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Conroy S, Thomas M. Urgent care for older people. Age Ageing 2022; 51:6146885. [PMID: 33620421 DOI: 10.1093/ageing/afab019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Geriatric medicine is the clinical specialty that focuses upon the care of older people-especially those with frailty (a state of increased vulnerability). In hospital, older people living with frailty are at high risk of developing a range of unpleasant outcomes such as delirium, falls, fractures, pressure sores and death. Comprehensive geriatric assessment is a form of holistic care that incorporates a specific set of clinical competencies that are able to reduce these adverse outcomes. Over the years, geriatric medicine has moved from being more of a community-based service towards a more acute specialty-encroaching now upon emergency department care. The challenge now is to work out how best to deliver geriatric care across the whole hospital (older people with frailty are not just cared for in geriatric wards!). The themed collection published on the Age & Ageing journal website outlines key articles that are attempting to develop solutions to this challenging conundrum. We hope that you enjoy reading them.
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Affiliation(s)
- Simon Conroy
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Matt Thomas
- Department of Medicine for Older People, Poole Hospital, Poole BH15 2JB, UK
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Cejalvo E, Martí-Vilar M, Merino-Soto C, Aguirre-Morales MT. Caregiving Role and Psychosocial and Individual Factors: A Systematic Review. Healthcare (Basel) 2021; 9:1690. [PMID: 34946416 PMCID: PMC8700856 DOI: 10.3390/healthcare9121690] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Taking care of a person with a physical disability can become a challenge for caregivers as they must combine the task of caring with their personal and daily needs. The aim of this study was to assess the impact that taking care of a person who needs support has on caregivers and to analyze certain characteristics they present, such as self-esteem and resilience. To that end, a bibliographic review was carried out from 1985, when the first article of taking care of a person who needs support was published, to 2020 (inclusive), in the databases of Web of Science (WoS), Scopus, Pubmed, Eric, Psycinfo, and Embase. The search yielded a total of (n = 37) articles subject to review, following the guidelines established in the PRISMA declaration. The results show that caregiving was highly overburdening and negatively affected the physical condition and the psychological and mental states of caregivers. In addition, certain psychological characteristics present in caregivers such as having high self-esteem and being resilient were found to act as protective factors against the caregiving burden.
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Affiliation(s)
- Elena Cejalvo
- Department of Basic Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain;
| | - Manuel Martí-Vilar
- Department of Basic Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain;
| | - César Merino-Soto
- Psychology Research Institute, Universidad de San Martín de Porres, Lima 34, Peru
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Non-pharmacological Interventions for Caregivers with Depression and Caregivers of Care Recipients with Co-morbid Depression: Systematic Review and Meta-analysis. J Gen Intern Med 2021; 36:3159-3178. [PMID: 34159546 PMCID: PMC8481392 DOI: 10.1007/s11606-021-06891-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Caregivers experiencing depression or caring for people experiencing depression are at risk of high burden. This systematic review examined the effect of non-pharmacological interventions for caregivers that (a) target improving caregivers' depressive symptoms, (b) help caregivers manage the depressive symptoms of the person for whom they provide care, or (c) both (a) and (b). METHODS Eligible trials published between January 1, 1985, and May 30, 2019 were retrieved from five electronic databases. The studies' methodological quality was assessed against 15 criteria. Pooled effect sizes (ESs) were calculated, and heterogeneity assessed using the Higgin's I2 statistic. Meta-regressions were also conducted to identify significant moderators (participant sub-group analyses) and mediators (identify how the interventions worked). RESULTS Sixteen studies evaluating 18 interventions were included for review. These studies included a total of 2178 participants (mean = 94, SD = 129.18, range 25-518). The most common condition (n = 10/16) of the care recipient was dementia. The average methodological score was in the moderate range (8.76/15). Interventions had a moderate effect on caregivers' depression in the short term (ES = - 0.62, 95% CI - 0.81, - 0.44), but the effect dissipated over time (ES = - 0.19; 95% CI - 0.29, - 0.09). A similar pattern was noted for anxiety. The moderator analysis was not significant, and of the mediators examined, significant ones were self-management skills of taking action, problem solving, and decision-making. DISCUSSION Non-pharmacological interventions are associated with improvement of depression and anxiety in caregivers, particularly in the short term. The main recommendation for future interventions is to include the self-management skills taking action, problem-solving, and decision-making. Enhancing the effect of these interventions will need to be the focus of future studies, particularly examining the impact of booster sessions. More research is needed on non-dementia caregiving and dyadic approaches.
