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Su Q, Fan L. Impact of caregiving on mental, self-rated, and physical health: evidence from the China health and retirement longitudinal study. Qual Life Res 2024; 33:1-10. [PMID: 38644418 DOI: 10.1007/s11136-024-03659-3] [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: 03/27/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Given the escalating demand for care services, understanding the impact of informal caregiving, providing unpaid care for family members, on own health is essential. This study longitudinally analyzed the association of caregiving (and different caregiver types) with mental, physical, and self-rated health. Urban-rural, gender, and employment heterogeneity were further investigated. METHOD Based on three-wave data (2011, 2013, and 2018) from the China Health and Retirement Longitudinal Study, we used growth curve models to assess the impact of informal caregiving (providing care to family members) and caregiver types (caregivers to grandchildren, parents, spouses, or multiple family members) on three health outcomes (depressive symptoms, self-rated health, and activities of daily living limitations). RESULTS Our study included 13,377 individuals. Results showed a negative correlation of caregiving with mental, physical, and self-rated health. Compared to noncaregivers, spousal caregivers and multiple caregivers were both associated with worsening mental, self-rated, and physical health. In contrast, adult child caregivers were only negatively associated with mental health, and grandparent caregiving did not significantly affect any health outcomes. Further heterogeneity analysis showed that gender did not moderate the relationship between caregiving and health, whereas the negative association between caregiving and health was more pronounced among the rural population and those employed in agriculture. DISCUSSION Findings from the present study suggest that caregiving is detrimental to health, and recommend considering caregiver type when examining caregiving and health. These findings have vital implications for policymakers in addressing the challenges of structuring and implementing a sustainable informal care system.
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Affiliation(s)
- Qing Su
- School of Public Health, Southeast University, No.87 Dingjiaqiao, Nanjing, 210009, China
| | - Lijun Fan
- School of Public Health, Southeast University, No.87 Dingjiaqiao, Nanjing, 210009, China.
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Armstrong MJ, Dai Y, Sovich K, LaBarre B, Paulson HL, Maixner SM, Fields JA, Lunde AM, Forsberg LK, Boeve BF, Manning CA, Galvin JE, Taylor AS, Li Z. Caregiver Experiences and Burden in Moderate-Advanced Dementia With Lewy Bodies. Neurol Clin Pract 2024; 14:e200292. [PMID: 38617555 PMCID: PMC11014644 DOI: 10.1212/cpj.0000000000200292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 04/16/2024]
Abstract
Background and Objectives Dementia with Lewy bodies (DLB) is a common degenerative dementia, but research on caregiver experiences in late stages is lacking. This study aimed to investigate the caregiving experience in moderate-advanced DLB to identify opportunities for improving care and support. Methods Dyads of individuals with moderate-advanced DLB and their primary informal caregivers were recruited from specialty clinics, advocacy organizations, and research registries. The study collected demographics, disease-related measures, and measures of the caregiver experience relating to caregiver support, burden, grief, self-efficacy, depression, quality of life, and coping. Spearman correlation coefficients and Wilcoxon rank-sum tests evaluated the relationships of caregiver measures with patient and caregiver variables with adjustments for multiple testing. Results Caregivers (n = 143) were mostly women (83.5%) and spouses (84.7%) (mean age 68 years; range 37-85). Almost 40% reported high burden and/or depression. Caregiver measures correlated with fluctuation and behavioral symptom severity, sleepiness, and autonomic symptoms of the person with DLB. Higher burden correlated with worse caregiver quality of life, higher depression, and grief. Greater self-efficacy, social support, and resilience correlated with lower caregiver burden. The most frequently reported caregiver concerns were being unable to plan for the future, having to put the needs of the person with DLB ahead of the caregiver's own needs, and worry that the person with DLB would become too dependent on the caregiver, but many additional concerns were endorsed. Caregivers were generally satisfied with medical team support. The lowest reported satisfaction related to information regarding disease progression and how well medical teams shared information with each other. Discussion Various patient-related and caregiver-related factors influence caregiver experiences in moderate-advanced DLB. Clinicians can target caregiver needs by providing support resources and DLB education and treating bothersome patient symptoms. Future research should investigate what interventions can modify and improve caregiver experiences in advanced DLB and identify therapeutics for patient symptoms currently without adequate treatments (e.g., fluctuations, daytime sleepiness). Trial Registration Information NCT04829656.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Yunfeng Dai
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Kaitlin Sovich
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Brian LaBarre
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Henry L Paulson
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Susan M Maixner
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Julie A Fields
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Angela M Lunde
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Leah K Forsberg
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Bradley F Boeve
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Carol A Manning
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - James E Galvin
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Angela S Taylor
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Zhigang Li
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
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Oh KM, Inoue M, Koizumi N, Beran K, Lee JAA. Chronic Health Conditions and Patient Portal Use in Caregivers of People With Alzheimer's Disease and Related Dementias. J Appl Gerontol 2024; 43:363-373. [PMID: 37982671 DOI: 10.1177/07334648231210677] [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: 11/21/2023] Open
Abstract
This study aimed to investigate both chronic health conditions and the utilization of patient portals, focusing particularly on caregivers responsible for individuals with Alzheimer's disease and related dementias (ADRD). Data from the Health Information National Trends Survey 2018-2020 were analyzed, involving a sample of 304 family and unpaid caregivers of individuals with ADRD. Among caregivers of individuals with ADRD, 77.6% had at least one chronic disease. A significant proportion (46.6%) of ADRD caregivers had never accessed their patient portals. The limited utilization of patient portals among caregivers responsible for individuals with ADRD, particularly those with lower education, advanced age, and few chronic conditions, becomes apparent due to challenges associated with digital literacy and discomfort with computers. Recognizing the crucial role caregivers play for individuals with ADRD and their health risks, there's a need for tailored training to enhance their health management skills and caregiving capabilities.
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Affiliation(s)
| | | | | | | | - Jung-Ah Anna Lee
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
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Vargas-Gonzalez JC, Chadha AS, Castro-Aldrete L, Ferretti MT, Tartaglia C. Informant characteristics are associated with the Clinical Dementia Rating Sum of Boxes scores in the Alzheimer's Disease patients participating in the National Alzheimer's Coordinating Center Uniform Data Set. RESEARCH SQUARE 2024:rs.3.rs-3982448. [PMID: 38559129 PMCID: PMC10980151 DOI: 10.21203/rs.3.rs-3982448/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background The Clinical Dementia Rating® Sum of Boxes (CDR®-SB) is used to stage dementia severity; it is one of the most common outcome measurements in Alzheimer's Disease (AD) research and clinical trials. The CDR®-SB requires an informant to provide input to stage a patient's dementia severity. The effect of the informant's characteristics on the CDR®-SB is unknown. We aimed to evaluate the effect of the informant's sex, relationship to the patient, and frequency of contact on the CDR®-SB scores in patients with Alzheimer's Disease with mild cognitive impairment or dementia included in the National Alzheimer's Coordinating Center Uniform Data Set (NACC-UDS). Methods We included all participants from the NACC-UDS that had AD as diagnosis, and information about the Mini-Mental State Examination or Montreal Cognitive Assessment scores, informant sex, relationship to patient and frequency of contact; we also analyzed the possible interaction between these characteristics on the CDR®-SB as the outcome. We performed a multilevel linear regression analysis. Results We included data from 20636 participants, totalling 47727 visits. Patients' age was 74.0 ± 9.4 years and 54.1% were females. Informant characteristics were mean age of 66.2 ± 13.2 years, 69.1% were females, and the relationship to patients was 60.5% spouse or partner, 26.7% children and 12.8% other relation. The CDR®-SB scores were 0.20 higher (CI 95%: 0.11 to 0.29) when the informant was female. When comparing to informant's relationship with the baseline being spouse or partner, the CDR®-SB was 0.39 higher (CI 95%: 0.25 to 0.53) when the informant was the patient's child and 0.18 lower (CI 95%: -0.35 to -0.01) if relationship was other. Regarding the frequency of contact, CDR®-SB scores were 0.38 higher (CI95%: 0.28 to 0.47) when contact was at least once a week, 0.65 higher (CI95%: 0.52 to 0.78) when contact was daily, and 0.57 higher (CI95%: 0.46 to 0.69) when informant was living with the patient, baseline was a frequency of less than once per week. Finally, the interaction between informant relationships other and female patients showed a 0.24 higher CDR®-SB score (CI95%: 0.03 to 0.46). Conclusions We found that the CDR®-SB scores are significantly modified by informant characteristics and frequency of contact in the NACC-UDS patients with AD diagnosis. These findings hold clinical significance as informant characteristics ideally should not impact the staging of AD patients, and any such effects could introduce bias into clinical evaluations in clinical trials. Future research endeavours should investigate strategies to address and mitigate the influence of these confounding variables.
