

To examine the role of caregiver-perceived relationship quality on caregiver burden at 6 months following stroke.

DESIGN

Prospective observational study.

SETTING

Community settings.

PARTICIPANTS

Adults enrolled in two randomized controlled trials after stroke (n = 60) and their caregivers (n = 60).

METHODS

Three constructs of relationship quality (relationship consensus, cohesion, and satisfaction) were examined as predictors of caregiver burden (the Abbreviated Dyadic Adjustment Scale). A hierarchical logistic regression and a Poisson regression with robust standard errors were used to examine the effect of relationship quality on caregiver burden while controlling for characteristics of stroke survivors and caregivers.

MAIN OUTCOME MEASUREMENTS

Caregiver burden was measured with the abridged version of the Zarit Burden Interview.

RESULTS

Poor relationship consensus (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.06-2.07; P = .02) increased the odds of high caregiver burden after controlling for characteristics of stroke survivors (age, comorbidity, cognitive fluency) and caregivers (gender, self-reported health). Relationship cohesion (OR  = 1.03; 95% CI = .84-1.25; P = .81) and relationship satisfaction (OR  = 1.53; 95% CI = .75-3.10; P = .24) did not predict caregiver burden.

CONCLUSION

Meaningful and agreeable goals and expectations between dyads are essential to reduce caregiver burden after stroke. Collaborative goal-setting between stroke survivors and their caregivers may be a promising intervention strategy to increase relationship consensus and reduce caregiver burden.

LEVEL OF EVIDENCE

III.

Exemplary Care among Chinese Dementia Familial Caregivers

OBJECTIVE

This study investigates the feasibility of using the Exemplary Care Scale (ECS) among Chinese dementia familial caregivers, and reports its psychometric properties.

METHOD

Back translation was used to develop the Chinese version of ECS (C-ECS). Three hundred and ninety-seven dyads of caregivers and their relatives with dementia responded to an assessment battery which included questions on care recipients' cognition, behavioral and psychological symptoms, daily activities assistance, social support, and caregiver well-being.

RESULTS

Results of an exploratory principal component analysis revealed two subscales in the 11-item C-ECS: considerate caregiving and preserving esteem. C-ECS and its subscales demonstrated sufficient reliability, as well as criteria-related validity through its association with care recipient's cognition and health, and caregivers' well-being and social support.

DISCUSSION

Our findings provide preliminary support to C-ECS as a reliable and valid measure of exemplary caregiving among Hong Kong Chinese familial dementia caregivers. In the light of the increasing importance of familial care in dementia care planning, we recommend the use of this brief scale in regular caregiver assessment in research and service delivery.

Predictors of potentially harmful behaviour by family caregivers towards patients treated for behavioural and psychological symptoms of dementia in Japan

BACKGROUND

Potentially harmful behaviour (PHB) by caregivers is detrimental to the physical and psychological well-being of care recipients. In Japan, few studies have investigated caregivers' PHB towards dementia patients. This study examined PHB in family caregivers of dementia patients with behavioural and psychological symptoms of dementia (BPSD) and identified factors related to PHB.

METHODS

Following primary consultations at an elderly psychiatric patient department, we enrolled 133 pairs of dementia patients and their family caregivers. We assessed PHB using the Japanese version of the modified Conflict Tactics Scale. We defined the presence of PHB as two or more points (PHB frequency of 'sometimes' or more) on at least one indicator of the modified Conflict Tactics Scale. We investigated the prevalence of PHB in relation to the clinical characteristics of the patients and their family caregivers. We evaluated BPSD using the Neuropsychiatric Inventory and caregiver burden using the eight-item Japanese version of the Zarit Caregiver Burden Interview.