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Shah R, Ali FM, Finlay AY, Salek MS. Family reported outcomes, an unmet need in the management of a patient's disease: appraisal of the literature. Health Qual Life Outcomes 2021; 19:194. [PMID: 34353345 PMCID: PMC8339395 DOI: 10.1186/s12955-021-01819-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A person's chronic health condition or disability can have a huge impact on the quality of life (QoL) of the whole family, but this important impact is often ignored. This literature review aims to understand the impact of patients' disease on family members across all medical specialities, and appraise existing generic and disease-specific family quality of life (QoL) measures. METHODS The databases Medline, EMBASE, CINHAL, ASSIA, PsycINFO and Scopus were searched for original articles in English measuring the impact of health conditions on patients' family members/partner using a valid instrument. RESULTS Of 114 articles screened, 86 met the inclusion criteria. They explored the impact of a relative's disease on 14,661 family members, mostly 'parents' or 'mothers', using 50 different instruments across 18 specialities including neurology, oncology and dermatology, in 33 countries including the USA, China and Australia. These studies revealed a huge impact of patients' illness on family members. An appraisal of family QoL instruments identified 48 instruments, 42 disease/speciality specific and six generic measures. Five of the six generics are aimed at carers of children, people with disability or restricted to chronic disease. The only generic instrument that measures the impact of any condition on family members across all specialities is the Family Reported Outcome Measure (FROM-16). Although most instruments demonstrated good reliability and validity, only 11 reported responsiveness and only one reported the minimal clinically important difference. CONCLUSIONS Family members' QoL is greatly impacted by a relative's condition. To support family members, there is a need for a generic tool that offers flexibility and brevity for use in clinical settings across all areas of medicine. FROM-16 could be the tool of choice, provided its robustness is demonstrated with further validation of its psychometric properties.
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Affiliation(s)
- R. Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F. M. Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - A. Y. Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M. S. Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Institute of Medicines Development, Cardiff, UK
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Cohen SA, Mendez-Luck CA, Greaney ML, Azzoli AB, Cook SK, Sabik NJ. Differences in Caregiving Intensity Among Distinct Sociodemographic Subgroups of Informal Caregivers: Joint Effects of Race/Ethnicity, Gender, and Employment. J Gerontol Nurs 2021; 47:23-32. [PMID: 34191652 DOI: 10.3928/00989134-20210610-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
More than 40 million informal caregivers in the United States provide essential care to older adults. Recent research has identified substantial differences in caregiving intensity by gender, race/ethnicity, and employment status. Using intersectionality theory, the current study extends the existing literature by exploring the relationship between caregiving intensity and the unique experiences of individuals with different intersections of gender, ethnicity, and employment. We used generalized linear models to estimate multivariate associations between caregiving intensity assessed by three different measures (hours of caregiving per month and number of activities of daily living and instrumental activities of daily living [IADLs] assisted with) and the three sociodemographic factors of interest (race/ethnicity, gender, and employment status). Unemployed White males provided, on average, 77 fewer hours per month of care (p < 0.001) and assisted with 1.9 fewer IADLs (p = 0.004) than unemployed Black males. Employed White females provided 42.6 fewer hours per month of care (p = 0.002) than employed Black females and 49.2 fewer hours per month (p = 0.036) than employed females of other races. Study findings suggest that examining racial/ethnic or gender differences in isolation does not provide a true picture of differences in caregiving intensity. There is a critical need to understand how the intersections of race/ethnicity, gender, employment, and other sociodemographic factors shape the experiences of caregiver subgroups. [Journal of Gerontological Nursing, 47(7), 23-32.].
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Fortinsky RH. Reply to: Comment on: Family caregiver assessment in primary care: How to strengthen the healthcare triad? J Am Geriatr Soc 2021; 69:2363-2364. [PMID: 34019697 DOI: 10.1111/jgs.17277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Richard H Fortinsky
- UConn Center on Aging, Department of Medicine, and Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Amer Nordin A, Mohd Hairi F, Choo WY, Hairi NN. Care Recipient Multimorbidity and Health Impacts on Informal Caregivers: A Systematic Review. THE GERONTOLOGIST 2020; 59:e611-e628. [PMID: 29982539 DOI: 10.1093/geront/gny072] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Caregiving outcomes have often been reported in terms of care recipients of single disease, rather than multiple health conditions. A systematic review was conducted to outline caregiving health outcomes and its association with care recipient multimorbidity for informal caregivers of older adults. RESEARCH DESIGN AND METHODS A search strategy was applied in six databases and grey literature. Inclusion criteria were primary observational studies on informal caregiving for care recipients aged 60 years and above, in the English language. Informal caregivers were those not formally hired and multimorbidity referred to presence of at least two health conditions. From a total of 2,101 titles, 230 abstracts were screened, and 19 articles were included. Quality assessment was conducted with application of the Newcastle-Ottawa-Scale. RESULTS Health-related and caregiving-related outcomes have been assessed for informal caregivers of older adults with multimorbidity. Caregiver subjective burden was most commonly evaluated and often reported to be low to moderate. In association with care recipient multimorbidity, caregiver burden, quality of life, and perceived difficulty in assisting the older adults were examined in 14 of the studies with mixed results. Studies were heterogeneous, with nonuniform definitions of informal caregivers and multimorbidity as well as measurement tools. DISCUSSION AND IMPLICATIONS This narrative review found that caring for older adults with multimorbidity impacts caregivers, although overall evidence is not conclusive. Despite caregiving-related outcomes being most commonly assessed among the caregivers, particularly subjective burden, findings suggest that it is worthwhile to examine other outcomes to enrich the evidence base.
