Measuring familism in dementia family caregivers: the revised familism scale

Look on the bright side: the relation between family values, positive aspects of care and caregiver burden

Family-centered values are important for caregiving. However, findings on their association with burden are inconsistent. We aim to analyze whether positive aspects of caregiving are mediating the effect of familism on burden among informal caregivers of older adults in Germany. Participants (n = 277) were drawn from the Attitudes Toward Informal Caregivers (ATTIC) project and include informal long-term caregivers of older relatives (aged ≥ 60) quota-sampled from Germany (December 2023). Mediation analyses (linear OLS regression) with robust standard errors were conducted with the classic and the counterfactual causal mediation framework. The classic approach indicated a significant positive direct effect of familism on burden, a significant negative direct effect of PAC on burden and a significant negative indirect effect of familism via PAC on burden; the total effect was not significant. The causal mediation approach supports this; the interaction between familism and PAC was not significant. Thus, sociocultural family-centered values seemed to worsen burden but also to reduce it through positive experiences of caregiving, which did not depend on the strength of familism values. The findings advance our understanding of the mechanisms underlying the stress appraisal of the informal care situation and emphasize the role of positive experiences of care.

Profiles of Dementia Caregivers according to Psychosocial and Resource Variables. Importance of Kinship

The present study aims to analyze the existence of different profiles in family caregivers of people with dementia according to psychosocial and resource variables. In addition, it aims to study whether there is a greater representation of each kinship group in each of the profiles and if there are differences in emotional distress among such profiles considering the kinship with the care-recipient. Participants were 288 family dementia caregivers, divided into four kinship groups (wives, husbands, sons and daughters). Psychosocial (familism, dysfunctional thoughts and experiential avoidance), resource (leisure activities and social support) and outcomes (depressive, anxious and guilt symptomatology) variables were collected. A hierarchical cluster analysis using Ward's method, an exploratory factor analysis of two fixed factors and contingency tables were performed. Five clusters were obtained: Low psychosocial vulnerability-High resources, Low psychosocial vulnerability-Low resources, Mixed, High psychosocial vulnerability-High resources, and High psychosocial vulnerability-Low resources. Results suggested that clusters associated with lower distress were the Low psychosocial vulnerability-High resources and the High psychosocial vulnerability-High resources. Clusters associated with higher distress were the Low psychosocial vulnerability-Low resources and Mixed. High levels of dysfunctional thoughts, familism and experiential avoidance do not always have a maladaptive function. This could depend on sociocultural and resource variables such as the kinship with the caregiver or perceived social support. The identification of profiles of family caregivers potentially needing protection and vulnerable to psychological distress could help to increase the effectiveness of interventions aimed at this population.

Cross-country variations in the caregiver role: evidence from the ENTWINE-iCohort study

BACKGROUND

Globally, economically developed countries face similar ageing demographics and the challenge of a 'care gap', yet they vary due to different care and formal support systems, and different cultural and societal norms around illness and care. The aim of this exploratory study was to examine cross-country variations in caregiver motivations, willingness, values, meaning in life, illness beliefs, and experiences of wellbeing, gain, health-related quality of life, burden and depression, across 6 European countries and Israel. Cross-country differences in the above-mentioned informal caregiver experiences are rarely described.

METHODS

An online survey (ENTWINE-iCohort) was conducted using validated measures wherever possible. This paper utilises data from 879 caregivers and seven countries (Greece, Italy, the Netherlands, Poland, Sweden, the UK, and Israel).

RESULTS

No consistent finding supporting the concurrent relationship between caregiver support policies/country culture and caregiver motivations/willingness was found. Caregivers in countries typically characterised by individualist cultures reported lower familism, higher self-enhancement values, and greater perceived illness threat compared to more collectivist countries. Search for meaning was higher in poorer countries than in wealthier countries. Higher negative caregiver experiences (e.g., burden) and lower positive experiences (e.g., wellbeing) were generally observed in countries with underdeveloped caregiver support as compared to countries with more developed formal support systems.

CONCLUSIONS

Cross-country variations can be explained to varying degrees by national policies around care (or their absence) and country cultural contexts. The results emphasise the importance of formal support services for achieving positive caregiver experiences, and help inform the development of policies and measures to support caregivers in Europe and Israel.