RESULTS

Of the family caregivers, 48.9% showed PHB. Multivariate analysis identified the following association with PHB: caregiver's Zarit Caregiver Burden Interview total score (odds ratio [OR], 1.09 per unit increase; 95% confidence interval [95%CI], 1.02-1.16), and Neuropsychiatric Inventory scores for patient irritability (OR, 1.22 per unit increase; 95%CI, 1.06-1.40), appetite/eating disorders (OR, 1.41 per unit increase; 95%CI = 1.08-1.84) and daughters-in-law caregivers (OR, 0.17, 95%CI, 0.05-0.57).

CONCLUSIONS

Specific BPSD symptoms could contribute to the expression of PHB. In addition to decreasing caregiver burden, more intensive treatment and care strategies are required to manage individual symptoms.

"Opening Our Time Capsule"-Creating an Individualized Music and Other Memory Cues Database to Promote Communication Between Spouses and People With Dementia During Visits to a Nursing Home

Background: Family members play a critical role in caring for people with dementia, and their involvement in care continues even after their loved ones are placed in long-term care facilities. The dynamics of family involvement following institutionalization are complex and challenging. The strain on caregivers does not cease and communication difficulties are a major barrier due to deteriorating language abilities as a result of dementia. Also, caregivers' involvement has implications on the quality of life of both the older adult and his family members. Objective: To help alleviate caregivers' burden during visiting hours, by promoting communication opportunities. The program included the creation of an individualized database using personal music and photos that present life episodes. Methods: A qualitative research was used to explore spouses' experience during visits and the process of creating and using the individualized database. Participants included three women who regularly visited their partners who had dementia and resided in a nursing home. The first phase included creating an individualized database for each couple. In the second phase, four meetings were conducted, each woman with her partner, utilizing the database on a tablet. A case study research design was used and various types of data were collected and analyzed. The data included interview reports (pre-post intervention), preparation meetings reports, spouses' recorded reactions at the end of each of the four visits, and the music therapist's written log during the program. Results: All documented data revealed the difficulties, mostly the communication barrier, encountered by the three women during their visits to the nursing home. All reported that using the individualized database helped them to find ways to communicate with their partners, relive shared past experiences, and alleviate the stress and feelings of disconnection during visits. Conclusions: Forming a bridge between past and present via individualized music and photos databases can be helpful in bridging the gap between people with dementia in nursing homes and their family members.

Cognitive behavioral intervention via a smartphone app for non-professional caregivers with depressive symptoms: study protocol for a randomized controlled trial

Background

Although major depression is a frequent disorder in non-professional caregivers and there are effective psychological interventions to prevent it, caregivers have difficulty accessing them. Interventions for depression applied through an app could improve accessibility; yet, to date, adherence to such interventions has been low. The objectives of this study are to (1) evaluate the efficacy of a cognitive behavioral depression prevention intervention administered through a smartphone app with and without telephone conference calls, (2) analyze the mediators of the change in the incidence of depression and depressive symptoms, and (3) assess adherence and satisfaction with the interventions.

Methods

A randomized controlled clinical trial will be conducted. Caregivers with elevated symptoms will be randomly assigned to a cognitive behavioral intervention administered by a smartphone app (CBIA) group, a CBIA plus telephone conference calls (TCCs) group (CBIA + TCC), or an attention control group. Each condition will consist of approximately 58 participants. Both interventions will be administered in five modules through a smartphone app and the CBIA + TCC group will receive additional TCCs in group format (four sessions of 30 min each). Trained blind assessors will conduct pre-treatment, post-treatment and follow-up assessments at 1, 3, 6, and 12 months.

Discussion

This study will provide evidence of the efficacy of a cognitive behavioral intervention to prevent depression in caregivers with elevated depressive symptoms administered through a smartphone app and the impact of feedback applied through conference calls to increase program adherence and efficacy. If the results were favorable, it would mean that we have developed a more effective, accessible, and clinically useful preventive depression intervention than the currently available ones for many present and future caregivers.

Trial registration

ClinicalTrials.gov: NCT03110991. Registered 5 April 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2793-2) contains supplementary material, which is available to authorized users.