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Ahmad N, Kunicki ZJ, Tambor E, Epstein-Lubow G, Tremont G. Burden and Depression among Empirically-Derived Subgroups of Family Caregivers for Individuals With Dementia. J Geriatr Psychiatry Neurol 2024; 37:163-172. [PMID: 37551824 PMCID: PMC10840657 DOI: 10.1177/08919887231195217] [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] [Indexed: 08/09/2023]
Abstract
Dementia caregiving experiences are not universal and different factors may influence the risk for burden and depression. This study examined factors such as the relationship with the care recipient, severity of dementia, and relationship satisfaction to uncover different types of caregiver burden profiles using baseline assessment for a telephone-based intervention study for dementia caregivers. Participants (n = 233) completed a battery of psychological and caregiving related surveys. The sample was predominantly White and female. Latent class analysis suggested four class models in subsamples of spousal caregivers and adult children caregivers. The results suggested four distinct classes among samples of spousal and adult child caregivers. Differences in burden emerged across both spouses and adult children, and differences in depression also emerged in the spousal sample. Our findings demonstrate the diversity of the caregiving experience and suggest that future psychosocial interventions may benefit from being tailored to the needs of caregiver subgroups.
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Affiliation(s)
- Nina Ahmad
- Department of Biology, Tufts University, Medford, MA, USA
| | - Zachary J. Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Gary Epstein-Lubow
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Education Development Center, Waltham, MA, USA
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Neuropsychology Program, Rhode Island Hospital, Providence, RI, USA
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Ruyant Belabbas E, Manceau C, Wawrziczny E. The relationship at the heart of the experience of daughter caregivers of a parent with dementia: An interpretative phenomenological analysis. DEMENTIA 2024; 23:175-190. [PMID: 38078431 DOI: 10.1177/14713012231220223] [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: 12/21/2023]
Abstract
BACKGROUND Parents with dementia require emotional, physical, psychological and financial support from their child caregivers to continue living at home. Daughter caregivers have been shown to be more involved in self-care and household tasks and to experience higher levels of distress than son caregivers. OBJECTIVE The aim of this study was to investigate the experience of daughter caregivers who provide informal care for a parent with dementia living in their own home. METHOD Semi-structured interviews were conducted with 11 daughter caregivers of a parent with Alzheimer's disease. Interviews were analysed using Interpretative Phenomenological Analysis. RESULTS Three axes emerged from the analyses: [1] the before conditions the after: the quality of the previous relationship with the parent with Alzheimer's disease is a determining factor and allows the identification of three profiles of daughter caregivers: 'the grateful', 'the resentful' and 'the ambivalent', [2] when the relationship protects against the sense of burden: the feeling of being invaded by the caregiving situation is influenced by the quality of the relationship with the parent with Alzheimer's disease, and [3] alone or almost: the support network is desired when it is absent but kept at arm's length when it is present. DISCUSSION The results underline the importance of assessing the quality of attachment and supporting the relationship with the parent (especially when the relationship prior to the disease was difficult). Daughter caregivers should also be encouraged to delegate tasks and refocus their actions related to their values. Family mediation sessions may be planned to improve the organisation of care and set up an efficient collaboration.
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Affiliation(s)
| | - Charlotte Manceau
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d'Ascq, France
| | - Emilie Wawrziczny
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d'Ascq, France
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Su Q. Impact of Caregiving on Cognitive Functioning: Evidence From the China Health and Retirement Longitudinal Study. J Gerontol B Psychol Sci Soc Sci 2023; 78:1796-1804. [PMID: 37329275 DOI: 10.1093/geronb/gbad090] [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: 01/19/2023] [Indexed: 06/19/2023] Open
Abstract
OBJECTIVES Few studies have examined the association between caregiving and the cognitive functioning of caregivers. This study explored the association between caring for family members and cognition and how the link differs by caregiving intensity and caregiving types. Furthermore, rural-urban and gender heterogeneity were investigated. METHODS This study analyzed Waves 2011, 2013, and 2018 of the China Health and Retirement Longitudinal Study, with cognitive functioning assessed in 3 dimensions: memory, executive function, and orientation function. The cognition trajectories between caregivers and noncaregivers were compared with the growth curve model. RESULTS Results demonstrated a positive association between caregiving and cognitive functioning (β = 0.249, p < .001). Considering caregiving intensity, the positive association was only found in low (β = 0.335, p < .001) and moderate-intensity caregivers (β = 0.250, p < .05) but not in high-intensity caregivers. Moreover, grandparents, adult children, and multiple caregivers had a higher average cognition level at age 60 than noncaregivers (all β > 0, all p < .05), and adult child caregivers exhibited a significantly slower rate of decline in cognition across age (β = 0.040, p < .01). However, spousal caregivers showed no significant disparities with noncaregivers. Moreover, the impact of caregiving on memory function is more apparent among urban adults. DISCUSSION Results indicate that caregiving can benefit cognitive function. This study proposes considering caregiving intensity and caregiving types when exploring caregiving and cognition. Based on these findings, policy-makers may overcome the challenges involved in establishing and developing a supportive informal care system in China.
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Affiliation(s)
- Qing Su
- School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
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You J, Qiao J, Dong Y, Vitaliano PP. A Double Whammy? Psychosocial Disadvantages of Dementia Caregivers with Cancer Histories. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:1090-1107. [PMID: 37115196 DOI: 10.1080/01634372.2023.2207392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/19/2023]
Abstract
Guided by the Diathesis-Stress model, this study examined how cancer history interacted with caregiving status to determine the psychosocial functioning of dementia caregivers. This study assessed a set of indicators for psychological health and social connections among 85 spousal caregivers of persons with Alzheimer's disease and 86 age- and gender-matched spouses of healthy controls at study entry and 15-18 months later. Results showed that dementia caregivers with cancer histories reported lower social connections relative to caregivers without cancer histories or non-caregivers with or without cancer histories, and reported lower psychological health relative to non-caregivers with and without cancer histories at two time points. The findings highlight that a history of cancer is a predisposing vulnerability factor for psychosocial dysfunctions among dementia caregivers and address gaps in knowledge about the psychosocial adjustment of cancer survivors as caregivers.