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Affiliation(s)
- Awatef Amer Nordin
- Department of Social and Preventive Medicine, Faculty of Medicine and Julius Centre University of Malaya (JCUM), University of Malaya, Kuala Lumpur, Malaysia
| | - Farizah Mohd Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine and Julius Centre University of Malaya (JCUM), University of Malaya, Kuala Lumpur, Malaysia.,Julius Centre University of Malaya (JCUM), University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Yuen Choo
- Department of Social and Preventive Medicine, Faculty of Medicine and Julius Centre University of Malaya (JCUM), University of Malaya, Kuala Lumpur, Malaysia.,Julius Centre University of Malaya (JCUM), University of Malaya, Kuala Lumpur, Malaysia
| | - Noran N Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine and Julius Centre University of Malaya (JCUM), University of Malaya, Kuala Lumpur, Malaysia.,Julius Centre University of Malaya (JCUM), University of Malaya, Kuala Lumpur, Malaysia
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McCusker J, Yaffe M, Lambert SD, Cole M, de Raad M, Belzile E, Ciampi A, Amir E, Hidalgo M. Unmet needs of family caregivers of hospitalized older adults preparing for discharge home. Chronic Illn 2020; 16:131-145. [PMID: 30079741 DOI: 10.1177/1742395318789467] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objectives To describe unmet needs of caregivers of hospitalized older adults during the transition from hospital back home, and identify subgroups with different needs. Methods Patients and family caregivers were recruited from an acute care hospital in Montreal, Canada. Measures included Instrumental Activities of Daily Living (IADL), Hospital Anxiety and Depression Scale (HADS), Zarit burden scale, and Family Inventory of Needs. Dimensions of unmet needs were explored with principal component analysis; regression tree models were used to identify subgroups with different unmet needs. Results A total of 146 patient-caregiver dyads were recruited. Three categories of caregiver unmet needs were identified: patient medical information; role clarity and support; and reassurance. Caregiver subgroups with highest unmet needs were those with high burden of care plus depressive symptoms ( n = 46) and those caring for patients with low IADL scores ( n = 10). Discussion Caregivers with high burden and depression are those with the greatest unmet needs during the care transition.
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Affiliation(s)
- Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,St. Mary's Research Centre, Montreal, Québec, Canada
| | - Mark Yaffe
- St. Mary's Research Centre, Montreal, Québec, Canada.,Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Family Medicine Centre, St. Mary's Hospital Centre, Montreal, Quebec, Canada
| | - Sylvie D Lambert
- St. Mary's Research Centre, Montreal, Québec, Canada.,Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Martin Cole
- St. Mary's Hospital Centre, Psychiatry, Montreal, Québec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Manon de Raad
- St. Mary's Research Centre, Montreal, Québec, Canada
| | - Eric Belzile
- St. Mary's Research Centre, Montreal, Québec, Canada
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,St. Mary's Research Centre, Montreal, Québec, Canada
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Cai Q, Sheehan JJ, Wu B, Alphs L, Connolly N, Benson C. Descriptive analysis of the economic burden of treatment resistance in a major depressive episode. Curr Med Res Opin 2020; 36:329-335. [PMID: 31540559 DOI: 10.1080/03007995.2019.1671087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives: To assess characteristics and healthcare costs associated with pharmacologically treated episodes of treatment-resistant depression (TRD) in patients with major depressive disorder (MDD).Methods: Patients aged ≥18 years with continuous health plan enrollment for ≥12 months before and after a newly observed MDD diagnosis (observed between 1 January 2010 and 31 December 2015) were included in this retrospective claims-based analysis. A pharmacologically treated episode was defined as beginning at the date of the first MDD diagnosis and ending when a gap of 180 days occurred between MDD diagnoses, or when a gap of 180 days occurred following the end of the antidepressant (AD)/antipsychotic (AP) drug supply. When such a gap occurred, the episode end date was determined to be either the date of the last MDD diagnosis or date of the end of AD/AP drug supply, whichever was later. An episode was considered TRD if ≥3 AD regimens occurred. Episode duration, medication regimens used, and relapse hospitalization were reported for TRD and non-TRD MDD episodes. Total all-cause and per-patient-per-month (PPPM) healthcare costs (in 2016 $) were estimated.Results: Of 48,440 patients identified with ≥1 AD-treated MDD episode, the mean (SD) age was 39 (15) years, and 62% were female. Of all episodes, 7% were TRD, with a mean duration of 571 (285) days vs. 200 (198) days for non-TRD MDD episodes. Mean total all-cause costs were $19,626 ($44,160) for TRD and $7440 ($25,150) for non-TRD MDD episodes.Conclusions: Results show TRD episodes are longer and costlier than non-TRD MDD episodes, and that higher costs are driven by episode duration. Longer episodes imply protracted suffering for patients with TRD and increased burden on caregivers. Effective intervention to shorten TRD episodes may lessen disease burden and reduce costs.
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Affiliation(s)
- Qian Cai
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | | | - Bingcao Wu
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | - Larry Alphs
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
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Wilkins VM, Sirey JA, Bruce ML. Caregiver Reward and Burden: Differing Constructs in Family Members Providing Care for Medically Ill Homebound Older Adults. J Aging Health 2019; 32:361-370. [DOI: 10.1177/0898264319825760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: This study examined the relationship between caregiver burden and reward and how each relates to factors, such as depression, within the caregiving dyad. Method: A total of 101 older adults and their primary family caregivers were recruited upon enrolling in home health care services. Patients were assessed for sociodemographic information, depression, disability, pain, and caregiver support at baseline and at 8 weeks. Caregivers were assessed at baseline for sociodemographic information, depression, caregiver burden, caregiver reward, and caregiving tasks they provide. Results: Burden and reward were significantly inversely correlated, but differentially associated with distinct patient and caregiver variables. Patients whose caregivers reported higher baseline levels of caregiver reward were more likely to have lower depression scores at follow-up. Discussion: Given that different aspects of patients and caregivers influence reward and burden, assessing caregivers for both burden and reward may better target caregiver interventions at the individual and family levels, particularly for older adult depression.