Quality of Life in Patients With Pancreatic Cancer and Their Caregivers: A Systematic Review

Little is known about quality of life (QOL) of patients with pancreatic cancer and their caregivers compared with adults with other cancers. This systematic review summarizes the available evidence base, identifies its limitations, and recommends directions for research and clinical application. A systematic review was conducted of research on QOL in adults with pancreatic cancer and their caregivers. Quality of life was examined in the following specific domains: psychological, physical, social, sexual, spiritual, and general. Of the 7130 articles reviewed, 36 studies met criteria for inclusion. Compared with healthy adults or population norms, adults with pancreatic cancer had worse QOL across all domains. Compared with patients with other cancer types, patients with pancreatic cancer evidenced worse psychological QOL. Physical and social QOL were either similar or more compromised than in patients with other cancers. Limited data preclude conclusions about sexual, spiritual, and caregiver QOL. Patients with pancreatic cancer evidence decrements in multiple QOL domains, with particular strain on psychological well-being. Methodological limitations of available studies restrict definitive conclusions. Future research with well-defined samples, appropriate statistical analyses, and longitudinal designs is needed. Findings from this review support the merits of distress screening, integration of mental health professionals into medical teams, and attention to caregiver burden.

Abuse of Older Persons With Dementia: A Review of the Literature

In view of the rapidly aging population, increasing attention has been paid to studying persons with dementia. Factors associated with its onset, prognosis, and treatment as well as ways to support caregivers in the community have been extensively studied. Despite the fact that older persons with dementia are at higher risk of abuse compared to their cognitively unimpaired counterparts in institutions and the community, however, relatively little attention has been paid to understanding such abuse. This review summarizes the available literature on abuse of older persons with dementia. It compares methodologies used across studies and highlights the implications of using different informants, sampling strategies, and abuse subtypes in studying abuse of persons with dementia and discussed the relevant cultural considerations for research. The results of this review provide important information for researchers, policy makers, and practitioners.

The Impact of Dementia on Relationships, Intimacy, and Sexuality in Later Life Couples: An Integrative Qualitative Analysis of Existing Literature

OBJECTIVES

The onset and progression of dementia can have a profound effect on the couple dyad. The aim of this systematic review was to analyze the literature investigating the impact of dementia on the relationships, intimacy, and sexuality in older couples.

METHODS

A systematic literature search was conducted in May 2016 for relevant research articles. Five databases were searched: Web of Science, PsycINFO, MedLine, Scopus and CINAHL. The reference lists of articles included in the review were screened along with the reference list of other relevant reviews.

RESULTS

Thirteen studies were identified that investigated relationships, intimacy, and sexuality from the perspective of the partner, the person with dementia or from the perspective of the couple jointly. The analysis revealed several themes including changes in responsibilities and roles, identity and self-esteem, affection, commitment, reciprocity, and sexual activity and satisfaction.

CONCLUSION

The results strongly suggest dementia has a significant impact on the couple relationship. There is a dearth of research involving the perspective of the person with dementia or the couple jointly. Future research should investigate the impact of dementia on relationships, intimacy, and sexuality from the perspective of partners, the person with dementia, and the couple jointly to ensure the development of appropriate information and services that meet the needs of both people in the couple relationship.

CLINICAL IMPLICATIONS

Clinicians should work closely with couples to develop tailored information and supports to assist couples in managing the multiple changes that occur in their relationship, intimacy, and sexuality due to dementia.

Burnout After Patient Death: Challenges for Direct Care Workers

CONTEXT

Direct care workers in long-term care can develop close relationships with their patients and subsequently experience significant grief after patient death. Consequences of this experience for employment outcomes have received little attention.

OBJECTIVES

To investigate staff, institutional, patient, and grief factors as predictors of burnout dimensions among direct care workers who had experienced recent patient death; determine which specific aspects of these factors are of particular importance; and establish grief as an independent predictor of burnout dimensions.