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Affiliation(s)
- Jin You
- Department of Psychology, Wuhan University, Wuhan, China
| | - Jinhui Qiao
- Department of Psychology, Wuhan University, Wuhan, China
| | - Yue Dong
- Centre for Behavioral Economics, Society and Technology, School of Economics and Finance, Queensland University of Technology, Australia
| | - Peter P Vitaliano
- School of Medicine, University of Washington at Seattle, Seattle, Washington, USA
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Huertas-Domingo C, Losada-Baltar A, Romero-Moreno R, Gallego-Alberto L, Márquez-González M. Sociocultural factors, guilt and depression in family caregivers of people with dementia. Kinship differences. Aging Ment Health 2023; 27:1655-1665. [PMID: 37020430 DOI: 10.1080/13607863.2023.2195821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/18/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES This study aims to analyze the role that family obligations and social desirability have for understanding guilt and depressive symptoms in family caregivers. A theoretical model is proposed to analyze this significance based on the kinship with the person cared for. METHODS Participants are 284 family caregivers of people with dementia divided into four kinship groups (husbands, wives, daughters and sons). Face-to-face interviews were conducted assessing sociodemographic variables, familism (family obligations), dysfunctional thoughts, social desirability, frequency and discomfort associated with problematic behaviors, guilt and depressive symptoms. Path analyses are performed to analyze the fit of the proposed model and multigroup analysis to study potential differences between kinship groups. RESULTS The proposed model fits the data well and explains significant percentages of variance of guilt feelings and depressive symptomatology for each group. The multigroup analysis suggests that, for daughters, higher family obligations were associated with depressive symptomatology through a report of higher dysfunctional thoughts. For daughters and wives, an indirect association between social desirability and guilt was observed through reaction to problematic behaviors. CONCLUSION The results support the need to consider the significance of sociocultural aspects such as family obligations and the desirability bias in the design and implementation of interventions for caregivers, especially for daughters. Considering that the variables that contribute to explaining caregivers' distress vary depending on the relationship with the person cared for, individualized interventions may be warranted depending on the kinship group.
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Affiliation(s)
| | - Andrés Losada-Baltar
- Departamento de Psicología, Universidad Rey Juan Carlos, Madrid, Comunidad de Madrid, Spain
| | - Rosa Romero-Moreno
- Departamento de Psicología, Universidad Rey Juan Carlos, Madrid, Comunidad de Madrid, Spain
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Wang J, Liu W, Yu S, Li X, Ma Y, Zhao Q, Lü Y, Xiao M. Social Networks Effects on Spouse and Adult-Child Dementia Caregivers' Experiences: A Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1374-1380.e1. [PMID: 37236264 DOI: 10.1016/j.jamda.2023.04.006] [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: 03/09/2023] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES A large body of literature addresses experiences of spouse and adult-children caregiver of individuals with dementia (IWDs) but has not examined the role and strength of social networks in associations between spouses and adult-children caregivers' experience. Based on the stress process model, we aimed to explore the strength levels of social networks and their association with spouses/adult-children caregivers for IWDs. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A questionnaire-based survey was conducted with a total of 146 family caregivers of IWDs (78 adult-child, and 68 spouses) in China. METHODS Data collection comprised 4 sections: (1) care-related stressors (dementia stage, neuropsychiatric symptoms); (2) caregiver context; (3) social network, using the Lubben Social Network Scale; and (4) caregiving experience, using the short-form Zarit Burden Interview and 9-item Positive Aspects of Caregiving Scale. Linear regression, mediation model analysis, and interactive analysis were performed to explore the mechanisms of associations between variables. RESULTS Spouses had weaker social network strength (β = -0.294, P = .001) and reported greater positive aspects of caregiving (β = 0.234, P = .003) than adult-children caregivers; no significant difference was found between them for caregiver burden. Mediation analysis suggests that associations between caregiver type and caregiver burden are indirect-only mediation effects of social networks (β = 0.140, 95% CI = 0.066-0.228). The social network strength suppressed the association between caregiver type and positive aspects of caregiving. The caregiver type/social network interaction statistically significantly (P = .025) affected the "positive aspects": a stronger social network was associated with more positive aspects of caregiving among the spouse subgroup (β = 0.341, P = .003). CONCLUSIONS AND IMPLICATIONS Social networks mediate responses to caregiving experiences among different care provider types and are vital intervention targets, especially for spousal caregivers. Our results can serve as references for identifying caregivers for clinical intervention.
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Affiliation(s)
- Jun Wang
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shiqi Yu
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuelian Li
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingzhuo Ma
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Lü
- Department of Geriatrics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Mingzhao Xiao
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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11
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Malhotra C, Balasubramanian I. Caregivers' End-of-Life Care Goals for Persons with Severe Dementia Change Over Time. J Alzheimers Dis 2023:JAD221161. [PMID: 37125548 DOI: 10.3233/jad-221161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Family caregivers make end-of-life (EOL) decisions for persons with severe dementia (PWSDs). It is not known whether the family caregivers' goals change over time. OBJECTIVE Assess caregivers' EOL care goal for PWSDs and change in these goals over time. METHODS Using a prospective cohort of 215 caregivers of PWSDs, we assessed the proportion of caregivers whose EOL care goal for PWSDs changed between two consecutive time points. Mixed effects multinomial regression models assessed factors associated with caregivers' EOL care goals for PWSD (maximal, moderate, minimal life extension); and change in EOL care goal from previous time point. RESULTS At baseline, 20% of the caregivers had a goal of maximal life extension for their PWSD, and 59% changed their EOL care goal at least once over a period of 16 months. Caregivers of PWSDs with lower quality of life (RR: 1.15, CI: 1.06, 1.24), who expected shorter life expectancy for PWSDs (RR: 10.34, CI: 2.14, 49.99) and who had an advance care planning discussion (RR: 3.52, CI: 1.11, 11.18) were more likely to have a goal of minimal life extension for PWSD. Caregivers with higher anticipatory grief (RR: 0.96, CI: 0.93,1) were more likely to have a goal of maximal life extension. Change in PWSDs' quality of life and change in caregivers' anticipatory grief were associated with change in caregivers' EOL care goals. CONCLUSION Caregivers' EOL care goals for PWSDs change over time with change in PWSD and caregiver related factors. Findings have implications regarding how health care providers can engage with caregivers.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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12
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Beach P, Hazzan AA, Regan C, Lieberman L. Quality of Life and Related Outcomes Among Unpaid Caregivers of Older Adults With Visual Impairment. Int J Aging Hum Dev 2022:914150221132167. [PMID: 36259284 DOI: 10.1177/00914150221132167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Caregivers of older adults with visual impairments are often family members who spend many hours caring for loved ones at the expense of their personal needs. The purpose of this study was to examine the quality of life of unpaid caregivers of older adults with visual impairments and determine the barriers and facilitators for improving their quality of life. To examine this population, 130 unpaid caregivers of older adults with visual impairments were surveyed using the Satisfaction with Life Scale, Living Arrangement and Indicators of Social Interaction Survey, the Geriatric Depression Scale (GDS), Caregiver Quality of Life (EQ-5D), and the Perceived Change Index (PCI). Results revealed that the unpaid caregivers face many challenges, but inexperience/difficulty with tasks and balancing their personal life were the biggest obstacles. Interventions could help improve quality of life and well-being as well as provide support services and access to community resources to reduce the family caregiver burden.
