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Associations Between Dysfunctional Thoughts, Leisure Activities, and IL-6 in Caregivers of Family Members With Dementia. Psychosom Med 2023; 85:175-181. [PMID: 36516289 DOI: 10.1097/psy.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Dementia caregiving is associated with negative physical health consequences, including inflammation processes. The objective of this study was to analyze the associations between dysfunctional thoughts, frequency of leisure activities, and interleukin 6 (IL-6) in a sample of dementia family caregivers. METHODS One hundred forty dementia caregivers participated in this cross-sectional study. The relationships among caregivers' dysfunctional thoughts, leisure activities, and IL-6 were adjusted for demographic characteristics, stressors, and physical and mental health indicators in a linear regression analysis. RESULTS Higher levels of dysfunctional thoughts ( t = -2.02, p = .045) were significantly associated with lower frequency of leisure activities. In turn, lower frequency of leisure activities was significantly associated with higher levels of IL-6 ( t = -2.03, p = .045). Dysfunctional thoughts were no longer significantly associated with IL-6 levels when both dysfunctional thoughts and leisure activities were included in the same model ( t = 1.78, p = .076). A significant indirect effect was found for the association between higher levels of dysfunctional thoughts and higher levels of IL-6 (standardized indirect effect = 0.036, bootstrap standard error = 0.026, 95% confidence interval = 0.0001-0.1000) through its association with fewer leisure activities. CONCLUSIONS Our findings suggest that the direct effect of caregivers' dysfunctional thoughts on IL-6 may be mediated by the impact on caregivers' frequency of leisure activities. Results suggest that training caregivers in reducing dysfunctional thoughts to thereby increase leisure activities may be useful in reducing inflammation.
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Klinedinst TC, Beach S, Donovan H, Rodakowski J, Campbell G. The Relationship between Personal and Contextual Factors and Participation Restriction in Mid-Life Caregivers. J Aging Health 2023:8982643221150051. [PMID: 36617465 DOI: 10.1177/08982643221150051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Mid-life family caregivers (CGs) are at risk for participation restriction, which can worsen quality of care for care recipients (CR) and increase CG burden and poor health. We aimed to identify factors associated with participation restriction in mid-life CGs. METHODS This was a cross-sectional study of CGs aged 40-64 years (n = 1100) from the 2015 cohort of the National Study of Caregiving (NSOC)/National Health and Aging Trends Study (NHATS). Multivariate logistic regression was used to evaluate personal and caregiving attributes associated with restricted participation. RESULTS Individual items from the negative and Positive aspects of caregiving (PAC) scales were associated with participation restriction. Mid-life caregivers with "frequent changes to caregiving routine" and "no time for self" were more likely to report restricted participation and those feeling "closer to the CR" were less likely to report restricted participation. DISCUSSION Interventions to optimize caregiving routines and improve dyadic relationships could decrease participation restriction in mid-life CGs.
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Affiliation(s)
- Tara C Klinedinst
- Department of Rehabilitation Sciences, 6186University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Internal Medicine, 605473OU-TU School of Community Medicine, Tulsa, OK, USA
| | - Scott Beach
- Department of Psychology, 6614University of Pittsburgh, Pittsburgh, PA, USA.,National Rehabilitation Research and Training Center on Family Support, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Heidi Donovan
- National Rehabilitation Research and Training Center on Family Support, 6614University of Pittsburgh, Pittsburgh, PA, USA.,School of Nursing, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Juleen Rodakowski
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Grace Campbell
- National Rehabilitation Research and Training Center on Family Support, 6614University of Pittsburgh, Pittsburgh, PA, USA.,School of Nursing, 6613Duquesne University, Pittsburgh, PA, USA
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Epstein R, Bock SD, Drew MJ, Scandalis Z. Infantilization across the life span: A large-scale internet study suggests that emotional abuse is especially damaging. MOTIVATION AND EMOTION 2022. [DOI: 10.1007/s11031-022-09989-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractWhen competent adults are treated like children, negative outcomes sometimes follow. We used a concurrent study design to conduct an internet-based study to determine how infantilization varies by demographic category and which types of infantilization might be most harmful. The test, which measured 15 types of infantilization, was taken by 32,118 people (mean age 27.6) from 153 countries (most from the United States). Test scores were correlated with self-reported happiness, depression, anger, sense of control, and personal and professional success, and regression analyses consistently showed that of the 15 types of infantilization we measured, emotional abuse was by far the best predictor of adverse outcomes. Infantilization was highest during the teen years and decreased gradually throughout adulthood. Effects were found for gender, education, and sexual orientation, with vulnerable groups more subject to infantilization. Our data, collected between 2011 and 2020, appear to parallel recent increases in authoritarianism and intolerance, with total infantilization scores increasing by 30.1% over this period.