METHODS

Participants were 140 certified nursing assistants and 80 homecare workers who recently experienced patient death. Data collection involved comprehensive semistructured in-person interviews. Standardized assessments and structured questions addressed staff, patient, and institutional characteristics, grief symptoms and grief avoidance, as well as burnout dimensions (depersonalization, emotional exhaustion, and personal accomplishment).

RESULTS

Hierarchical regressions revealed that grief factors accounted for unique variance in depersonalization, over and above staff, patient, and institutional factors. Supervisor support and caregiving benefits were consistently associated with higher levels on burnout dimensions. In contrast, coworker support was associated with a higher likelihood of depersonalization and emotional exhaustion.

CONCLUSION

Findings suggest that grief over patient death plays an overlooked role in direct care worker burnout. High supervisor support and caregiving benefits may have protective effects with respect to burnout, whereas high coworker support may constitute a reflection of burnout.

Burden, emotional distress and quality of life among informal caregivers of lung cancer patients: An exploratory study

This study was conducted to explore the interrelationships among caregiver burden, emotional status and quality of life (QoL) in caregivers of lung cancer patients, and to identify whether caregiver burden and health status are associated with patient emotional status and QoL. Forty-three dyads of lung cancer patients and their caregivers were included for analysis. Caregiver-reported outcomes were measured by Caregiver Burden Scale (CBS), Caregivers Quality of Life Index-Cancer (CQOLC) and Hospital Anxiety and Depression Scale (HADS), while patient-reported outcomes were collected by HADS and Lung Cancer Symptom Scale (LCSS). The majority of the CBS and CQOLC scores were significantly higher in anxious and depressed caregivers than non-anxious and non-depressed caregivers (p < .01 or .05). Caregivers of depressed patients experienced significantly greater emotional distress than those of non-depressed patients (p < .01). Significantly positive associations were identified among most of the CBS, CQOLC and caregiver HADS scores. Patient LCSS scores were positively correlated with the CBS and caregiver HADS scores, and patient HADS scores were also positively related to caregiver HADS scores. The close interrelationships between caregiver and patient health outcomes provide evidence that lung cancer patients and their caregivers should be viewed as a unit in future supportive service models.

The prevalence of potentially abusive behaviours in family caregiving: findings from a national survey of family carers of older people

BACKGROUND

family caregiving can be both rewarding and fulfilling; however, conflicts can occur in the caregiving relationship, and some family carers may engage in behaviours that could be potentially harmful to the older person for whom them provide care.

OBJECTIVE

to determine the prevalence of potentially abusive behaviours towards older people by family carers.

DESIGN

a postal cross-sectional survey of a nationally representative sample of family carers of community-dwelling older people.

SUBJECTS

a randomly selected sample of family carers in receipt of a social welfare payment for the care they provide to a relative aged 65 and older.

METHODS

a self-completion questionnaire was posted to 4,000 family carers of older people across Ireland, and a total of 2,311 eligible completed questionnaires were returned, yielding a response rate of 58%.

RESULTS

more than a third of family carers (36.8%) reported that they engaged in potentially harmful behaviours towards their older family member in the 3 months prior to the survey. Of those potentially harmful behaviours, a third (35.9%) reported that they engaged in potentially harmful psychological behaviours and 8% reported engaging in potentially harmful physical behaviours.

CONCLUSIONS

potentially abusive carer behaviours need to be detected at an early stage so that preventive interventions can be introduced to avert caregiving situations deteriorating into serious cases of elder abuse.

Impact of Behavioral Symptoms in Dementia Patients on Depression in Daughter and Daughter-in-Law Caregivers

BACKGROUND

One caregiver relationship that has been neglected in caregiver depression research is the daughter-in-law. Compared with Western countries, in which those who are closer in familial relationships such as the spouse or child usually take care of the patient, in many Asian countries, the daughter-in-law often assumes the caretaker role. However, not much research has been done on how this relationship may result in different caregiver outcomes. We sought to identify whether the association between patient characteristics and caregiver depressive symptoms differs according to the familial relationship between caregiver and patient.

