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Lim JM, Barlas J, Kaur D, Ng P. Unmasking the Struggle: A Scoping Review Exploring Post-Traumatic Stress Symptoms in Caregivers of Individuals with Neurodevelopmental, Psychiatric and Neurocognitive Disorders. TRAUMA, VIOLENCE & ABUSE 2024; 25:3191-3210. [PMID: 38676377 DOI: 10.1177/15248380241241018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The impact of caregiving on caregivers' mental health is typically considered within the caregiver stress and burden literature; however, more recently, research has investigated the experience of post-traumatic stress symptoms (PTSS) in caregivers. As an emerging area of research, it is timely to conduct a scoping review to map the existing literature in relation to PTSS among adult caregivers of children and adults with neurodevelopmental disorders (NDD), neurocognitive disorders, and psychiatric disorders. The scoping review was conducted using Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines and Arksey and O'Malley's five-stage methodology framework. Published and unpublished gray literature between 2005 and 2022 was included in the scoping review. Nine thousand one hundred and twenty-five studies were originally identified for screening and 22 studies were selected for inclusion in the final review. Trauma and PTSS experienced by NDD caregivers were related to news breaking, NDD diagnosis, and behavioral issues, whereas caregivers of individuals with psychosis reported aggression and violence as traumatic events. Studies showed that up to half of caregivers reported PTSS, although no conclusions could be drawn about prevalence rates. A wide variety of tools measuring PTSS were used across the 22 studies. Many symptoms of PTSS were reported by caregivers, and cognitive appraisals were associated with PTSS in caregivers. The findings highlight the importance of recognizing the impact of trauma in caregiver mental health and the potential value of using traumatic stress frameworks with these populations. Research should be expanded to establish prevalence rates and to examine the long-term impact of trauma on caregiving as caregivers and care recipients age.
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Affiliation(s)
- Jan Mei Lim
- James Cook University, Singapore, Singapore
- Institute of Mental Health, Singapore, Singapore
| | | | | | - Pamela Ng
- Institute of Mental Health, Singapore, Singapore
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Ong WJ, Goh CMJ, Tan GTH, Shahwan S, Subramaniam M. A qualitative enquiry on the impact of mental illness stigma on caregiving role and experiences in Singapore. Front Psychiatry 2024; 15:1417514. [PMID: 39041047 PMCID: PMC11262131 DOI: 10.3389/fpsyt.2024.1417514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/13/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction Given that mental illness stigma is a common occurrence amongst people with mental illness and caregivers (CGs) can be a potential victim of stigma themselves, there is a need to examine caregivers' perspective on the phenomenon. This study is part of a larger study which aims to qualitatively examine the concept of mental illness stigma amongst different stakeholders in Singapore. Methods Focus group discussions (FGDs) were conducted amongst 21 informal caregivers to explore the experience of stigma encountered by them and their care recipients, and how it may implicate their caregiving experience. Both inductive and deductive thematic analyses were employed to analyze the data. Results Three overarching themes of stigma encounters that may have implication on caregiving experience were identified: 1) Stigma within the family; 2) Structural stigma; and 3) Stigma by association. Experience of stigma within family (e.g., social exclusion and lack of understanding) limits the caregiving supports available to CGs. CGs also took up a mediating role between their care recipients and other family who may hold stigmatizing views. Witnessing their care recipients being subjected to structural disadvantages (e.g., employment, school, and mandatory conscription) can induce emotional stresses amongst CGs and motivate them to protest and seek redress on their behalf. Furthermore, encounters of stigma themselves (e.g., being judged or blamed for their loved one's condition) also led to feelings of guilt and self-blame amongst the CGs. Discussion These findings can aid the formulation of interventions in informing CGs on what to expect on their caregiving journey and supporting them in dealing with issues relating to stigma and highlight the importance of anti-stigma efforts in organizational settings such as schools, corporations, and government agencies.
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Affiliation(s)
- Wei Jie Ong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Menne HL, Pendergrast C. Examining predictors of loneliness among Older Americans Act National Family Caregiver Support Program participants. Front Public Health 2024; 12:1337838. [PMID: 39011327 PMCID: PMC11247641 DOI: 10.3389/fpubh.2024.1337838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 06/10/2024] [Indexed: 07/17/2024] Open
Abstract
Family caregivers may be at particular risk for social isolation and loneliness. Multiple factors can impact caregivers' health and well-being outcomes, including loneliness. Guided by an adaptation of the Stress Process Model of Caregiving, this study uses the 2019 National Survey of Older Americans Act Participants (NSOAAP)-Family Caregiver Support module to inform efforts to reduce loneliness through family caregiver support programs. A hierarchical multiple regression model reveals that caregivers who report more loneliness are more likely to be female, Hispanic, living alone, not a child or other caregiver of the care recipient, have a care recipient with 3+ ADL needs, experience more social life conflict related to caregiving, experience less joy in caregiving, feel less appreciated by the care recipient, feel less support in caregiving, and attend counseling. This study helps advance the goals of the National Strategy to Support Family Caregivers, and the findings underscore the importance of continuing and expanding efforts to address loneliness and related well-being outcomes among family caregivers.
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Affiliation(s)
- Heather L. Menne
- Department of Sociology and Gerontology, Miami University, Oxford, OH, United States
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Arora K, Wolf DA. Paid Leave Mandates and Care for Older Parents. Milbank Q 2024. [PMID: 38899473 DOI: 10.1111/1468-0009.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/03/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Policy Points We examined the effect of the Paid Family Leave policy (PFL) and Paid Sick Leave policy (PSL) on care provision to older parents. We found that PSL adoption led to an increase in care provision, an effect mainly attributable to respondents in states/periods when PSL and PFL were concurrently offered. Some of the strongest effects were found among women and unpartnered adult children. PFL adoption by itself was not associated with care provision to parents except when PFL also offered job protection. Paid leave policies have heterogeneous effects on eldercare and their design and implementation should be carefully considered. CONTEXT Family caregivers play a critical role in the American long-term care system. However, care responsibilities are known to potentially conflict with paid work, as about half of family caregivers are employed. The federal Family and Medical Leave Act passed by the US Congress in 1993 provides a nonuniversal, unpaid work benefit. In response, several states and localities have adopted the Paid Family Leave policy (PFL) and Paid Sick Leave policy (PSL) over the last two decades. Our objective is to examine the effect of these policies on the probability of personal care provision to older parents. METHODS This study used longitudinal data from the Health and Retirement Study (1998-2020). Difference-in-differences regression models were estimated to examine associations between state- and local-level PFL and PSL mandates and personal care provision to older parents. We analyzed heterogeneous effects by the type of paid leave exposure (provision of job protection with PFL and availability of both PSL and PFL [with or without job protection] concurrently). We also examined results for different population subgroups. FINDINGS PSL implementation was associated with a four- to five-percentage point increase in the probability of personal care provision. These effects were mainly attributable to respondents in states/periods when PSL and PFL were concurrently offered. The strongest effects were found among adult children who were employed at baseline, women, younger, unpartnered, and college educated. PFL implementation by itself was not associated with care provision to parents except when the policy also offered job protection. CONCLUSIONS Paid leave policies have heterogeneous impacts on personal care provision, potentially owing to differences in program features, variation in caregiving needs, and respondent characteristics. Overall, the results indicate that offering paid sick leave and paid family leave, when combined with job protection, could support potential family caregivers.
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Affiliation(s)
| | - Douglas A Wolf
- Maxwell School of Citizenship and Public Affairs, Syracuse University
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Liang J, Aranda MP, Jang Y, Wilber K. The Role of Social Isolation on Mediating Depression and Anxiety among Primary Family Caregivers of Older Adults: A Two-Wave Mediation Analysis. Int J Behav Med 2024; 31:445-458. [PMID: 37878186 PMCID: PMC11043211 DOI: 10.1007/s12529-023-10227-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Primary family caregivers of older people with chronic care conditions are highly vulnerable to social isolation and psychological strains such as depression and anxiety due to their demanding responsibilities. This study examines how social isolation mediates the relationship between caregiving stress and mental health symptoms of primary family caregivers. METHODS The analytic sample included 881 primary caregivers of older adults from the 2015 and 2017 National Study of Caregiving (NSOC). Social isolation was measured using a composite structure that includes objective social disconnectedness and subjective loneliness. Two-wave mediation models were estimated to examine longitudinally if social isolation mediated the relationship between caregiving stress (subjective & objective stress) and mental health symptoms (depression & anxiety) of primary caregivers. RESULTS The study findings indicate that both subjective (β = 0.32, p < 0.001) and objective stress (β = 0.21, p = 0.003) have direct effects on depression among primary caregivers. Social isolation was found to only mediate the relationship between objective stress and depression (β = 0.18, p < 0.001). In contrast, no significant direct and indirect pathway was found in the anxiety model. CONCLUSIONS The study demonstrates the internal mechanism where objective strains of caregiving make family caregivers socially isolated, which in turn leads to increased symptoms of depression. Future interventions and practices aimed at improving the psychological well-being of family caregivers should prioritize strategies aimed at increasing social engagement, particularly for those with heavy caregiver burdens.
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Affiliation(s)
- Jiaming Liang
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA.
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, USA.
| | - Maria P Aranda
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, USA
| | - Yuri Jang
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, USA
- Department of Social Welfare, Ewha Womans University, Seoul, Republic of Korea
| | - Kathleen Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, USA
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Mahomed A, Pretorius C. Giving voice to the voiceless: Understanding the perceived needs of dementia family carers in Soweto, a South African township. DEMENTIA 2024; 23:622-642. [PMID: 38354041 PMCID: PMC11059838 DOI: 10.1177/14713012241234155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
This qualitative study aimed to provide family caregivers with an independent platform to reflect on and identify their needs in the role of dementia caregiver. Thirty caregivers were interviewed using a semi-structured approach, and data analysis followed a reflective thematic analysis method. The study revealed that Black African caregivers in townships require sufficient information and orientation to dementia-specific services, psychoeducation on dementia as a disease and its behavioural manifestations, as well as practical skills to manage the disease process. Caregivers expressed the need for in-depth, accessible education to boost their confidence and resilience in handling the challenges of dementia caregiving. They also proposed community initiatives to raise awareness, promote knowledge, and facilitate early detection and diagnosis of dementia. Additional needs included informational and educational workshops, resources like transportation services and helplines, day care facilities, media campaigns, and collaboration with the government for funding and policy change. New caregivers were advised to seek comprehensive education, support, and services while preserving the dignity of their family members with dementia. Remarkably, the identified needs and community initiatives aligned with the priority areas outlined by ADI for a National Dementia Plan, which South Africa currently lacks. The study highlights the importance of developing a National Dementia Plan in South Africa through collaboration among stakeholders, including communities, policy-makers, and multidisciplinary healthcare teams, while ensuring that individuals and families affected by dementia have a voice.