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Kor PPK, Li ML, Kwok DKS, Leung AYM, Lai DLL, Liu JYW. Evaluating the effectiveness of a 6-week hybrid mindfulness-based intervention in reducing the stress among caregivers of patients with dementia during COVID-19 pandemic: protocol of a randomized controlled trial. BMC Psychol 2022; 10:178. [PMID: 35854347 PMCID: PMC9295093 DOI: 10.1186/s40359-022-00876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background Mindfulness-based intervention (MBI), an emotion-focused approach, has been shown promising and sustainable effects on enhancing the well-being of caregivers of patients with dementia (PWD). However, the conventional MBI was quite demanding, had high rates of attrition and inconsistent long-term effect. The social distancing measures introduced during the COVID-19 pandemic also restricted face-to-face psychosocial intervention. The study aims to evaluate the effectiveness of a 6-week hybrid MBI in caregivers of PWD over a 6-month follow up. Methods This is a single-blinded, parallel-group randomized controlled trial (RCT). Eligible participants from three local nongovernmental organizations (NGOs) will be randomly divided into intervention groups and control groups in a ratio of 1:1. The participants in the intervention group will receive 6 weekly 90-min group-based sessions delivered through a face-to-face and online approach. The participants in the control group will receive brief education on dementia care with the same group size, duration, and frequency as the sessions in the intervention group. Immediately after the intervention and at the 6-month follow-up, caring stress and other outcomes will be assessed. Besides, a focus group interview will be conducted to identify the strengths, limitations, and therapeutic components of the intervention from their perspectives. For quantitative data, intention-to-treat analysis and Generalized Estimating Equations (GEE) will be used. For qualitative data, content analysis will be used. Discussion This proposed hybrid model of MBI has several advantages, such as lower duration, longer follow-up period and easier access by family caregivers. Also, physiological indicators (e.g., heart rate viability and neuropsychiatric symptoms) will be measured in this study to show the body change after MBI. The quantitative and qualitative data of this research can also benefit the development of online or hybrid MBI for caregivers of PWD during the COVID-19 pandemic. Despite these strengths, it does have practical challenges and limitations. However, this proposed intervention has the potential to benefit not only the participants, but also the researcher as well as public health providers. Trial registration: NCT05242614. Registered on 2022-02-16, https://clinicaltrials.gov/ct2/show/NCT05242614
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Affiliation(s)
| | - Meng Li Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Denis Ka Shaw Kwok
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Angela Yee Man Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.,WHO Collaborating Centre for Community Health Services, The Hong Kong Polytechnic University, Hong Kong, China
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5
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Velloze IG, Jester DJ, Jeste DV, Mausbach BT. Interventions to reduce loneliness in caregivers: An integrative review of the literature. Psychiatry Res 2022; 311:114508. [PMID: 35334424 DOI: 10.1016/j.psychres.2022.114508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/07/2023]
Abstract
Older adults are at an increased risk of loneliness. Many also serve as informal caregivers for persons with dementia and other disabling conditions, further predisposing them to loneliness. The primary objective was to assess current loneliness interventions for caregivers to inform development of effective therapies to improve their quality of life. An integrative review of the literature was conducted using five electronic databases and 12 studies were included for further analysis. Data were extracted regarding the type of intervention implemented, caregiver characteristics, and intervention effects. Five main intervention types emerged: mindful meditation, computer applications, music therapy, peer support, and community programs. Most care recipients had dementia, and most caregivers were spouses. Peer support was the most frequently utilized intervention, and common intervention strategies included providing emotional support, expanding one's social network, and supplying psychoeducational materials. Most interventions had methodological limitations and demonstrated small effect sizes. Hence, there remains a continued need for well-designed interventions that target loneliness in informal caregiver. Caregivers may benefit from interventions that expand their social network to improve their emotional regulation and understanding of their role. Further research on the role of group versus individual therapy is necessary to strengthen interventions and broaden their application.
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Affiliation(s)
- Isabelle G Velloze
- Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Dylan J Jester
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, United States of America
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, United States of America; Department of Neurosciences, University of California San Diego, La Jolla, California, United States of America
| | - Brent T Mausbach
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America.