MATERIALS AND METHODS

Ninety-five daughter (n = 47) and daughter-in-law (n = 48) caregivers of dementia patients were asked to report their own depressive symptoms and patient behavioral symptoms. Patients' cognitive abilities, daily activities, and global dementia ratings were obtained. Hierarchical linear regression was employed to determine predictors of depressive symptoms.

RESULTS

Daughters-in-law had marginally higher depressive scores. After adjusting for caregiver and patient characteristics, in both groups, greater dependency in activities of daily living and more severe and frequent behavioral symptoms predicted higher caregiver depressive scores. However, greater severity and frequency of behavioral symptoms predicted depression to a greater degree in daughters compared with daughters-in-law.

CONCLUSIONS

Although behavioral symptoms predicted depression in both caregiver groups, the association was much stronger for daughters. This suggests that the emotional relationship between the daughter and patient exacerbates the negative effect of behavioral symptoms on caregiver depression. The familial relationship between the caregiver and dementia patient should be considered in managing caregiver stress.

Diverse Family Structures and the Care of Older Persons

Demographic and social trends lead to a variety of micro-level and internal structural contexts that influence caregiving in families with older members. The results of macro-level changes have received little focused attention in the aging literature, where much of the caregiving research has addressed issues within the context of traditional family structure. Yet the conventional nuclear family model is increasingly uncommon as new, pluralistic models of family life are emerging in contemporary society. The majority of elder care is provided by relatives, albeit with varying patterns of involvement and responsibility across family structures. Both conventional and pluralistic families face challenges in meeting the care needs of their oldest members, leaving some older adults at risk of having unmet needs. Additional research on family risk and resilience related to the care of older relatives is warranted, particularly with respect to pluralistic models of family life.

Providing care to relatives with mental illness: reactions and distress among primary informal caregivers

BACKGROUND

The responsibility of caring for relatives with mental illness often falls on the family members. It has been reported that the reactions to or consequences of providing care are what rendered the role of a caregiver challenging and hence a source of distress. This present study thus aimed to identify socio-demographic correlates of caregiving experiences using the Caregiver Reaction Assessment (CRA) and to examine the associations between reactions to caregiving and psychological distress.

METHODS

A total of 350 caregivers with relatives seeking outpatient care at a tertiary psychiatric hospital were recruited for this study. Distress among caregivers was assessed using the Patient Health Questionnaire (PHQ-9). The CRA was administered to measure reactions from caregiving in four domains including impact on schedule and health (ISH), impact on finance (IF), lack of family support (LFS) and caregiver esteem (CE). Participants also completed a questionnaire that asked for their socio-demographic information. Multivariable linear regression analysis was first used with domains of CRA as outcome variables and socio-demographic variables as predictors in the models. The next set of multivariable linear regression analysis tested for the association between CRA domains and distress with CRA domain scores as outcome variables and PHQ-9 score as predictor, controlling for socio-demographic variables.

RESULTS

Socio-demographic correlates of CRA domains identified were age, education, employment, income and ethnicity. Domain scores of CRA were significantly associated with PHQ-9 score even after controlling for socio-demographic variables. A higher distress score was associated with greater impact felt in the domain of ISH (β = 0.080, P < 0.001), IF (β = 0.064, P < 0.001), and LFS (β = 0.057, P < 0.001), and was associated with lower CE domain scores (β = -0.021, P < 0.05).

CONCLUSION

This study identified several socio-demographic correlates of caregiving reaction in the different domains. Each of these domains was found to be significantly associated with caregiver distress. Higher distress was associated with stronger impact on the negative domains and a lower impact in the positive domain of caregiving reaction. Interventions such as educational programs at the caregiver level, and also promoting wider social care support in these domains may help to address caregiver distress.