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Affiliation(s)
- Aqeela Mahomed
- Department of Psychology, Stellenbosch University, South Africa
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Luo Y, Yuan K, Li Y, Liu Y, Pan Y. The "spillover effect" of long-term care insurance in China on spouses' health and well-being. Soc Sci Med 2024; 340:116487. [PMID: 38096600 DOI: 10.1016/j.socscimed.2023.116487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024]
Abstract
This study examined the spillover effect of long-term care insurance (LTCI) on the health outcomes and well-being of spouses for Chinese middle and old-aged adults with expected LTC demand or actual care burdens. Using panel data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we investigated the impact of the introduction of LTCI pilots across several cities on old individuals by using the difference-in-differences (DID) approach. We found a spillover effect of LTCI on the health and well-being outcomes of spouses of middle and old-aged individuals with functional limitations. It might due to the fact that LTCI could relieve economic burden by reducing out-of-pocket medical expenditures, which further affects health and well-being of spouses. The spillover effect on health and well-being was found to be stronger for male spouses and low-educated spouses. Spouses of the individuals aged below 80 years old and those live without adult children were more likely to benefit from the introduction of LTCI. Moreover, providing combination benefits seems to make spouses better off than offering direct services. Therefore, the results implied that the expansion of LTCI not only helped the care recipients themselves but could also improve the health and well-being of the spouses of functionally impaired older adults.
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Affiliation(s)
- Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Kexin Yuan
- School of Software and Microelectronics, Peking University, Beijing, China
| | - Yuxiao Li
- School of Applied Economics, Renmin University of China, Beijing, China
| | - Yating Liu
- School of Nursing, Peking University, China
| | - Yao Pan
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China.
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Paoletti J, Phetmisy CN, Lai VD, Fagundes CP. Perceived income inadequacy is associated with Epstein-Barr Virus latency and mental health outcomes in informal caregivers who are also employed in the healthcare industry. Psychoneuroendocrinology 2023; 158:106388. [PMID: 37729703 DOI: 10.1016/j.psyneuen.2023.106388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/24/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023]
Abstract
Finances are a prevalent source of stress. In a sample of 799 nursing home workers measured multiple times over 18 months, we found that higher perceived income inadequacy, the perception that one's expenses exceeds one's incomes, was associated with poorer self-reported mental health indicators and Epstein-Barr Virus antibody titers (a marker of cell-mediated immune function). Perceived income inadequacy predicted outcomes over and above the role of other socioeconomic status variables (objective household income and education). Mental health variables were not related to Epstein-Barr Virus antibody titers. Additionally, we found an interaction between perceived income inadequacy and informal caregiver status on our mental health outcomes; informal caregivers with higher perceived income inadequacy had poorer mental health than non-caregivers with the same perceived income inadequacy. Our findings may add nuance to the reserve capacity model, which states that those at lower socioeconomic levels are at higher risk of adverse health outcomes partly because they have fewer resources to address demands and strain. Perceived income inadequacy may significantly predict mental and physical well-being beyond other socioeconomic status variables, especially among lower-income employees. Caregiving stress and perceived income inadequacy may have synergistic effects on mental health.
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Affiliation(s)
| | | | | | - Christopher P Fagundes
- Rice University, USA; University of Texas MD Anderson Cancer Center, USA; Baylor College of Medicine, USA
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Sugihara Y, Sugisawa H. Influence of medical care tasks on subjective burden and gain among older adults' family caregivers: structural equation modeling for testing the role of formal and informal support. BMC Geriatr 2023; 23:628. [PMID: 37803249 PMCID: PMC10559595 DOI: 10.1186/s12877-023-04348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The number of caregivers performing medical care tasks at home for older adults is expected to increase. Family caregivers, who are not healthcare professionals, are likely to find these activities difficult and burdensome. However, appropriate support may decrease the negative and increase the positive aspects of caregiving. This study investigated direct associations between caregivers providing medical care at home and their negative and positive appraisals of caregiving (burden and gain), indirect associations through healthcare professional support and informal support, and whether the associations between medical care tasks and caregivers' appraisals of caregiving differed based on the support received. METHODS Interview surveys were conducted in 2013, 2016, and 2019 in a Tokyo Metropolitan Area city with family caregivers of community-dwelling older adults who were certified as requiring care in Japan's long-term care insurance system. This study analyzed the combined data from each survey (n = 983). Structural equation modeling (SEM) analysis was utilized to examine direct associations between providing medical care and caregiver appraisals and indirect relationships through healthcare professional support and informal support. The modulating effects of these forms of support on the relationship between medical care and caregiver appraisals were assessed using multigroup SEM analyses. RESULTS Approximately 9% of family caregivers provided medical care at home. The results of SEM analyses, controlled for care recipients' physical and cognitive difficulties; caregivers' age, sex, and economic condition; and survey year, revealed no direct associations between providing medical care and caregivers' sense of burden and gain. They also did not reveal any indirect effects through either healthcare professional support or informal support. However, the results of multigroup SEM analyses indicated that caregivers providing medical care who used home-visit services by physicians and/or nurses, compared to those who did not, tended to exhibit a greater sense of gain. CONCLUSIONS These results suggest that family caregivers providing medical care at home can positively change their appraisals of caregiving if they receive appropriate support. Home medical care services provided by healthcare professionals can effectively support caregivers. Developing strategies and policies to make medical care services at home more accessible to caregivers is crucial.
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Affiliation(s)
- Yoko Sugihara
- Department of Urban Science and Policy, Faculty of Urban Environmental Sciences, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo, 192-0397, Japan.
| | - Hidehiro Sugisawa
- Gerontology Program, J. F. Oberlin University Graduate School of International Studies, 1-1- 12 Sendagaya, Shibuya-ku, Tokyo, 151-0051, Japan
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Wu J, Williams A, Wang L, Kitchen P. A comparative analysis of carer-employees in Canada over time: a cross-sectional analysis of Canada's General Social Survey, 2012 and 2018. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:840-855. [PMID: 37165142 PMCID: PMC10484878 DOI: 10.17269/s41997-023-00762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES The aims of the study are to identify trends in the socio-demographic, health, and work profiles of Canadian carer-employees (CEs) over time, as well as the gender difference in the intensity of caring. METHODS Cross-sectional data from cycles 26 and 32, collected in 2012 and 2018 respectively, of the Canadian General Social Survey (GSS) were used. Logistic, multinomial logistic, and linear regressions were used to estimate how caregiving is associated with caregivers' health, well-being, and work in both cycles. Regressions from both cycles were then compared with chi-square tests for significant differences over time. RESULTS The proportion of male CEs grew between 2012 and 2018, and women were no longer more likely to be a CE. The intensity of care for female CEs was significantly increased from 2012 to 2018 as compared with their male counterparts. General health (2018: OR = 0.25[0.11, 0.61] vs. 2012: OR = 0.33[0.15, 0.72]) and life satisfaction ([Formula: see text] = -0.42[0.54, -0.30] vs. [Formula: see text] = -0.22[-0.30, -0.14]) were significantly worsened with respect to the role of CEs from 2012 to 2018. CONCLUSION Our study provides the evidence that CEs' health and well-being have worsened over time, especially for female CEs, indicating that the needs of CEs are growing at a faster rate than the supports available. The results are meaningful in informing and justifying the provision of CE supports at work in order to sustain CEs in the workplace, such as the carer-friendly workplace policies.
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Affiliation(s)
- Jerry Wu
- Department of Mathematics, University of Waterloo, Waterloo, ON, Canada
| | - Allison Williams
- School of Earth, Environment & Society, McMaster University, Hamilton, ON, Canada
| | - Li Wang
- Offord Center for Child Study & Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Peter Kitchen
- School of Earth, Environment & Society, McMaster University, Hamilton, ON, Canada
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Van Orden KA, Bower E, Lutz J, Silva C. Engage coaching for caregivers: a pilot trial to reduce loneliness in dementia caregivers. Aging Ment Health 2023; 27:2019-2026. [PMID: 36898849 PMCID: PMC10492891 DOI: 10.1080/13607863.2023.2187345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES There are no evidence-based interventions for reducing loneliness in family caregivers of people with dementia (ADRD caregivers), despite heightened risk. We examined feasibility, acceptability, and potential efficacy of a brief behavioral intervention, Engage Coaching for Caregivers, to reduce loneliness and increase social connection for older ADRD caregivers experiencing stress and loneliness. METHODS A single-arm clinical trial of 8 individual sessions of Engage Coaching delivered remotely. Outcomes assessed 3-months post-intervention included loneliness and relationship satisfaction (co-primary) and perceived social isolation (secondary). RESULTS Engage Coaching was feasible to deliver, with n = 25 of 30 enrolled completing at least 80% of sessions. 83% indicated the program met expectations and 100% reported the program was suitable and convenient. Improvements were observed in loneliness (standardized response mean [SRM] = 0.63), relationship satisfaction (SRM = 0.56), and perceived social isolation (SRM = 0.70). CONCLUSION Engage Coaching is a promising behavioral intervention to enhance social connection for older ADRD caregivers.