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Xu XY, Leung D, Leung AYM, Kwan RYC, Liang TN, Chai AJ. "Am I entitled to take a break in caregiving?": Perceptions of leisure activities of family caregivers of loved ones with dementia in China. DEMENTIA 2022; 21:1682-1698. [PMID: 35481765 DOI: 10.1177/14713012221093879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Leisure activities are essential for family caregivers of loved ones with dementia living in the community, yet these caregivers tend not to engage in them, especially in China, wherein it may have a negative impact on their physical and psychological health. To date, limited knowledge exists regarding underlying reasons that deter these family caregivers from doing leisure activities. This study aims to explore perceptions of family caregivers of people living with dementia and their engagement in leisure activities. A qualitative descriptive research design was used with semi-structured, face-to-face, individual in-depth interviews. The data were collected in Shijiazhuang, China between October and November 2019. Content analysis was used to develop categories. Results of 20 family caregivers (5 men and 15 women, mean age = 55.6±12.7) reported their perceptions under four main categories: (i) "the condition of leisure life," (ii) "needs for leisure activities," (iii) "reasons for the reluctance to do leisure activities," and (iv) "motivations supporting the implementation of leisure activities." In addition to the heavy caregiving workload and lack of support, traditional Chinese beliefs including filial commitment and "fatalistic voluntarism" were the reasons that prevented Chinese family caregivers of people living with dementia from doing leisure activities. However, engaging their loved ones in leisure activities, like doing exercise together, could motivate family caregivers themselves to participate in leisure activities. These findings encourage healthcare professionals to consider the influence of culture on family caregivers' engagement in leisure activities which is one of the ways to reduce stress. Family caregivers may benefit from the leisure activities by learning how to better cope with and balance caregiving tasks with their leisure pursuits in the community.
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Affiliation(s)
- Xin Yi Xu
- Postdoctoral Research Station in Basic Medicine, Hebei Medical University, China, Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Doris Leung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Angela Yee Man Leung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | | | - Ting Na Liang
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Ai Jun Chai
- Good Clinical Practice Centre, The First Hospital of Shijiazhuang, China
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Associations between pleasant events, activity restriction, stressors, and blood pressure in caregivers of persons with dementia. Int Psychogeriatr 2022; 34:275-285. [PMID: 34134797 DOI: 10.1017/s1041610221000715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Caring for a relative with dementia is associated with adverse consequences for cardiovascular health. Cognitive and behavioral factors, such as high perceived activity restriction and low frequency of pleasant events have been found to be associated with higher levels of blood pressure, but the role these variables play in the stress and coping process remains understudied. The objective of this study is to analyze the associations between behavioral and psychological symptoms of dementia, activity restriction, frequency of pleasant events, and mean arterial pressure. DESIGN Face-to-face interviews and cross-sectional analyses. SETTING Social services, healthcare centers, and adult day services of Comunidad de Madrid, Spain. PARTICIPANTS One hundred and two family caregivers of a spouse or parent with dementia. MEASUREMENTS Apart from various sociodemographic and health-related variables, behavioral and psychological symptoms of dementia, activity restriction, and frequency of leisure activities were assessed. In addition, measurement of blood pressure levels was conducted through an electronic sphygmomanometer. RESULTS The obtained model suggests that there is a significant indirect association between behavioral and psychological symptoms of dementia and mean arterial pressure through activity restriction and frequency of pleasant events. CONCLUSIONS The findings of this study provide preliminary support for a potential indirect effect between behavioral and psychological symptoms of dementia and blood pressure, through the effects of behavioral and psychological symptoms of dementia on the caregivers' levels of activity restriction and frequency of pleasant activities. Our manuscript provides additional support for the pleasant events and activity restriction model (Mausbach et al., 2011; Chattillion et al., 2013), by highlighting the importance of considering caregiving stressors as a source of caregivers' activity restriction in the theoretical framework of the model.
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The prevalence of physical activity among informal carers: a systematic review of international literature. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Leung DKY, Wong KKY, Spector A, Wong GHY. Exploring dementia family carers' self-initiated strategies in managing behavioural and psychological symptoms in dementia: a qualitative study. BMJ Open 2021; 11:e048761. [PMID: 34433600 PMCID: PMC8388289 DOI: 10.1136/bmjopen-2021-048761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Carer's self-initiated management strategies of behavioural and psychological symptoms of dementia (BPSD) can inform intervention development. These strategies are affected by cultural values. Little is known about non-Western dementia carers' BPSD management strategies. This study aimed to explore self-initiated strategies in managing BPSD adopted by Chinese carers. DESIGN Qualitative study using thematic framework method. SETTING Community setting in Hong Kong. PARTICIPANTS 16 dementia carers with purposive sampling to include carers of different relationships to the people living with dementia (PLwD), education level and living arrangement. RESULTS Six overarching themes emerged from the data: (1) maintaining personhood in PLwD, (2) responding positively to BPSD, (3) explanation and bargaining, (4) responding negatively to BPSD, (5) controlling upsetting thoughts, and (6) getting respite care. Chinese carers treasured warm and supportive family relationships. They identified and minimised triggers to alleviate BPSD. Some carers struggled with care tasks and reacted with confrontation and avoidance. Changing attitudes and getting social and emotional support were described to manage carers' distress. Few self-care strategies including getting respite care were reported. CONCLUSIONS Carers' self-initiated strategies largely aligned with existing theoretical frameworks in BPSD management, such as person-centred approach, and echoed Asian culture, which advocates filial piety and supportive family relationships. While these cultural values encourage the engagement of people living with dementia in the normal process of family life, they may also prevent carers from taking time away from care. Interventions could support carers by enhancing their knowledge and skills in managing BPSD, providing social and emotional support, and providing guidance in self-care. Future cross-cultural research could explore factors contributing to how carers manage BPSD and how interventions could be culturally adapted to facilitate carers to apply learnt skills in daily practice and hence benefit the people living with dementia and carer population.
