What are the factors that facilitate or hinder resilience in older spousal dementia carers? A qualitative study

Factors affecting support: experiences of Iranian older spousal caregivers of people with Alzheimer's disease and their support resources

OBJECTIVES

Older spouses are a significant part of family caregivers of patients with Alzheimer's disease (AD) and need support. Evidence suggests that different factors influence the support of older spousal caregivers. However, there is little evidence about these factors in developing countries like Iran. This study aimed to identify the factors affecting the support of Iranian older spousal caregivers of people with AD.

METHOD

This qualitative study used Graneheim and Lundman's conventional content analysis approach. Through purposive sampling, 10 caregivers, three family members, and three professionals were recruited from various cognitive clinics and centers. In-depth and semi-structured interviews were used to collect data and continued until conceptual saturation was achieved.

RESULTS

Two themes were derived from the data as factors affecting support, which included (1) caregiver's support-seeking (complexity of the patient's condition, caregiver's geriatric health, the burden of caring for a spouse with AD, marital bond quality, caregiver's support-phobic beliefs, caregiver's awareness of care) and (2) capacities of support resources (supportive family, supportiveness of society, formal systems' capability to provide support services).

CONCLUSION

The present study provided practical information about the factors influencing the support of older spousal caregivers. Healthcare providers and policymakers can use these concepts to improve the support process by strengthening caregivers' support-seeking motivation and enhancing capacities in support resources.

Predicting the level of resilience of adults aged 25-65 relation to the elderly according to their interpersonal problem-solving methods

BACKGROUND

Elderly home caregivers are among the first and most important people involved in elderly care. Since the process of caring for the elderly affects the mental, physical, and life conditions of the caregivers, it is of utmost importance to study interpersonal problem-solving methods and the role they play in the resilience of caregivers. In this regard, the study was conducted to predict the resilience of adults aged 25-65 years compared to the elderly according to their interpersonal problem-solving methods.

MATERIALS AND METHODS

This is a descriptive correlational study. Two-hundred and sixty-two adults aged 25-65 living in Iran in different genders, marital status, majors, and occupations participated in this study. The data obtained from responding to questionnaires of resilience and interpersonal problem solving of respondents were analyzed using Pearson's correlation coefficient and linear regression correlation coefficient.

RESULTS

The findings showed that there is a significant relationship between resilience and some problem-solving methods (frankness and transparency, realism, exposure, sympathy, pursuit and challenge, and incentive agreement) of elderly home caregivers. According to the result of linear regression, among the respondents' interpersonal problem-solving methods, realism was the only predictive variable for resilience (P = 0.006). That is, being more realistic is related to more resilience in caring for the elderly.

CONCLUSIONS

Some interpersonal problem-solving methods of adults are related to their resilience in caring for the elderly. Paying attention to these resilient practices and behaviors can be effective in improving the quality of care for the elderly and reducing their difficulties. The results of this study can be used in long-term and practical planning for elderly home caregivers.

Through the Eyes of a Young Carer: A Photo Elicitation Study of Protective Resilience

Caregiving is recognised as a source of stress with potential for negative health impacts as well as positive outcomes and development of resilience. For young carers, children, and adolescents providing care for close family members, adaptation through resilience is crucial, yet work using a resilience approach is limited. This study explored protective factors and pathways to resilience in a sample of young carers, through application of the socioecological model in caring relationships. An in-depth qualitative approach was used, with in-person interviews facilitated by auto-driven photo elicitation. Deductive thematic analysis was applied, framed by three levels (individual, community, and society) of the socioecological model of resilience. Twelve participants (nine girls and three boys) aged 5-18 years, each providing care to a family member, were recruited using opportunity and volunteer sampling via carers' centres in the southwest of England. Ten key themes were identified, four at the individual level: pre-empting challenges and planning, cognitive strategies, emotional strategies, and seeking solitude; three at the community level: family support, friendships, and pets and inanimate objects; and three at the society level: professional support, access to caregiver activities and community, and being outdoors. The location of themes at each level indicated relevance of the socioecological model to identification of protective factors in a young carer population. These findings have important applications for guidance to charities and organisations supporting young carers. Identification of factors that promote resilience offers support for the development of well-informed interventions, which harness these protective factors to develop resilience and improve health for young carers.

Partner Caregiver Resilience: A Scoping Review

PURPOSE

Caring for older adults with Alzheimer's disease and related dementias (ADRD) is a significant challenge for partner caregivers (i.e., committed, married, or cohabiting individuals). Understanding partner caregivers' needs is crucial to promote their well-being during the disease trajectory. The concept of resilience may help explain how ADRD partner caregivers manage in the face of significant challenges. The purpose of the current scoping review was to synthesize the qualitative evidence of the level of resilience among partner caregivers of persons with ADRD.

METHOD

A scoping review was conducted, which resulted in 19 research studies meeting inclusion criteria.

RESULTS

Findings were grouped by significant aspects of resilience as reflected in the studies reviewed, including risk and protective factors, partner caregivers' characteristics, and challenges and facilitators of resilience. Knowledge, skills, and access to social, psychological, and emotional support are needed to foster partner caregiver resilience.

CONCLUSION

Further resilience research is necessary to inform development of public policies, programs, and interventions tailored to the unique needs of ADRD partner caregivers. [Research in Gerontological Nursing, 17(2), 99-108.].

Talk with Ted: an embodied conversational agent for caregivers

Communication is key to the success of any relationship. When it comes to caregivers, having a conversation with a person living with some form of cognitive impairment, such as dementia, can be a struggle. Most people living with dementia experience some form of communication impairment that reduces their ability to express their needs. In this case study, we present the design of an embodied conversation agent (ECA), Ted, designed to educate caregivers about the importance of good communication principles when engaging with people living with dementia. This training tool was trialed and compared to an online training tool, with 23 caregivers divided into two cohorts (12 in the ECA condition, and 11 in the online training tool condition), over a period of 8 weeks using a mixed evaluation approach. Our findings suggest that (a) caregivers developed an emotional connection with the ECA and retained the learning from their interactions with Ted even after 8 weeks had elapsed, (b) caregivers implemented the learnings in their practice, and (c) the changes in care practice were well received by people living with dementia.

A Prescription for Wellness in Early PD: Just What the Doctor Ordered

BACKGROUND

Being diagnosed with a neurodegenerative disease is a life-changing event and a critical time to help patients cope and move forward in a proactive way. Historically, the main focus of Parkinson's disease (PD) treatment has been on the motor features with limited attention given to non-motor and mental health sequelae, which have the most impact on quality of life. Although depression and anxiety have been described at the time of PD diagnosis, demoralization, intolerance of uncertainty, decreased self-efficacy, stigma and loneliness can also present and have negative effects on the trajectory of the disease. Hence, understanding the psychological impact of the diagnosis and how to provide better counselling at this critical time point may be the key to a better long-term trajectory and quality of life.

FOCUS

There has been a paradigm shift in the treatment of chronic illness moving beyond the medical model, which focuses on fighting illness with the physician being in charge of the treatment process and the patient being the passive recipient, toward a more holistic (i.e., physical, psychological, social, and spiritual health) biopsychosocial approach that emphasizes behavioral factors with the patient being an active collaborator in their treatment. Hence, we propose that fostering resilience, social support, and psychological flexibility offer promise toward attenuating negative reactions and improving overall well-being.

CONCLUSION

Through a proactive wellness approach incorporating lifestyle choices, people with PD (PwP) can not only achieve improved states of health, well-being, and quality of life, but actually thrive.