Cohort profile: The ENTWINE iCohort study, a multinational longitudinal web-based study of informal care

Informal care is a key pillar of long-term care provision across Europe and will likely play an even greater role in the future. Thus, research that enhances our understanding of caregiving experiences becomes increasingly relevant. The ENTWINE iCohort Study examines the personal, psychological, social, economic, and geographic factors that shape caregiving experiences. Here, we present the baseline cohort of the study and describe its design, recruitment methods, data collection procedures, measures, and early baseline findings. The study was conducted in nine countries: Germany, Greece, Ireland, Israel, Italy, the Netherlands, Poland, Sweden, and the United Kingdom. The study comprised a web-based longitudinal survey (baseline + 6-month follow-up) and optional weekly diary assessments conducted separately with caregivers and care recipients. From 14 August 2020 to 31 August 2021, 1872 caregivers and 402 care recipients were enrolled at baseline. Participants were recruited via Facebook and, to a lesser extent, via the study website or caregiver/patient organisations. Caregiver participants were predominantly female (87%) and primary caregivers (82%), with a median age of 55 years. A large proportion (80%) held at least post-secondary education, and two-thirds were married/partnered. Over half of the caregivers were employed (53%) and caring for a person with multiple chronic conditions (56%), and nearly three-quarters were caring for either a parent (42%) or a spouse/partner (32%). About three-quarters of care recipient participants were female (77%), not employed (74%), and had at least post-secondary education (77%), with a median age of 55 years. Over half of the care recipients were married/partnered (59%), receiving care primarily from their spouses/partners (61%), and diagnosed with multiple chronic conditions (57%). This study examining numerous potential influences on caregiving experiences provides an opportunity to better understand the multidimensional nature of these experiences. Such data could have implications for developing caregiving services and policies, and for future informal care research.

Sociocultural factors, guilt and depression in family caregivers of people with dementia. Kinship differences

OBJECTIVES

This study aims to analyze the role that family obligations and social desirability have for understanding guilt and depressive symptoms in family caregivers. A theoretical model is proposed to analyze this significance based on the kinship with the person cared for.

METHODS

Participants are 284 family caregivers of people with dementia divided into four kinship groups (husbands, wives, daughters and sons). Face-to-face interviews were conducted assessing sociodemographic variables, familism (family obligations), dysfunctional thoughts, social desirability, frequency and discomfort associated with problematic behaviors, guilt and depressive symptoms. Path analyses are performed to analyze the fit of the proposed model and multigroup analysis to study potential differences between kinship groups.

RESULTS

The proposed model fits the data well and explains significant percentages of variance of guilt feelings and depressive symptomatology for each group. The multigroup analysis suggests that, for daughters, higher family obligations were associated with depressive symptomatology through a report of higher dysfunctional thoughts. For daughters and wives, an indirect association between social desirability and guilt was observed through reaction to problematic behaviors.

CONCLUSION

The results support the need to consider the significance of sociocultural aspects such as family obligations and the desirability bias in the design and implementation of interventions for caregivers, especially for daughters. Considering that the variables that contribute to explaining caregivers' distress vary depending on the relationship with the person cared for, individualized interventions may be warranted depending on the kinship group.

Hospitalizations and Emergency Room Admissions by Mexican American Older Adults with and without Dementia and Caregiver Mental Health

BACKGROUND

Evidence from predominately non-Hispanic White populations indicates that emergency room (ER) admissions and hospitalizations by older adults with and without dementia are associated with caregiver stress and depressive symptoms. These results may not generalize to Hispanic populations because of cultural differences in caregiving roles, responsibilities, and perspectives about care burden.

OBJECTIVE

Investigate the association between ER admissions and hospitalizations by Mexican American older adults with and without dementia and symptoms of depression and stress among family caregivers.

METHODS

Data came from the 2010/11 wave of the Hispanic Established Populations for the Epidemiologic Study of the Elderly and Medicare claims files. The final sample included 326 older adults and their caregivers. Negative binomial regression was used to model the association between hospitalizations and ER admissions by older adults in the previous two years and caregivers' depressive symptoms and stress in 2010/11.

RESULTS

The number of older adult ER admissions and hospitalizations was not associated with caregiver depressive symptoms. Two or more ER admissions (incident rate ratio [IRR] = 1.26, 95% CI = 1.05-1.51) and two or more hospitalizations (IRR = 1.32, 95% CI = 1.07-1.61) were associated with significantly higher caregiver stress. Additionally, ER admissions and hospitalizations for a circulatory disease or injury and poisoning were associated with significantly higher caregiver stress. These associations were not modified by the care recipient's dementia status.

CONCLUSION

Hospitalizations and ER admissions by older Mexican Americans were associated with greater caregiver stress but not depressive symptoms. These associations were similar for caregivers to older adults with and without dementia.

Hispanic Caregivers of the Money Follows the Person Program in Connecticut: Satisfaction, Familism, and Burden

Hispanic caregivers provide more assistance than the U.S. average, but underutilize support services and report low levels of program satisfaction. A possible exception is the Money Follows the Person (MFP) program. Using an ordered logit statistical approach, we studied program satisfaction of all Hispanic caregivers assisting Connecticut MFP participants from 2014 to 2019, examining the effects of caregiver familism, burden, and personal characteristics including self-reported health and perceived financial situation. Healthier caregivers with positive perceptions of MFP’s usefulness and lower subjective burden reported higher program satisfaction. In ordered logits for separate blocks, familism elements (finding caregiving worthwhile, feeling well-supported as a caregiver, and having a good relationship with the care recipient) were statistically significant and associated with higher satisfaction. Our exclusive focus on Hispanic caregivers highlights the role of familism in satisfaction, and demonstrates that programs with a supportive caregiver component can supplement familism ties and overcome barriers to service usage.