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Affiliation(s)
- Dara K Y Leung
- Social Work and Social Administration, Hong Kong University, Hong Kong
| | - Kayla K Y Wong
- Social Work and Social Administration, Hong Kong University, Hong Kong
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Gloria H Y Wong
- Social Work and Social Administration, Hong Kong University, Hong Kong
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10
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Lee K, Yefimova M, Puga F, Pickering CE. Gender Differences in Caregiver Burden Among Family Caregivers of Persons With Dementia. J Gerontol Nurs 2021; 47:33-42. [PMID: 34191655 DOI: 10.3928/00989134-20210610-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The current study aimed to identify gender-dependent factors that influence caregiver burden among family caregivers of persons with dementia through secondary data analysis. We used a nationally representative survey of 379 family caregivers of persons with dementia completed in 2014. We examined factors affecting the burden experience of male and female caregivers, guided by the stress process model, using hierarchical regression. The analytic sample included 159 males (42%) and 220 females (58%). For males, age of care recipient, being an adult child, social support, instrumental activities of daily living performed, and caregiving impact on caregivers' health influenced burden. For females, co-residence, social support, caregivers' current health, and caregiving impact on caregivers' health impacted burden. Understanding gender differences related to caregiving burden is beneficial for developing effective targeted interventions that support the caregiving role and improve the quality of life of caregivers. [Journal of Gerontological Nursing, 47(7), 33-42.].
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11
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Cardiovascular Disease Incidence and Risk in Family Caregivers of Adults With Chronic Conditions: A Systematic Review. J Cardiovasc Nurs 2021; 37:E47-E60. [PMID: 33938535 DOI: 10.1097/jcn.0000000000000816] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Family caregivers experience psychological distress or physical strain that may lead to an increased risk of cardiovascular disease (CVD) morbidity and mortality. OBJECTIVE This systematic review aimed to describe the current evidence and gaps in the literature on measures used to assess CVD outcomes in family caregivers, the association of caregiving with CVD incidence/risk outcomes, and associated factors in family caregivers of patients with chronic disease. METHODS Medline, PubMed, CINAHL, Web of Science, and Google Scholar were searched for English-language, peer-reviewed studies published from 2008 to 2020 that examined CVD incidence and risk among family caregivers of adults with chronic conditions. RESULTS Forty-one studies were included in this review. The measures used to assess CVD risk were categorized into biochemical, subclinical markers, components of metabolic syndrome, and global risk scores. Compared with noncaregivers, caregivers were more likely to have higher CVD incidence rates and objectively measured risk. Cardiovascular disease risks were also increased by their caregiving experience, including hours/duration of caregiving, caregivers' poor sleep status, psychological symptoms, poor engagement in physical/leisure activities, and care recipient's disease severity. CONCLUSIONS Although there were limited longitudinal studies in caregivers of patients with diverse health conditions, we found evidence that caregivers are at high risk of CVD. Further research for various caregiver groups using robust methods of measuring CVD risk is needed. Caregiver factors should be considered in developing interventions aimed at reducing CVD risk for caregivers.
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12
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Polenick CA, Struble LM, Stanislawski B, Turnwald M, Broderick B, Gitlin LN, Kales HC. "I've learned to just go with the flow": Family caregivers' strategies for managing behavioral and psychological symptoms of dementia. DEMENTIA 2020; 19:590-605. [PMID: 29886777 PMCID: PMC6522324 DOI: 10.1177/1471301218780768] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background/Objectives: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent, stressful, and challenging to manage. Caregivers’ approaches for handling these behaviors have implications for both care partners’ well-being. Yet the specific strategies that caregivers use in their daily management of BPSD are relatively unknown. This study used in-depth focus group data to examine family caregivers’ strategies for managing BPSD. Design: As part of a larger study (NINR R01NR014200), four focus groups were conducted with a total of 26 family caregivers of older adults with dementia. Caregivers were asked to describe the strategies they use to manage BPSD. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major categories. Results: Caregivers managed BPSD through: 1) modifying interactions within the care dyad (e.g., simplifying communication); 2) modifying the care environment (e.g., using written prompts); 3) activity engagement; 4) humor; 5) self-care; and 6) social support. Conclusion: Family caregivers manage BPSD using strategies to minimize stress and address the needs of both care partners. Caregivers’ own accounts of these approaches reveal a window into their everyday management of difficult behaviors. The present findings generate key information for routine clinical care and targeted interventions to promote caregiver well-being.