Caregiving During the COVID-19 Pandemic: Factors Associated With Feelings of Caregiver Preparedness

Examination of caregiver preparedness for the COVID-19 pandemic can inform efforts to support caregivers in future times of global crisis. Informal caregivers of adults with dementia or severe disabilities (n = 72, Mage = 62.82 years, 90.28% female) were recruited through Adult Day Centers across the United States. Caregivers responding to an online survey regarding their experiences and preparedness reported an increase in burden, stress, and time spent caregiving since the onset of the pandemic. Caregivers reported feeling prepared for typical caregiving responsibilities but felt less prepared for someone else to assume the role of primary caregiver. Multiple regression modeling indicated that resilience accounted for significant variance in primary caregiver preparedness, over and above burden, but only caregiver age accounted for significant variability in a component representing feeling prepared to delegate caregiving to another person. These findings have implications for research and applied efforts to promote caregiver well-being and preparedness.

Resilience in Older People: A Concept Analysis

(1) Background: Resilience has been presented as a potential protective factor to be promoted in difficult experiences in older people. However, further clarification of the concept of resilience for this population is required, as this is of critical interest for nursing care. (2) Aim: To develop the concept of resilience in older people to establish the elements that refer to the nursing outcome. Personal resilience (1309) from the Nursing Outcomes Classification (NOC), specifically in older people. (3) Methods: Concept analysis using Beth Rodgers' evolutionary model. The attributes, antecedents, consequents, and empirical elements were described in the integrative review, with searches in PubMed, CINAHL, PsycINFO, LILACS, and Embase databases. A total of 2431 citations have been identified, and 110 studies were included. (4) Results: The concept of "resilience in older people" is composed of two attributes, available resources and positive behaviors, and is defined as positive attitudes of older people with the assistance of resources available from experiences of adversity. Conclusion: This analysis and concept development of resilience in older people provided sensitive indicators for nursing care in the context of adversity, considering available resources and with positive attitudes during this phase of life span.

The impact of caring for family members with mental illnesses on the caregiver: a scoping review

A large number of multidisciplinary, qualitative and quantitative research suggests that providing care for family members with mental health illnesses can have both positive and negative effects on the carers' wellbeing. However, to date a comprehensive overview and synthesis of literature that compares and contrasts positive and negative effects of family-caregiving on the carer is missing. To address this gap, this scoping review examines the effects of family-caregiving on carers' wellbeing. A Boolean search generated a total of 92 relevant articles that were included in the analysis. The results suggest that, to understand the effects of family-caregiving on the carer's mental and physical wellbeing, it is necessary to take a combination of situational and sociodemographic characteristics into consideration. Elderly, female, spousal-carers and primary-carers may be a group that is at risk of suffering from a lack of positive mental and physical wellbeing as a result of caring. However, the negative effects of caregiving can be balanced by extraversion, social support and religious or spiritual beliefs. Therefore, future interventions that aim to promote family caregivers' wellbeing may need to take personality, particular circumstances as well as cultural and personal beliefs into consideration.

Variability in perceived burden and health trajectories among older caregivers: a population-based study in Sweden

BACKGROUND

The negative effects of informal caregiving are determined by the characteristics of the caregiver-care receiver dyad and the context of care. In this study, we aimed to identify which subgroups of older informal caregivers (1) experience the greatest subjective burden and (2) incur a faster decline in objective health status.

METHODS

From a total of 3363 older participants in the Swedish National study on Aging and Care in Kungsholmen (SNAC-K), we identified 629 informal caregivers (19.2%, mean age 69.9 years). Limitations to life and perceived burden were self-reported, and objective health status was quantified using the comprehensive clinical and functional Health Assessment Tool (HAT) score (range: 0-10). Ordered logistic regressions and linear mixed models were used to estimate the associations between caregiving-related exposures and subjective outcomes (cross-sectionally) and objective health trajectories (over 12 years), respectively.

RESULTS

Having a dual role (providing and receiving care simultaneously), caring for a spouse, living in the same household as the care receiver and spending more hours on caregiving were associated with more limitations and burden. In addition, having a dual role (β=-0.12, 95% CI -0.23 to -0.02) and caring for a spouse (β=-0.08, 95% CI -0.14 to -0.02) were associated with a faster HAT score decline. Being female and having a poor social network were associated with an exacerbation of the health decline.

CONCLUSIONS

Both the heterogeneity among caregivers and the related contextual factors should be accounted for by policymakers as well as in future research investigating the health impact of informal caregiving.

What are the Challenges and Resilience Resources Identified by Informal Carers During the First UK COVID-19 Lockdown? A Longitudinal Qualitative Study Using Naturalistic Data

COVID-19 has posed serious challenges for informal carers living in the UK. This article examines some of the specific challenges facing carers and the resources they used to manage them throughout the first UK lockdown. We used a framework approach to analyse naturalistic, longitudinal data from 30 carers taking part in 96 of Mobilise's daily Virtual Cuppas between March and July 2020. We found that lack of information and social restrictions cumulatively impacted carers' sense of certainty, control and motivation. This took an emotional toll on the carers, leading to exhaustion and burden. However, carers quickly established new routines and used humour and self-care to actively manage their wellbeing. Carers received support but also provided it to those in need, including fellow members of the caregiving community, supporting an ecological approach to carer resilience. Our findings may be used to anticipate challenges and promote protective resilience resources in future lockdowns.

Exploring Resilience in UK-Based Domiciliary Care Workers before and during the COVID-19 Pandemic

Domiciliary carers (DCs) provide an invaluable service that enables people living with dementia (PLWD) to remain living in their own homes for as long as possible. We know a lot about the negative impacts of providing domiciliary care and recent evidence suggests that this was exacerbated by the COVID-19 pandemic. However, we know much less about how these DCs manage the stressors associated with their roles. The current study adopts a resilience perspective to identify the resources that DCs caring for PLWD draw on to manage the stress associated with their roles before and during the COVID-19 pandemic. We conducted semi-structured interviews with 19 DCs from across the UK. Data were analysed using a directed qualitative content analysis. Themes included: healthy boundaries; motivation to care; psychological attributes; managing work; and support. The findings have implications for employers and may go some way towards improving DC working conditions, retaining staff, and attracting new DCs in the future.

A continuum of languishing to flourishing: exploring experiences of psychological resilience in multiple sclerosis family caregivers

PURPOSE

Resilience research in family caregiving in chronic neurological conditions is growing, but multiple sclerosis (MS) caregivers are noticeably absent from this body of work. MS caregivers represent a unique population due to the disease's early onset, prolonged life expectancy, and heterogeneity. As such, this study aimed to explore MS caregivers' conceptualizations of resilience, examine MS caregivers' experiences of resilience development, and determine which assets and resources influence resilience in this role.

METHODS

Twenty-four Canadian MS caregivers were recruited. Semi-structured in-depth interviews were conducted with questions derived from an ecological resilience framework. Data were analysed using reflexive thematic analysis.

RESULTS

Themes constructed a cyclical resilience model, beginning with encounters with hardship and extending to thriving adjustment. Subthemes included reports of additive challenges, impactful individual and community resources, and multi-level adaptive pathways. Within this cycle, the achievement of healthy adjustment exerted a positive feedback function and informed future responses to lifelong challenges.

CONCLUSIONS

Despite the salience of resilience processes within caregiver testimonies, inadequate resources at societal levels were evident. These findings afford researchers and decision-makers relevant information for designing and implementing resilience-building interventions for MS caregivers that attend to contextual factors and current systemic support deficiencies.