Association between familism and mental health in dementia caregivers: a systematic review and meta-analysis

BACKGROUND

Dementia caregivers suffer from mental health problems while caring for dementia patients. As a core value, familism has been linked to the mental health of dementia caregivers. This study aims to systematically review the familism of dementia caregivers and to examine the association between familism and mental health of anxiety, depression, and burden in empirical research studies.

METHODS

We conducted a systematic search in various databases like Medline, PubMed, and Embase databases from inception till April 2021. Fisher's z was calculated with correlation coefficient or regression coefficient values for three familism dimensions and mental health of anxiety, depression, and burden. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 2.0 software.

RESULTS

A total of seven studies with 1178 participants were eligible for the meta-analysis. For caregivers' anxiety, three of seven studies, with 358 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that dementia caregivers' familism was significantly related to anxiety. The pooled z-value was 0.148 (95% CI = 0.043-0.253). In addition, caregivers' familism significantly affected depression (z = 0.080; 95% CI = 0.003-0.156), as did familial obligation (z = 0.122; 95% CI = 0.034-0.211), but perceived family support was not associated with this (z = 0.051, 95% CI = -0.038-0.140). As for caregiver burden, there was no evidence that familism was significantly associated with it (z = -0.073; 95% CI = -0.297 to 0.151), including familial obligation and perceived family support (z = -0.087 and -0.089, respectively; 95% CI = -0.278 to 0.104 and -0.335 to 0.157, respectively).

CONCLUSIONS

An association between caregiver familism and anxiety/depression exists in dementia patients. More research is needed to explore the relationship between familism and burden.

Dementia Family Caregiving in Rural Appalachia: A Sociocultural Model of Care Decisions and Service Use

OBJECTIVES

Examinations of cultural variations in caregiving experiences and practices tend to focus on racially and ethnically diverse family caregivers. We extended this research by exploring the role of place-based cultural constructs on care decisions of family caregivers for persons living with dementia in rural Appalachia whose experiences and backgrounds dwell outside the lines of dominant culture.

METHODS

Guided by our sociocultural conceptual model of service use and a descriptive qualitative study design, we conducted in-depth interviews with 30 caregivers for persons living with dementia to understand how predisposing and enabling factors influence caregiving decisions, including the use of services to care for persons living with dementia.

RESULTS

Three predisposing factors reflecting the culture of rural Appalachian counties in Virginia (reasons for becoming a caregiver, previous caregiving experience, and deference to the person living with dementia) shaped decisions about caregiving responsibilities and service use. Three place-based enabling factors (a personal sense of belonging, knowledge of services, and family support for service use) played an important role in facilitating access to services.

DISCUSSION

Findings revealed subtle variation across caregivers in this study and in comparison, to caregivers' experiences more generally. We interpret these variations in light of culturally influenced attitudes, family norms, and sources of information about formal services. Place-based cultural experience influenced dementia family caregivers' behaviors and choices regarding formal service use, suggesting that investigators should pay more attention to cultural influences in future caregiving research.

Family caregivers of people with dementia in the context of the sociocultural stress and coping model: An examination of gender differences

The study assessed gender differences in the associations between familism dimensions, dysfunctional thoughts, and resource and outcome variables in 190 Spanish dementia family caregivers. A theoretical model was tested through path analysis, obtaining an excellent fit of the model to the data. Higher scores in the familial obligations dimension were associated with lower self-efficacy for self-care and obtaining respite and leisure frequency, and higher anxious and depressive feelings, in female caregivers only. Significant between-gender differences were obtained, suggesting that female caregivers holding strong familistic values are more vulnerable to the negative consequences of caregiving compared to male caregivers.

A Multinational Longitudinal Study Incorporating Intensive Methods to Examine Caregiver Experiences in the Context of Chronic Health Conditions: Protocol of the ENTWINE-iCohort

Informal caregivers are those who provide unpaid care to a relative or friend with a chronic illness, disability or other long-lasting health or care need. Providing informal care in the context of chronic health conditions presents a significant global challenge. Examination of the determinants of informal caregivers' behaviour, especially in terms of motivations and willingness to provide/receive care, is crucial to understanding the nature of caregiver and care recipient experiences. A large group of international researchers have co-operated to execute the ENTWINE iCohort-a multinational, transdisciplinary, longitudinal study incorporating intensive methods to examine caregiver experiences in the context of chronic health conditions. The aim of ENTWINE-iCohort is to investigate the broad spectrum of factors, i.e., cultural, personal, geographical, relational, psychological, and economic that may affect motivations, willingness to provide or receive care, among diverse groups of informal caregivers and their care recipients, in different countries that have different care systems. Study questionnaires will be disseminated on-line in nine countries: Germany, Greece, Ireland, Italy, Israel, the Netherlands, Poland, Sweden, and the UK. Cross-sectional and longitudinal multivariate analysis, including intensive longitudinal and dyadic data analysis will be applied to examine the relative contribution of the above factors to caregiver or care recipient wellbeing.

