Influence of family dynamics on burden among family caregivers in aging Japan

The mediating effect of self-efficacy on the relationship between self-care ability and disability level in older adult patients with chronic diseases

Objective

This study investigates the mediating effect of self-efficacy on the relationship between self-care ability and disability level in older adult patients with chronic diseases.

Methods

A convenience sampling method was used to select 372 older adult patients with chronic diseases from five tertiary hospitals in Chengdu, Sichuan Province. General demographic information was collected using a questionnaire, and self-efficacy, self-care ability, and disability were assessed using standardized scales. Data were analyzed using SPSS 26.0, and the PROCESS macro was employed to test the mediating effect of self-efficacy.

Results

The mean score for self-efficacy was 26.09 ± 7.20, for self-care ability was 113.19 ± 23.31, and for disability was 154.19 ± 29.32. Self-efficacy was positively correlated with self-care ability (r = 0.73, p < 0.001. and negatively correlated with disability (r = -0.84, p < 0.001. and self-care ability and disability (r = -0.91, p < 0.001.. The indirect effect of self-efficacy on the relationship between self-care ability and level of disability was -0.03 (95% CI -0.08 to -0.04), accounting for 16.67% of the total effect.

Conclusion

Self-efficacy partially mediates the relationship between self-care ability and disability in older adult patients with chronic conditions. Healthcare providers can improve self-care behaviours and self-efficacy in older adult patients through effective interventions to reduce the incidence of disability.

Development and validation of a health literacy scale for family caregivers of older people with chronic illness

BACKGROUND

Family caregivers (FCs) encounter a variety of health problems in older people with chronic illness, necessitating a certain level of health literacy to access, understand, appraise and apply health information and services. This study aimed to develop and validate a scale for measuring health literacy among FCs of older people with chronic illness.

METHODS

Concept mapping was first employed to develop a conceptual model of health literacy of FCs. Scale domains were derived from the conceptual model, and item generation was performed using deductive and inductive methods. Quantitative methods, including merging scale dimensions and items, expert reviews, cognitive interviews, and item reduction analysis, were used to refine the scale. Confirmatory factor analysis was employed to validate the scale's structure. Concurrent validity, internal consistency, and test-retest reliability were also examined.

RESULTS

A 20-dimension conceptual model was developed, and 60 items were generated for the scale. Expert review (content validity index > 0.85) and cognitive interview with FCs confirmed the relevance and clarity of the majority of the generated scale items. Confirmatory factor analysis with 451 FCs of older people with chronic illness supported a 5-factor structure (symptom management, daily personal care and household tasks, care coordination, communication and relationship with the care recipient, and self-care of caregivers) with 42 finalized scale items, including four levels of health literacy skills (accessing, understanding, appraising and applying health information). Concurrent validity with the European Health Literacy Questionnaire (HLS-EU-Q47) was satisfactory (r = 0.67, p < 0.01). The Cronbach's α coefficient of the scale was 0.96, with subscales ranging from 0.84 to 0.91. The two-week test-retest reliability was 0.77 (p < 0.01).

CONCLUSION

This study developed a conceptual model explaining the concept and factors of health literacy among FCs of older people with chronic illness that could provide the groundwork for future studies in developing relevant evidence-based interventions. A new Health Literacy Scale-Family Caregiver (HLS-FC) with satisfactory psychometric properties was developed in this study, which can be utilized to identify caregivers with insufficient health literacy and facilitate timely interventions by healthcare professionals.

Association between Caregivers' Fear of Post-fracture Patients Falling and a Decline in Patients' Activities

Objectives

To evaluate caregivers' fear of post-fracture patients falling, we previously developed the Caregivers' Fear of Falling Index (CFFI). In this study, we investigated the relationship between patient performance in activities of daily living (ADLs) and CFFI.

Methods

We surveyed 55 patients receiving home-visit rehabilitation after fall-related fracture and their primary caregivers. Participants (patient and caregiver pair) were divided into two groups based on patient performance in basic ADLs (BADLs) and instrumental ADLs (IADLs). ROC analysis was conducted to assess the usefulness of CFFI and Falls Efficacy Scale-International (FES-I) in determining declines in performance in BADLs and IADLs. Multivariate logistic regression analysis was performed to examine the association between CFFI and declining performance in BADLs and IADLs.