Relational, community-based and practical: Support systems used by Canadian spousal caregivers living seasonally in the United States

Every year tens of thousands of older Canadians travel to the southern United States (US) to live there seasonally during the winter months to enjoy a warmer climate-a practice known as international retirement migration. Several factors facilitate participation in this transnational mobility, including having the financial resources needed to live abroad. For those managing chronic or acute health conditions, traveling with a caregiver (typically a spouse) is another important facilitator. In this qualitative analysis, we explore the transnational systems of support that Canadian international retirement migrant spousal caregivers draw upon to enable them to provide care while in the US. We report on the findings of ten semi-structured dyad interviews (n = 20 participants) conducted with Canadian international retirement migrants living seasonally in Yuma, Arizona. The dyads consisted of spouses, one of whom had defined care needs and the other of whom provided informal care. Through thematic analysis of these interviews, we identified three types of transnational support systems that spousal caregivers draw on: relational, community-based and practical. While aspects of these support systems have been documented in other informal care-giving studies, this analysis demonstrates their copresence in the transnational care-giving context associated with international retirement migration. Overall, this analysis highlights the benefits of close social relations enjoyed by international retirement migrants providing informal care to mitigate the lack of access to their established support networks at home.

Belongingness challenged: Exploring the impact on older adults during the COVID-19 pandemic

OBJECTIVES

The sense of belonging is a fundamental human need. Enacting it through face-to-face social activities was no longer possible during the COVID-19 pandemic. In this study, we investigate how the sense of belonging, and how it is enacted, changed longitudinally amongst older adults in the UK. In addition, we examine the interplay of the sense of belonging and resilience over time.

METHODS

We employed a longitudinal qualitative research design to explore the experiences of older adults during one year of the COVID-19 pandemic (April 2020-April 2021). The analysis was undertaken with constructivist grounded theory.

FINDINGS

Before the pandemic older adults were free to engage in social relationships with family and friends, often enacted within social activity groups where they felt valued and gained positive experiences. During the pandemic face to face enactment of belongingness was reduced; adjustments needed to be made to maintain the sense of belonging. The experience of older adults was heterogeneous. We examine three themes. First, how belongingness was enacted prior to the pandemic. Examples include: family holidays, visiting each other, sports activities, eating with friends and family, and visiting cultural events. Second, how participants adapted and maintained their social involvement. Examples include: distanced face-to-face activities; and learning new technology. Third, for some, a belongingness gap emerged and persisted. There was an irretrievable loss of family members or friends, the closure of social groups, or withdrawal from groups as priorities changed. As a consequence, of challenged belongingness, participants expressed increased loneliness, anxiety, social isolation, frustration and, feelings of depression. For many, the disrupted sense of belonging no longer fostered resilience, and some previously resilient participants were no longer resilient.

Impact of the COVID-19 pandemic on community services for homebound older adults in New York City

The ongoing COVID-19 pandemic has affected multiple aspects of society. Based on data from a community program, this study examined how the pandemic influenced community services for homebound older adults and whether those services could be delivered via internet-based information and communications technology. Using mixed methods, we collected quantitative data from client profiles and service documents and qualitative data from phone interviews with program staff members and clients. The quantitative results show that during the pandemic, more services were provided for the physical well-being of homebound older adults than for their psychological and home environment needs. Service duration during the pandemic was significantly longer than prior to the pandemic. The qualitative data indicate that the pandemic has influenced inputs, activities and outcomes of the program. The program staff members and clients expressed concerns about delivering services online. Based on the findings, we provide suggestions for future practice and policy.

A systematic review of systematic reviews of needs of family caregivers of older adults with dementia

Family caregivers provide vital assistance to older adults living with dementia. An accurate assessment of the needs of caregivers supports the development and provision of appropriate solutions to address these needs. This review of systematic reviews analyzes and synthesizes the needs identified by family caregivers. We conducted a systematic review of systematic reviews using the AMSTAR guideline. Electronic databases were searched for systematic reviews on the needs of caregivers in the context of dementia using a combination of keywords and medical subject headings. Records resulting from the search were screened by two reviewers. Data on the needs of caregivers were extracted from the articles and analyzed using a narrative synthesis approach. Out of the 17 potentially eligible systematic reviews obtained initially, 6 met the inclusion criteria. In total, 20 main needs were identified in the reviews included in this study. The need for information and social support were prominent in this review. Factors such as gender, resources available to the caregiver and the care recipient's health status may influence caregivers' needs. Interventions can be tailored toward addressing the most prominent needs of caregivers such as adequate information and resources and available programs may further accommodate and offer need-tailored support to them.

Profiles of social, cultural, and economic capital as longitudinal predictors of stress, positive experiences of caring, and depression among spousal carers of people with dementia

OBJECTIVE

We explored (1) social, cultural, and economic capital in spousal carers of people with dementia; (2) profiles of carers with different levels of capital; (3) whether the identified profiles differ in levels of stress and positive experiences of caring, and likelihood of depression over time.

METHODS

Baseline (2014-2016), 12-month, and 24-month follow-up data were analyzed for 984 coresident spousal carers of people with dementia. We assessed social, cultural, and economic capital, stress, positive experiences of caring, depression.

RESULTS

On average, carers reported infrequent social and cultural participation. Most carers were not socially isolated, trusted their neighbours, had education at least to age 16, and had an income aligned with the 2014 UK average. We identified four groups of carers with different levels of capital. Although on average stress was low, depression was infrequent, and positive experiences of caring were moderately frequent, the group of carers with lowest capital was the least stressed and reported the most positive experiences of caring over time. Compared to the two groups with better capital, those with poorer capital were more likely to be depressed over time.

CONCLUSION

Social, cultural, and economic resources may decrease likelihood of depression, but not stress, in carers of people with dementia.

Correlation Among Psychological Resilience, Social Support, and Coping Style in Patients With Complicated Hepatolithiasis

Objectives: To investigate the correlation between psychological resilience, social support, and coping styles in patients with complicated hepatolithiasis.

Methods: The objective sampling method was used in this study to select a total of 156 patients with complicated hepatolithiasis in a Third-class Grade A hospital in Changsha, Hunan Province from January to December 2019. Self-designed general data questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Social Support Rating Scale (SSRS), and the Simplified Coping Style Questionnaire (SCSQ) were used to conduct a questionnaire investigation. Spearman correlation analysis was used to analyze the correlation between psychological resilience, social support, and coping styles in patients with complicated hepatolithiasis.

Results: Both the total score of psychological resilience (45.79 ± 16.28) and social support (35.71 ± 9.92) of patients with complicated hepatolithiasis were significantly lower than those of the domestic norm. The total score of psychological resilience of patients with complicated hepatolithiasis was positively correlated with the total score of social support (r = 0.570, p < 0.01). The total score of psychological resilience and its three dimensions were positively correlated with the positive coping (r = 0.682, 0.673, 0.663, 0.535, p < 0.01)and negatively correlated with negative coping (r = −0.240, −0.207, −0.221, −0.286, p < 0.01).

Conclusions: This study indicated that strengthening social support and improving the coping style of patients with complicated hepatolithiasis are helpful to improve their psychological resilience, which provided theory basis and reference for further intervention measures to improve social support system and coping styles.

Differences in the predictors of the resilience between carers of people with young- and late-onset dementia: a comparative study

Resilience is a subjective process related to both protective and risk factors, external and internal to the individual. Considering the psychosocial differences between young-onset dementia (YOD) and late-onset dementia (LOD) groups, carers' resilience may not be understood in the same way in both groups.

Objective

The aim of this study was to compare the resilience of carers in YOD and LOD and to examine which factors might be associated with resilience in both groups of carers.

Methods

The study was conducted with 120 people with dementia (49 YOD) and their primary carers. The carers had their resilience, quality of life, depressive symptoms, and burden assessed and answered the sociodemographic questionnaire. We assessed care recipients' global cognition, dementia severity, social cognition, facial expression recognition, awareness of disease, the ability to perform activities of daily living, depressive symptoms, and neuropsychiatric symptoms. For data analysis, unpaired two-tailed Student's t-test and linear regressions were conducted.

Results

Resilience did not differ between groups (p=0.865). Resilience was inversely related to carers' depressive symptoms in both YOD (p=0.028) and LOD (p=0.005) groups. The carers' schooling (p=0.005), duration of disease (p=0.019), and depressive symptoms of care recipient (p<0.001) were related to carers' resilience only in LOD group.