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Affiliation(s)
- Kimberly A. Van Orden
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, 14642, United States
| | - Emily Bower
- Pacific University, School of Graduate Psychology, Hillsboro, OR
| | - Julie Lutz
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, 14642, United States
| | - Caroline Silva
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, 14642, United States
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Kellett K, Robison J, McAbee-Sevick H, Gitlin LN, Verrier Piersol C, Fortinsky RH. Implementing the Care of Persons With Dementia in Their Environments (COPE) Intervention in Community-Based Programs: Acceptability and Perceived Benefit From Care Managers' and Interventionists' Perspectives. THE GERONTOLOGIST 2023; 63:28-39. [PMID: 35581164 PMCID: PMC9872768 DOI: 10.1093/geront/gnac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Nonpharmacologic interventions have demonstrated benefits for people living with dementia and their caregivers. Few studies have evaluated their implementation in real-world settings. Using normalization process theory (NPT), an implementation science framework, this study evaluated the acceptability of the care of persons with dementia in their environments (COPE) intervention by care managers and interventionists implemented in a Medicaid and state-revenue funded home and community-based services (HCBS) program. RESEARCH DESIGN AND METHODS NPT and data from 9 care manager focus groups (n = 61) and 2 interventionist focus groups (n = 8) were utilized to understand COPE acceptability to program care managers and interventionists. NPT's 4 criteria, coherence, cognitive participation, collective action, and reflexive monitoring, framed the research questions used to evaluate the intervention's implementation. RESULTS Care managers and interventionists demonstrated a shared understanding of COPE aims and the value of practices implemented (coherence). Training by national experts facilitated program buy-in to meet COPE goals and was demonstrated by care managers and interventionists as they used the training to broaden their program involvement (cognitive participation). Operational work done by care managers and interventionists to implement the intervention (collective action) and their shared perceptions of program benefits (reflexive monitoring) contributed to program implementation, families' positive responses to COPE and enhanced sustainability. DISCUSSION AND IMPLICATIONS Introducing evidence-based dementia care interventions into HCBS programs strongly depends upon building shared understandings between care managers and interventionists and valuing the contributions of all stakeholders involved in delivering care innovations to people living with dementia and their caregivers.
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Affiliation(s)
- Kathy Kellett
- UConn Center on Aging, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
| | - Julie Robison
- UConn Center on Aging, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
| | - Heather McAbee-Sevick
- UConn Center on Aging, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Richard H Fortinsky
- UConn Center on Aging, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
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Le DD, Ibuka Y. Understanding the effects of informal caregiving on health and well-being: Heterogeneity and mechanisms. Soc Sci Med 2023; 317:115630. [PMID: 36580861 DOI: 10.1016/j.socscimed.2022.115630] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/10/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
This study examines the heterogenous effects of informal caregiving on caregivers' health and well-being and the mechanisms of the effects, which remain largely undiscussed in previous literature. We used a combined estimation of fixed effects and the instrumental variables to address unobserved time-invariant individual characteristics and the endogeneity problem between caregivers' health and caregiving status. Using data from the four waves of the Japanese Study of Aging and Retirement collected in 2007, 2009, 2011, and 2013, and covering individuals aged 50 to 75 at the baselines, we found robust evidence of the negative effects of informal caregiving on caregivers' mental health and life satisfaction, but not on their physical health. Regarding heterogenous effects, we found that informal caregiving adversely affected female but not male caregivers' mental health and life satisfaction. Our results also showed that informal caregiving had greater effects on individuals providing care for their mothers-in-law, with a higher socioeconomic status, living with their in-laws, and belonging to younger groups. Our results indicated that the loss of social networks and leisure and social activities were channels through which informal caregiving might negatively affect caregivers' health and well-being. This study provides suggestions that policy makers may use to mitigate the negative effects of caregiving with targeted interventions, while formulating policies to support informal caregivers.
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Affiliation(s)
- Duc Dung Le
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato-ku, Tokyo 108-8345, Japan.
| | - Yoko Ibuka
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato-ku, Tokyo 108-8345, Japan.
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Christie HL, Dam AEH, van Boxtel M, Köhler S, Verhey F, de Vugt ME. Lessons Learned From an Effectiveness Evaluation of Inlife, a Web-Based Social Support Intervention for Caregivers of People With Dementia: Randomized Controlled Trial. JMIR Aging 2022; 5:e38656. [PMID: 36476485 PMCID: PMC9773030 DOI: 10.2196/38656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Informal care for people with dementia not only affects the well-being of the primary caregiver but also changes their roles and interactions with the social environment. New online interventions might facilitate access to social support. Recently, an online social support platform, Inlife, was developed in the Netherlands and aims to enhance social support and positive interactions in informal support networks. OBJECTIVE This study aimed to evaluate the effectiveness of Inlife for caregivers of people with dementia. METHODS A randomized controlled trial with 96 caregivers of people with dementia was performed. Participants were randomly assigned to the Inlife intervention or the waiting list control group. After 16 weeks of Inlife use, the waiting list control group could start using Inlife. Effects were evaluated at baseline (T0), 8 weeks (T1), and 16 weeks (T2). The 16-week follow-up assessment (T2) served as the primary endpoint to evaluate the results for the primary and secondary outcome variables evaluated with online self-report questionnaires. The primary outcomes included feelings of caregiver competence and perceived social support. The secondary outcomes included received support, feelings of loneliness, psychological complaints (eg, anxiety, stress), and quality of life. RESULTS No significant improvements were demonstrated for the intervention group (n=48) relative to the control group (n=48) for the primary outcomes (feeling of carer competence: b=-0.057, 95% CI -0.715 to 0.602, P=.87; perceived social support: b=-15.877, 95% CI -78.284 to 46.530, P=.62) or any secondary outcome. This contrasts with our qualitative findings showing the potential of Inlife to facilitate the care process in daily life. Adherence was not optimal for all Inlife users. Additional per-protocol and sensitivity analyses also revealed no beneficial results for high active Inlife users or specific subgroups. Inlife users were more active when part of a larger network. CONCLUSIONS Researchers should be modest regarding the effectiveness of online caregiver interventions in terms of quantitative measures of well-being and quality of life. Nevertheless, online tools have the potential to facilitate the caregiver process in daily life. Lessons learned include the importance of harnessing the power of human interaction in eHealth, making use of the user's social capital, and the need to develop research methods that can identify benefits in daily life that are ecologically valid for caregivers. TRIAL REGISTRATION Netherlands Trial Register NTR6131; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-017-2097-y.
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Affiliation(s)
- Hannah Liane Christie
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alieske Elisabeth Henrike Dam
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Martin van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Marjolein Elisabeth de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
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15
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Keita Fakeye MB, Samuel LJ, Wolff JL. Financial Contributions and Experiences of Non-Spousal, Employed Family Caregivers. J Appl Gerontol 2022; 41:2459-2468. [PMID: 35838604 PMCID: PMC9671815 DOI: 10.1177/07334648221115261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The economic impacts of caring for an older adult may be amplified for employed family and unpaid caregivers. We examine out-of-pocket spending among employed, retired, and unemployed caregivers. Among employed caregivers, we identify correlates of spending and assess whether spending and work productivity loss contribute to financial burden. Analyses use the 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving. We find that employed caregivers incur more out-of-pocket spending on caregiving than retired and unemployed counterparts. Employed caregivers spending more than $500 out-of-pocket provide more hours of care and assist older adults with greater impairment. Among employed family caregivers, caregiver and care recipient Medicaid enrollment, spending, and work productivity loss are associated with financial burden. Findings suggest that caregiving exacerbates economic well-being among employed caregivers, particularly for those with socioeconomic vulnerability.
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Affiliation(s)
- Maningbè B. Keita Fakeye
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jennifer L. Wolff
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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16
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Avieli H, Band-Winterstein T, Zamir A. Juggling between caregiving and self-actualization: Older parents' lifelong experience of caring for an adult child with developmental disabilities. PLoS One 2022; 17:e0276779. [PMID: 36327274 PMCID: PMC9632868 DOI: 10.1371/journal.pone.0276779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Recently, the number of adults with Developmental Disabilities (DD) who live with their parents has increased. This study aims to explore how parents report retrospectively and interpret their experience in the context of self-actualization in the long-term care of a child with a developmental disability. Four forms of parents' experiences emerged from the analysis: "This child is my whole world"-Total devotion; "I Can Do Both"-Actualizing personal and familial goals as well as caregiving issues; "It's a mission, it's a calling, it's a full-time job"-Self-actualization through caregiving; and "Disability will not stop me"-Emphasizing self-actualization. While prior studies have created a distinct separation between caregiving and self-actualization, the current study focuses on the complex dynamics of lifelong parental caregiving for a child with DD, illustrating the parents' ways of actualizing their life goals in the context of caregiving over the years.
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Affiliation(s)
- Hila Avieli
- Department of Criminology, Ariel University, Haifa, Israel
| | - Tova Band-Winterstein
- Department of Gerontology, The Minerva Center on Intersectionality in Aging (MCIA), University of Haifa, Haifa, Israel
| | - Alon Zamir
- Department of Community Mental Health, The Minerva Center on Intersectionality in Aging (MCIA), University of Haifa, Haifa, Israel
- * E-mail:
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17
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Masoud S, Glassner AA, Mendoza M, Rhodes S, White CL. "A Different Way to Survive": The Experiences of Family Caregivers of Persons Living With Dementia During the COVID-19 Pandemic. JOURNAL OF FAMILY NURSING 2022; 28:243-257. [PMID: 35808849 PMCID: PMC9272038 DOI: 10.1177/10748407221111079] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Family caregivers of persons living with dementia often experience challenges to their health and quality of life related to their caregiving role. The COVID-19 pandemic added substantially to the responsibilities of family caregivers, potentially putting them at greater risk of poor health outcomes and impeded quality of life. To better understand the impact of the pandemic on the experiences of family caregivers, a multimethods study was conducted. Family caregivers of persons living with dementia were invited to complete a cross-sectional survey and a subset of survey respondents were invited to participate in focus groups for added insight. A total of 161 caregivers responded to the survey and 30 participated in the focus groups. Qualitative data from focus groups were used to elucidate deeper insight into quantitative findings from the survey. Findings reflect that the pandemic affected family caregiver health and wellness, access of care and resources, identity, and resilience.