The caregiver burden in male romantic partners of women with non-metastatic breast cancer: The protective role of couple satisfaction

We examined the evolution of the subjective burden of romantic partners caring for women with non-metastatic breast cancer and investigated the moderating role of couple satisfaction on caring stress. Forty-seven partners filled out questionnaires 3 and 12 months after surgery. Using a stress process model, we examined caring stressors and moderating factors (couple satisfaction, coping and social support) as predictors of subjective burden. Results showed that subjective burden decreases over time and that the couple satisfaction largely explains it above and beyond other influential variables. Partners dissatisfied with their couple relationship are especially vulnerable to the stress of caregiving.

Quality of in-home care, long-term care placement, and the survival of persons with dementia

PURPOSE OF THE STUDY

Caregivers of persons with dementia living at home adopt a variety of caregiving styles that vary in quality. Three styles of high-quality care and poor-quality care have been identified. The outcomes, however, of varying styles of caregiving are unknown. Our purpose was to investigate the linkage of quality of care to long-term care placement and survival.

DESIGN AND METHODS

We used a sample of 148 primary caregivers of a relative living at home and needing assistance due to memory or thinking problems. We used items from four existing scales and five new items to construct measures of high-quality and poor-quality care. Long-term care and survival were determined from two follow-ups. Cox proportional hazards regression was used to estimate the relationship of quality of care to long-term care placement and survival.

RESULTS

Poor quality of care increased the risk of long-term care placement, as expected, but high-quality care was not related to placement. Surprisingly, high-quality care increased the risk of death while poor-quality care decreased the risk. Secondary results were: wishful/intrapsychic coping (a dysfunctional type of emotion-focused coping) and long-term care placement shortened the survival; and caregiver personality traits of neuroticism and agreeableness lengthened the survival.

IMPLICATIONS

It is premature to recommend caregiver interventions based on our unexpected findings. Further studies are vital and should include care-recipient impairments and the quality of life of the person with dementia as additional outcomes.

Structural equation model linking dementia cognitive functioning, caregiver mental health, burden, and quality of informal care in Argentina

The purpose of this study was to create a path model linking cognitive functioning in individuals with dementia, caregiver burden and mental health, and quality of care provided for the individual with dementia in Argentina. One hundred and two dementia caregivers from San Lucas, Argentina completed questionnaires assessing these constructs. Regressions found that caregiver burden, depression, anxiety, and satisfaction with life explained 18.8% of the variance in quality of care-respect and 14.7% of the variance in quality of care-provide. A structural equation model with generally adequate fit indices uncovered that cognitive functioning in individuals with dementia was inversely associated with caregiver burden, caregiver burden was inversely associated with mental health, and mental health was positively associated with quality of care. Further, patient cognitive functioning yielded a significant indirect effect on caregiver mental health through caregiver burden, as did burden on quality of care through mental health. Despite this negative cascade, these relationships may also be reversed with the development and use of dementia caregiver interventions that improve caregiver burden and mental health and as a result, the quality of care for individuals with dementia in Latin America.

Association Between Depressive Symptoms, Multiple Dimensions of Depression, and Elder Abuse: A Cross-Sectional, Population-Based Analysis of Older Adults in Urban Chicago

OBJECTIVE

Depression is conceptualized as both a risk factor for and a consequence of elder abuse; however, current research is equivocal. This study examined associations between elder abuse and dimensions of depressive symptoms in older adults.

METHOD

Participants were 10,419 older adults enrolled in theChicago Health and Aging Project (CHAP), a population-based study of older adults. Regression was used to determine the relationships between depressive symptoms, depression dimensions, and abuse variables.

RESULTS

Depressive symptoms were consistently associated with elder abuse. Participants in the highest tertile of depressive symptoms were twice as likely to have confirmed abuse with a perpetrator (odds ratio = 2.07, 95% confidence interval = [1.21, 3.52], p = .008). Elder abuse subtypes and depression dimensions were differentially associated.