Conclusions

The context of care, clinical status of the care recipient, and mental health resources affected the carers' resilience in the LOD group. Conversely, resilience seems to be affected only by carers' mental health in the YOD group. The understanding of these differences is crucial for the developing of intervention strategies.

Understanding the Quality of Life Impacts of Providing Informal Care to People with Dementia: A Systematic Review of Qualitative Studies

BACKGROUND

There is currently a lack of a comprehensive review identifying the broad scope of factors that impact quality of life (QoL) of informal carers of people with dementia to validate existing measures and inform the provision of support services for carers of people with dementia that impact QoL domains important to them.

OBJECTIVE

To explore and identify QoL impacts on informal carers from providing care to people with dementia.

METHODS

A systematic review was conducted across four databases: EMBASE, CINAHL, PsychINFO, and Medline. Eligible studies consisted of published, peer-reviewed, qualitative studies focusing on lived experiences of informal carers of people with dementia. Non-English studies and quantitative studies were excluded. Screening of included studies was conducted independently by three reviewers. A "best-fit" framework synthesis was used to combine the qualitative data, applying deductive and inductive analysis techniques. Quality assessment was conducted using the Critical Appraisal Skills Programme.

RESULTS

Of the 4,251 articles identified, 59 articles were included. Five main themes pertaining to QoL aspects were identified that included coping (emotion-coping and problem-coping), relationship with the person with dementia (sense of loss and change in relationship), support (formal support and informal support), interference with life (control over caring situation and freedom and independence), and health (physical health, emotional and mental health, and social health).

CONCLUSION

This study identified domains of QoL that are impacted by providing informal care to people living with dementia, offering a conceptual framework for instrument validation and development as well as guidance for service provision.

Resilience and post-traumatic growth in the transition to motherhood during the COVID-19 pandemic: A qualitative exploratory study

Most perinatal research relating to COVID‐19 focuses on its negative impact on maternal and parental mental health. Currently, there are limited data on how to optimise positive health during the pandemic. We aimed to bridge this knowledge gap by exploring how women have adapted to becoming a new parent during the pandemic and to identify elements of resilience and growth within their narratives. Mothers of infants under the age of 4 months were recruited as part of a wider UK mixed‐methods study. Semi‐structured interviews with 20 mothers elicited data about how COVID‐19 had influenced their transition to parent a new infant, and if and how they adapted during the pandemic, what strategies they used, and if and how these had been effective. Directed qualitative content analysis was undertaken, and pre‐existing theoretical frameworks of resilience and post‐traumatic growth (PTG) were used to analyse and interpret the data set. The findings show evidence of a range of resilience and PTG concepts experienced during the pandemic in this cohort. Salient resilience themes included personal (active coping, reflective functioning, and meaning‐making), relational (social support, partner relationships, and family relationships), and contextual (health and social connectedness) factors. There was also evidence of PTG in terms of the potential for new work‐related and leisure opportunities, and women developing wider and more meaningful connections with others. Although further research is needed, and with individuals from diverse socioeconomic backgrounds, these findings emphasise the significance of social support and connectivity as vital to positive mental health. Opportunities to increase digital innovations to connect and support new parents should be maximised to buffer the negative impacts of further social distancing and crisis situations.

Spousal Caregiver Resilience in A Nutshell: A Directed Content Analysis in the Context of Dementia Caregiving in Vietnam

OBJECTIVES

This study aims to define resilience of spousal family caregivers for older adults living with dementia in the Vietnamese context.

METHODS

A directed content analysis was conducted on 22 interview transcripts, including nine follow-up interviews, of a sub-sample of 13 spousal caregivers, drawn from a larger study with family caregivers for relatives with dementia in a hospital in Vietnam. The study started with key categories from the theory of the unifying model of resilience in dementia caregiving to guide the analysis process, while new codes and categories were identified during this process.

FINDINGS

The study results show a revision and extension of this model by introducing a revised model with newly developed sub-categories under the five revised key categories of adversity, resilience processes, outcomes, internal resources, and external resources.

CONCLUSIONS

The results provide evidence for the development of resilience-based interventions and services for spousal caregivers in their contexts.

Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden

(1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer-care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.

Exploring experiences of family caregivers for older adults with chronic illness: A scoping review

A Scoping Review was conducted to explore key issues that underpin the experiences of family caregivers of older adults with chronic illness. The review aims to identify the gap in literature and synthesise evidence on this topic. Globally, family caregivers of older adults with chronic illness experience burden. Evidence suggests that family caregivers' needs are poorly understood and remain largely under recognised by healthcare services. Moreover, little is known about the experience of family caregivers caring for older adults with multiple chronic conditions. Data bases used included: (EBSCOhost, CINAHL, Science Direct, SCOPUS, MEDLINE, PubMed, ISI web of science and grey literature. 3352 records were identified, 58 full-text articles were assessed for eligibility, and 11 papers included in the literature review. Data are narratively synthesized. This review provides findings that suggest further research.

Towards conceptual convergence: A systematic review of psychological resilience in family caregivers of persons living with chronic neurological conditions

Background

The demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this specific population is warranted.

Aim

In this systematic review we aimed to: (1) examine the origins and conceptualizations of resilience; (2) summarize current resilience measurement tools; and (3) synthesize correlates, predictors and outcomes of resilience in family caregivers of persons with CNCs.

Design

We sourced English articles published up to July 2020 across five databases using search terms involving CNCs, family caregivers and resilience.

Results

A total of 50 studies were retained. Nearly half (44%) of the studies used trait‐based resilience definitions, while about one third (36%) used process‐based definitions. Twelve different resilience scales were used, revealing mostly moderate to high‐resilience levels. Findings confirmed that resilience is related to multiple indicators of healthy functioning (e.g., quality of life, social support, positive coping), as it buffers against negative outcomes of burden and distress. Discordance relating to the interaction between resilience and demographic, sociocultural and environmental factors was apparent.

Conclusions

Incongruity remains with respect to how resilience is defined and assessed, despite consistent definitional concepts of healthy adaptation and equilibrium. The array of implications of resilience for well‐being confirms the potential for resilience to be leveraged within caregiver health promotion initiatives via policy and practice.

Patient or Public Contribution

The findings may inform future recommendations for researchers and practitioners to develop high‐quality resilience‐building interventions and programmes to better mobilize and support this vulnerable group.

Positive life stories of Stroke-Survivor's spousal caregiving in Hong Kong: Lessons for policy and practice

BACKGROUND

Advances in medical-care for immediately post-stroke mean that many stroke-survivors now live a normal lifespan, although they may suffer residual disability. They are often cared for at home by their spouse, who may be ill-prepared for this task, and may also have health concerns. As demands on formal services increase with population aging in Hong Kong, equipping spousal-caregivers with positive effective caring strategies is increasingly important.

OBJECTIVE

To understand what constitutes positive spousal-caregiving for stroke-survivors in Hong Kong within the cultural lens of 'Zhong (Loyalty)' METHOD: Naturalistic qualitative research was employed to hear stories about positive caregiving from Hong Kong couples living with stroke sequelae. Three in-depth face-to-face semi-structured interviews were undertaken with eleven dyads (stroke-survivor alone, spousal-caregiver alone, then the couple together). Data validation was by member-checking, further questions, and feedback at a second interview, and corroboration by field-notes.

FINDINGS

A strength-based interactive model of positive spousal-caregiving was described, whose core tenet was Zhong (Loyalty). This fostered, and in turn was nurtured by, three paired key behaviours (1. Learning new skills linked with satisfaction when efforts paid off; 2. Utilizing formal and informal resources linked with supporting others; 3. Cherishing and bringing out the best linked with managing life- and self-care). Couples' capacity to develop these behaviours reflected their inner strengths.