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Abstract
Objectif: Évaluation (faisabilité, acceptabilité, pertinence et bienfaits potentiels) d'une intervention de transition pour proches aidants. Méthode: L'intervention visait à fournir du soutien émotionnel, de l'information sur les ressources communautaires et du soutien au développement des capacités d'adaptation pour les proches aidants de patients de 65 ans et plus qui avaient reçu leur congé suite à une hospitalisation de courte durée. L'approche méthodologique a impliqué un seul groupe, qui a été évalué lors d'un pré-test et d'un post-test effectué trois mois après le début de l'intervention. Résultats: Quatre-vingt-onze dyades patients-proches ont été recrutées. Soixante-trois (69 %) proches aidants ont reçu les cinq séances d'intervention (tel que prévu) et 60 (66 %) proches aidants ont complété le test final. Une diminution significative de l'anxiété et de la dépression des proches aidants et un taux de satisfaction élevé ont été notés après l'intervention. Discussion: Cette intervention de transition pour les patients plus âgés et leurs proches aidants devrait faire l'objet d'une évaluation plus poussée, de préférence avec un groupe de contrôle, en tant qu'intervention autonome ou comme une composante d'une intervention de transition complète. Objective: To conduct a formative evaluation of a transitional intervention for family caregivers, with assessment of feasibility, acceptability, appropriateness, and potential benefits. Methods: The intervention aimed to provide emotional support, information on community resources, and information and support for development of coping skills for the caregivers of patients aged 65 and older who were to be discharged home from an acute medical hospital admission. We used a one-group, pre- and three-month post-test study design. Results: Ninety-one patient-caregiver dyads were recruited. Of these, 63 caregivers (69%) received all five planned intervention sessions, while 60 (66%) completed the post-test. There were significant reductions in caregiver anxiety and depression following the intervention, and high rates of satisfaction. Discussion: This transitional intervention should be further evaluated, preferably with a control group, either as a stand-alone intervention or as one component of a comprehensive transitional intervention for older patients and their caregivers.
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Williams N, Jamal S, Guthrie DM. The relationship between caregiver burden and depressive symptoms in Ontario home care clients. Home Health Care Serv Q 2018; 37:60-76. [DOI: 10.1080/01621424.2018.1425647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nicole Williams
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Samantha Jamal
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Dawn M. Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
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McCusker J, Yaffe M, Sussman T, Cole M, Sewitch M, Strumpf E, Freeman E, Lambert S, de Raad M. La gestion de la dépression chez les aînés et leurs aidants naturels : résultats d’un programme de recherche au Québec. SANTE MENTALE AU QUEBEC 2017. [DOI: 10.7202/1040254ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La dépression est un problème répandu, sérieux, et souvent chronique chez les aînés, qui sont souvent atteints de maladies physiques chroniques, et affecte de façon négative leurs traitements et leurs soins. Malheureusement, le taux de détection et de suivi adéquat de la dépression est faible dans cette population. Au cours des deux dernières décennies, notre équipe a mené une série d’études pour mieux comprendre et améliorer la gestion de la dépression chez les aînés. Nous présentons une revue narrative et synthèse de 25 articles qui incluent : 4 revues systématiques, 10 études observationnelles, 9 essais d’interventions, et 2 conférences de consensus. Nous proposons en conclusion nos recommandations pour 1) la détection de la dépression dans les soins de santé primaires ; 2) les soins collaboratifs de la dépression ; 3) des interventions d’autogestion de la dépression ; 4) le rôle des aidants naturels dans les interventions d’autogestion de la dépression.
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Affiliation(s)
- Jane McCusker
- Centre de recherche de St. Mary, Montréal, Canada
- Département d’épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada
| | - Mark Yaffe
- Département de médecine familiale, Centre hospitalier de St. Mary, Montréal, Canada
- Département de médecine de famille, Université McGill, Montréal, Canada
| | - Tamara Sussman
- École de travail social, Université McGill, Montréal, Canada
| | - Martin Cole
- Centre de recherche de St. Mary, Montréal, Canada
- Département de psychiatrie, Centre hospitalier de St. Mary, Montréal, Canada
- Département de psychiatrie, Université McGill, Montréal, Canada
| | - Maida Sewitch
- Département d’épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada
- Institut de recherche du Centre universitaire de santé McGill, Montréal, Canada
- Centre universitaire de santé McGill, Divisions de gastroentérologie et d’épidémiologie clinique, Montréal, Canada
| | - Erin Strumpf
- Département d’économie, Université McGill, Montréal, Canada
| | - Ellen Freeman
- Centre de recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada
| | - Sylvie Lambert
- Centre de recherche de St. Mary, Montréal, Canada
- École des sciences infirmières Ingram, Université McGill, Montréal, Canada
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Wilcox ME, Freiheit EA, Faris P, Hogan DB, Patten SB, Anderson T, Ghali WA, Knudtson M, Demchuk A, Maxwell CJ. Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study. BMC Psychiatry 2016; 16:277. [PMID: 27491769 PMCID: PMC4973530 DOI: 10.1186/s12888-016-0986-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography. METHODS This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits. RESULTS Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months. CONCLUSIONS Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
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Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | | | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Research, Innovation and Analytics, Alberta Health Services, Foothills Medical Centre, Calgary, Canada
| | - David B. Hogan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine (Division of Geriatric Medicine), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Todd Anderson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - William A. Ghali
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Merril Knudtson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Colleen J. Maxwell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1 ON Canada ,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
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Polenick CA, Flora SR. Behavioral activation for depression in older adults: theoretical and practical considerations. THE BEHAVIOR ANALYST 2015; 36:35-55. [PMID: 25729131 DOI: 10.1007/bf03392291] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Late-life depression (LLD) is a major public health concern that can have devastating effects on older individuals and their families. Behavioral theories predict that decreases in response-contingent positive reinforcement and increases in negatively reinforced avoidance behaviors, often accompanied by aversive life events, result in the selection and maintenance of depression. Based on these theories, behavioral activation treatments for depression are designed to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement. We discuss the applicability of behavioral models for LLD, and we briefly review current behavioral activation interventions for LLD with an emphasis on implications for future behavior-analytic research. Behavioral activation has been demonstrated to be effective in reducing depression and increasing healthy behavior in older adults. Potential challenges and considerations for future research are discussed. We suggest that applied behavior analysts and clinical behavior analysts are particularly well suited to improve and expand on the knowledge base and practical application of behavioral activation interventions with this population.