DISCUSSION

These findings highlight the importance of routine depression screening in older adults as a component of abuse prevention and intervention. They also provide profiles of depressive symptoms that may more accurately characterize risk for specific types of abuse.

The association of relationship quality and social networks with depression, anxiety, and suicidal ideation among older married adults: Findings from a cross-sectional analysis of the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

Important associations have been found between social relationships and various mental health outcomes. However, limited data exists for these associations among older adults especially in terms of relationship quality in partnerships. This study aimed to examine the associations of positive and negative partner interactions and social networks with depression, anxiety and suicidal ideation.

METHODS

Nationally-representative, cross-sectional data of the Irish Longitudinal Study on Ageing (TILDA) was analyzed. The analytical sample consisted of 4988 community dwelling adults aged >50 years in spouse/partner relationships. Information on sociodemographics and social relationships were assessed using standard questions. Validated scales for depression and anxiety, and a single-item question for suicidal ideation were used to assess mental health outcomes. Multivariable logistic regression was used to assess the association between social relationships and depression, anxiety, and suicidal ideation.

RESULTS

After adjusting for confounders, negative partner interactions were significantly associated with increased likelihood of depression, anxiety, and suicidal ideation, while positive partner interactions were significantly and inversely related to anxiety and suicidal ideation. Higher levels of social integration were significantly associated with lower odds for depression.

LIMITATIONS

Given the cross-sectional nature of the research, no firm conclusions can be made in terms of directions of causality.

CONCLUSION

By assessing the available social network of older adults, as well as the areas in their social relationships that need to be addressed, it may be possible for practitioners and policy makers to maximize the benefits of network integration and minimize the potentially harmful aspects of social relationships, thereby improving overall mental health and emotional well-being.

Spousal caregiving and financial strain among middle-aged and older adults

We examine whether spousal caregivers face difficulties in meeting their basic household expenses compared to nonspousal caregivers and whether social support mechanisms ameliorate any financial strain from caregiving responsibilities. We use data for caregivers aged 45 and over drawn from a nationally representative, cross-sectional Canadian Community Health Survey--Healthy Aging (N = 5,067). Spousal caregiving is associated with a 35% increase in the likelihood of experiencing difficulties in meeting basic expenses compared to other types of caregiving. Each of social support mechanisms (affectionate, emotional/informational, and positive social interaction), singularly and combined, lessens financial strain from caregiving. Our findings suggest that spousal caregivers are particularly vulnerable because they have fewer resources to draw on for support and perform much more intensive care. Our results highlight the importance of developing appropriate policies and programs to support caregivers.

Long-term efficacy of indicated prevention of depression in non-professional caregivers: randomized controlled trial

BACKGROUND

Although depression is a common problem among non-professional caregivers, only one trial has evaluated the efficacy of indicated prevention targeting this population and the long-term efficacy is unknown. The aim of this study was to evaluate the long-term efficacy of a brief intervention for the indicated prevention of depression in a sample of female caregivers.

METHOD

A randomized controlled trial was conducted involving 173 participants (mean age 53.9 years) who were allocated to the intervention (n = 89) or the usual-care control group (n = 84). Blinded interviewers conducted assessments at 1, 3, 6 and 12 months of follow-up. The main outcome measure was the incidence of major depression and the secondary outcomes were compliance with treatment, depressive symptoms, emotional distress and caregiver burden.

RESULTS

At the 12-month follow-up, a lower incidence of depression as evaluated using the Structured Clinical Interview for Axis I Disorders of the DSM-IV was found in the intervention group compared with the control group (10.1% v. 25.0%). The relative risk was 0.40 and statistically significant [χ2 = 6.68, degrees of freedom = 1, p = 0.010, 95% confidence interval (CI) 0.20-0.81], and the number needed to treat was 7 (95% CI 4-27). There was a significant delay in the onset of depression in the intervention group (p = 0.008). The good complier caregivers had a lower incidence of depression. The intervention effect on depressive symptoms, emotional distress and caregiver burden were maintained for 12 months.