CONCLUSIONS

Couples who practiced positive caring and were resilient in the face of adversity were likely to optimise dyadic health and deal constructively with unexpected challenges. To address a looming shortfall between client need, and formal health and social services in Hong Kong, evidence-based policies are required to support effective, positive community-based spousal-caregiving.

Resilience, Emotional Intelligence, and Occupational Performance in Family Members Who Are the Caretakers of Patients with Dementia in Spain: A Cross-Sectional, Analytical, and Descriptive Study

Background: The concern in the scientific community for the study of people with dementia and their families is comprehensible, especially the importance of knowing the effects that caring for the patient has on their family dynamic, paying special attention to the main caregiver. The objective of this study was to analyze the relationship of resilience and emotional intelligence with functional performance in the main caregivers of people with dementia in Spain according to the phase of the disease. Methods: A cross-sectional, descriptive, and analytical study was carried out. A total of 144 primary family caregivers of patients with dementia in Spain were included in the study. The following variables were measured: sociodemographic, psychosocial, and occupational, as well as resilience and emotional intelligence. Results: The caregivers obtained a low moderate resilience (mean = 64.01 ± 14.5), an emotional intelligence bordering between moderate and high (mean = 78.48 ± 14.82), and a 61.8% self-care categorized as somewhat and quite a bit. The presence of higher levels of resilience in family caregivers of people with dementia were positively related to the time spent on self-care (r = 0.227; p = 0.033) and leisure (r = 0.262; p = 0.014), especially in the moderate phase of the disease, while in the severe phase, this relationship appeared with productivity (r = 0.355; p = 0.034). The higher levels of emotional intelligence were positively related to a greater time dedicated to self-care (r = 0.233, p = 0.005), as well as the data observed in the moderate and severe phase (r = 0.214; p = 0.046 and r = 0.398; p = 0.016 respectively). Conclusions: The primary caregivers of relatives with dementia who have higher levels of resilience and emotional intelligence spend more time on self-care and leisure activities, especially in the moderate phase of the disease.

"I've been always strong to conquer any suffering:" challenges and resilience of Chinese American dementia caregivers in a life course perspective

OBJECTIVES

This study investigated the resilience of a growing but largely underserved and understudied population-Chinese American dementia caregivers, whose experience is embedded in their development throughout the life span, process of migration, and sociocultural contexts.

METHOD

Narrative data were collected from in-depth interviews with 27 Chinese caregivers in New York City. Based on the hybrid grounded theory model, a three-steps coding procedure was implemented to identify themes emerged from the data.

RESULTS

16 themes emerged from the data and fit two categories, challenge and resilience, in each of the four principles-time and place, timing in lives, linked lives, and agency-of the developmental life course perspective. Physical and emotional exhaustion is the challenge theme that was the most frequently mentioned followed by limited knowledge of dementia, navigating the U.S. health care system, and limited time for self-development. Three aspects of resilience-sense of mastery, access to formal and informal support, and commitment to care-were salient among the Chinese American caregivers.

CONCLUSION

This study shed important light on the multifaceted challenges and resilience of Chinese American caregivers. The findings indicate the necessity of developing culturally meaningful services for immigrant caregivers to address their complex challenges and improve their multifaceted resilience.

Factors impacting resilience as a result of exposure to COVID-19: The ecological resilience model

Despite the severe psychological impact of the COVID-19 pandemic, some individuals do not develop high levels of psychological distress and can be termed resilient. Using the ecological resilience model, we examined factors promoting or hindering resilience in the COVID-19 pandemic. Of the 1034 participants (49.9±16.2 years; females 51.2%) from Italian general population, 70% displayed resilient outcomes and 30% reported moderate-severe anxiety and/or depression. A binary regression model revealed that factors promoting resilience were mostly psychological (e.g., trait resilience, conscientiousness) together with social distancing. Conversely, factors hindering resilience included COVID-19-anxiety, COVID-19-related PTSD symptoms, intolerance of uncertainty, loneliness, living with children, higher education, and living in regions where the virus was starting to spread. In conclusion, the ecological resilience model in the COVID-19 pandemic explained 64% of the variance and identified factors promoting or hindering resilient outcomes. Critically, these findings can inform psychological interventions supporting individuals by strengthening factors associated with resilience.

Resilience and supporting people living with dementia during the time of COVID-19; A qualitative study

OBJECTIVES

To explore the different factors of resilience for people living with dementia and unpaid carers, in response to sudden changes in care and lifestyle during the COVID-19 pandemic.

METHODS

Unpaid carers and people living with dementia were offered telephone interviews in April 2020 to discuss their experiences since the COVID-19 pandemic. Participants were asked about the benefits and challenges of accessing dementia support, as well as coping, symptoms, strategies and impacts. Each transcript was analysed using inductive and deductive thematic analysis by two researchers.

FINDINGS

Semi-structured interviews from 50 participants (n = 42 unpaid carers and n = 8 people living with dementia) reported protective and risk factors of resilience concerning (1) communication, (2) adaptations, (3) support networks and (4) lifestyle factors and coping mechanisms.

CONCLUSIONS

Resilience factors considered both organisational factors for external support, along with individual coping mechanisms. Organisations and social support services should consider resilience factors in future service planning, to better support people living with dementia, or caring someone living with dementia, during times of great stress. The ecological model of resilience established from this research refers to resilience during times of unexpected change in the COVID-19 pandemic; however, it could be considered relevant in other periods of high stress within this cohort.

Exploring resilience in adult daughter and spousal carers of people living with dementia in North West England: an ecological approach

Purpose

Research has shown that informal carers of people living with dementia (PLWD) can be resilient in the face of caregiving challenges. However, little is known about resilience across different kinship ties. This study aims to update and build on our previous work, using an ecological resilience framework to identify and explore the factors that facilitate or hinder resilience across spousal and adult daughter carers of PLWD.

Design/methodology/approach

This study conducted in-depth qualitative interviews with a purposive sample of 13 carers from North West England and analysed the data using a constructivist grounded theory approach (Charmaz, 2003).

Findings

Adult daughters were motivated to care out of reciprocity, whereas spouses were motivated to care out of marital duty. Spouses had a more positive and accepting attitude towards caregiving and were better able to maintain continuity, which facilitated their resilience.

Research limitations/implications

Resilience emerged on multiple levels and depended on the type of kinship tie, which supports an ecological approach to resilience. The implications of these findings are discussed.

Originality/value

This paper makes a novel contribution to the literature as it uses an in-depth qualitative methodology to compare resilience across spousal and adult daughter carers of PLWD. This study adopts an ecological approach to identify not just individual-level resilience resources but also interactive community- and societal-level resources.

An analysis of carer burden among family carers of people with and without dementia in Ireland

OBJECTIVE

Despite the policy relevance of carer burden, limited research focuses on family carers' experience of carer burden among different disease groups. This study aimed to examine differences in carer burden among family carers of people with and without dementia.

DESIGN

Secondary data analysis was conducted on a national cross-sectional dataset. Multivariable ordered logistic regression was used to analyze four levels of carer burden (low, mild, moderate, high). The main independent variable was dementia diagnosis, and controls included variables relating to the care recipient, family carer, and context of care.

SETTING

The original survey was funded by Irish Health Service Executive and undertaken by the National Centre for the Protection of Older People in Ireland.

PARTICIPANTS

The original dataset consisted of 2,311 family carers of older people in Ireland. Approximately, one-fifth of this sample had a diagnosis of dementia.

MEASUREMENTS

Carer burden was measured using the standardized 22-item Zarit Burden Interview. Care-recipient dependency was measured using the Activities for Daily Living Scale. Sociodemographic details and information about the context of caring were collected using self-report scales.