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Affiliation(s)
- Sara Masoud
- The University of Texas Health Science Center at San Antonio, USA
| | | | - Mayra Mendoza
- The University of Texas Health Science Center at San Antonio, USA
| | - Shanae Rhodes
- The University of Texas Health Science Center at San Antonio, USA
| | - Carole L White
- The University of Texas Health Science Center at San Antonio, USA
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18
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Rice JD, Sperling SA, Brown DS, Mittleman MS, Manning CA. Evaluating the efficacy of TeleFAMILIES: a telehealth intervention for caregivers of community-dwelling people with dementia. Aging Ment Health 2022; 26:1613-1619. [PMID: 34125635 DOI: 10.1080/13607863.2021.1935462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Examine the efficacy of a telehealth-administered intervention for caregivers of persons with dementia. Two hundred sixteen caregivers engaged in the FAMILIES intervention over six months, either virtually (n = 59) or in-person (n = 157). The telehealth protocol (TeleFAMILIES) was conducted online. Caregivers engaged in six sessions, including individual and family/group counseling, ad hoc counseling, and had access to support groups. Sessions included person-centered assessments of caregivers' physical, emotional, social needs, and current support networks. Primary outcome variables were change in total score between baseline and completion on the Zarit Burden Interview (ZBI), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), and the Revised Memory and Behavior Problems Checklist (RMBPC). TeleFAMILIES caregivers reported significant reductions in ZBI (p = .002) and CESD-R scores (p < .001). RMBPC reaction scores significantly improved (p = .02) and improved more than in-person caregivers' scores (F (3, 119) = 2.71, p = .048, partial eta2 = .06). For those classified as having a higher risk of depression at baseline, a significantly larger portion TeleFAMILIES caregivers converted to a classification of lower depression risk at completion (p = .02). Compared to the in-person group, TeleFAMILIES caregivers experienced the same, if not greater improvements in perceived burden, depressive symptomatology, and their ability to manage their reactions to behavioral symptoms of dementia. The strengths of TeleFAMILIES are the convenience of telehealth services and its mitigation of barriers to care.
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Affiliation(s)
- Jasmen D Rice
- Hartford HealthCare Ayer Neuroscience Institute, Memory Care Center, Wethersfield, CT, USA
| | - Scott A Sperling
- Center for Neuro-Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel S Brown
- OSF HealthCare Illinois Neurological Institute, Peoria, IL, USA
| | - Mary S Mittleman
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Carol A Manning
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
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19
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Home care practices of cancer caregivers and the effect of perceived social support on care burden. Support Care Cancer 2022; 30:8323-8332. [PMID: 35854156 DOI: 10.1007/s00520-022-07266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Caregivers have to manage tasks at home such as providing management of the patient's follow-up. Social support is known to have protective effects, especially for caregivers for cancer patients. The aim of this study is to examine the effect of home care practices and perceived social support level of caregivers of cancer patients on the burden of care. METHODS A descriptive and cross-sectional study. A total of 222 caregivers were included in the study. In this study, Caregiver and Patient Identification Form, Caregiver's Home Care Practices Questionnaire Form, Zarit Caregiver Burden Scale, Multidimensional Scale of Perceived Social Support, and Karnofsky Performance Scales were used. RESULTS Of the caregivers included in the study, it was found that 47.3% were in the 40-61 age group, and 64.4% were women. The total score of caregivers from MSPSS was 61.29 ± 17.27, the total score they received from the Home Care Practices Questionnaire was 28.88 ± 7.72, and the total score they got from the ZBI was 29.11 ± 14.58. It was found that there was a weak and negative correlation between the perceived social support total scores and caregiver burden scores of caregivers (p < .01). In particular, in the regression analysis, a significant correlation was found between the total score of home care practices and personal sub-dimension scores (r: .91, p < .001, tolerance value: .158, VIF: 6.311). CONCLUSIONS It has been determined that the increase in home care practices of caregivers of cancer patients and the low level of perceived social support increase the burden of care.
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20
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Health equity and wellbeing among older people’s caregivers in New Zealand during COVID-19: Protocol for a qualitative study. PLoS One 2022; 17:e0271114. [PMID: 35839228 PMCID: PMC9286244 DOI: 10.1371/journal.pone.0271114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Knowledge of the challenges unpaid caregivers faced providing care to older people during the COVID-19 pandemic is limited. Challenges may be especially pronounced for those experiencing inequitable access to health and social care. This participatory action research study, located in New Zealand, has four main objectives, (i) to understand the challenges and rewards associated with caregiving to older care recipients during the COVID-19 pandemic restrictions; (ii) to map and collate resources developed (or mobilised) by organisations during the pandemic; (iii) to co-produce policy recommendations, identify useful caregiver resources and practices, prioritise unmet needs (challenges); and, (iv) to use project results in knowledge translation, in order to improve caregivers access to resources, and raise the profile and recognition of caregivers contribution to society. Methods and analysis Māori, Pacific and rural-dwelling caregivers to 30 older care-recipients, and 30 representatives from organisations supporting caregivers in New Zealand will be interviewed. Combining data from the interviews and caregivers letters (from an archive of older people’s pandemic experiences), framework analysis will be used to examine the interrelated systems of the human ecological model and the impact on caregiving experiences during the pandemic. Resources that service providers had created or used for caregivers and older people will be collated and categorised. Through co-production with caregivers and community partners we will produce three short films describing caregivers’ pandemic experiences; identify a suite of resources for caregivers to use in future events requiring self-isolation, and in everyday life; and generate ideas to address unresolved issues.
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21
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Zarei S, Lakhanpal G, Sadavoy J. Tele-Mindfulness for Dementia's Family Caregivers: a Randomized Trial with a Usual Care Control Group. Curr Alzheimer Res 2022; 19:364-372. [PMID: 35570513 DOI: 10.2174/1567205019666220514131015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Caring for a family member with dementia is stressful and challenging. Family caregivers, as a vulnerable marginalized population and invisible backbone of the health care system, need accessible and effective interventions that are tailored to their particular needs. OBJECTIVES To evaluate the feasibility and effectiveness of a live online mindfulness-based cognitive therapy (tele-MBCT) intervention for family caregivers of individuals with dementia. METHOD Family caregivers were assigned to a tele-MBCT intervention or a usual care control group. Tele-MBCT participants attended eight weekly live online training and practiced mindfulness practices at home. All participants completed surveys at baseline, post-intervention, and 4-week follow-up. RESULTS 26 participants (age 60±13 years) were enrolled and randomized (14 into the intervention and 12 into the control group), and 92.3% completed the study. 88% of the participants were female, and 70% were caring for a parent for the mean of 5.12±2.88 years. 84% of the participants in the intervention group attended at least seven sessions and the average of daily practice was 23.58±45.71 minutes. All participants were satisfied with the intervention, and 88.8% were satisfied with the online delivery method. Participants in the intervention group showed Pre-Post improvement in self-compassion (t (11) = -2.49, p=0.03) and coping strategies (t (11) = 3.62, p=0.004) compared to the control group. CONCLUSION Tele-MBCT is a feasible intervention and may improve psychological outcomes and adaptive coping in family caregivers of individuals with dementia. A larger controlled trial is warranted.
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Affiliation(s)
- Shadi Zarei
- Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gita Lakhanpal
- Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario
| | - Joel Sadavoy
- Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario.,Department of Psychiatry, University of Toronto, Toronto, Canada
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22
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Van Orden KA, Heffner KL. Promoting Social Connection in Dementia Caregivers: A Call for Empirical Development of Targeted Interventions. THE GERONTOLOGIST 2022; 62:1258-1265. [PMID: 35235943 PMCID: PMC9579462 DOI: 10.1093/geront/gnac032] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Social connection is an understudied target of intervention for the health of individuals providing care for a family member with Alzheimer's disease and related dementias (ADRD). To guide future research, we discuss considerations for interventions to promote social connection, with a particular focus on reducing loneliness: (a) include caregiver perspectives in designing and delivering interventions; (b) adapt to stages of dementia; (c) consider caregiving demands, including the use of brief interventions; (d) specify and measure mechanisms of action and principles of interventions; (e) consider dissemination and implementation at all stages of research. With support from the National Institute on Aging for a Roybal Center for Translational Research in the Behavioral and Social Sciences of Aging, we are developing a portfolio of mechanism-informed and principle-driven behavioral interventions to promote social connection in ADRD caregivers that can be flexibly applied to meet a diverse set of needs while maximizing resources and reducing demands on caregivers.
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Affiliation(s)
- Kimberly A Van Orden
- Address correspondence to: Kimberly A. Van Orden, PhD, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Box Psych Research, Rochester, NY 14642, USA. E-mail:
| | - Kathi L Heffner
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
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23
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Zavagli V, Raccichini M, Ostan R, Ercolani G, Franchini L, Varani S, Pannuti R. Identifying the prevalence of unmet supportive care needs among family caregivers of cancer patients: an Italian investigation on home palliative care setting. Support Care Cancer 2022; 30:3451-3461. [PMID: 34999950 DOI: 10.1007/s00520-021-06655-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Family caregivers (FCs) are crucial resources in caring for cancer patients at home. The aim of this investigation was (1) to measure the prevalence of unmet needs reported by FCs of cancer patients in home palliative care, and (2) to investigate whether their needs change as their socio-demographic characteristics and the patients' functional abilities change. METHODS FCs completed a battery of self-report questionnaires, including the Cancer Caregiving Tasks, Consequences, and Needs (CaTCoN). RESULTS Data were collected from 251 FCs (74 men and 177 women, mean age 58.5 ± 14.2 years). Most of the participants experienced a substantial caregiving workload related to practical help (89.8%), provided some or a lot of personal care (73.1%), and psychological support (67.7%) to patients. More than half of the FCs reported that the patient's disease caused them negative physical effects (62.7%). Emotional, psychosocial, and psychological needs were referred. Some FCs reported that the patient's disease caused them a lot of stress (57.3%) and that they did not have enough time for friends/acquaintances (69.5%) and family (55.7%). The need to see a psychologist also emerged (44.0%). Age, caregiving duration, and patients' functional status correlated with FCs' unmet needs. Women reported more negative social, physical, and psychological consequences and a more frequent need to talk to a psychologist. CONCLUSION The analysis demonstrated that cancer caregiving is burdensome. The results can guide the development and implementation of tailored programs or support policies so that FCs can provide appropriate care to patients while preserving their own well-being.