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Affiliation(s)
| | | | - Barbara Stanislawski
- Department of Psychiatry, University of Michigan, USA; Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), USA
| | | | | | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, USA; School of Nursing, Johns Hopkins University, USA
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, USA; Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), USA; Geriatric Research, Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, USA
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13
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Xu XY, Kwan RYC, Leung AYM. Behavioural activation for family dementia caregivers: A systematic review and meta-analysis. Geriatr Nurs 2020; 41:544-552. [PMID: 32143964 DOI: 10.1016/j.gerinurse.2020.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 11/17/2022]
Abstract
The current study aims to investigate the effectiveness of behavioral activation (BA) for family dementia caregivers. A systematic literature search was conducted through PubMed, Medline, CINAHL, Cochrane, Embase and PsycINFO for studies published from March 1988 to September 2019. Standardized mean differences (SMDs) were combined to synthesize pooled effect measures using random effects. The review was based on ten randomized controlled trials. Depression was significantly reduced after participants received BA (n = 9; 786 participants; SMD = -0.69; 95% CI: -1.12 to -0.25; p = 0.002). BA also has a positive impact on other areas of psychological health (e.g., self-efficacy, anxiety, and distress) and physical health (e.g., interleukin-6) in family dementia caregivers. In conclusion, BA not only has a moderate effect on reducing depression but also has the potential to improve other areas of psychological and cardiovascular health in family caregivers. However, more interventional studies of BA for family dementia caregivers are needed.
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Affiliation(s)
- Xin Yi Xu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Rick Yiu Cho Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Angela Yee Man Leung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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14
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Polenick CA, DePasquale N. Predictors of Secondary Role Strains Among Spousal Caregivers of Older Adults With Functional Disability. THE GERONTOLOGIST 2020; 59:486-498. [PMID: 29325105 DOI: 10.1093/geront/gnx204] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Aging spouses commonly care for a partner with functional disability, but little is known about how spousal caregiving may impact different life domains. This study evaluated how caregiving characteristics are associated with secondary role strains among spousal caregivers. RESEARCH DESIGN AND METHODS This cross-sectional study examined 367 spousal caregivers and their partners from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Hierarchical regressions were estimated to determine how caregiver background factors (sociodemographics, health conditions) along with primary objective (care activities, care recipient health conditions, and dementia status) and subjective (emotional caregiving difficulties, role overload) stressors are linked to care-related valued activity restriction, negative caregiving relationship quality, and care-related family disagreements. Gender differences were considered. RESULTS After accounting for all predictors, older caregivers and caregivers providing more help with activities of daily living and health system interactions (e.g., scheduling appointments) were more likely to report activity restriction, whereas caregivers with more emotional difficulties reported higher negative caregiving relationship quality. Role overload was positively associated with all three secondary strains. For husbands only, caring for a partner with more chronic conditions was linked to higher negative caregiving relationship quality and caring for a partner with dementia was associated with a greater likelihood of family disagreements. DISCUSSION AND IMPLICATIONS Secondary role strains may develop through similar and unique pathways for caregiving wives and husbands. Further research is needed to identify those who could benefit from support in managing their care responsibilities alongside other life areas.
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Affiliation(s)
| | - Nicole DePasquale
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
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15
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Xu XY, Kwan RYC, Leung AYM. Factors associated with the risk of cardiovascular disease in family caregivers of people with dementia: a systematic review. J Int Med Res 2020; 48:300060519845472. [PMID: 31115265 PMCID: PMC7140198 DOI: 10.1177/0300060519845472] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/01/2019] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to systematically review studies that reported factors associated with the risk of cardiovascular disease (CVD) in family caregivers of people with dementia (PWD). Methods Literature was searched in PubMed, Medline, CINAHL, and PsycINFO using keywords generated from the terms “dementia”, “caregiver”, and “cardiovascular disease”. We included studies that examined factors associated with CVD risk in family caregivers of PWD, those with longitudinal or cross-sectional study designs, and those published in English. Results A total of 34 studies were included in this review. Stress and depressive symptoms, pleasant leisure activity, coping self-efficacy and coping strategy, physical activity, and social support were the main modifiable associated factors of CVD risk in family caregivers of PWD. However, the association between sleep and CVD risk was unclear. Caregiving status, the duration of caregiving, genes, and race, were the main non-modifiable associated factors of CVD risk in family caregivers. Conclusion This review showed seven modifiable factors of CVD risk. In particular, leisure activities, physical activity, and social support were significantly negatively associated with the risk of CVD. Researchers and clinical professionals are recommended to consider these risk factors when they develop interventions to reduce CVD risk in family caregivers of PWD.