RESULTS

In our model, dementia diagnosis and dependency level were significantly associated with carer burden. Family carer and context of care variables including gender, marital status, education, residence, co-residence, and perceived support showed significant relationships with carer burden. Our results highlighted significant differences in carer burden distribution; in particular, family carers of people with dementia were less likely to report low or mild carer burden (-6.95 ppts and -3.64 ppts, respectively) and more likely to report moderate or high carer burden (8.46 ppts and 2.13 ppts, respectively).

CONCLUSION

Our findings suggest that family carers of people with dementia may experience additional challenges associated with caring. Therefore, family carers of people with dementia may require tailored social supports to maintain good health and well-being.

Resilience and Related Factors: A Comparison of Fathers and Mothers of Patients With Cleft Lip and/or Palate in China

Background: Resilience has become a hot spot in the field of positive psychology to study life-change events. However, there were little information on resilience among the fathers and mothers of patients with cleft lip and/or palate respectively. The present study aimed to explore and compare the level and potential influential factors associated with resilience among fathers/mothers of patients with cleft lip and/or palate in China. Method: A cross-sectional study was carried out between April 2019 and July 2020 among fathers/mothers of patients with cleft lip and/or palate in two cleft lip and/or palate treatment centers in China. Sixty Nine fathers and 179 mothers of patients with cleft lip and/or palate were interviewed with a questionnaire on demographic variables and the Resilience Scale-14 (RS-14), Herth Hope Index (HHI), Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Parenting Stress Index-Short Form (PSI-SF) and Coping Health Inventory for Parents (CHIP). T-test/univariate one-way ANOVA, Pearson's r, hierarchical linear regression analysis were conducted to explore the influential factors of resilience. Results: Fathers of patients with cleft lip and/or palate had a higher level of resilience (77.77 ± 14.18) than mothers (74.52 ± 14.33) though without significance. Resilience was positively associated with hope, perceived social support, optimism and coping and negatively correlated with parenting stress both in the fathers and the mothers. Hierarchical linear regression analysis showed that hope (β = 0.400, P < 0.01), coping (β = 0.281, P < 0.05), job status, medical payments (β = -0.240, P < 0.05) were found to be associated with resilience among the fathers of patients with CL/P, and all four variables in the model could explain 42.8% of the variance in resilience; Hope (β = 0.225, P < 0.05), perceived social support (β = 0.194, P < 0.05), the age of patients (β = 0.189, P < 0.05) were found to be associated with resilience among the mothers, and all three variables in the model could explain 27.6% of the variance in resilience. Conclusion: Our study showed that, in China, fathers of patients with cleft lip and/or palate had a higher level of resilience than mothers though without significance. Hope was the only communal variable strongly associated with resilience among both the fathers and the mothers; besides, coping, job status and medical payments were found to be associated with resilience among the fathers; while perceived social support and the age of patients were found to be associated with resilience among the mothers. The results suggest that enhance hope in parents of patients with cleft lip and/or palate might greatly help improve their resilience. Besides, fathers and mothers need specific intervention to prompt their resilience.

Developing a new behavioral framework for dementia care partner resilience (CP-R): A mixed research synthesis

BACKGROUND AND OBJECTIVES

Caring for a person living with dementia requires resilience, the capacity to recover and grow from challenging situations. Despite the increasing interest in assessing and promoting resilience for dementia care partners, behaviors that indicate this attribute are not well known. The goal of this study is to synthesize the literature to identify resilience-related behaviors and develop a new framework for future validation and intervention research.

RESEARCH DESIGN AND METHODS

We searched English-language peer-reviewed articles (January 1991 - June 2019) reporting qualitative or quantitative descriptions of resilience-related behaviors among dementia care partners. Thematic analysis was used to categorize behaviors into domains, identify the relationships among them, and generate a thematic map.

RESULTS

Sixteen articles were identified according to predefined inclusion criteria. Four domains emerged: (1) problem-response behaviors (problem-solving, problem-distancing); (2) self-growth behaviors (self-care activities, spiritual-related activities, and developing and maintaining meaningful social relationships); (3) help-related behaviors (help-seeking and help-receiving), and (4) learning-related behaviors (learning from others and reflection). Definitions of each domain, identification of corresponding behaviors, and formulation of Care Partner Resilience (CP-R) behavioral framework were informed by this mixed research synthesis and other relevant literature.

DISCUSSION AND IMPLICATIONS

The CP-R framework emerged as a result of a new focus on identifying and cultivating strengths instead of evaluating strain and burden. It serves as a useful foundation for understanding the impact of specific behaviors on dementia care partner resilience. Once validated, this framework will inform the development of future measures, research, interventions, and policies for dementia care partners.

Trajectories of resilience among widows: a latent transition model

OBJECTIVES

In 2015 we identified three profiles of adaptation following spousal bereavement: Vulnerables; Copers and Resilients (Spahni, Morselli, Perrig-Chiello, & Bennett, 2015). However, adaptation to spousal bereavement is a dynamic process. Thus, we examine the trajectories of the same participants longitudinally over two years. We identify the stability and change in profiles of adaptation to widowhood; probability of stability and change; factors that influence trajectories in profile membership.

METHODS

Data stem from a longitudinal questionnaire study of 309 older widowed people. The questionnaire included five measures of well-being, serving as the dependent variables of this analysis, and measures of personal resources and contextual factors, including social support, marital happiness, psychological resilience, and demography. Data was analysed using latent transition analysis of the variables loneliness, hopelessness, depressive symptoms, life satisfaction, and subjective health.

RESULTS

The analysis replicated the three Wave 1 profiles as the best theoretical fit: Vulnerables; Copers; and Resilients. Stability was most common, but some participants moved to more or less adaptive profiles, the former being more frequent. Younger age, longer time since widowhood, new life perspectives facilitated adaptation. Those transitioning to less adaptive profiles were more likely to be women and older.

DISCUSSION

The path to adaptation was not linear. Many of the explanatory variables contributed both to positive and negative adaptation. These include previous caring experience, education, psychological resilience and personal strength. This suggests these explanatory variables do not act in isolation but are likely to interact with each other, and with other, yet not measured, factors.

Resilience in older persons: A systematic review of the conceptual literature

Although ageing research increasingly incorporates resilience, a common notion on what resilience means is lacking. We aimed to give a comprehensive overview of the conceptual literature on resilience in older persons, identifying areas of consensus and variation/debate. A systematic search of eight databases from different disciplines led to the inclusion of 36 texts. Across the conceptual literature of resilience in older persons, three common features of descriptions of resilience were identified: a stressor, a response and a mechanism. Based on differences in their interpretation of how resilience is expressed we distinguished two perspectives. The first, classical and most widely applied perspective, describes the expression of resilience as a positive response to a high intensity stressor. The second, newer perspective, describes resilience in the context of responses relative to equilibrium, following low intensity stressors. Almost all descriptions across the two perspectives describe the resilience mechanism to be dynamic and emphasize the importance of the context in achieving resilience. This review provides clarity on the current conceptual status of resilience in older persons, an important step towards a higher level of consistency in the future use of resilience in ageing.

The Influence of Life Experiences on the Development of Resilience in Older People With Co-morbid Health Problems

Background: Co-morbidity is a major late-life challenge with poor outcomes, yet many older people are resilient. We consider an ecopsychosocial framework of resilience to investigate this disparity. This theorises that sources of resilience may be personal, social and structural. We explored older people's responses and reactions to significant life experiences, to understand resilience development for managing later life health challenges.

Methods: We applied a two-stage, cross-sectional mixed-methods design to the Cognitive Function and Ageing Studies Wales (CFAS Wales). Participants' defined quantitatively as resilient (high level of well-being despite co-morbidity) were identified in the wave 1 dataset. A sub-sample of the resilient participants aged 65+ were randomly selected for semi-structured interviews (N = 20). Qualitative thematic analyses were both inductive and deductive.