Results

ROC analysis showed that CFFI exhibited a higher accuracy than FES-I (AUC: 0.73 in BADLs, 0.77 in IADLs) as an indicator of reduced ADL performance. Multivariate logistic analysis adjusted for age, sex, and physical function showed that CFFI was associated with a decline in patients' performance in IADLs (odds ratio, 0.92; 95% confidence interval, 0.85-0.99).

Conclusions

Caregivers' fear of post-fracture patients falling was associated with a decline in patients' performance in IADLs. These findings may serve as a guide for supporting caregivers of post-fracture patients.

Reliability and Validity of Caregivers' Fear of Falling Index When Caring for Home-Based Rehabilitation Patients With Fall-Related Fractures

OBJECTIVE

To evaluate the reliability and validity of this new measure, called the caregivers' fear of falling index (CFFI).

METHODS

The study surveyed home-based rehabilitation patients with fall-related fracture, and their primary caregivers. The characteristics of these patients were evaluated, and the caregivers were surveyed using the CFFI and Falls Efficacy Scale-International (FES-I). The reliability of the CFFI was assessed using item-total correlation, while the validity of the CFFI was evaluated through correlation coefficients calculated between the CFFI and the FES-I.

RESULTS

The participants were 51 patient-caregiver pairs. The internal consistency of the CFFI showed an alpha coefficient of 0.904. No items were excluded in the corrected item-total correlations. The CFFI showed a moderate correlation with FES-I (r=0.432, p=0.002).

CONCLUSION

This study found the CFFI to be a reliable and valid tool for measuring the primary caregivers' fear. The CFFI may be a useful tool for healthcare professionals to identify and supporting these primary caregivers.

The shift from old age to very old age: an analysis of the perception of aging among older people

Background

The oldest-old (individuals over 90 years) are a fast-growing population. Understanding the perceptions of older people about very old age is the first step towards developing optimal geriatric care for an aging population. This study aimed to explore the potential shift from old age to very old age through the exploration of older people’s perception of aging.

Methods

Qualitative study conducted through individual interviews in the homes of older people. We voluntarily chose to include persons a decade under and above 90 years old to explore other factors than age that could participate in the shift from old age to very old age. The sampling was theoretical. We carried out the analyses using an inductive approach based on the phases of grounded theory. The researchers used triangulation. Collection was concluded when theoretical saturation was reached.

Results

Fourteen participants were interviewed. The shift from old age to very old age was not based on age but occurred when participants became conscious of the irreversibility of aging and its effects, and when they started living day-by-day, renouncing to any plan in a near future. The transition to very old age seemed to be preceded by a progressive disengagement from non-essentials activities. Participants reported a sensation of progressive social exclusion due to the loss of contemporaries or spouse, the difficulty to connect with younger generations or the absence of relationships in their neighborhood. The last step of life was feared, not because of the idea of death itself but because of the associated suffering and loss of autonomy.

Conclusion

Precipitating and slowing factors of the shift to very old age were identified to help general practitioners support older patients throughout their life trajectories.

Supporting an informal care group - Social contacts and communication as important aspects in the psychosocial well-being of informal caregivers of older patients in Belgium

BACKGROUND

Increasingly, informal caregivers in Belgium care in group for an older patient. This study aimed to decrease the caregiver burden and to increase the well-being of caregivers and patients by supporting the needs of informal care groups of older patients (≥70 years).

METHOD

Through an online self-management tool, the groups were supported to make informed choices concerning the care for the older patient, taking into account the standards, values, concerns and needs of every caregiver and patient. A pre-post study was performed.

RESULTS

Although patients and caregivers considered the self-management tool as useful and supportive, no clear evidence for decreased caregiver burden was found. There was a positive trend in group characteristics such as the distribution of tasks, communication and prevalence of conflicts. Caregivers also stated that they took more time for themselves, had less feelings of guilt and experienced less barriers to ask help.