Family Dynamics in Dementia Caregiving: Development and Validation of the Interpersonal Triggers of Guilt in Dementia Caregiving Questionnaire (ITGDCQ)

The objective was to develop the Interpersonal Triggers of Guilt in Dementia Caregiving Questionnaire (ITGDCQ). An emotion frequently experienced by caregivers is guilt. However, the studies analyzing potential factors that generate guilt are scarce. Guilt may be generated through interpersonal interactions. A total of 201 dementia caregivers were evaluated for frequency of leisure, guilt, anxiety, depression, and a pool of items measuring the frequency, and guilt was derived from different behaviors performed by the care recipient (ITGDCQ-CR) and other relatives (ITGDCQ-OR). Exploratory factor analysis of the ITGDCQ-CR showed a two-factor solution, explaining 56.24% of the variance. The ITGDCQ-OR subscale also showed two factors, explaining 63.24% of the variance. All the factors had acceptable to good reliability indexes. Positive associations were found between both subscales and depression, anxiety, guilt, and stress associated with CR's behavioral problems. ITGDCQ-CR was negatively correlated with frequency of leisure. The interpersonal dynamics assessed with the ITGDCQ generated other emotions such as anger or sadness. Through structural equation modeling, 28% of the variance of caregivers' distress was explained by the assessed variables, including a significant contribution of the interpersonal dynamics assessed with the ITGDCQ. The results provide preliminary support for the use of the ITGDCQ as a valid and reliable measure of care recipients' or other relatives' factors that trigger or facilitate the experience of guilt in the caregivers. The association between these factors and caregiver distress suggests potential clinical implications for the findings.

Personal values profiles in dementia family caregivers: their association with ambivalent feelings and anxious and depressive symptoms

OBJECTIVE

Culture-related variables, such as personal values, have been suggested as important in stress processes, such as family caregiving of people with dementia. Personal values may be categorized into two dimensions: family and own personal values. Drawing upon the Sociocultural Stress and Coping model, the objective of this study is to analyze differences between caregivers depending on their values profiles.

METHOD

Participants were 333 family caregivers of a spouse or a parent with dementia. Caregivers chose their two most important values, apart from caregiving, from a list of eight family-related and non-family-related values (own values). Therefore, three values profiles were possible: Family-values profile (FVP: the two values are family related), Mixed-values profile (MVP: one family related value and one own value), and Own-values profile (OVP: two own values were selected). In addition to values, sociodemographic variables, commitment and satisfaction with caregiving value and with chosen values, ambivalent feelings, and anxiety and depression symptomatology were assessed. ANOVA analyses were conducted.

RESULTS

The analyses suggest that caregivers in the FVP had lower levels of anxiety and ambivalent feelings and a higher commitment to and satisfaction with their chosen values than the other profiles. No differences were found for commitment and satisfaction with the caregiving value.

CONCLUSION

Caregivers' value profiles seem to play an important role in the effects of stress over psychological health. Possible explanations of these effects about potential role conflicts and a higher commitment to values are discussed.

Sociocultural Influences on the Feeling of Loneliness of Family Caregivers of People with Dementia: The Role of Kinship

The extent to which familism, dysfunctional thoughts, and coping variables contribute to explaining feelings of loneliness in caregivers, controlling for kinship, is analyzed. Participants were 273 family caregivers of people with dementia. Sociodemographic variables, familism, dysfunctional thoughts, coping strategies for requesting and receiving help, perceived social support, and leisure activities were assessed. The fit of a theoretical model for explaining the effect of cultural and psychological variables on feelings of loneliness in each kinship group was tested. No significant differences in the distribution of loneliness by kinship were found. Higher levels of familism are associated with more dysfunctional thoughts, that are linked to more maladaptive strategies for coping with caring (e.g., less social support and fewer leisure activities). This in turn is associated with higher scores in the feeling of loneliness. The model bore particular relevance to the group of daughters, husbands, and sons, yet not in the case of wives. Sociocultural and coping factors associated with the caring process seem to play an important role in explaining feelings of loneliness in caregivers. Sociocultural factors associated with the care process seem to play an important role in explaining feelings of loneliness in caregivers.