Results: The analyses revealed four primary life experiences reflecting different developmental trajectories. “Early years as formative” and “work and employment as formative” occurred at normative developmental stages in the life-course. In contrast non-normative life events such as loss, bereavement, illness of self, and others underpinned the themes of “adverse events and experiences” and “caring experiences.” Four potential mechanisms for resilience were central to these life experiences, reflecting reactions, actions, and development: “character and self-identity;” “approach to life and insight;” “meaningful relationships and belonging.”

Conclusions: This work contributes further theoretical insights into the ecopsychosocial resilience framework. It highlights the process of interdependence between the individual and the wider environment, suggesting how the availability and accessibility of resources and human agency (protective factors), can influence, and be influenced by, the timing of significant events and experiences. In doing so, it corroborates international healthy ageing policy which recognises resilience as important for a public health response to support older people to adjust to changes and losses experienced in later life. It highlights the importance of current and future policies and services for supporting the management of adverse events earlier in the life-course, and recommends that policies and services take a “long view” on population health and well-being and consider the whole life-course, in addition to specific points in the ageing process.

Validation of the Polish version of the Brief Resilience Scale (BRS)

Background

We conducted three studies to validate the Polish version of the BRS. Our objectives are as follows: first, to explore the dimensional structure of the scale and to determine the internal consistency (study 1: n = 1022); second, to determine the congruent and divergent validity of the BRS (study 2: n = 242); and third, to examine sensitivity of the BRS scale to detect high-risk population (study 3: n = 602).

Methods

To explore the dimensional structure of the scale, we tested a two-factor model with one factor for positively worded items and one factor for negatively worded items. To determine the congruent and divergent validity of the BRS, we analysed correlations among BRS and resilience, positive mental health, and with positive and negative religious coping. We used Student’s t-test to examine sensitivity of the BRS scale to detect a high-risk population.

Results

Based on the CFA, a bivariate model was confirmed for items positively and negatively formulated with a higher order factor, which indicates the homogeneity of the scale, similar to the analyses carried out for their language versions confirming this type of homogeneity of the scale. The internal compatibility assessment based on Cronbach’s Alpha and McDonald’s Omega is good (0.88). Our analyses intended to test convergent and divergent validity, and showed that the BRS results are significantly related to a questionnaire measuring similar constructions. Our validation studies also provided important diagnoses regarding BRS "sensitivity", indicating that groups with higher stress levels achieved lower BRS resilience results.

Conclusion

The results of our research indicate that the Polish version of the BRS should be considered to be a reliable and valid research tool. The Polish version of BRS is a reliable and accurate way of measuring resilience as the ability to bounce back from adversity and overcome various challenges or stressors. This scale may be used for both research and intervention purposes.

The impact of caregiving on the health status of regional carers in Australia: Findings from a mixed-method study

While it is known that informal carers provide the majority of caregiving in Australia, there remains limited understanding of the challenges that regional carers face in their caring role and the impact of the caregiving role on carer well-being.

OBJECTIVE

The aim of this study was to better understand the health status of caregivers as the person they care for was entering the National Disability Support Scheme.

DESIGN

This is a mixed-methods study.

SETTING

The study was undertaken in regional New South Wales, Australia.

PARTICIPANTS

Seventy-five carers were enrolled into the study. All lived in regional New South Wales.

MAIN OUTCOME MEASURE

The World Health Organization Well-being Index was used for quantitative data collection, and semi-structured interviews were undertaken for the collection of qualitative data.

RESULT

Quantitative data indicated that carers from Aboriginal or Torres Strait Islander backgrounds and those from low socio-economic status had significantly lower scores on the well-being index. Two key qualitative categories were evident describing carer's journey to resilience by (a) adjusting to reality predominantly through cognitive reframing strategies and (b) carers accessing external supports.

CONCLUSION

The health status of regional carers who are predominantly women is experiencing low levels of well-being. While many of these carers have initiated successful coping responses to the challenges of caring, there is an urgent need to increase the supports available to this population. As the recent National Disability Support Scheme is embedded, it is of importance to monitor if there are improvements in the health status of carers over time.

Shared Experiences of Resilience Amongst Couples Where One Partner Is Living With Dementia-A Grounded Theory Study

Resilience is a concept which may help explain how older people are able to live well with dementia. Existing resilience research in dementia focuses on the caregiver and relatively little is known about how dyads (person with dementia and care partner) experience resilience. Using constructivist grounded theory, this qualitative study aimed to develop a theory of shared resilience amongst couples where one partner is living with dementia. Interviews were conducted with 12 dyads (n = 24) to explore their shared understanding of resilience, what helps to develop and maintain their resilience and how resilience shapes their relationship and mutual well-being. Findings indicate that resilience was experienced as continuing with a "normal" life as a couple notwithstanding the impact of dementia. This is in contrast to models of resilience which emphasize bouncing back or flourishing in the face of adversity. Instead, couples described a shared resilience that enabled them to maintain their couplehood, a sense of togetherness and reciprocity in their relationship, which in turn provided a further source of resilience. Findings emphasize the importance of dyadic research in developing a clearer understanding of the experience of living well with dementia. Interventions aimed at building resilience should engage dyads to consider how the couple's shared resilience can be maintained and enhanced.

Resilience in older people living with dementia - A narrative analysis

Dominant discourses surrounding dementia tend to focus on narratives of loss and decline. Simultaneously, individuals living with dementia are vulnerable to being dispossessed of personal narratives supportive of identity and well-being. How older people with dementia story their experiences of resilience in this context has not previously been investigated. In response, this qualitative study utilised a narrative approach to understand lived experiences of resilience shared by eight older people living with dementia. Structural analyses indicated that participants' personal narratives regarding resilience in living with dementia contained distinct and common phases (The Diagnosis, Initial Tasks, 'The High Point', Reflecting on Limitations and Focusing on Today) as well as a variety of dynamic characters. Overarching themes within participants' narratives included sense of self/identity, being connected to others, sense of agency and having positive attitudes. Participants narrated richer, more active personal stories than those typically represented in dominant social discourses surrounding dementia. As such, their narratives depict lived experiences of resilience that unfolded over time in response to adversity and uncertainty and involved a dialectical process in relation to adjustment and well-being. The findings have important implications for the way resilience in living with dementia is framed and supported.

Fostering the Resilience of People With Dementia: A Narrative Literature Review

Background: Resilience is a process through which people use resources to adapt to adversity. Interventions aiming to support resilience in people with dementia have been developed. However, the optimal content, structure and impact of these interventions is unclear. This literature review explores the factors through which interventions foster resilience in people with dementia and examines their efficacy.

Methods: Eight databases were searched systematically, for literature published from 2000 to 2019. Following the removal of duplicate articles, the titles and abstracts of 6,749 articles were screened. Articles were selected if they: reported empirical studies in English; focused on resilience; involved people with dementia and psychosocial interventions. The full text of 53 articles were examined and three studies, reported in six papers, were included in the final review. Data were systematically extracted, and two authors critiqued the studies using the Critical Appraisal Skills Programme check lists. The studies were examined to determine how resilience was defined and operationalized and their findings were synthesized using the theoretical resilience framework.

Results: Five interventions aiming to foster resilience were identified: Dementia Advisors; Peer Support Network Services; Visual Arts Enrichment Activities; Memory Makers; and Early-Stage and Beyond Community Activities. All studies defined resilience as a process and most involved people with mild dementia who had family carers. The interventions impacted resilience by reducing the adversity of stigma and social isolation; increasing personal and social resources, providing stigma-free space and reciprocal support. Interventions empowered people with dementia, increasing their self-esteem and self-worth. Resilience can be fostered both during, and after interventions. However, the efficacy of interventions could not be determined because the research designs utilized did not measure efficacy.