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Affiliation(s)
- Xin Yi Xu
- School of Nursing, Faculty of Health and Social Sciences, The
Hong Kong Polytechnic University, Hong Kong, China
- Centre for Gerontological Nursing, School of Nursing, Faculty of
Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong,
China
| | - Rick Yiu Cho Kwan
- School of Nursing, Faculty of Health and Social Sciences, The
Hong Kong Polytechnic University, Hong Kong, China
- Centre for Gerontological Nursing, School of Nursing, Faculty of
Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong,
China
| | - Angela Yee Man Leung
- School of Nursing, Faculty of Health and Social Sciences, The
Hong Kong Polytechnic University, Hong Kong, China
- Centre for Gerontological Nursing, School of Nursing, Faculty of
Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong,
China
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Kajiwara K, Mantani A, Noto H, Miyashita M. The relationship between caregiver burden and caregiver pulse rate measured by using a wristwatch-type pulsimeter with accelerometer in home-based family caregivers for persons with dementia: Pilot study. Psychogeriatrics 2019; 19:83-84. [PMID: 30152601 DOI: 10.1111/psyg.12364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kohei Kajiwara
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Hiroko Noto
- Department of Health Sciences, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Mika Miyashita
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Cross AJ, Garip G, Sheffield D. The psychosocial impact of caregiving in dementia and quality of life: a systematic review and meta-synthesis of qualitative research. Psychol Health 2018; 33:1321-1342. [PMID: 30260239 DOI: 10.1080/08870446.2018.1496250] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE A systematic meta-synthesis of qualitative studies was conducted to interpret and synthesise findings from studies investigating the experiences, quality of life, and psychosocial impact of caregiving on adult informal caregivers of people with dementia. DESIGN The meta-synthesis was conducted according to the principles of meta-ethnography. RESULTS Fourteen studies describing the experiences of 265 informal caregivers were reviewed. The meta-synthesis elicited the following themes: (1) understanding and making sense of the dementia diagnosis, changing symptoms, and the caregiver role; (2) coping strategies, psychological facilitators and rewards of caregiver role; (3) challenges of caring for a person with dementia and their behaviour; (4) caregivers' relationships with care-recipient and other informal caregivers; and (5) caregivers' experiences of formal support services and material resources. CONCLUSION Our findings highlight the need for a person-centred approach to care planning that also accounts for the needs of the informal caregiver to promote better caregiver well-being and quality of life. Caregivers' emotional support, coping, resilience, need for information and respite care and adjustment to caregiver identity should be reviewed as part of the care package for the person with dementia.
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Affiliation(s)
- Ainslea J Cross
- a University of Derby Online Learning , University of Derby , Derby , UK
| | - Gulcan Garip
- a University of Derby Online Learning , University of Derby , Derby , UK
| | - David Sheffield
- a University of Derby Online Learning , University of Derby , Derby , UK
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Márquez-González M, Cabrera I, Losada A, Knight BG. Attentional avoidant biases as mediators in the association between experiential avoidance and blood pressure in dementia family caregivers. Aging Ment Health 2018; 22:669-677. [PMID: 28282722 DOI: 10.1080/13607863.2017.1293003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Experiential avoidance in caregiving (EAC) has been found to be related with dementia family caregivers´ distress and blood pressure (BP). The association between EAC and avoidant attentional biases to emotional stimuli in dementia caregivers, and the potential mediating role of these attentional biases in the association between EAC and increased BP are explored. METHOD Seventy nine dementia family caregivers performed a dot-probe task with emotional pictures (distressing and positive) varying in content (general vs. caregiving-related (CR)) and time of exposure (100 vs. 500 ms). They also completed measures of EAC, anxiety, depression, alexithymia and rumination, and their BP was measured. RESULTS EAC was associated with avoidant attentional biases to CR emotional pictures and negative pictures in general at 100 ms. Experiential Avoidance in Caregiving Questionnaire (EACQ) 'avoidant behaviors' and EACQ 'intolerance of negativity' factors were associated with diastolic and systolic BP, respectively, with attentional avoidance of CR emotional pictures (distressing and positive, respectively) mediating this association. CONCLUSION Attentional avoidance of CR emotional stimuli may be the link between EAC and increased BP, as it prevents emotional processing and facilitates the maintenance of physiological activation. EAC may pose a risk for cardiovascular disease in dementia caregivers.