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Affiliation(s)
- Pamela Beach
- Department of Kinesiology, Sport Studies, and Physical Education, 14788State University of New York at Brockport, Brockport, NY, USA
| | - Afeez Abiola Hazzan
- Department of Healthcare Studies, Sport Studies, and Physical Education, State University of New York at Brockport, Brockport, NY, USA
| | - Cassidy Regan
- Department of Kinesiology, Sport Studies, and Physical Education, 14788State University of New York at Brockport, Brockport, NY, USA
| | - Lauren Lieberman
- Department of Kinesiology, Sport Studies, and Physical Education, 14788State University of New York at Brockport, Brockport, NY, USA
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13
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Dreyer J, Bergmann JM, Köhler K, Hochgraeber I, Pinkert C, Roes M, Thyrian JR, Wiegelmann H, Holle B. Differences and commonalities of home-based care arrangements for persons living with dementia in Germany - a theory-driven development of types using multiple correspondence analysis and hierarchical cluster analysis. BMC Geriatr 2022; 22:723. [PMID: 36050645 PMCID: PMC9438141 DOI: 10.1186/s12877-022-03310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most persons with dementia live at home and want to stay there as long as possible. In most cases, informal carers such as spouses or children care for them. Together with other family members and professional carers, they form care arrangements to address the complex needs of persons with dementia. One major aim of informal carers is to keep the care arrangement stable. The middle-range theory of 'stability of home-based care arrangements for people living with dementia' (SoCA-Dem theory) offers a theory to understand what constitutes and influences the stability of home-based care arrangements. Based on this theory, the aim of this study was to (1) uncover the underlying structures of differences and commonalities of home-based care arrangements for persons living with dementia, (2) construct types of these care arrangements, and (3) compare these types with regard to their stability. METHOD This is a secondary analysis of data from a convenience sample of n = 320 care arrangements for persons with dementia obtained in the observational DemNet-D study. Data were analysed using multiple correspondence analysis and hierarchical cluster analysis. Sociodemographic data and variables related to the structure of the care arrangement (D-IVA), burden of the informal carer (BICS-D), dementia severity (FAST), and quality of life of the person with dementia (QOL-AD) were included. RESULTS The multiple correspondence analysis identified 27 axes that explained the entire variance between all care arrangements. The two axes 'dementia and care trajectory' and 'structure of the dyadic relationship' best distinguished care arrangements from each other and together explained 27.10% of the variance. The subsequent cluster analysis identified four types of care arrangements. Two types included spouse-centred care arrangements, and two types included child-centred care arrangements at different phases of the dementia and care trajectory. The types differ with regard to their stability. CONCLUSION The results highlight the heterogeneity and commonality of care arrangements for persons living with dementia. They contribute to a better understanding of informal dementia home care. Furthermore, the results can guide the development of tailored support for persons living with dementia and their caring families.
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Affiliation(s)
- Jan Dreyer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany.
| | | | - Kerstin Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Iris Hochgraeber
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Christiane Pinkert
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
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The impact of care-recipient relationship type on health-related quality of life in community-dwelling older adults with dementia and their informal caregivers. Qual Life Res 2022; 31:3377-3390. [PMID: 35969331 DOI: 10.1007/s11136-022-03203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To assess whether there was an association between care-recipient relationship type and health-related quality of life (HRQL) of older persons living with dementia (PLWD) and their informal caregivers, and whether this association was affected by PLWD' dementia severity. METHODS This was a secondary data analysis study. PLWD (n = 1230) and caregivers (n = 1871) were identified from participants in the National Health and Aging Trends Study (NHATS) Round 5 and the National Study of Caregiving (NSOC) II, respectively. A series of bivariate and multivariable regression models examined the associations among relationship type and HRQL in PLWD and caregivers, adjusted for socio-demographic variables and dementia severity. RESULTS PLWD and caregivers' HRQL outcomes varied by relationship type. PLWD cared for by an adult-child caregiver, or multiple caregivers experienced higher functional limitations than those cared for by a spousal caregiver (β = .79, CI [.39, 1.19]; β = .50, CI [.17, .82], respectively). "Other" caregivers, such as extended family members or friends, had lower odds of experiencing negative emotional burden and social strain than spousal caregivers (β = .79, CI [.39, 1.19]; β = .50, CI [.17, .82], respectively). Lower odds of experiencing negative emotional burden were also found with multiple caregivers. The effect of an adult-child caregiver on social strain was no longer significant when the dementia severity of PLWD was included in the analysis. CONCLUSION The type of care-recipient relationship impacts the HRQL in both PLWD and their informal caregivers. Dementia severity of the PLWD appears to affect this association.
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15
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Hovland CA, Fuller KA. African American Family Caregivers Share How they Prepared for the Death of an Older Adult with Dementia: A Pilot Study of Hospice Care in A Nursing Home. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:129-145. [PMID: 35226595 DOI: 10.1080/15524256.2022.2042458] [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: 06/14/2023]
Abstract
The focus of this pilot study was to ascertain how bereaved African American caregivers prepared for the death of an older family member who died from a dementia-related diagnosis and the role of hospice care; an area with little research to date. Because African American older adults in the United States are at greater risk than Caucasian older adults for dementia-related health problems though less likely to be diagnosed, treated, or to enroll in hospice services, this exploratory study asked questions of the family caregivers' experiences in preparing for the death. Purposive criterion sampling was used to identify six African American bereaved caregivers whose family member lived in a nursing home (five who were enrolled in hospice services) who were extensively interviewed, with the use of conventional content analysis of the transcripts to identify the findings. Because of the limited sample size, themes identified were considered preliminary and may help guide ongoing and further research. Five primary themes revealed ways caregivers prepared: accepting reality; "I just kind of knew;" person with dementia "was ready;" "spending time;" and, getting your "business in order." All caregivers believed it was important to be prepared for the death, with the five who received hospice services reporting that they were prepared. Further research is needed to explore these preliminary findings of African American caregivers of family members with dementia at end-of-life to further inform social work and hospice team care.
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Affiliation(s)
- Cynthia A Hovland
- School of Social Work, Cleveland State University, Cleveland, Ohio, USA
| | - Kimberly A Fuller
- School of Social Work, Cleveland State University, Cleveland, Ohio, USA
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16
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Kew CL, Juengst SB, Kelley B, Osborne CL. Linking Problems Reported by Care Partners of Individuals With Alzheimer’s Disease and Lewy Body Dementia to the International Classification of Functioning Disability and Health. Gerontol Geriatr Med 2022; 8:23337214221086810. [PMID: 35368457 PMCID: PMC8973046 DOI: 10.1177/23337214221086810] [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: 11/29/2021] [Revised: 02/02/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
Aim This study aims to classify, describe, and compare the problems reported by care partners of adults with Alzheimer’s disease (AD) and Lewy body dementia (LBD) using the International Classification of Functioning Disability and Health (ICF) Methods Problems that care partners experience were collected during a problem-solving training intervention. The meaningful concepts were then extracted and linked to the ICF using a standardized linking technique. Results 402 meaningful concepts were extracted from 128 problems reported by care partners. 79.4% of the concepts were linkable to the ICF. “Body functions” was most frequently addressed followed by “Activities and participation.” LBD care partners reported more problems (M = 23.6 ± 13.4) on average than AD care partners (M = 19.4 ± 12.1). LBD care partners reported greater relative proportions of problems in mental function (emotional and sleep functions) than AD care partners. Conclusion This study suggests that the experience of LBD care partners may include significantly more challenges and may be more emotionally demanding than the care experience of AD care partners. Interventions designed to support care partners of adults with dementia may need to be tailored to meet the needs of care partners based on the care receiver’s type of dementia.