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Ogunlana MO, Dada OO, Oyewo OS, Odole AC, Ogunsan MO. Quality of life and burden of informal caregivers of stroke survivors. Hong Kong Physiother J 2014. [DOI: 10.1016/j.hkpj.2013.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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17
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Polenick CA, Martire LM. Caregiver attributions for late-life depression and their associations with caregiver burden. FAMILY PROCESS 2013; 52:709-722. [PMID: 24329412 PMCID: PMC4761441 DOI: 10.1111/famp.12032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Late-life depression (LLD) has detrimental effects on family caregivers that may be compounded when caregivers believe that depressive behaviors are volitional or within the patient's capacity to control. In this study we examined three person-centered caregiver attributions that place responsibility for LLD on the patient (i.e., character, controllability, and intention), and the impact of such attributions on levels of general caregiver burden and burden specific to patient depressive symptoms. Participants were 212 spouses and adult children of older adults enrolled in a depression treatment study. Over one third of caregivers endorsed character attributions, which significantly predicted greater levels of both general and depression-specific burden. Intention attributions were significantly associated with general burden, but not depression-specific burden. Contrary to our expectation, controllability attributions did not predict either type of burden. Our findings suggest that the assessment of family caregiver attributions for LLD may be useful in identifying caregivers at risk for burden and subsequent health effects, as well as those who may need education and support to provide effective care to a vulnerable population of older adults.
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Affiliation(s)
- Courtney Allyn Polenick
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA
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18
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Pierluissi E, Mehta KM, Kirby KA, Boscardin WJ, Fortinsky RH, Palmer RM, Landefeld CS. Depressive symptoms after hospitalization in older adults: function and mortality outcomes. J Am Geriatr Soc 2012. [PMID: 23176725 DOI: 10.1111/jgs.12008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine the relationship between depressive symptoms after hospitalization and survival and functional outcomes. DESIGN Secondary analysis of a prospective cohort study. SETTING General medical service of two urban, teaching hospitals in Ohio. PARTICIPANTS Hospitalized individuals aged 70 and older. MEASUREMENTS Ten depressive symptoms, instrumental activities of daily living (IADLs), and basic activities of daily living (ADLs) were measured at hospital discharge and 1, 3, 6, and 12 months later. Participant-specific changes in depressive symptoms (slopes) were determined using all data points. Four groups were also defined according to number of depressive symptoms (≤3 symptoms, low; 4-10 symptoms, high) at discharge and follow-up: low-low, low-high, high-low, and high-high. Mortality was measured 3, 6, and 12 months after hospital discharge. RESULTS Participant-specific discharge depressive symptoms and change in depressive symptoms over time (slopes) were associated (P < .05) with functional and mortality outcomes. At 1 year, more participants in the low-low depressive symptom group (49%) were alive and independent in IADLs and ADLs than in the low-high group (37%, P = .02), and more participants in the high-low group (39%) were alive and independent in IADLs and ADLs than in the high-high group (19%, P < .001). CONCLUSION Number of depressive symptoms and change in number of depressive symptoms during the year after discharge were associated with functional and mortality outcomes in hospitalized older adults. Fewer participants with persistently high or increasing depressive symptoms after hospitalization were alive and functionally independent 1 year later than participants with decreasing or persistently low symptoms, respectively.
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Affiliation(s)
- Edgar Pierluissi
- Division of Geriatrics, University of California at San Francisco, San Francisco, California 94110, USA.
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19
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van Exel J, Bobinac A, Koopmanschap M, Brouwer W. The invisible hands made visible: recognizing the value of informal care in healthcare decision-making. Expert Rev Pharmacoecon Outcomes Res 2012; 8:557-61. [PMID: 20528366 DOI: 10.1586/14737167.8.6.557] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The healthcare sector depends heavily on the informal care provided by families and friends of those who are ill. Informal caregivers may experience significant burden as well as health and well-being effects. Resource allocation decisions, in particular from a societal perspective, should account explicitly for these effects in the social environment of patients. This is not only important to make a complete welfare economic assessment of treatments, but also to ensure the lasting involvement of informal caregivers in the care-giving process. Measurement and valuation techniques for the costs and effects of informal care have been developed and their use is becoming more common. Decision-makers in healthcare - and eventually families and patients - would be helped by more uniformity in methods.