Conclusions: Interventions need facilitators to ensure they are strength-based, person-centered and they enable reciprocal social interactions. Future research needs to develop interventions that aim to foster the resilience of people with dementia who lack family carers and/or have more advanced dementia through meaningful activities that are identified by people with dementia as important to their resilience. Robust methodologies, including randomized controlled trials should be used to measure effectiveness and explore the impact of interventions regarding the: interplay between individual and community resources; the importance of reciprocity; and temporal aspects of resilience.

Psychosocial Interventions for Family Carers of People With Dementia: A Systematic Review and Meta-Analysis

Objective:This study aimed to review and synthesize findings of the effectiveness of psychosocial interventions aimed at improving outcomes for family carers of people with dementia. Method: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the following databases: Cochrane, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Excerpta Medica Database (EMBASE), and Applied Social Sciences Index and Abstracts (ASSIA). RevMan 5 software was used to conduct meta-analysis and subgroup analysis using a random-effects model. Results: The search yielded 22 high-quality intervention articles that were suitable for further meta-analysis. Meta-analysis revealed that psychosocial interventions have a small to moderate significant effect on carer burden (standardized mean difference [SMD] = −0.34, confidence interval [CI] = [−0.59, −0.09]), depression (SMD = −0.36, CI = [−0.60, −0.13]), and general health (SMD = 0.34, CI = [0.18, 0.51]). Discussion: Psychosocial interventions had a positive impact on carer outcomes; however, these results should be interpreted with caution, given the significant level of heterogeneity in study designs. Future research could examine contextual and implementation mechanisms underlying psychosocial interventions to develop effective support systems for family carers of people with dementia.

Transition Experiences of Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: An Interpretive Description Study

INTRODUCTION

Family caregivers provide most of the care for older persons living with dementia (PLWD) and multiple chronic conditions (MCCs) in the community. Caregivers experience transitions, such as changes to their health, roles, and responsibilities, during the process of caring. Transitions encompass a time when caregivers undergo stressful responses to change. However, we know little about the transition experiences of caregivers of persons living with both dementia and MCCs.

OBJECTIVE

This qualitative study explored the transition experiences of caregivers of PLWD within the context of MCCs, from the perspective of both caregivers and practitioners. The research question was the following: What are the transition experiences of family caregivers in providing care to older PLWD and MCCs living in the community?

METHODS

This study was conducted using an interpretive description approach. Semistructured interviews were conducted with 19 caregivers of older community-dwelling PLWD and MCCs and 7 health-care providers working with caregivers in Ontario, Canada. Concurrent data collection and inductive data analysis were used.

RESULTS

Caregivers of older PLWD and MCCs experienced four key transitions: (a) taking on responsibility for managing multiple complex conditions, (b) my health is getting worse, (c) caregiving now defines my social life, and (d) expecting that things will change. Findings highlight how the coexistence of MCCs with dementia complicates caregiver transitions and the importance of social networks for facilitating transitions.

CONCLUSION

The study provided insight on the transition experiences of caregivers of older PLWD and MCCs. MCCs increased the care load and further complicated caregivers' transition experiences. Health-care providers, such as nurses, can play important roles in supporting caregivers during these transitions and engage them as partners in care.

The Specialized Early Care for Alzheimer's method of caring for people with dementia: an investigation of what works and how

BACKGROUND AND RATIONALE

SPECAL is a model of care for people with dementia based on a novel conceptualisation of memory and how this changes in dementia. Carers adapt their communication style to prevent distress and promote well-being for the person with dementia. However, there is limited scientific evidence on the effectiveness of SPECAL.

AIM

This study explored mechanisms of SPECAL through a qualitative enquiry with family carers.

METHOD

Semi-structured interviews were conducted with family carers who had been coached in SPECAL and applied its principles and practices. Thematic analysis was applied.

FINDINGS

All participants had found SPECAL helpful in caring for a person with dementia. The core themes of this positive experience were empathy, harmony and resilience. Synthesis of these themes contributes to a proposed model of the mechanisms of SPECAL.

CONCLUSION

In applying SPECAL, carers gained an empathetic insight to the feelings of the person with dementia. This empathy leads to a more harmonious environment, which enhances the carer's resilience.

How does carer resilience change over time and care status? A qualitative longitudinal study

Objectives: Little research examines trajectories of carer resilience or the factors that facilitate or hinder resilience over time. We use qualitative longitudinal methods to examine trajectories of resilience and which assets and resources are associated with resilience and care status transitions in spousal dementia carers. Method: Based on an original sample of 23 spousal dementia carers (Donnellan, Bennett, & Soulsby, 2015 ), we conducted 13 follow-up interviews, including: 5 continuing home carers, 3 former carers (institutionalised), and 5 former carers (widowed). Results: Five participants remained resilient (stable resilient), three remained non-resilient (stable non-resilient) and four participants became resilient (non-resilient to resilient). Only one participant became non-resilient (resilient to non-resilient). Stable resilience was characterised by continuing individual assets and community resources. Carers who became resilient returned to previous resources, or gained new resources. Conclusion: Institutionalisation and widowhood are not always barriers to resilience; spousal dementia carers can remain or even become resilient over time despite deteriorating health, institutionalisation, or death of the care recipient.

Qualitative exploration of emotional and social changes from diagnosis to bereavement for spousal caregivers of persons with dementia

OBJECTIVES

To understand how bereaved spousal caregivers of persons with dementia perceive and respond to changes over the course of their spouse's disease, from diagnosis into bereavement.

DESIGN

Qualitative interview study with convenience sampling and thematic analysis approach.

PARTICIPANTS

Participants included eight women and two men (n=10) who had been spousal caregivers for a person with dementia prior to his/her death. Participants were older adults who self-reported good health and were bereaved longer than a year.

SETTING

Data collected in a small Canadian prairie city between fall 2014 and winter 2015.

FINDINGS

Two overarching themes were developed as important components of participants' caregiving journey: emotional reactions to change and variation in social connectedness throughout the caregiving and bereavement journey. Four key sub-themes developed through the analysis of emotional reactions to events: memorable grief overshadows persistent grief, a progressive feeling of hopelessness and overwhelmed, relief is common but hidden and gratitude is a milestone in a constructive bereavement. Three key variations of social connectedness throughout the caregiving and bereavement journey were developed: the importance of social inclusion throughout a caregiving and bereavement journey, the repeated loss of companionship and withdrawing from social interactions is contingent on needs.

CONCLUSIONS

The findings suggest that emotional changes throughout caregiving and bereavement are not linear. The need for support from family, friends and new social supports is influential in enabling the caregiver to move forward during caregiving and bereavement.

Exploring dimensions of social support and resilience when providing care at the end of life: a qualitative study

Background: Research shows that formal and informal social support can facilitate resilience in carers. There is a paucity of research exploring social support and resilience amongst recently bereaved informal carers. Aim: To examine how the presence or absence of distinct dimensions of social support facilitate or hinder resilience in recently bereaved informal carers. Participants: 44 bereaved carers, who had been identified by GP as 'main carer' of someone recently deceased (3-12 months), aged between 38 and 87 years old (mean= 67). Methods: Thematic analysis then the Ecological Framework of Resilience as an organisational tool to develop overarching themes in the data. We used the Sherbourne and Stewart model to identify social support that was lacking as well as social support that was present. Results: A range of social support types were identified. There was an emphasis on the importance of relationships with both health professionals and family members, including the care recipient. However, social support was not necessary for resilience if the participant had other resources. Conclusions: Social support for carers providing end of life care is almost exclusively based around end of life care 'work'. In comparison to other research our study suggests that relationships with family and health professionals are paramount. Multidimensional support is needed for carers to enhance their resilience.