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Affiliation(s)
- Chung Lin Kew
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical School, Dallas, TX, USA
- Department of Applied Clinical Research, UT Southwestern Medical School, Dallas, Dallas, TX, USA
- School of Public Health, Texas A&M University College Station, College Station, TX, USA
| | - Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical School, Dallas, TX, USA
- Department of Applied Clinical Research, UT Southwestern Medical School, Dallas, Dallas, TX, USA
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
| | - Brendan Kelley
- Department of Neurology, UT Southwestern Medical School, Dallas, TX, USA
| | - Candice L. Osborne
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical School, Dallas, TX, USA
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17
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Hui Z, Yang C, Fan Lee DT. Stressors and coping strategies in Chinese family caregivers of people with dementia in long-term care facilities: A qualitative descriptive study. DEMENTIA 2022; 21:957-971. [PMID: 35130752 DOI: 10.1177/14713012211066661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed to explore the stressors along with coping strategies in Chinese family caregivers whose relative with dementia had been placed into a long-term care facility. METHODS A qualitative descriptive study was conducted with 17 Chinese family caregivers of institutionalised older adults with dementia, recruited via purposeful sampling. Information regarding stressors along with coping strategies was collected through face-to-face semi-structured individual interviews. The interviews were audio-recorded, transcribed, anonymised and imported into MAXQDA 2018.2. Data were analysed with qualitative content analysis. FINDINGS Three categories of stressors emerged: socioeconomic pressure, hassles arising from continuing caregiving and suboptimal care provided by the facility. In particular, the family caregivers' experienced tremendous pressure of negative comments from people around since long-term care placement was traditionally viewed as unfilial in Chinese societies. Various coping strategies were adopted by Chinese family caregivers to deal with the stressors; however, they were not always adaptive. IMPLICATIONS Health care authorities and professionals should recognise family caregivers' stressors after long-term care placement of a relative with dementia with the consideration of the unique socio-cultural needs. Appropriate and effective interventions should be developed and implemented to facilitate family caregivers to cope with stressful situations after long-term care placement and further to safeguard their psychosocial well-being.
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Affiliation(s)
- Zhaozhao Hui
- School of Public Health, Health Science Centre, 26451Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, 26451The Chinese University of Hong Kong, Hong Kong, China
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing, Faculty of Medicine, 26451The Chinese University of Hong Kong, Hong Kong, China
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18
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Johansson MF, McKee KJ, Dahlberg L, Summer Meranius M, Williams CL, Marmstål Hammar L. Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031788. [PMID: 35162811 PMCID: PMC8835239 DOI: 10.3390/ijerph19031788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer–care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.
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Affiliation(s)
- Marcus F. Johansson
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
- Correspondence:
| | - Kevin J. McKee
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
| | - Lena Dahlberg
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
- Aging Research Center, Karolinska Institutet & Stockholm University, Tomtebodavägen 18A, 171 65 Solna, Sweden
| | | | - Christine L. Williams
- Christine E Lynn College of Nursing, Florida Atlantic University Boca Raton, FL 334 31, USA;
| | - Lena Marmstål Hammar
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
- School of Health, Care and Social Welfare, Mälardalen University, 721 23 Västerås, Sweden;
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden
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19
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Besser LM, Galvin JE. Rural Versus Non-Rural Residence and Psychosocial Outcomes Among Caregivers of Patients with Dementia and Related Disorders. J Alzheimers Dis 2022; 85:993-999. [PMID: 34897088 PMCID: PMC8821350 DOI: 10.3233/jad-215162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We used data on 718 dementia caregivers and multivariable linear regression to test associations between residential locale and psychosocial outcomes (grief, wellbeing, burden, quality of life [QOL], self-efficacy/mastery, and social networks). Rural residence (versus urban or suburban) was not associated with the psychosocial outcomes. However, for rural caregivers, greater self-efficacy/mastery was associated with lower grief (versus urban/suburban) and burden (versus suburban), and greater social network quality was associated with lower burden (versus suburban) and higher QOL (versus urban). Interventions targeting self-efficacy/mastery and social networks may be particularly effective at improving rural caregivers' mental health and QOL.
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Affiliation(s)
- Lilah M. Besser
- Institute for Human Health and Disease Intervention (I-HEALTH), Department of Urban and Regional Planning, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136
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20
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Care-giver wellbeing: exploring gender, relationship-to-care-recipient and care-giving demands in the Canadian Longitudinal Study on Aging. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The three-way intersection of gender, relationship-to-care-recipient and care-giving demands has not, to our knowledge, been examined in relation to the wellbeing of family care-givers. We explore inequalities in depressive symptoms and life satisfaction, comparing wives, husbands, daughters and sons providing very-intensive care (36+ hours/week) with those providing less care and disparities between these groups in the factors related to disadvantage. Data from the Canadian Longitudinal Study on Aging (N = 5,994) support the existence of differences between the groups. Very-intensive care-giving wives report the most depressive symptoms and lowest life satisfaction; less-intensive care-giving sons report the fewest depressive symptoms, and less-intensive care-giving daughters report the highest life satisfaction. However, group differences in life satisfaction disappear among very-intensive care-givers. Drawing on Intersectionality and Stress Process theories, data from regression analyses reveal a non-significant gender–relationship–demand interaction term, but, health, socio-economic and social support resources play a strong mediating role between care demand and wellbeing. Analyses of the eight groups separately reveal diversity in the care-giving experience. Among less-intensive care-givers, the mediating role of resources remains strong even as differences are evident. Among very-intensive care-givers, the role of resources is less and differences in wellbeing between the groups are magnified. Policy implications emphasise the imperative to personalise services to meet the varied needs of care-givers.