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Affiliation(s)
- Veronica Zavagli
- National Tumor Assistance ANT, via Jacopo di Paolo 36, 40128, Bologna, Italy.
| | - Melania Raccichini
- National Tumor Assistance ANT, via Jacopo di Paolo 36, 40128, Bologna, Italy
| | - Rita Ostan
- National Tumor Assistance ANT, via Jacopo di Paolo 36, 40128, Bologna, Italy
| | - Giacomo Ercolani
- National Tumor Assistance ANT, via Jacopo di Paolo 36, 40128, Bologna, Italy
| | - Luca Franchini
- National Tumor Assistance ANT, via Jacopo di Paolo 36, 40128, Bologna, Italy
| | - Silvia Varani
- National Tumor Assistance ANT, via Jacopo di Paolo 36, 40128, Bologna, Italy
| | - Raffaella Pannuti
- National Tumor Assistance ANT, via Jacopo di Paolo 36, 40128, Bologna, Italy
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Gavrilov B, Schmidt M, Kasten S, Sommer S, Hunzelar C, Bockheim F, Paños-Willuhn J, Offenberg L, Oberholz M, Ikar N, Weltermann B. More GP contacts and poorer health of informal caregivers with low socioeconomic status in Germany: results from the population-based DEGS1 and the cross-sectional GPCare-1 study. BMJ Open 2021; 11:e053146. [PMID: 36916141 PMCID: PMC8719219 DOI: 10.1136/bmjopen-2021-053146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Informal caregivers are known to have poorer mental health. Risk factors for caregiver burden include low education, female gender, cohabitation with the care recipient and lack of resources. General practitioners (GPs) have an important role in supporting caregivers. Drawing on data from two surveys, associations between caregivers' socioeconomic status (SES), psychophysical health and GP contacts are analysed. DESIGN Cross-sectional study. The study draws on data from two surveys (German Health Interview and Examination Survey for Adults, DEGS1 and General Practice Care-1, GPCare-1). SETTING Germany. PARTICIPANTS DEGS1: German general population (18+ years) n=7987. GPCare-1: general practice patients (18+ years) n=813. PRIMARY OUTCOME Psychophysical health, GP contacts and communication. METHODS Using representative DEGS1 data, the prevalence of informal caregivers, caregivers' burden, chronic stress, various health conditions and frequency of GP contacts were evaluated stratified by SES. Data from the GPCare-1 study addressed caregivers' experiences and communication preferences with GPs. RESULTS In the DEGS1, the prevalence of caregivers was 6.5%. Compared with non-caregivers, caregivers scored significantly higher for chronic stress (15.45 vs 11.90), self-reported poor health (37.6% vs 23.7%) and GP visits last year (3.95 vs 3.11), while lifestyle and chronic diseases were similar. Compared with caregivers with medium/high SES, those with low SES had a significantly lower prevalence of high/medium caregiver burden (47.9% vs 67.7%) but poorer self-reported health (56.9% vs 33.0%), while other characteristics did not differ. In the GPCare-1 study, the prevalence of caregivers was 12.6%. The majority of them felt that their GP takes their problems seriously (63.6%) without difference by SES. CONCLUSION Caregivers with low SES constitute an especially high-risk group for psychological strain, requiring special GP attention to support their needs.
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Affiliation(s)
- Boris Gavrilov
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Manuela Schmidt
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Stefanie Kasten
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Samira Sommer
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Carmen Hunzelar
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Florian Bockheim
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Joana Paños-Willuhn
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Luisa Offenberg
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Maja Oberholz
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Nur Ikar
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
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Lee J, Baik S, Becker T, Cheon J. Themes describing social isolation in family caregivers of people living with dementia: A scoping review. DEMENTIA 2021; 21:701-721. [PMID: 34872364 DOI: 10.1177/14713012211056288] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The number of people with dementia has been increasing. Evidence shows that over 16 million family caregivers provide unpaid care for people with dementia. However, family caregivers experience several challenges throughout their caregiving role, including that of social isolation. Although social isolation in people with dementia has been well documented, social isolation in their family caregivers has not received as much scholarly attention. This scoping review sought to address this dearth of research through the following research question: "What are themes, concepts, or constructs that describe social isolation of family caregivers for people living with dementia?". METHOD An electronic search was conducted in PubMed, PsycInfo, and Scopus, using the following Boolean search phrase: dementia AND "social isolation" AND (caregiver OR carers). Content analysis was conducted to identify relevant themes. FINDINGS The initial search yielded 301 studies. Through screening processes, 13 studies were eligible for review. Based on a synthesis of evidence, five themes emerged from the data: disease progression, psychological state, social networks, social supports, and technology. DISCUSSION This review demonstrates that caregiving is related to social isolation in family caregivers of people living with dementia. The experience of social isolation was related to the progression of dementia, psychological states, and lack of supports. In contrast, social supports, social networks, and using technology may reduce social isolation. Identifying themes provides policy and practice implications, such as using information and communication technology to create and redefine social networks.
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Affiliation(s)
- Joonyup Lee
- 115980University of Maryland School of Social Work, Baltimore, MA, USA
| | - Sol Baik
- 115980University of Maryland School of Social Work, Baltimore, MA, USA
| | - Todd Becker
- 115980University of Maryland School of Social Work, Baltimore, MA, USA
| | - Jihyang Cheon
- 115980University of Maryland School of Social Work, Baltimore, MA, USA
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26
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Informal Caregiving, Loneliness and Social Isolation: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212101. [PMID: 34831857 PMCID: PMC8618455 DOI: 10.3390/ijerph182212101] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
Background: Several empirical studies have shown an association between informal caregiving for adults and loneliness or social isolation. Nevertheless, a systematic review is lacking synthesizing studies which have investigated these aforementioned associations. Therefore, our purpose was to give an overview of the existing evidence from observational studies. Materials and Methods: Three electronic databases (Medline, PsycINFO, CINAHL) were searched in June 2021. Observational studies investigating the association between informal caregiving for adults and loneliness or social isolation were included. In contrast, studies examining grandchild care or private care for chronically ill children were excluded. Data extractions covered study design, assessment of informal caregiving, loneliness and social isolation, the characteristics of the sample, the analytical approach and key findings. Study quality was assessed based on the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Each step (study selection, data extraction and evaluation of study quality) was conducted by two reviewers. Results: In sum, twelve studies were included in our review (seven cross-sectional studies and five longitudinal studies)—all included studies were either from North America or Europe. The studies mainly showed an association between providing informal care and higher loneliness levels. The overall study quality was fair to good. Conclusion: Our systematic review mainly identified associations between providing informal care and higher loneliness levels. This is of great importance in assisting informal caregivers in avoiding loneliness, since it is associated with subsequent morbidity and mortality. Moreover, high loneliness levels of informal caregivers may have adverse consequences for informal care recipients.
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Serpentini S, Guandalini B, Tosin G, Ronconi L, Cristaldi G, Amatulli R, Deledda G, Riccardi S, Sommacal S, Iannopollo L, Calvo V, Merluzzi TV. Assessment of self-efficacy for caregiving in oncology: Italian validation of the caregiver inventory (CGI-I). BMC Palliat Care 2021; 20:166. [PMID: 34670541 PMCID: PMC8529803 DOI: 10.1186/s12904-021-00849-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background The Caregiver Inventory (CGI), a measure of self-efficacy for caregiving that takes into account aspects of caregiving that are neglected by current measures of caregiving, was translated into Italian and validated. Methods Ninety-one caregivers from a variety of locations in Italy completed the CGI-Italian (CGI-I) as well as the Hospital Anxiety and Depression Scale (HADS) and the Family Strain Questionnaire - Short Form (FSQ-SF). Results A confirmatory factor analysis based on the original CGI factor structure resulted in an adequate fit of the CGI-I using standard fit indices. Thus, the original factor structure was validated in the CGI-I: Managing Medical Information (α = 0.87), Caring for Care Recipient (α = 0.68), Caring for Oneself (α = 0.78), and Managing Difficult Interactions/Emotions (α = 0.55). The CGI-I total score was inversely related to anxiety (HADS, r = − 0.35, p = <.05), and depression (HADS, r = − 0.45, p = <.05). In addition, the CGI-I was inversely related to caregiver stress (FSQ-SF, r = − 0.39, p = <.05). Care of Oneself and Managing Difficult Interactions/Emotions emerged as the strongest and most robust negative relationships with anxiety, depression, and caregiver stress, which replicated, with similar constructs, findings from the original CGI. Conclusions The results of this study established the CGI-I as a reliable and valid measure of self-efficacy for caregiving. This study also confirms the importance of self-care and managing difficult communication in the process of successfully navigating the demands of caregiving and in constructing interventions for caregivers who need support. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00849-5.
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Affiliation(s)
- S Serpentini
- Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - B Guandalini
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA) University of Padua, Padua, Italy
| | - G Tosin
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA) University of Padua, Padua, Italy
| | - L Ronconi
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA) University of Padua, Padua, Italy
| | - G Cristaldi
- Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - R Amatulli
- Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - G Deledda
- Clinical Psychology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - S Riccardi
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Sommacal
- Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - L Iannopollo
- Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - V Calvo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA) University of Padua, Padua, Italy
| | - T V Merluzzi
- Department of Psychology, University of Notre Dame, Notre Dame, IN, 46556, USA.
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Raj M, Feldman SJ, Platt JE, Chang T. "If It Needs to be Done, It Needs to be Done": National Survey of Youth Experiences and Perspectives on Caregiving. J Adolesc Health 2021; 69:664-667. [PMID: 33846056 PMCID: PMC8867996 DOI: 10.1016/j.jadohealth.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/29/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to explore youth experiences and perspectives on family caregiving to improve programs and policies that impact the well-being of youth. METHODS In August 2020, we asked three open-ended questions about current and anticipated caregiving responsibilities, impact, and needs using MyVoice, a national text message poll of youth. Content and thematic analysis was conducted to evaluate qualitative responses. RESULTS In our sample (n = 1,076), 35% of respondents reported previously or currently providing care for an adult relative either independently or by helping another relative. Participants believed caregiving had or would hinder their educational or career goals and that specific training would better prepare them to be a caregiver. CONCLUSIONS The prevalence of youth caregiving may be higher than previous estimates. Healthcare professionals should evaluate youth for caregiving responsibilities and support them in identifying resources or interventions to reduce potential impacts of caregiving burden on health outcomes.