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Affiliation(s)
- Job van Exel
- Erasmus MC, Department of Health Policy and Management, and Institute for Medical Technology Assessment. Office L4-125, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
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20
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Abstract
Major depression in older medical inpatients is frequent, persistent, and disabling (Cole and Bellavance, 1997). The incidence is 20.5%–30.2% during the 12 months following admission to hospital (Fenton et al., 1997; Cole et al., 2008). Up to 73% of patients have a protracted course (Koenig et al., 1992; Cole et al., 2006; Koenig, 2006). Moreover, major depression in older medical inpatients appears to be associated with decreased function (Covinsky et al., 1997), increased use of health care services (Koenig et al., 1989; Büla et al., 2001), increased caregiver burden (McCusker et al., 2007), and possibly increased mortality (Cole, 2007).
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Van Durme T, Macq J, Jeanmart C, Gobert M. Tools for measuring the impact of informal caregiving of the elderly: a literature review. Int J Nurs Stud 2011; 49:490-504. [PMID: 22078211 DOI: 10.1016/j.ijnurstu.2011.10.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 10/09/2011] [Accepted: 10/17/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVES (1) Describe available tools to assess the impact of informal caregiving of home-dwelling elderly, (2) identify an acceptable and appropriate tool for a study aiming at the evaluation of the impact of innovative projects for care and support of care for elderly at home, on their main informal caregiver and (3) find a definition of 'main informal caregiver'. STUDY DESIGN Literature review by searches of the following electronic databases: MEDLINE, CINAHL, EMBASE, using firstly keywords and exclusion criteria, then citations and reference search. RESULTS This review has identified 105 scales assessing the impact of informal caregiving of the elderly. Those scales were described in terms of characteristics of the care receiver population, content and psychometric properties. Most retrieved scales are intended to measure the impact of caregiving on caregivers' health of elderly with dementia (n=49), overall elderly (n=21), cancer patients (n=7), chronically ill patients (n=7), psychiatric patients (n=7) and stroke patients (n=3). Dimensions of the impact of caregiving were classified into its positive (n=34), negative (n=55) or neither positive nor negative (n=16) consequences on the informal caregiver's health. Internal consistency varied from 0.48 to 0.99 and in half of the cases (n=52), construct validity was reported. Scales comprised 1-200 questions. The Zarit Burden Interview (ZBI-12) was selected for the study and an operational definition of the concept of "main informal caregiver" was constructed. CONCLUSION This review identified a large number of scales that can be used to assess the impact of caregiving, viewed through different dimensions. The Zarit Burden Interview can be a useful tool for researchers and clinicians due to its user-friendliness, extensively validation and international use, making comparisons between groups possible. Despite the fact that only the original version of each scale was selected, this inventory should be a useful tool for intervention studies and even clinicians work.
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Affiliation(s)
- Thérèse Van Durme
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium.
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22
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23
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Joutsenniemi K, Moustgaard H, Koskinen S, Ripatti S, Martikainen P. Psychiatric comorbidity in couples: a longitudinal study of 202,959 married and cohabiting individuals. Soc Psychiatry Psychiatr Epidemiol 2011; 46:623-33. [PMID: 20458461 DOI: 10.1007/s00127-010-0228-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 04/13/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine whether partner's psychiatric and somatic disorders are risk factors for incidence of psychiatric disorders among non-psychiatric individuals at baseline. METHODS Register-based 6-year follow-up on Finns (106,935 men and 96,024 women aged 40 and over), living with a married or cohabiting partner at the end of 1997. The outcome measures included non-psychotic major depressive disorder (MDD), substance use disorder (SUD), and severe psychiatric disorder, evaluated using information on reimbursement for drug costs, purchases of prescription medication, and principal causes of hospitalization. RESULTS Among persons whose partner had any psychiatric disorder, the incidence rate ratio (IRR) for own MDD, controlling for own age at baseline, was 1.58 (95% confidence interval 1.48-1.69) in men, and 1.58 (1.48-1.69) in women. Among persons whose partner had somatic hospitalization, the IRR for own MDD was 1.14 (1.08-1.20) in men and 1.20 (1.15-1.25) in women. Among both men and women, the highest risk for incidence of own MDD was among persons whose partner had both MDD and SUD (IRR 2.65, 1.67-4.21 and IRR 2.13, 1.62-2.80, respectively). Further adjustment for sociodemographic and union characteristics had little effect on the associations. CONCLUSIONS In married and cohabiting couples, partner's somatic and particularly psychiatric morbidity associate with psychiatric disorders in non-psychiatric subjects, independent of sociodemographic and union characteristics. The healthy spouse's care burden is a potential point of intervention in order to prevent new psychiatric morbidity, but also to provide the mentally ill first partner a chance to recover in a supportive family environment.
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Affiliation(s)
- Kaisla Joutsenniemi
- Mental Health Problems and Substance Abuse Services Unit, National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland.