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21
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Hsieh S, Yuan J, Lu ZK, Li M. Deprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia. Front Pharmacol 2021; 12:706750. [PMID: 34899285 PMCID: PMC8662997 DOI: 10.3389/fphar.2021.706750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/01/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Antipsychotics are commonly used in dementia patients but have potential risks that often outweigh clinical benefits. Limited studies have assessed the healthcare utilization and medical costs associated with antipsychotic use, especially those focused on cumulative days of use. Objectives: To examine clinical and economic burdens associated with different cumulative days of antipsychotic use in older adults with dementia in the United States. Methods: This study used Medicare Current Beneficiary Survey (2015–2017). Older (≥65 years) Medicare beneficiaries with dementia, without concurrent schizophrenia, bipolar disorder, Huntingon’s disease, or Tourette’s syndrome were included. Antipsychotic use was measured using Medicare Part D prescription events. Healthcare utilization was measured as inpatient services, outpatient services, and emergency room (ER) visits. Total medical costs were classified as Medicare and out-of-pocket costs. The logistic regression, negative binomial regression, and generalized linear model with a log link and gamma distribution were used to examine factors, healthcare utilization, and medical costs. Survey sampling weights were applied to generate national estimates. Results: Among older adults with dementia, 13.18% used antipsychotics. Factors associated with antipsychotic use were being Hispanic (OR: 2.90; 95% CI: 1.45, 5.78), widowed (OR: 3.52; 95% CI: 1.46, 8.48), and single (OR: 3.25; 95% CI: 1.53, 6.87). Compared to non-users, antipsychotic use was associated with higher inpatient visits (IRR: 2.11; 95% CI 1.53, 2.90), ER visits (IRR: 1.61; 95% CI: 1.21, 2.13), total costs (β: 0.53; 95% CI: 0.36, 0.71), Medicare costs (β: 0.49; 95% CI 0.26, 0.72), and out-of-pocket costs (β: 0.66; 95% CI: 0.35, 0.97). With the increase in cumulative days of antipsychotic use, the magnitude of clinical and economic burdens was decreased. Conclusion: The significant clinical and economic burdens associated with antipsychotic use, especially with short-term use, provide real-world evidence to inform clinical practice on deprescribing antipsychotics among community-dwelling geriatric dementia patients.
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Affiliation(s)
- Stephanie Hsieh
- Department of Pharmacy, Scarborough Health Network - Centenary Hospital, Scarborough, ON, Canada
| | - Jing Yuan
- Department of Clinical Pharmacy and Pharmacy Administration, Fudan University, Shanghai, China
| | - Z Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States
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22
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Rañola MB. The Road Less Travelled: Identifying Support Needs in Lewy Body Dementia. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2021. [DOI: 10.21307/ajon-2021-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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O’Caoimh R, Calnan M, Dhar A, Molloy DW. Prevalence and Predictors of Caregiver Burden in a Memory Clinic Population. J Alzheimers Dis Rep 2021; 5:739-747. [PMID: 34755048 PMCID: PMC8543373 DOI: 10.3233/adr-201003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although caregiver burden is common among carers of people with dementia, little is known about its prevalence and predictors among caregivers of patients attending memory clinics. OBJECTIVE To examine carer and patient-specific characteristics associated with caregiver burden across the cognitive spectrum in a memory clinic population. METHODS Consecutive patients referred to a university hospital geriatric memory clinic were included. Caregiver burden was scored using the Caregiver Burden Score (CBS), (modified Zarit), with scores≥15/30 suggesting burden. BPSD were measured with the dysfunctional behaviour rating instrument (DBRI). Cognition was screened using the Montreal Cognitive Assessment (MoCA) and Quick Mild Cognitive Impairment (Qmci) screen. RESULTS In all, 351 patients were included, median age 77 (±11) years; 65.5% were female. The prevalence of caregiver burden was 33.6% overall, increasing from 10.8% in subjective cognitive decline (SCD), to 15% in mild cognitive impairment (MCI) and 43% in dementia; CBS scores were significantly higher in dementia (p < 0.001). Caregivers with burden were significantly younger (p = 0.045) and were more likely to be adult children (p = 0.007). The CBS weakly correlated with the stage of cognitive impairment (r = 0.16) but had moderate correlation with MoCA (r = -0.54) and Qmci scores (r = -0.60). After adjustment for co-variates, DBRI scores alone independently predicted burden (odds ratio 1.23;1.11-1.35, p < 0.001). CONCLUSION Caregiver burden is associated with the stage of cognitive impairment, with higher prevalence proportions in those with dementia compared with MCI and SCD. Only the severity of neuropsychiatric symptoms independently predicted caregiver burden in this population and its presence should prompt assessment for burden.
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Affiliation(s)
- Rónán O’Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork City, Ireland
- Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork City, Ireland
| | - Mareeta Calnan
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork City, Ireland
| | - Arup Dhar
- Baker Heart and Diabetes Institute, Melbourne VIC, Australia
- NeuroCentrix, Noble Park, VIC, Australia
| | - D. William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork City, Ireland
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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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Fleisher J, Hess S, Sennott B, Myrick E, Wallace EK, Lee J, Sanghvi M, Woo K, Ouyang B, Wilkinson J, Beck J, Johnson T, Hall D, Chodosh J. Longitudinal, Interdisciplinary Home Visits vs. Usual Care for Homebound People with Advanced Parkinson's Disease (IN-HOME-PD): Study protocol for a controlled trial. JMIR Res Protoc 2021; 10:e31690. [PMID: 34238753 PMCID: PMC8479607 DOI: 10.2196/31690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 01/10/2023] Open
Abstract
Background The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization. Objective The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care. Methods In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage–matched control dyads drawn from US participants in the longitudinal Parkinson’s Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination. Results The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway. Conclusions To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs. Trial Registration ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. International Registered Report Identifier (IRRID) PRR1-10.2196/31690
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Affiliation(s)
- Jori Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Serena Hess
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Brianna Sennott
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Erica Myrick
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US.,Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, US
| | - Ellen Klostermann Wallace
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Jeanette Lee
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US.,Social Work and Community Health, Rush University Medical Center, Chicago, US
| | - Maya Sanghvi
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US.,Yale College, Yale University, New Haven, US
| | - Katheryn Woo
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, US
| | - Jayne Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, US.,Department of Neurology, University of Pennsylvania, Philadelphia, US
| | | | - Tricia Johnson
- Department of Health Systems Management, Rush University Medical Center, Chicago, US
| | - Deborah Hall
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, New York, US.,VA New York Harbor Healthcare System, New York, US
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Bentley A, Morgan T, Salifu Y, Walshe C. Exploring the experiences of living with Lewy body dementia: An integrative review. J Adv Nurs 2021; 77:4632-4645. [PMID: 34146346 DOI: 10.1111/jan.14932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 01/30/2023]
Abstract
AIM Lewy body dementia is a common neurodegenerative dementia with unique challenges in managing day-to-day life. A more in-depth multifaceted picture of the Lewy body dementia lived experience will enable identification of best practice and future research direction. The review aim was to explore experiences of people living with Lewy body dementia and their family carers. DESIGN Integrative review method informed by Whittemore and Knafl, supported by the information retrieval framework PALETTE. A convergent integrated approach enabled synthesis of key findings and theme identification. DATA SOURCES Medline, CINAHL, PsycINFO, AMED, and ALOIS databases were systematically searched to find studies published between 1995 and 2020. REVIEW METHODS Twenty-six articles from twenty studies were synthesized (from 1583 retrieved). Quality and relevance were appraised using the Mixed-Methods Appraisal Tool and Gough's 'Weight of Evidence' framework. Data management was supported by ATLAS.ti 8 and COVIDENCE software. RESULTS Four themes were identified: living with an uncertain diagnosis and prognosis; fear of the now - worry for the future; living with behavioural and psychiatric symptoms; and maintaining a social and emotional life. People reported difficulty finding information and support around diagnosis, disease progression and managing complex symptoms. The result is increased caregiver burden, grief and stress and reduced quality of life. CONCLUSION Delayed diagnosis and complex symptom burden means people are not getting the timely support and information they need to live and die well. Current evidence is largely quantitative, with a focus on family caregiver burden and unmet need. The challenge remains in how to capture a more holistic picture of the lived experience for people living with Lewy body dementia and those who care for them. IMPACT This review highlighted current knowledge and identified gaps in exploring the lived experience for people with Lewy body dementia and their families.