CONCLUSIONS

This is the first study to demonstrate that a brief problem-solving intervention can prevent the onset of depression among non-professional caregivers over the longer term.

Exploration of Individual and Family Factors Related to Community Reintegration in Veterans With Traumatic Brain Injury

BACKGROUND

Community reintegration (CR) poses a major problem for military veterans who have experienced a traumatic brain injury (TBI). Factors contributing to CR after TBI are poorly understood.

OBJECTIVE

To address the gap in knowledge, an ecological framework was used to explore individual and family factors related to CR.

DESIGN

Baseline data from an intervention study with 83 veterans with primarily mild to moderate TBI were analyzed. Instruments measured CR, depressive symptoms, physical health, quality of the relationship with the family member, and sociodemographics. Posttraumatic stress disorder and TBI characteristics were determined through record review.

RESULTS

Five variables that exhibited significant bivariate relationships with CR (veteran rating of quality of relationship, physical functioning, bodily pain, posttraumatic stress disorder diagnosis, and depressive symptoms) were entered into hierarchical regression analysis. In the final analysis, the five variables together accounted for 35% of the variance, but only depression was a significant predictor of CR, with more depressed veterans exhibiting lower CR.

CONCLUSIONS

Efforts to support CR of Veterans with TBI should carefully assess and target depression, a modifiable factor.

Prevalence of major depressive episodes in non-professional caregivers

Despite research demonstrating the psychological burden associated with caregiving, there is limited information regarding the real rates of clinical depression among non-professional caregivers (NCs) of dependent patients. The goals of the current study are (a) to report the prevalence of major depressive episodes (MDEs) and the frequency of depressive symptoms in NCs from Galicia (Spain) and (b) to examine the relationship between MDEs and characteristics of caregivers, care recipients, and the care situation. A sample of 504 NCs providing care to persons with all kinds of disorders that result in dependency was randomly selected, and the occurrence of MDEs was assessed by trained interviewers who applied the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV). Overall, 8.9% of NCs met the criteria for a current MDE. Sleep problems, diminished ability to think or concentrate, and depressed mood were the clinical depressive symptoms most frequently reported. MDEs were significantly more common among NCs older than 55 years old (odds ratio [OR]=1.96; 95% confidence interval [CI]: 1.02-3.75) and those who were unemployed (OR=3.43; 95% CI 1.02-11.48). The findings highlight the magnitude of major depression in this population.

Grief after patient death: direct care staff in nursing homes and homecare

CONTEXT

Patient death is common in long-term care (LTC). Yet, little attention has been paid to how direct care staff members, who provide the bulk of daily LTC, experience patient death and to what extent they are prepared for this experience.

OBJECTIVES

To 1) determine how grief symptoms typically reported by bereaved family caregivers are experienced among direct care staff, 2) explore how prepared the staff members were for the death of their patients, and 3) identify characteristics associated with their grief.

METHODS

This was a cross-sectional study of direct care staff experiencing recent patient death. Participants were 140 certified nursing assistants and 80 homecare workers. Standardized assessments and structured questions addressed staff (e.g., preparedness for death), institutional (e.g., support availability), and patient/relational factors (e.g., relationship quality). Data analyses included bivariate group comparisons and hierarchical regression.

RESULTS

Grief reactions of staff reflected many of the core grief symptoms reported by bereaved family caregivers in a large-scale caregiving study. Feelings of being "not at all prepared" for the death and struggling with "acceptance of death" were prevalent among the staff. Grief was more intense when staff-patient relationships were closer, care was provided for longer, and staff felt emotionally unprepared for the death.

CONCLUSION

Grief symptoms like those experienced by family caregivers are common among direct care workers after patient death. Increasing preparedness for this experience via better training and support is likely to improve the occupational experience of direct care workers and ultimately allow them to provide better palliative care in nursing homes and homecare.