CONCLUSION

Tailor-made support of informal care groups starts with facilitating and guiding a process to achieve consent within the group to optimise the care for the patient and also for the caregivers. With a shared vision and supported decisions, caregivers can enter into conversations with the professional caregiver to coordinate adjusted support regarding the care needs.

[Relation of smoking status to family health and personality traits in residents aged over 18 years in China]

OBJECTIVE

To explore the relation of smoking status to family health and personality traits in residents aged over 18 years in China by binary Logistic regression analysis, to identify the psychosocial factors that influence tobacco use, and to provide evidence to predict smoking susceptibility based on personality traits and prevent smoking at individual and family levels.

METHODS

Residents aged over 18 years in China were selected from "the Survey of Chinese Family Health Index (2021)". General characteristic questionnaire, short-form of family health scale, 10-item big five inventory were used to collect sociodemographic information, family health function and personality traits. And the relation of smoking status to family health and personality traits were analyzed by binary Logistic regression analysis.

RESULTS

Totally 10 315 adults were collected, of whom there were 2 171 smokers. The smoking rate was 21.05%, 41.76% of the residents were male, 3.69% female, 20.03% urban, 23.77% rural, 12.60% aged between 18 and 35 years, 27.11% aged between 36 and 59 years, 34.35% aged over 60 years, and the smoking rate varied in gender, location, age, education, marital status, family types, and average household monthly income (P < 0.05). Furthermore, the scores of family health, family social and emotional health processes, family healthy lifestyle, family health resources, family external social support, agreeableness, openness, and neuroticism among smokers were lower than those of the non-smokers (P < 0.05). The results of binary Logistic regression analysis showed that the residents over 35 years old, with low educational level and divorced were the risk factors to smoking (P < 0.05), while female, unmarried, nuclear family, high scores of family social and emotional health processes and family health resources, openness, neuroticism, and agreeableness were the protective factors to smoking (P < 0.05).

CONCLUSION

Besides gender, age, location, education, marital status, family types and average household monthly income, family health, and personality traits were also important factors influencing smoking status. Tobacco control based on personality traits and family health is essential, and more convincing research is necessary to determine the relation of tobacco use, tobacco dependence and smoking cessation to family health and personality traits.

[Relationship between the use of home-visit nursing services and family caregivers' experience of interprofessional care]

AIM

To examine the relationship between the use of home-visit nursing services (VNS) for patients and their family caregivers' experience of interprofessional care, which is an indicator of the care process.

METHODS

We used data from a cross-sectional survey in Japan, 2020. Family caregivers 40-74 years old and caring for community-dwelling patients with chronic conditions were recruited. The outcome variable was family caregivers' experience, reflecting the quality of interprofessional care for patients and their caregivers. We used the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS), which includes two domains: attention for the patient and attention for the caregiver. The main factor was the use of VNS, and covariates were socioeconomic factors of the caregivers and the use of other health and social care services. J-IEXPAC CAREGIVERS scores were divided into two groups by median values and analyzed by multivariate logistic regression analyses.

RESULTS

A total of 566 caregivers were included in the analysis. The median age was 62 years old. VNS was used in 86 cases (15.2%). Logistic regression analyses revealed that the use of VNS was significantly associated with a higher total score group for J-IEXPAC CAREGIVERS (odds ratio = 3.02; 95% confidence interval 1.54-5.91). Of the J-IEXPAC CAREGIVERS domains, attention for the patient was significant.

CONCLUSIONS

We found that the use of VNS was likely to provide a better experience among family caregivers. Our findings suggest that visiting nurses fulfill their expected role as core members of a multidisciplinary team.

Burden, family functioning, and psychological health of older caregivers of older adults: a path analysis

Objectives: To evaluate an explanatory model of direct and indirect associations regarding the psychological health of older caregivers of functionally dependent older adults. Methods: This is a cross-sectional study performed with older caregivers recruited in contexts of outpatient and home care. We collected information on sociodemographic characteristics, duration of caregiving, physical and cognitive function indicators of the older care recipients, perceived burden, family functioning, and psychological health measures (psychological need satisfaction and depressive symptoms). Results: We evaluated 133 caregivers (76% female, 69.5 ± 6.98 years). Variables that were significantly correlated with psychological health were selected to form an association model to be tested by structural equation modeling via path analysis. Depressive symptom variability was best explained by this model. Caregiver burden remained in the model as a mediator of indirect associations between physical function for instrumental activities of daily living and indicators of family functioning and psychological health. Three associative paths between caregiver burden and depressive symptoms were found — one of them was direct and the other two were mediated whether by family functioning or by the level of psychological need satisfaction. Conclusion: Depressive symptoms were the psychological health indicator best explained by the model involving instrumental functional demands that generate burden. Clinical consequences suggested by the model indicate interventions aimed at family functioning and opportunities of psychological need satisfaction as strategies for promoting caregivers’ psychological health.