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Affiliation(s)
- Allison Bentley
- Cambridgeshire and Peterborough NHS Foundation Trust, Windsor Research Unit, Fulbourn Hospital, Cambridge, UK.,International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Health Innovation One, Lancaster University, Lancaster, UK
| | - Tessa Morgan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Yakubu Salifu
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Health Innovation One, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Health Innovation One, Lancaster University, Lancaster, UK
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Johansson MF, McKee KJ, Dahlberg L, Williams CL, Summer Meranius M, Hanson E, Magnusson L, Ekman B, Marmstål Hammar L. A comparison of spouse and non-spouse carers of people with dementia: a descriptive analysis of Swedish national survey data. BMC Geriatr 2021; 21:338. [PMID: 34078292 PMCID: PMC8170983 DOI: 10.1186/s12877-021-02264-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Being an informal carer of a person with dementia (PwD) can have a negative effect on the carer's health and quality of life, and spouse carers have been found to be especially vulnerable. Yet relatively little is known about the care provided and support received by spouse carers. This study compares spouse carers to other informal carers of PwDs regarding their care provision, the support received and the psychosocial impact of care. METHODS The study was a cross-sectional questionnaire-based survey of a stratified random sample of the Swedish population aged 18 or over. The questionnaire explored how much care the respondent provided, the support received, and the psychosocial impact of providing care. Of 30,009 people sampled, 11,168 (37.7 %) responded, of whom 330 (2.95 %) were informal carers of a PwD. RESULTS In comparison to non-spouse carers, spouse carers provided more care more frequently, did so with less support from family or the local authority, while more frequently experiencing negative impacts on their social life and psychological and physical health. Spouse carers also received more carer support and more frequently experienced a closeness in their relationship with the care-recipient. CONCLUSIONS Spouse carers of PwD differed from non-spouse carers on virtually all aspects of their care situation. Policy and practice must be more sensitive to how the carer-care-recipient relationship shapes the experience of care, so that support is based on an understanding of the individual carer's actual needs and preferences rather than on preconceptions drawn from a generalised support model.
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Affiliation(s)
- Marcus F Johansson
- School of Health and Welfare, Dalarna University, SE-791 88, Falun, Sweden.
| | - Kevin J McKee
- School of Health and Welfare, Dalarna University, SE-791 88, Falun, Sweden
| | - Lena Dahlberg
- School of Health and Welfare, Dalarna University, SE-791 88, Falun, Sweden.,Aging Research Center, Karolinska Institutet & Stockholm University, Tomtebodavägen 18A, 171 65, Solna, Sweden
| | - Christine L Williams
- Christine E Lynn College of Nursing, Florida Atlantic University, FL, 334 31, Boca Raton, USA
| | - Martina Summer Meranius
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23, Västerås, Sweden
| | - Elizabeth Hanson
- Swedish Family Care Competence Centre, Linnaeus University, Box 762, SE-391 27, Kalmar, Sweden
| | - Lennart Magnusson
- Swedish Family Care Competence Centre, Linnaeus University, Box 762, SE-391 27, Kalmar, Sweden
| | - Björn Ekman
- Department of Clinical Sciences, Lund University, SE-202 13, Malmö, Sweden
| | - Lena Marmstål Hammar
- School of Health and Welfare, Dalarna University, SE-791 88, Falun, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, SE-721 23, Västerås, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, SE-14152, Huddinge, Sweden
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Neo SHS, Ku JSM, Tan JYT, Yoon S. Lived Experiences and Long-Term Challenges and Needs of Asian Left Ventricular Assist Device Caregivers. Palliat Med Rep 2021; 2:84-92. [PMID: 34223507 PMCID: PMC8241394 DOI: 10.1089/pmr.2021.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Caregivers are essential for improved outcomes in patients living with left ventricular assist device (LVAD). There is a paucity of research on a long-term LVAD caregivers' experiences and burdens. Objectives: The aim of this study was to explore long-term challenges and needs of LVAD caregivers in the Asian health care setting. Design: We conducted semistructured interviews with caregivers of patients who were currently or previously living with the LVAD. Settings/Subjects: Caregivers were recruited from the National Heart Centre Singapore. Measurements: Interviews were conducted in English and Chinese. All interviews were transcribed verbatim and analyzed based on grounded theory. Chinese interviews were translated to English before transcription. Results: A multiethnic and multireligious sample of 11 caregivers participated. Median caregiving duration was 45 months. Caregivers described long-term challenges that were multifaceted. Misaligned patient expectations, stigmatization and limited social resources within the family and society affected caregivers' coping. Existing gender roles and spiritual and cultural influences shaped how caregivers appraised, made meaning of caregiving, and assessed support. Long-term caregivers' needs included learning from role models, shifting perspectives, enhancing communication between patient and caregivers, advocacy efforts, and holistic medical care. Conclusions: Gender roles as well as cultural and spiritual influences affected coping and access to support in long-term Asian LVAD caregivers. Future interventions should consider culturally relevant approaches to improve well-being and quality of life of caregivers.
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Affiliation(s)
- Shirlyn Hui Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Jasmine Si Min Ku
- Department of Medical Social Services, National Heart Centre Singapore, Singapore, Singapore
| | - Jasmine Yun Ting Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
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Rigby T, Johnson DK, Taylor A, Galvin JE. Comparison of the Caregiving Experience of Grief, Burden, and Quality of Life in Dementia with Lewy Bodies, Alzheimer's Disease, and Parkinson's Disease Dementia. J Alzheimers Dis 2021; 80:421-432. [PMID: 33554912 PMCID: PMC8483604 DOI: 10.3233/jad-201326] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Caregivers of persons living with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and Parkinson's disease dementia (PDD) are faced with numerous challenges. However, little is known about the caregiving experience across different dementias. OBJECTIVE The aims of this cross-sectional study were to examine the differences in the caregiver experience between DLB, PDD, and AD. METHODS Respondents were caregivers (N = 515; 384 DLB, 69 AD, 62 PDD) who completed a 230-question survey including sociodemographics, disease severity, neuropsychiatric symptoms, and measures of grief, burden, depression, quality of life, social support, well-being, care confidence, and mastery/self-efficacy. RESULTS There were no differences in caregiver age, sex, race, or education, or in the distribution of disease severity between diagnostic groups. Constructs were highly intercorrelated with positive attributes (caregiver QoL, care recipient QoL, social support, well-being, mastery and care confidence) being inversely correlated with negative attributes (burden, grief, and depression). Across dementia etiologies, no differences were reported for quality of life, social support, depression, well-being, psychological well-being, mastery, care confidence, burden or grief. Instead, we found that the caregiver's experience was dependent on caregiver characteristics, person living with dementia characteristics and their most disturbing symptom, with behavior, personality changes, and sleep having the greatest effect on constructs. CONCLUSION Caregiver ratings of psychosocial constructs may be more dependent on care recipient-caregiver dyad characteristics and the current symptoms than the underlying cause of those symptoms. Interventions to improve the caregiving experience should be developed to address specific psychosocial constructs rather than focusing on disease etiology or stage.