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Affiliation(s)
- Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, Illinois.
| | - Sara J. Feldman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jodyn E. Platt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tammy Chang
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Kabasawa K, Tanaka J, Komata T, Matsui K, Nakamura K, Ito Y, Narita I. Determination of specific life changes on psychological distress during the COVID-19 pandemic. PLoS One 2021; 16:e0256481. [PMID: 34460838 PMCID: PMC8405026 DOI: 10.1371/journal.pone.0256481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic might affect many aspects of the community and a range of psychiatric risk factors due to life changes, including people's behaviors and perceptions. In this study, we aim to identify specific life changes that correlate with psychological distress within the social context of the COVID-19 pandemic in Japan. In July 2020, workers (company employees and civil servants) in Japan were recruited from local institutions that had not had any confirmed COVID-19 cases as well as neighborhoods that had only a few cases. Participants completed a COVID-19 mental health survey (N = 609; 66.9% male). Psychological distress was identified based on Kessler-6 scores (≥13). Life changes were assessed by an open-ended question about life changes in participants and their family, workplace, and community due to the COVID-19 pandemic. A convergent mixed-method approach was used to compare the context of perceived life changes in participants with psychological distress and those without. As a result, 8.9% of participants had psychological distress, and sex and age categories were different between those with psychological distress and those without. Among the participants who responded to the open-ended question, the biggest life change was "staying at home," and the next biggest life changes were "event cancellations" and "increased workload" in participants with psychological distress, and "no changes" and "mask-wearing" in those without psychological distress, respectively. Regarding emotional/perceptual changes, "stress," "fear," and "anger" were more frequently reported by participants with psychological distress than those without (P <0.001). By integrating these findings, we identified themes focusing on vulnerable characteristics related to psychological distress. This study may provide a source in society for mediating psychological distress during a pandemic.
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Affiliation(s)
- Keiko Kabasawa
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- * E-mail:
| | - Junta Tanaka
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tomoyo Komata
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Katsuhiro Matsui
- Department of Humanities, Faculty of Humanities, Niigata University, Niigata, Japan
| | - Kazutoshi Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yumi Ito
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Zavagli V, Raccichini M, Ostan R, Franchini L, Bonazzi A, Varani S, Pannuti R. The ANT Home Care Model in Palliative and End-of-Life Care. An Investigation on Family Caregivers' Satisfaction with the Services Provided. TRANSLATIONAL MEDICINE AT UNISA 2021; 23:1-6. [PMID: 34447700 PMCID: PMC8370521 DOI: 10.37825/2239-9747.1022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The World Health Organization plan for a Decade of Healthy Ageing 2020-2030 has established some priorities in the field of palliative and end-of-life care. It states that "people require non-discriminatory access to good-quality palliative and end-of-life care" and recommends the "implementation of strategies for the provision of information, training, respite and support for informal caregivers". The priorities described are in line with the home care services that National Tumor Assistance (ANT) Foundation has been providing in Italy. This 5-years investigation was designed to measure caregivers' satisfaction and determine what types of support services are associated with greater satisfaction. 5.441 family caregivers filled out autonomously a 6-item questionnaire at the end of home care assistance, focusing on the level of satisfaction with the social and health services received. The overall data indicate a high satisfaction rate for the home care assistance received. In particular, participants rate positively the assistance provided by healthcare professionals (physicians, nurses and psychologists). The most appreciated aspects of assistance are those ensuring a global management of patients and their families, whereas an area of deficiency emerged was the continuity of care, suggesting the importance to implement the networks between the health care facilities and home care services. The present investigation constitutes a mean to highlight the aspects associated with greater satisfaction and the ones perceived as less satisfactory by caregivers. Moreover, this research constitutes a crucial instrument to improve home care assistance provided by ANT ensuring the best quality of life for both patients and their families.
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Affiliation(s)
- V Zavagli
- ANT Italia Foundation, Bologna, Italy
| | | | - R Ostan
- ANT Italia Foundation, Bologna, Italy
| | | | - A Bonazzi
- ANT Italia Foundation, Bologna, Italy
| | - S Varani
- ANT Italia Foundation, Bologna, Italy
| | - R Pannuti
- ANT Italia Foundation, Bologna, Italy
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Liotta G, Roller-Wirnsberger R, Iaccarino G, Goossens E, Tziraki C, Obbia P, Pais S, Cacciatore F, Zavagli V, Schena F, Vinci A, D'Amico G, Terraciano E, Gentili S, Lindner S, Illario M. From the bench to practice - Field integration of community-based services for older citizens with different levels of functional limitation across European Regions. TRANSLATIONAL MEDICINE AT UNISA 2021; 23:1-8. [PMID: 34447704 PMCID: PMC8370530 DOI: 10.37825/2239-9747.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action group A3 together with members of the Reference site collaborative network (RSCN) in December 2019 in Rome focused on integration of evidence-based approaches on health and care delivery for older citizens at different levels of needs with expertise coming from stakeholder across Europe. It was the final aim of the group to co-create culturally sensitive pathways and facilitate co-ownership for further implementation of the pathways in different care systems across Europe. The study design is a mixed method approach. Based on data analysis from a cohort of community-dwelling over-65 citizens in the framework of a longitudinal observational study in Rome, which included health, social and functional capacity data, three personas profiles were developed: the pre-frail, the frail and the very frail personas. Based on these data, experts were asked to co-create care pathways due to evidence and eminence during a workshop and included into a final report. All working groups agreed on a common understanding that integration of care means person-centered integration of health and social care, longitudinally provided across primary and secondary health care including citizens’ individual social, economic and human resources. Elements for consideration during care for pre-frail people are loneliness and social isolation, which, lead to limitation of physical autonomy in the light of reduced access to social support. Frail people need adaption of environmental structures and, again, social resource allocation to maintain at home. Very frail are generally vulnerable patients with complex needs. Most of them remain at home because of a strong individual social support and integrated health care delivery. The approach described in this publication may represent a first approach to scaling-up care delivery in a person-centered approach.
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Affiliation(s)
- G Liotta
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, Rome, Italy
| | | | - G Iaccarino
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | | | - C Tziraki
- Research Institute, Melabev and Hebrew University, Jerusalem, Israel
| | - P Obbia
- University of Turin, Department of Medical Science, Turin, Italy
| | - S Pais
- University of Algarve, Department of Biomedical Sciences and Medicine, Algarve Biomedical Center, Portugal.,Comprehensive Health Research Centre (CHRC), Portugal
| | - F Cacciatore
- University of Naples "Federico II", Department of Translational Science, Naples, Italy
| | - V Zavagli
- Psycho-oncology Unit, ANT Foundation, Bologna, Italy
| | - F Schena
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | - A Vinci
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, Rome, Italy
| | - G D'Amico
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, Rome, Italy
| | - E Terraciano
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, Rome, Italy
| | - S Gentili
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, Rome, Italy
| | - S Lindner
- Medical University of Graz, Department of Internal Medicine, Graz, Austria
| | - M Illario
- University of Naples "Federico II", Department of Public Health, Naples, Italy
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Johnson SS, Sowa M, McCann R, Cohen SA, Nash CC, Greaney ML, Alexander RA, Kasten J, Martin MP, McEntee ML, Suri Y, Roman C, Bane S, Opthof E. Knowing Well, Being Well: well-being born of understanding: The Science of Teamwork. Am J Health Promot 2021; 35:1028-1047. [PMID: 34351249 DOI: 10.1177/08901171211030142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Li L, Wister AV, Mitchell B. Social Isolation Among Spousal and Adult-Child Caregivers: Findings From the Canadian Longitudinal Study on Aging. J Gerontol B Psychol Sci Soc Sci 2021; 76:1415-1429. [PMID: 33170276 DOI: 10.1093/geronb/gbaa197] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The caregiving outcomes of spousal and adult-child caregivers are widely studied since they are the most common source of support provided to adults. However, the literature on social isolation among spousal and adult-child caregivers is very limited. In order to further elaborate and specify unique caregiving outcomes, this study focuses on social isolation, both longitudinally and comparatively between spousal and adult-child caregivers. METHODS This study was based on the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 5,226 participants (1,293 spousal caregivers and 3,933 adult-child caregivers) were selected. The Linear mixed models were used to examine the effect of caregiver type and caregiving intensity on social isolation over the course of survey. RESULTS Spousal and adult-child caregivers reported greater social isolation over time, and spousal caregivers exhibited a steeper increase in social isolation from Baseline to Follow-up 1 than adult-child caregivers. Also, an increase in caregiving hours resulted in greater social isolation. Finally, male spousal or adult-child caregivers were more likely to be socially isolated over time than their female counterparts. DISCUSSION The findings of this study contribute to the existing literature on caregiving outcomes by demonstrating an association between family caregiving and social isolation. The results indicate a strong need for intervention programs that aim to enhance social connectedness among family caregivers, and especially for those who perform intensive caregiving, are older age, and are from a lower socioeconomic status.
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Affiliation(s)
- Lun Li
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Andrew V Wister
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Barbara Mitchell
- Department of Gerontology & Department of Sociology/Anthropology, Simon Fraser University, Burnaby, British Columbia, Canada
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Cohen SA, Nash CC, Greaney ML. Informal Caregiving During the COVID-19 Pandemic in the US: Background, Challenges, and Opportunities. Am J Health Promot 2021; 35:1032-1036. [PMID: 34351245 DOI: 10.1177/08901171211030142c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Wang L, Ji C, Kitchen P, Williams A. Social participation and depressive symptoms of carer-employees of older adults in Canada: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Canadian Journal of Public Health 2021; 112:927-937. [PMID: 34114195 PMCID: PMC8523635 DOI: 10.17269/s41997-021-00524-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/29/2021] [Indexed: 11/20/2022]
Abstract
Objectives This study used two waves of data from the Canadian Longitudinal Study on Aging (CLSA) to investigate the association between social participation and depressive symptoms in carer-employees (CEs) and non-carer-employees (NCEs). Methods Adopting Pearlin et al.’s stress model, multivariate linear regression was used to examine the relationships among carer role, social participation, and depressive symptoms in Canadian employees using the first two waves of CLSA data, while controlling for possible confounders. Results Higher levels of social participation were found to be associated with lower depressive symptoms in both waves. Social participation was found to moderate depressive symptoms for CEs when compared with NCEs in Wave 2 but not in Wave 1. Conclusion The present study highlights the importance of social participation in reducing CEs’ depressive symptoms. The findings provide support for innovative policy and intervention efforts to encourage and enhance social participation at work via carer-friendly workplace policies for CEs across Canada.