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Affiliation(s)
- María Márquez-González
- a Department of Biological and Health Psychology , Universidad Autónoma de Madrid , Madrid , Spain
| | - Isabel Cabrera
- a Department of Biological and Health Psychology , Universidad Autónoma de Madrid , Madrid , Spain
| | - Andrés Losada
- b Department of Psychology , Universidad Rey Juan Carlos , Madrid , Spain
| | - Bob G Knight
- c School of Psychology and Counselling, University of Southern Queensland , Toowoomba , Australia
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Abstract
OBJECTIVE Elevated blood pressure is a significant public health concern, particularly given its association with cardiovascular disease risk, including stroke. Caring for a loved one with Alzheimer disease has been associated with physical health morbidity, including higher blood pressure. Engagement in adaptive coping strategies may help prevent blood pressure elevation in this population. This 5-year longitudinal study examined whether greater participation in pleasant leisure activities was associated with reduced blood pressure in caregivers. METHODS Participants were 126 in-home spousal Alzheimer's caregivers (M [SD] age = 74.2 [7.9] years) that completed five yearly assessments. Linear mixed-effects models analysis was used to examine the longitudinal relationship between pleasant leisure activities and caregivers' blood pressure, after adjusting for demographic and health characteristics. RESULTS Greater engagement in pleasant leisure activities was associated with reduced mean arterial blood pressure (B = -0.08, SE = 0.04, p = .040). Follow-up analyses indicated that engagement in activities was significantly associated with reduced diastolic (B = -0.07, SE = 0.03, p = .030) but not systolic blood pressure (B = -0.10, SE = 0.06, p = .114). In addition, mean arterial blood pressure was significantly reduced when caregiving duties ended because of placement of care recipients in nursing homes (B = -3.10, SE = 1.11, p = .005) or death of the care recipient (B = -2.64, SE = 1.14, p = .021). CONCLUSIONS Greater engagement in pleasant leisure activities was associated with lowered caregivers' blood pressure over time. Participation in pleasant leisure activities may have cardiovascular health benefits for Alzheimer's caregivers.
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Allen AP, Curran EA, Duggan Á, Cryan JF, Chorcoráin AN, Dinan TG, Molloy DW, Kearney PM, Clarke G. A systematic review of the psychobiological burden of informal caregiving for patients with dementia: Focus on cognitive and biological markers of chronic stress. Neurosci Biobehav Rev 2016; 73:123-164. [PMID: 27986469 DOI: 10.1016/j.neubiorev.2016.12.006] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/28/2016] [Accepted: 12/09/2016] [Indexed: 12/18/2022]
Abstract
As the physiological impact of chronic stress is difficult to study in humans, naturalistic stressors are invaluable sources of information in this area. This review systematically evaluates the research literature examining biomarkers of chronic stress, including neurocognition, in informal dementia caregivers. We identified 151 papers for inclusion in the final review, including papers examining differences between caregivers and controls as well as interventions aimed at counteracting the biological burden of chronic caregiving stress. Results indicate that cortisol was increased in caregivers in a majority of studies examining this biomarker. There was mixed evidence for differences in epinephrine, norepinephrine and other cardiovascular markers. There was a high level of heterogeneity in immune system measures. Caregivers performed more poorly on attention and executive functioning tests. There was mixed evidence for memory performance. Interventions to reduce stress improved cognition but had mixed effects on cortisol. Risk of bias was generally low to moderate. Given the rising need for family caregivers worldwide, the implications of these findings can no longer be neglected.
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Affiliation(s)
- Andrew P Allen
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Eileen A Curran
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Áine Duggan
- School of Medicine, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland
| | - Aoife Ní Chorcoráin
- Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| | - D William Molloy
- Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland
| | - Patricia M Kearney
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Gerard Clarke
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland.
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21
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Caregiver burden and fatigue in caregivers of people with dementia: Measuring human herpesvirus (HHV)-6 and -7 DNA levels in saliva. Arch Gerontol Geriatr 2016; 66:42-8. [DOI: 10.1016/j.archger.2016.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/22/2022]
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Lewis LF. Caregiving for a loved one with dementia at the end of life: an emergent theory of rediscovering. Am J Alzheimers Dis Other Demen 2015; 30:488-96. [PMID: 25425737 PMCID: PMC10852728 DOI: 10.1177/1533317514559829] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Millions face the challenges of caregiving for a loved one with dementia. A classic Glaserian grounded theory methodology was used to discover the problem that caregivers of individuals with dementia face at the end of life and how they attempt to resolve that problem. Data were collected from a theoretical sample of 101 participants through in-person interviews, online interviews, book and blog memoirs of caregivers, and participant observation. Constant comparative method revealed a basic social psychological problem of role entrapment. Caregivers attempt to resolve this problem through a 5-stage basic social psychological process of rediscovering including missing the past, sacrificing self, yearning for escape, reclaiming identity, and finding joy. Health care professionals can support caregivers through this journey by validating, preparing caregivers for future stages, and encouraging natural coping strategies identified in this process. This study provides a substantive theory that may serve as a framework for future studies.