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Sussman T, Yaffe M, McCusker J, Parry D, Sewitch M, Van Bussel L, Ferrer I. Improving the management of late-life depression in primary care: barriers and facilitators. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:326307. [PMID: 21738868 PMCID: PMC3123847 DOI: 10.1155/2011/326307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/01/2011] [Indexed: 11/18/2022]
Abstract
The objectives of this study were to elicit Canadian health professionals' views on the barriers to identifying and treating late-life depression in primary care settings and on the solutions felt to be most important and feasible to implement. A consensus development process was used to generate, rank, and discuss solutions. Twenty-three health professionals participated in the consensus process. Results were analysed using quantitative and qualitative methods. Participants generated 12 solutions. One solution, developing mechanisms to increase family physicians' awareness of resources, was highly ranked for importance and feasibility by most participants. Another solution, providing family physicians with direct mental health support, was highly ranked as important but not as feasible by most participants. Deliberations emphasized the importance of case specific, as needed support based on the principles of shared care. The results suggest that practitioners highly value collaborative care but question the feasibility of implementing these principles in current Canadian primary care contexts.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, 3506 University Street, Room 300, Montreal, QC, Canada H3A 2A7
| | - Mark Yaffe
- Family Medicine, St. Mary's Hospital Center, McGill University, 3830 Lacombe Avenue, Montreal, QC, Canada H3T 1M5
| | - Jane McCusker
- Epidemiology, Biostatistics and Occupational Health, St. Mary's Hospital Center, McGill University, 3830 Lacombe Avenue, Montreal, QC, Canada H3T 1M5
| | - David Parry
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital Center, Faculty of Law, McGill University, 3830 Lacombe Avenue, Montreal, QC, Canada H3T 1M5
| | - Maida Sewitch
- Department of Medicine, McGill University, 3830 Lacombe Avenue, Montreal, QC, Canada H3T 1M5
| | - Lisa Van Bussel
- Division of Geriatric Psychiatry, Department of Psychiatry, St. Joseph's Health Centre, The University of Western Ontario, 850 Highbury Avenue, London, ON, Canada N6A 4G5
| | - Ilyan Ferrer
- School of Social Work, McGill University, 3506 University Street, Montreal, QC, Canada H3A 2A7
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Akosile CO, Okoye EC, Nwankwo MJ, Akosile CO, Mbada CE. Quality of life and its correlates in caregivers of stroke survivors from a Nigerian population. Qual Life Res 2011; 20:1379-84. [PMID: 21380764 DOI: 10.1007/s11136-011-9876-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The study aimed at determining the quality of life (QOL) of caregivers of stroke survivors in a Nigeria population and some patient and caregiver-related variables that may be associated with it. METHOD A survey of the QOL of volunteering informal caregivers of stroke survivors in purposively selected tertiary health centres from South-Eastern Nigeria was done using the SF-12 questionnaire. RESULT Caregivers rated their QOL fairly well. Older age, female gender and closeness in relationship to survivor were caregivers' variables that were significantly related to poorer QOL scores. Being a woman close relative is associated with lower mental health scores while being an older close relative contributed to lower physical health score (P < 0.05). Caregivers' scores on the physical and mental health domains correlated moderately with each other (r = 0.52) and highly with their overall QOL scores (r = 0.81 and 0.88). CONCLUSION Caring for stroke survivors in Nigeria seems to have adverse effects on the QOL of closer relatives who are either women or older. There is a need for clinicians to help those caregivers at risk find ways of improving and optimizing their QOL.
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Affiliation(s)
- Christopher O Akosile
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria.
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26
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Depressive symptoms of informal caregivers are associated with those of community-dwelling dependent care recipients. Int Psychogeriatr 2010; 22:1310-7. [PMID: 20637136 DOI: 10.1017/s104161021000089x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The relationship between care recipients' depressive symptoms and those of caregivers remains unknown. We evaluated the association between the depressive status of caregivers and that of community-dwelling disabled care recipients. METHODS A prospective cohort study of 893 care recipients and paired caregivers was conducted. The care recipients were all eligible for a universal-coverage long-term care insurance program and their ages ranged from 65 to 104 years. They and their paired caregivers (age range 31-90 years) completed the 15-item Geriatric Depression Scale (GDS-15, score range: 0-15) assessment at baseline. The GDS-15 was used to measure the depression of caregivers and recipients with a threshold of <6/6+. The data included each care recipient's demographic characteristics, overall health status, basic activities of daily living, and comorbidities. The data also included the caregiver's demographic characteristics, including the caregiver's relationship to the recipient, and the caregiver's subjective burden as assessed by the Japanese version of the Zarit Burden Interview (ZBI). RESULTS The mean GDS-15 scores of care recipients and caregivers were 6.7 points and 5.6 points, respectively. There was a positive correlation between the GDS-15 scores of caregivers and care recipients (r = 0.307, p<0.001). Multivariate logistic regression analysis adjusting for potential confounders including ZBI score indicated that the depressive symptoms of caregivers were associated with those whose care recipients were in the groups with moderate and high GDS-15 scores (OR: 1.97, 95% CI: 1.39-2.81, OR: 3.13, 95% CI: 1.87-5.24, respectively). CONCLUSION Caregivers' depressive symptoms are associated with the depressive mood of the care recipients even after adjusting for confounders including caregiver burden.