A Study of the Structure of Japanese University Students' Awareness of Long-Term Care Socialization

This study aimed to examine the structure of the awareness of long-term care socialization by focusing on the younger generation's awareness in order to improve a sustainable long-term care system. A questionnaire that assessed personal attributes and awareness of long-term care socialization was administered. In total, the answers of 209 students (48.4%) were collected for factors related to the awareness of long-term care socialization extracted through exploratory factor analysis. Additionally, the responses 149 students (56.7%) were collected for the construct validity verified through confirmatory factor analysis. According to the exploratory factor analysis, awareness of long-term care socialization included 10 items and three factors: "care burden when caring for family", "feelings about leaving family care to society", and "sense of responsibility to care for family as a member of the family". The goodness-of-fit model in the confirmatory factor analysis proved the awareness of long-term care socialization scale's construct validity. The structure of the awareness of long-term care socialization included three factors: "care burden when caring for family", "sense of responsibility to care for family as a member of the family", and "feelings about leaving family care to society". This study demonstrated the scale's good reliability and validity.

Multiple Caregivers, Many Minds: Family Discord and Caregiver Outcomes

BACKGROUND AND OBJECTIVES

Family caregivers often have other family members helping to provide care. The purpose of our study was to examine relationships between care coordination quality among family members and the following caregiver outcomes: caregiver mental health (depressive symptoms, anxiety), social activity restrictions, and caregiver burden.

RESEARCH DESIGN AND METHODS

Secondary analysis was conducted using data from the 2017 Pittsburgh Regional Caregivers' Survey. Six hundred and fifty-five caregivers who had other family members helping with care reported discordance in care coordination, depressive symptoms, anxiety, social activity restrictions, caregiving burden, and covariates such as demographics and known risk factors for negative caregiver outcomes. We used multiple logistic regression and negative binominal expansion models in the analysis.

RESULTS

Discordant care coordination was associated with higher levels of caregiver depressive symptoms (p < .001), anxiety (p < .01), social activity restriction (p < .001), and caregiver burden (p < .001) after controlling for known risk factors.

DISCUSSION AND IMPLICATIONS

We found that lower quality of family care coordination was associated with negative caregiver outcomes. Future research should further investigate the dynamics of family care coordination and impacts on both caregivers and care recipients. The results suggest that caregiver interventions attempting to understand and decrease care coordination discord should be a priority.

Characterizing the role of, and physical and emotional burden on caregivers of patients with heart failure: Results from a cross-sectional survey in Japan

The aim of this cross-sectional survey was to characterize the role of and burden on caregivers of heart failure (HF) patients in Japan, since such data are limited at present. Data from 126 caregivers whose average age was 63.5 years were analyzed. Helping to prepare meals/cooking was the most frequently reported activity (47% of caregivers); 24% found this the most burdensome. The most frequently reported physical consequence of caregiving was feeling physically tired (44%); emotionally worrying about the patient (62%) was the most frequent psychological consequence. Approximately half of the caregivers reported that caring for patients impacted their lifestyle. Although 40% of caregivers asked questions to physicians regarding diet or lifestyle modifications, 19% did not ask any. Caregivers play a crucial role in the management of HF patients in Japan but experience physical and emotional burden. Solutions are required to reduce the caregiver burden associated with HF.

Mixed methods study protocol to examine perceptions of family medicine among long-term patients of a family medicine clinic in Japan

INTRODUCTION

Family physicians or general practitioners play central roles in many countries' primary care systems, but family medicine (FM) remains relatively unestablished in Japan. Previous studies in Japan have examined the general population's understanding of FM as a medical specialty, but none have explored this topic using actual FM clinic patients. Here, we describe a protocol to explore the perceptions of FM among long-term patients of one of Japan's oldest FM clinics.