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Affiliation(s)
- Li Wang
- Offord Centre for Child Study & Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Chris Ji
- Department of Mathematics, University of Waterloo, Waterloo, Ontario, Canada
| | - Peter Kitchen
- School of Earth, Environment and Society, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Allison Williams
- School of Earth, Environment and Society, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
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Geographic distance and social isolation among family care-givers providing care to older adults in Canada. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x2100060x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Family care-giving is associated with social isolation, which can lead to adverse health and wellbeing outcomes among family care-givers. The role of geographic distance in care-giver social isolation (CSI) is unclear and has received mixed research findings. Framed by the Ecological Model of Caregiver Isolation, this study examined the relationship between geographic distance and CSI, including the interaction between geographic distance and care-giving intensity for CSI. Linear regression and analysis of covariance were used to test these hypotheses using a sub-set of family care-givers from the 2012 Canadian General Social Survey (N = 2,881). Care-givers living a short distance from receivers reported lower levels of social isolation than co-resident, moderate-distance and long-distance care-givers. Being involved in higher-intensity care-giving as the primary care-giver, undertaking more care-giving tasks and providing care more frequently resulted in higher CSI scores. Long- and moderate-distance care-givers reported greater CSI than co-resident and short-distance care-givers only when providing higher-intensity care-giving. Employing a granulated measure of geographic distance positioned within an ecological framework facilitates an understanding of the nuanced association between geographic proximity and CSI. Furthermore, the identified interaction effects between geographic distance and care-giving intensity on CSI further explicate the complexity of care-giving experiences. The findings are relevant for programmes supporting care-givers in different contexts, especially distance care-givers.
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Reblin M, Ketcher D, McCormick R, Barrios-Monroy V, Sutton SK, Zebrack B, Wells KJ, Sahebjam S, Forsyth P, Byrne MM. A randomized wait-list controlled trial of a social support intervention for caregivers of patients with primary malignant brain tumor. BMC Health Serv Res 2021; 21:360. [PMID: 33865382 PMCID: PMC8052543 DOI: 10.1186/s12913-021-06372-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informal family caregivers constitute an important and increasingly demanding role in the cancer healthcare system. This is especially true for caregivers of patients with primary malignant brain tumors based on the rapid progression of disease, including physical and cognitive debilitation. Informal social network resources such as friends and family can provide social support to caregivers, which lowers caregiver burden and improves overall quality of life. However, barriers to obtaining needed social support exist for caregivers. To address this need, our team developed and is assessing a multi-component caregiver support intervention that uses a blend of technology and personal contact to improve caregiver social support. METHODS We are currently conducting a prospective, longitudinal 2-group randomized controlled trial which compares caregivers who receive the intervention to a wait-list control group. Only caregivers directly receive the intervention, but the patient-caregiver dyads are enrolled so we can assess outcomes in both. The 8-week intervention consists of two components: (1) The electronic Social Network Assessment Program, a web-based tool to visualize existing social support resources and provide a tailored list of additional resources; and (2) Caregiver Navigation, including weekly phone sessions with a Caregiver Navigator to address caregiver social support needs. Outcomes are assessed by questionnaires completed by the caregiver (baseline, 4-week, 8-week) and the cancer patient (baseline, and 8-week). At 8 weeks, caregivers in the wait-list condition may opt into the intervention. Our primary outcome is caregiver well-being; we also explore patient well-being and caregiver and patient health care utilization. DISCUSSION This protocol describes a study testing a novel social support intervention that pairs a web-based social network visualization tool and resource list (eSNAP) with personalized caregiver navigation. This intervention is responsive to a family-centered model of care and calls for clinical and research priorities focused on informal caregiving research. TRIAL REGISTRATION clinicaltrials.gov , Registration number: NCT04268979 ; Date of registration: February 10, 2020, retrospectively registered.
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Affiliation(s)
- Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
| | - Dana Ketcher
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Rachael McCormick
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Veronica Barrios-Monroy
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Solmaz Sahebjam
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Peter Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Margaret M Byrne
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
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Fabius CD, Wolff JL, Kasper JD. Race Differences in Characteristics and Experiences of Black and White Caregivers of Older Americans. THE GERONTOLOGIST 2021; 60:1244-1253. [PMID: 32400881 DOI: 10.1093/geront/gnaa042] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Racial disparities in health and socioeconomic characteristics of older adults have implications for the experiences of their family and unpaid caregivers, but knowledge to date has primarily drawn from convenience samples. Using a population-based sample, we examine associations between caregiver race and caregiving-related effects. RESEARCH DESIGN AND METHODS Study participants include white (n = 992) and black (n = 556) respondents to the 2015 National Study of Caregiving who assisted community-dwelling older adults with disabilities who participated in the National Health and Aging Trends Study. Guided by Pearlin's Stress Process Model, hierarchical logistic regression models were constructed to examine race differences in caregiving-related effects after adjusting for caregiving context, stressors, and resources. RESULTS Relative to white caregivers, blacks more often provided in excess of 40 hr of care per week (54.3% vs 38.6%) and more often cared for an older adult with dementia (27.1% vs 20.7%) who was living below the federal poverty line (31.7% vs 11.9%) or was Medicaid-eligible (42.2% vs 11.8%). Black caregivers more often used supportive services (32.9% vs 24.8%). In fully adjusted regression models, black caregivers were more likely to report gains and less likely to report emotional difficulty than whites. Service utilization did not attenuate caregiving-related emotional difficulty or participation restrictions, regardless of race. DISCUSSION AND IMPLICATIONS Findings highlight caregiving disparities and counterintuitive differences in experiences and indicate the importance of identifying supports such as paid family leave and faith and community-based programming to better support community-dwelling low-income older adults and their family and unpaid caregivers.
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Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer L Wolff
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Judith D Kasper
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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39
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Ghahramani F, Wang J. Intention to Adopt mHealth Apps Among Informal Caregivers: Cross-Sectional Study. JMIR Mhealth Uhealth 2021; 9:e24755. [PMID: 33729166 PMCID: PMC8294641 DOI: 10.2196/24755] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/14/2020] [Accepted: 02/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background Caregiving responsibility can change caregivers’ lives; modify their emotions; and make them feel frustrated, fearful, and nervous, thereby imposing physical and mental stress. Caregiving-related mobile apps provide a platform for obtaining valuable and trusted information, connecting more easily with other caregivers, monitoring medications, and managing appointments, and assessing health requirements and conditions of care receivers. Such apps also incorporate valuable resources that address care for the caregivers. Despite the potential benefits of caregiving-related apps, only a limited number of caregivers have adopted and used them.
Objective The aim of this study is to explore the important factors that affect caregivers’ intentions to integrate related mobile apps into their routine caregiving responsibilities.
Methods Using the protection motivation theory, we conducted a cross-sectional study among 249 participants. Purposive sampling was used to target participants who met 4 inclusion criteria: US residents, owning and using a smartphone, informal caregivers (individuals who give care to a friend or family member without payment) who provided at least 8 hours of care per week in the past year, and those currently not using any mobile app for caregiving purposes. We created a survey using Qualtrics and posted it on Amazon’s Mechanical Turk website. Participants received monetary compensation after successful completion of the survey.
Results We found that capabilities and skills of caregivers to use mobile apps, the app’s effectiveness in responding to the needs of caregivers, the degree of control of caregivers over their responsibilities, and the decisions they make for their care receivers can predict their willingness to adopt caregiving-related apps. In addition, the severity of health status and vulnerability of care receivers to unexpected health changes indirectly shape their caregivers’ decisions to adopt and use mobile apps for caregiving purposes.
Conclusions This study explores the important factors that affect informal caregivers’ intentions to adopt related mobile apps into their routine caregiving responsibilities. The results contribute to both mobile health adoption and the caregiving literature, and they offer significant implications for developers, health care practitioners, and policy makers.
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Affiliation(s)
- Fereshteh Ghahramani
- College of Computing and Digital Media, DePaul University, Chicago, IL, United States
| | - Jingguo Wang
- Department of Information Systems and Operations Management, University of Texas at Arlington, Arlington, TX, United States
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Cohen SA, Kunicki ZJ, Drohan MM, Greaney ML. Exploring Changes in Caregiver Burden and Caregiving Intensity due to COVID-19. Gerontol Geriatr Med 2021; 7:2333721421999279. [PMID: 33718523 PMCID: PMC7919204 DOI: 10.1177/2333721421999279] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 12/23/2022] Open
Abstract
This study explored self-reported changes in caregiving intensity (CI) and
caregiver burden (CB) among informal caregivers due to the COVID-19 pandemic
overall and by gender. Informal caregivers for someone age 50+ completed a
survey via Amazon’s MTurk in June 2020. Participants reported changes in CI and
CB due to COVID-19 and provided demographic information. Multinomial logistic
regression models assessed changes in CI and CB attributed to the COVID-19
pandemic overall and by gender. The sample (n = 835) was 68.5%
male and had an average age of 34 years (SD 9.8); 55.7% had
increased CI, and 53.1% had increased CB attributed to the pandemic. Increased
CB due to COVID-19 was associated with increased CI (OR 5.67, 95% CI 3.92–8.00).
Male caregivers with decreased CI due to COVID-19 were nearly seven times as
likely as those with no change in CI to have reduced CB due to COVID-19 (OR
6.91, 95% CI 3.29–14.52). Women with decreased CI due to COVID-19 were over
eight times as likely to have reduced CB due to COVID (OR 8.30, 95% CI
2.66–25.91). Results indicate that many caregivers experienced increases in CI
and CB since the start of the COVID-19 pandemic, and that these changes are
complex and vary by gender.
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Affiliation(s)
| | - Zachary J Kunicki
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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41
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Fortinsky RH. Family Caregiver Assessment in Primary Care: How to Strengthen the HealthCare Triad? J Am Geriatr Soc 2021; 69:286-288. [PMID: 33349914 DOI: 10.1111/jgs.16994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Richard H Fortinsky
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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42
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Robison JT, Shugrue NA, Fortinsky RH, Fabius CD, Baker K, Porter M, Grady JJ. A New Stage of the Caregiving Career: Informal Caregiving After Long-Term Institutionalization. THE GERONTOLOGIST 2020; 61:1211-1220. [PMID: 33170252 DOI: 10.1093/geront/gnaa185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The "unexpected career" of caregiving has previously been conceptualized in stages: community care through institutional placement/residence, ending with death of the care recipient. Transition programs such as Money Follows the Person (MFP) created a new stage of the caregiving career, caring for someone post-long-term institutionalization, about which little is known. Using Pearlin's Caregiver Stress Process Model, this study explores effects on caregivers from the return of their loved ones to the community after a long-term institutional stay. RESEARCH DESIGN AND METHODS Cross-sectional surveys of 656 caregivers of persons transitioned through Connecticut's MFP program 2014-18, completed 6 months post-transition. RESULTS Regardless of the age/disability of the care recipient, and despite experiencing high caregiving intensity, caregivers experienced less burden, anxiety, and depression, and higher benefits of caregiving than demonstrated in literature for the general caregiving population. Most felt less stressed than before and during the participant's institutional stay. Factors associated with worse outcomes included worry about safety, strained finances, missing work, and desiring additional services. Black and Hispanic caregivers experienced lower burden and anxiety and higher benefits of caregiving than White caregivers. DISCUSSION AND IMPLICATIONS By providing community supports to participants, transition programs can have broad ancillary benefits for caregivers and improve outcomes in the Pearlin model, lessening potentially deleterious effects of an unexpected return to intensive caregiving duties after institutional placement. Positive results for Black and Hispanic caregivers may reflect cultural expectations in caring for family that buffer the adverse effects of caregiving.