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Bobinac A, van Exel NJA, Rutten FFH, Brouwer WBF. Health effects in significant others: separating family and care-giving effects. Med Decis Making 2010; 31:292-8. [PMID: 20671212 DOI: 10.1177/0272989x10374212] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Changes in the health of patients may affect the health of so-called "significant others" in 2 distinct ways. First, an individual may provide informal care to the patient and be burdened by the process of care giving. We label this indirect effect of a patient's health on the health of the care giver the "care-giving effect." Second, a person may suffer from health losses because someone in his or her social environment is ill, regardless of his or her care-giving status. The health of the patient then directly affects the health of this significant other, which we label the "family effect." METHODS We investigate the occurrence of the family and care-giving effect in a convenience sample of Dutch care givers (n = 751). The family effect was approximated by the health status of the patient (measured on EuroQol-VAS), and the care-giving effect by the number of the care-giving tasks was provided. It was assumed that care givers' health is positively associated with patients' health, that is, the family effect, and negatively associated with care-giving burden, that is, the care-giving effect. Relationships are studied using multivariate regressions. RESULTS Our results support the existence of both types of health effects. The analysis shows that the 2 effects are separable and independently associated with the health of care givers. Not accounting for the family effect conflates the care-giving effect. CONCLUSIONS If the goal of health care policy is to optimize health, all important effects should be captured. The scope of economic evaluations should also include health effects in significant others. This study suggests that significant others include both care givers and broader groups of affected individuals, such as family members.
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Affiliation(s)
- Ana Bobinac
- Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - N Job A van Exel
- Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Frans F H Rutten
- Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Werner B F Brouwer
- Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
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McCusker J, Latimer E, Cole M, Ciampi A, Sewitch M. The nature of informal caregiving for medically ill older people with and without depression. Int J Geriatr Psychiatry 2009; 24:239-46. [PMID: 18618842 DOI: 10.1002/gps.2096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To describe patient and caregiver perceptions of the nature of informal caregiving in a sample of older medical inpatients with and without depression. METHODS One hundred and fifty-four patient-caregiver pairs were recruited from a larger prospective observational study of three groups of medical inpatients aged 65 and over, with major, minor, and no depression, respectively, and with at most mild cognitive impairment. Interviews were conducted at the time of hospital admission to assess characteristics of patients (disability, comorbidity, perceptions of support) and caregivers (relationship, residence, types of assistance and time spent caregiving). Time spent on the physical tasks of caregiving (assistance with activities of daily living, physical care, transport) was estimated by all caregivers. Time spent on emotional or other support was estimated only for non-coresident caregivers RESULTS In multivariable analyses, neither major nor minor depression was associated with time spent on physical support; major depression was associated with significantly increased time spent by non-coresident caregivers on emotional or other support; minor depression was associated with perceived inadequacy of support. CONCLUSIONS Major depression is independently associated with greater time spent by non-coresident caregivers on emotional or other support; minor depression is associated with perceived inadequacy of support.
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Affiliation(s)
- Jane McCusker
- St Mary's Hospital, McGill University, Montreal, Quebec, Canada.
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29
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Wilkins VM, Bruce ML, Sirey JA. Caregiving tasks and training interest of family caregivers of medically ill homebound older adults. J Aging Health 2009; 21:528-42. [PMID: 19252141 DOI: 10.1177/0898264309332838] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study assessed the caregiving activities and training interests of family caregivers of medically ill older adults without dementia who receive home health care. METHODS Participants were 101 family caregivers of patients from the Training in the Assessment of Depression (TRIAD) study. Caregivers were assessed using a sociodemographic questionnaire and measures of caregiver tasks and training interest. RESULTS Family caregivers provided a variety of caregiving tasks and their interest in training was independent of current provision of tasks. Black caregivers expressed greater overall interest in receiving training than did White caregivers, as did younger caregivers compared to same-generation caregivers. DISCUSSION Family caregivers in this study evidenced both a range of care provision and clear interest in improving caregiving skills through training. Research efforts should focus on meeting the specific training needs of family caregivers and determining the impact training can have on patient health outcomes.
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Affiliation(s)
- Victoria M Wilkins
- Department of Psychiatry, Weill Medical College of Cornell University, 21 Bloomingdale Road, White Plains, NY 10605, USA.
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Zauszniewski JA, Bekhet AK, Suresky MJ. Factors associated with perceived burden, resourcefulness, and quality of life in female family members of adults with serious mental illness. J Am Psychiatr Nurses Assoc 2008; 14:125-35. [PMID: 21665761 DOI: 10.1177/1078390308315612] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Each year, 54 million American adults are affected by serious mental illness. Most of these persons depend on female family members for support or assistance, and unless these women are resourceful, they may experience considerable burden, stigma by association, depressive thoughts, and poor quality of life. OBJECTIVE In this study, we examined the associations between characteristics of female family members (age, race, education), adults with serious mental illness (age, diagnosis), and the family situation (relationship, living arrangements, care provided) and caregivers' burden, stigma, depressive cognitions, resourcefulness, and quality of life. STUDY DESIGN In this descriptive, cross-sectional study, a convenience sample of 60 female relatives of adults with serious mental illness provided demographic information and completed established measures of the study variables. RESULTS We discuss associations between contextual variables and process regulators, resourcefulness, and quality of life. CONCLUSIONS The results highlight the importance of targeting interventions for caregivers of adults with serious mental illness who are parents, caregivers of younger seriously mentally ill persons in earlier stages of diagnosis, and caregivers of persons who have bipolar disorder. J Am Psychiatr Nurses Assoc, 2008; 14(2), 125-135. DOI: 10.1177/1078390308315612.
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