METHODS AND ANALYSIS

The study will be conducted at the Motowanishi Family Clinic in Hokkaido, Japan, using patients who have attended the clinic for over 10 years. The analysis will adopt a two-phase explanatory sequential mixed methods design. During phase I, quantitative data from participants' medical records will be collected and reviewed, and patients' perceptions of FM will be assessed through a questionnaire. The correlations between participants' knowledge that the clinic specialises in FM and various characteristics will be examined. In phase II, qualitative data will be collected through semi-structured interviews of approximately 10 participants selected using maximum variation sampling based on phase I results. A thematic analysis will be conducted in phase II to identify patients' perceptions and changes in perceptions. Finally, each theme identified in phase II will be transformed into a quantitative variable to analyse the relationships between the phases. A joint display will be used to integrate the phases' findings and examine how phase II results explain phase I results.

ETHICS AND DISSEMINATION

The institutional review board of the Japan Primary Care Association has approved this research (2019-003). The results will be presented at the association's annual academic meeting and submitted for publication in relevant journals. The findings will also be provided to the patients via the clinic's internal newsletter.

Quality of life, burden, family emotional support: a model for older adults who are caregivers

OBJECTIVE

To investigate associations between quality of life, sex, age, burden, and nature of emotional support available in the family in older adults who are caregivers of older relatives.

METHOD

Cross-sectional and correlational study on 148 caregivers gathered in public and private healthcare services, who were subjected to psychological measures of quality of life, burden, exchange of emotional support, sex, and age. Data were analyzed using Chi-square, Fisher's exact test and path analyses (p < 0.05).

RESULTS

A total of 77% women, average age of 69.7 years. There were significant associations between exchange of support and burden due to the provided assistance, being a woman and satisfaction with the received support, satisfaction with the received support and burden, burden and quality of life, and satisfaction with the received support and feeling of burden due to the provided support.

CONCLUSION

Satisfaction with the received emotional support moderate the association between sex and burden, and such moderate the association between satisfaction with emotional support and perceived quality of life.

Humanistic and economic burden among caregivers of patients with cancer in Japan

Aims: As the number of cancer patients increases in Japan, and people are living longer with cancer, the need for caregivers of cancer patients is expected to increase substantially. This study intended to reveal the humanistic and economic burden among caregivers of cancer patients, and to compare it with the burden among caregivers of patients with other conditions (other caregivers) and non-caregivers.Materials and methods: This cross-sectional analysis used data from the Japan National Health and Wellness Survey 2017. Outcome measures included the Short Form 12-item Health Survey for health-related quality of life (HRQoL), EuroQol 5-dimension scale (EQ-5D) for health states utilities, Work Productivity and Activity Impairment questionnaire for the impact of health on productivity and activity, and indirect costs. Multivariate analysis was used to compare across groups, with adjustment for potential confounding effects.Results: A total of 251 caregivers of cancer patients, 1,543 other caregivers, and 27,300 non-caregivers were identified. Caregivers of cancer patients (average 48.0 years old) tended to be younger than non-caregivers (51.5) and other caregivers (54.4) and had the highest education level (57.8% completed university education). Fewer non-caregivers had stress-related comorbidities than caregivers. Non-caregivers had significantly higher EQ-5D index scores than caregivers (average 0.81 vs. 0.73 vs. 0.74). Caregivers of cancer patients had significantly lower mental component summary scores than non-caregivers (40.18 vs. 46.70), and the difference indicated a clinically meaningful decrease in HRQoL. Caregivers of cancer patients had significantly higher presenteeism (37.31% vs. 20.43%), total work productivity impairment (38.85% vs. 21.98%), and activity impairment (40.94% vs. 25.78%) than non-caregivers. Additionally, caregivers of cancer patients had significantly higher total indirect costs (36.34% vs. 20.03% of average annual income).Conclusions: These results have implications for future healthcare planning, suggesting the importance of healthcare systems in Japan to consider the substantial burden borne by caregivers of cancer patients.