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Affiliation(s)
- Julie T Robison
- Center on Aging, UConn Health, Farmington, Connecticut.,Department of Public Health Sciences, UConn Health, Farmington, Connecticut
| | | | - Richard H Fortinsky
- Center on Aging, UConn Health, Farmington, Connecticut.,Department of Public Health Sciences, UConn Health, Farmington, Connecticut
| | - Chanee D Fabius
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kristin Baker
- Center on Aging, UConn Health, Farmington, Connecticut
| | - Martha Porter
- Center on Aging, UConn Health, Farmington, Connecticut
| | - James J Grady
- Department of Public Health Sciences, UConn Health, Farmington, Connecticut
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43
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Lin XY, Saksono H, Stowell E, Lachman ME, Castaneda-Sceppa C, Parker AG. Go&Grow: An Evaluation of a Pervasive Social Exergame for Caregivers of Loved Ones with Dementia. ACTA ACUST UNITED AC 2020; 4. [PMID: 33150303 DOI: 10.1145/3415222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Caregivers of persons with dementia (PWD) experience higher rates of stress, social isolation, and poor mental and physical health compared to non-caregiving populations. There is a vital need for engaging, sustainable, and scalable resources to support social, physical, and emotional wellbeing amongst caregivers of PWD. To explore this open design space, we designed and conducted a 6-week mixed-method evaluation of Go&Grow, a pervasive social exergame in which flowers grow as users increase physical activity and interact with other caregivers of PWD. Our findings showed that using Go&Grow helped participants relieve stress, increase physical activity, and develop empathy for and patience towards the loved one with dementia that they cared for. At the same time, tension arose as some caregivers desired to learn about the life challenges that Go&Grow users faced, while others hesitated to share such content. We discuss our findings and recommendations for future technology that promotes caregivers' time for themselves, understanding of PWD, and connections with other caregivers.
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Affiliation(s)
| | - Herman Saksono
- Khoury College of Computer Sciences, Northeastern University, USA
| | - Elizabeth Stowell
- Khoury College of Computer Sciences & Bouve College of Health Sciences, Northeastern University, USA
| | | | | | - Andrea G Parker
- School of Interactive Computing, Georgia Institute of Technology, USA
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44
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Abstract
Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies to support caregivers. Caregiving as chronic stress exposure is the conceptual driver for much of this research. We review and synthesize the literature on the impact of caregiving and intervention strategies for supporting caregivers. The impact of caregiving is highly variable, driven largely by the intensity of care provided and the suffering of the care recipient. The intervention literature is littered with many failures and some successes. Successful interventions address both the pragmatics of care and the emotional toll of caregiving. We conclude with both research and policy recommendations that address a national agenda for caregiving.
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Affiliation(s)
- Richard Schulz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA; .,University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Scott R Beach
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Sara J Czaja
- Center on Aging and Behavioral Research, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Lynn M Martire
- College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Joan K Monin
- School of Public Health, Yale University, New Haven, Connecticut 06520, USA
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45
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Tziraki C, Grimes C, Ventura F, O’Caoimh R, Santana S, Zavagli V, Varani S, Tramontano D, Apóstolo J, Geurden B, De Luca V, Tramontano G, Romano MR, Anastasaki M, Lionis C, Rodríguez-Acuña R, Capelas ML, dos Santos Afonso T, Molloy DW, Liotta G, Iaccarino G, Triassi M, Eklund P, Roller-Wirnsberger R, Illario M. Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases. Prim Health Care Res Dev 2020; 21:e32. [PMID: 32928334 PMCID: PMC7503185 DOI: 10.1017/s1463423620000328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
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Affiliation(s)
- Chariklia Tziraki
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV – Community Clubs for Elders, Jerusalem, Israel
| | | | - Filipa Ventura
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rónán O’Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | | | | | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - João Apóstolo
- Department of Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Bart Geurden
- Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Maria Rosaria Romano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Lionis
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Manuel Luis Capelas
- Interdisciplinary Health Research Center (CIIS), Institute of Health Sciences, Portuguese Catholic University, Lisbon, Portugal
| | - Tânia dos Santos Afonso
- Faculty of Pharmacy, Center for Pharmaceutical Studies, University of Coimbra, Coimbra, Portugal
| | - David William Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, University College of Cork, Cork, Ireland
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Patrik Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Maddalena Illario
- Department of Public Health, Federico II University of Naples, Naples, Italy
- Health Innovation Division, General Directorate for Health, Campania Region, Naples, Italy
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Abstract
This study explored predictors of family caregiver burden against the backdrop of the rapidly aging population and gradually weakening family care in urban China. It used a unique sample from the 2017 survey on older adults with functional disability and their family caregivers in Shanghai, China. A multi-pronged approach and ordinary least squares (OLS) regression were employed to identify predictors of family caregiver burden. Statistical analysis revealed that approximately 25% of caregivers felt stressed. Many independent variables related to caregivers, care recipients, their relationship, and social support had statistically significant impacts on caregiver burden. This study also found that caregiver educational level, caregiver family economic status, and the number of other caregivers had significant moderating effects on the correlation between older people's ability to perform activities of daily living (ADL) and family caregiver burden. Policy implications derived from those findings were also discussed.
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Affiliation(s)
- Jun Li
- East China University of Political Science and Law, Shanghai, China
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47
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Browne CV, Braun KL, Mokuau NK, Wu YY, Muneoka S. Examining Long-Term Service and Support Needs and Preferences of Native Hawaiian Elders: A Mixed-Method Approach. J Aging Health 2020; 32:582-590. [PMID: 30957684 PMCID: PMC6996835 DOI: 10.1177/0898264319839903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The Native Hawaiian population experiences numerous disparities in health and income. Using a mixed-method research (MMR) design, we summarize findings from three phases of an MMR approach used to uncover kūpuna (elder) long-term service and support (LTSS) needs and care preferences. Methods: Key informants in Hawaiian health were interviewed, secondary analyses of large state data sets were conducted, and kūpuna and "ohana (family) caregivers were engaged in listening sessions. Results: Quantitative data confirmed numerous health disparities experienced by older Native Hawaiians, whereas qualitative data exposed their limited knowledge of this poor health profile and revealed their historical and contemporary experiences with discrimination in education, employment, and health care. Hawaiian culture was identified as a continued source of resilience in support of elders and family caregiving regardless of geographic setting. Discussion: We suggest three practice, policy, and research directions that offer the potential to respond to and improve kūpuna health and service use.
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Affiliation(s)
| | | | | | - Yan Yan Wu
- University of Hawai‘i at Mānoa, Honolulu, USA
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48
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Neighbourhood relationships moderate the positive association between family caregiver burden and psychological distress in Japanese adults: a cross-sectional study. Public Health 2020; 185:80-86. [DOI: 10.1016/j.puhe.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 12/16/2022]
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Feng Z, Cramm JM, Jin C, Twisk J, Nieboer AP. The longitudinal relationship between income and social participation among Chinese older people. SSM Popul Health 2020; 11:100636. [PMID: 32802932 PMCID: PMC7419328 DOI: 10.1016/j.ssmph.2020.100636] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022] Open
Abstract
The vital role of active social participation in older people's lives is widely acknowledged. The maintenance of adequate levels of social participation is an essential element of successful aging. Low income may inhibit older people from engaging in social activities. Given its recent rapid economic growth, China provides a unique setting for the study of changes in income and social participation among older people over time. In this study, the longitudinal relationship between income and social participation among Chinese older people was investigated using a nationally representative dataset from three waves of the China Health and Retirement Longitudinal Study (CHARLS). At baseline, a total of 3863 participants with a mean age of 60.4 years (range: 50-89) were included in our study; 49.9% of the participants were female, and 64.4% lived in rural areas. Generalized estimating equations were used to analyze the longitudinal relationship between income and social participation, with and without adjustment for background variables (age, gender, marital status, educational level, empty-nest status, area of residence, and multimorbidity). The results of unadjusted and adjusted analyses clearly showed a longitudinal association between income and social participation. People from the highest income group were almost two times more likely to participate in social activities than were those from the lowest income group. People with a higher educational level are also more likely to participate in social activities compared to people with a lower educational level. Being married and living with children decreased the odds of social participation. Social participation is also less likely among older aged and those living in rural areas. Our findings indicate that higher income levels are associated positively with social participation over time among older people in China.
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Affiliation(s)
- Zeyun Feng
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR. Rotterdam, the Netherlands
- Department of Health Technology Assessment, Shanghai Health Development Research Center (Shanghai Medical Information Center), Jianguo Road 602, Shanghai, 200031, China
| | - Jane Murray Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR. Rotterdam, the Netherlands
| | - Chunlin Jin
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Jianguo Road 602, Shanghai, 200031, China
| | - Jos Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anna Petra Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR. Rotterdam, the Netherlands
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Turgeman-Lupo K, Toker S, Ben-Avi N, Shenhar-Tsarfaty S. The depressive price of being a sandwich-generation caregiver: can organizations and managers help? EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2020. [DOI: 10.1080/1359432x.2020.1762574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Keren Turgeman-Lupo
- Management and Human Resources Program, Israel Academic College in Ramat-Gan, Tel Aviv, Israel
| | - Sharon Toker
- Coller School of Management, Tel Aviv University, Tel Aviv, Israel
| | - Nili Ben-Avi
- Coller School of Management, Tel Aviv University, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Departments of Internal Medicine “”, “D” and “E”, Tel-Aviv Sourasky Medical Center Israel, Tel Aviv, Israel
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