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Affiliation(s)
- Laura Foran Lewis
- College of Nursing and Health Sciences, University of Vermont, Burlington, VT 05405, USA
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Abstract
OBJECTIVES Caring for a spouse with dementia is a source of chronic stress and is associated with a heightened prevalence of self-reported sleep problems. Styles and strategies for coping with stress have been associated with objective measures of sleep in non-caregiver populations. The current study evaluated relationships between caregiver coping style and sleep disturbance using in-home polysomnography. METHODS Sixty spousal caregivers (mean [standard deviation] age = 73.31 [7.05] years; 81.7% female) completed the Brief Cope, the Hamilton Rating Scale for Depression, and three nights of in-home polysomnography. Participants were categorized into two groups based on the presence or absence of clinically significant low sleep efficiency (<80%). A factor analysis of the Brief Cope yielded higher-order factors that included approach coping and avoidant coping (explained variance, 27.2% and 16.9%, respectively). Coping factors were entered into a binary logistic regression predicting sleep efficiency group while controlling for sleep apnea, medication use, and depression, as measured by the Hamilton Rating Scale for Depression. RESULTS In fully adjusted models, for each unit increase on the avoidant coping factor, participants were 3.4 times more likely to be classified in the low sleep efficiency group (B = 1.224, χ2(1) = 4.967, p = .026, exp(B) = 3.401, 95% confidence interval = 1.159-9.981). Approach coping was unrelated to sleep efficiency in both adjusted and unadjusted models. CONCLUSIONS These findings highlight the importance of coping among caregivers and indicate that avoidant coping may be a modifiable predictor of sleep disturbance in conditions of chronic stress.
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Mausbach BT, Chattillion EA, Ho J, Flynn LM, Tiznado D, von Känel R, Patterson TL, Grant I. Why does placement of persons with Alzheimer's disease into long-term care improve caregivers' well-being? Examination of psychological mediators. Psychol Aging 2014; 29:776-86. [PMID: 25133414 DOI: 10.1037/a0037626] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Caregiving for individuals with Alzheimer's disease is associated with chronic stress and elevated symptoms of depression. Placement of the care receiver (CR) into a long-term care setting may be associated with improved caregiver well-being; however, the psychological mechanisms underlying this relationship are unclear. This study evaluated whether decreases in activity restriction and increases in personal mastery mediated placement-related reductions in caregiver depressive symptoms. In a 5-year longitudinal study of 126 spousal Alzheimer's disease caregivers, we used multilevel models to evaluate placement-related changes in depressive symptoms (short form of the Center for Epidemiologic Studies Depression scale), activity restriction (Activity Restriction Scale), and personal mastery (Pearlin Mastery Scale) in 44 caregivers who placed their spouses into long-term care relative to caregivers who never placed their CRs. The Monte Carlo method for assessing mediation was used to evaluate the significance of the indirect effect of activity restriction and personal mastery on postplacement changes in depressive symptoms. Placement of the CR was associated with significant reductions in depressive symptoms and activity restriction and was also associated with increased personal mastery. Lower activity restriction and higher personal mastery were associated with reduced depressive symptoms. Furthermore, both variables significantly mediated the effect of placement on depressive symptoms. Placement-related reductions in activity restriction and increases in personal mastery are important psychological factors that help explain postplacement reductions in depressive symptoms. The implications for clinical care provided to caregivers are discussed.
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Affiliation(s)
| | - Elizabeth A Chattillion
- Joint Doctoral Program in Clinical Psychology, San Diego State University/ University of California-San Diego
| | - Jennifer Ho
- Joint Doctoral Program in Clinical Psychology, San Diego State University/ University of California-San Diego
| | - Laura M Flynn
- Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii at Manoa
| | | | - Roland von Känel
- Department of General Internal Medicine, Inselspital, Bern University Hospital
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Ho JS, Bordon J, Wang V, Ceglowski J, Kim DH, Chattillion EA, Patterson TL, Grant I, Ziegler MG, Mills PJ, Mausbach BT. Reduced activity restriction buffers the relations between chronic stress and sympathetic nervous system activation. J Gerontol B Psychol Sci Soc Sci 2013; 69:408-16. [PMID: 23685924 DOI: 10.1093/geronb/gbt028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Caregivers of dementia patients are at risk for developing cardiovascular disease (CVD), and this risk increases the longer they provide care. Greater perceptions that caregiving restricts social/recreational activities (i.e., activity restriction [AR]) has been associated with poorer health, and AR may exacerbate the relations between stress and health outcomes. The current study examined the interactive role of greater exposure to stress and increased AR on plasma catecholamine (CAT) levels: norepinephrine (NE) and epinephrine (EPI). METHOD A total of 84 dementia caregivers completed a standard assessment battery, and a nurse collected blood, which was assayed for NE and EPI. Separate regressions for NE and EPI were used to determine whether the relations between years caregiving and CATs were greater in those with high versus low AR. RESULTS A significant interaction was found between years caregiving and AR in predicting resting EPI (p = .032) but not resting NE (p = .103). Post hoc analyses indicated that years caregiving was significantly associated with EPI when AR was high (p = .008) but not when AR was low (p = .799). Additionally, years caregiving was not significantly associated with NE when AR was high or low. DISCUSSION The subjective experience of AR can play an important role in determining risk for detrimental physical health outcomes, particularly CVD risk.
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Affiliation(s)
- Jennifer S Ho
- Correspondence should be addressed to Brent T. Mausbach, Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0993. E-mail:
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