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Affiliation(s)
- Taylor Rigby
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - David K. Johnson
- Department of Neurology, University of California at Davis Health Sciences, Davis, CA, USA
| | - Angela Taylor
- The Lewy Body Dementia Association, Atlanta, GA, USA
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Galvin JE, Tolea MI, Chrisphonte S. The positive and negative appraisals of caregiving (PANAC) scale: A new measure to examine the caregiving experience in Alzheimer's disease and related dementias. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12104. [PMID: 33283038 PMCID: PMC7683961 DOI: 10.1002/trc2.12104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/23/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Dementia caregiving is often examined as a monolithic experience describing the challenges caregivers face, exploring one construct at a time, with little research on the positive experiences of caregiving. To address this, we developed the Positive and Negative Appraisals of Caregiving (PANAC) scale. METHODS PANAC was validated in 253 patient-caregiver dyads. Factor analyses revealed a two-factor solution: Positive Appraisals (PAs) and Negative Appraisals (NAs). Psychometric properties were compared with patient and caregiver characteristics and outcomes, disease stage, and etiology. RESULTS Internal consistency was good with Cronbach's alpha: 0.82 NA and 0.80 PA (P < 0.001). NA correlated with patient and caregiver characteristics, whereas PA correlated only with caregiver characteristics. The PA/NA ratio could be used to capture change due to an intervention. DISCUSSION The PANAC scale is a useful measure of the overall caregiver experience accounting for negative and positive experiences and may be used to tailor support to individual caregivers.
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Affiliation(s)
- James E. Galvin
- Department of NeurologyComprehensive Center for Brain HealthUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Magdalena I. Tolea
- Department of NeurologyComprehensive Center for Brain HealthUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Stephanie Chrisphonte
- Department of NeurologyComprehensive Center for Brain HealthUniversity of Miami Miller School of MedicineMiamiFloridaUSA
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Häikiö K, Cloutier D, Rugkåsa J. Is health literacy of family carers associated with carer burden, quality of life, and time spent on informal care for older persons living with dementia? PLoS One 2020; 15:e0241982. [PMID: 33216771 PMCID: PMC7678960 DOI: 10.1371/journal.pone.0241982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Family carers are cornerstones in the care of older people living with dementia. Family carers report extensive carer burden, reduced health-related quality of life (HRQoL), and extensive time spent on informal care (Time). Health literacy (HL) is a concept associated with people's ability to access health services, and navigate the healthcare system. This study's aim was to investigate HL among family carers, and investigate the associations between HL and carer burden, HRQoL, and Time spent on informal care. METHOD We designed a self-administered survey comprising validated instruments, including the Health Literacy Scale (HLS-N-Q12) to measure HL, Relative Stress Scale (RSS) to measure carer burden, the EQ-5D-5L instrument to measure HRQoL, and some modified questions from the Resource Utilization in Dementia (RUD) questionnaire to measure time spent on informal care (Time). Descriptive analysis in addition to bivariate and multiple linear regressions were undertaken. In multiple linear regression analysis, we used HL as the independent variable to predict the outcomes (carer burden, HRQoL, Time). Analyses were adjusted for the effects of explanatory independent variables: age, gender, education levels, urban residency, having worked as health personnel, caring for someone with severe/mild dementia, and being born abroad. FINDINGS In a non-probability sample of 188 family carers from across Norway, most of them female and over the age of 60, we found high levels of HL. In the bivariate analysis, carer burden and HRQoL (EQvalue) showed significant associations with HL. In the multiple regression analyses, HL was statistically significantly associated with carer burden (B = -0.18 CI:-0.33,-0.02 p = 0.02), HRQoL (EQvalue: B = 0.003 with 95% CI: 0.001, 0.006 p = 0.04), and Time (B = -0.03 with 95% CI: -0.06, 0.000, p = 0.046), after adjusting for the effect of independent variables. CONCLUSION This is one of the first studies to investigate the associations between HL and different outcomes for family carers of older people living with dementia. Additional research into the associations identified here is needed to further develop our understanding of how to support family carers in their roles. Targeted support that increases family carers' HL may have potential to enhance their ability to provide sustainable care over time.
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Affiliation(s)
- Kristin Häikiö
- HØKH-Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Denise Cloutier
- Department of Geography & Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Jorun Rugkåsa
- HØKH-Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Center for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
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Liu C, Fabius CD, Howard VJ, Haley WE, Roth DL. Change in Social Engagement among Incident Caregivers and Controls: Findings from the Caregiving Transitions Study. J Aging Health 2020; 33:114-124. [PMID: 32962491 DOI: 10.1177/0898264320961946] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives:We aimed to compare incident family caregivers and matched controls on change in social network variables and satisfaction with social activities. Methods: A total of 479 participants from the Caregiving Transitions Study were included in the analysis, 244 (50.9%) of whom began substantial and sustained caregiving between baseline and follow-up interviews. We assessed associations between incident caregiving and change in social network size, change in monthly social contact, and satisfaction with social activities. Results: Incident caregivers reported lower satisfaction with social activities and greater decline in social network size than controls. Among only the caregivers, dementia caregivers reported greater decline in social network size while caregivers who were spouses, experienced higher strain, and provided more hours of care reported lower satisfaction with social activities. Discussion: Social engagement declined more among incident caregivers than controls. Future studies should aim to understand why subgroups of caregivers reported lower social engagement.
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Affiliation(s)
- Chelsea Liu
- Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Chanee D Fabius
- Bloomberg School of Public Health, Johns Hopkins University, USA
| | | | | | - David L Roth
- Center on Aging and Health, Johns Hopkins University, USA
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Zhou DHR, Hung SL, Lo TLT. Can We Hit Two Birds with One Stone: An Effectiveness Study of Peer-support Groups for Low-income Spousal and Adult Children Caregivers of Hong Kong Older Adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:227-249. [PMID: 32264770 DOI: 10.1080/01634372.2020.1746722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
This study aims to assess the effectiveness of peer support groups for low-income older adults' caregivers in the Hong Kong community. It compares the effectiveness of peer support groups on spouse and adult children caregivers. The peer support program was structured into three stages, including six training sessions for peer specialists, eight caregiver support group sessions, and non-structured informal contact. The study adopted a quasi-experiment design supplemented with qualitative data collected from focused group interviews. It involved a user group of 58 participants and a control group of 42 participants. Both quantitative and qualitative data were collected before, after the peer support groups, and at a three-month follow-up. The quantitative results showed that the peer support program was more effective in promoting social support for adult children caregivers but not for spousal caregivers. Three focus group interviews suggested that the community-based peer-support group could be helpful to improve stress management, emotional regulation skills, and social networks of the caregivers. Based on the research findings, we discuss the various needs of spousal and adult children caregivers, provide recommendations for service providers and practitioners to consider homogenous group services to address the diverse needs of spousal and adult children caregivers.
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Affiliation(s)
- De-Hui Ruth Zhou
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong Kong, China
| | - Suet-Lin Hung
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China
| | - Temmy Lee Ting Lo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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Zhong Y, Wang J, Nicholas S. Social support and depressive symptoms among family caregivers of older people with disabilities in four provinces of urban China: the mediating role of caregiver burden. BMC Geriatr 2020; 20:3. [PMID: 31898490 PMCID: PMC6941264 DOI: 10.1186/s12877-019-1403-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/22/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To examine the relationship between social support and depressive symptoms of Chinese family caregivers of older people with disabilities, and to evaluate the role of caregiver burden as a potential mediator of that relationship. METHODS A survey questionnaire was completed face-to-face by 567 primary family caregivers of older people with disabilities in four provinces in China. Covariates that may affect depressive symptoms, such as the characteristics of disabled people (socio-economic factors, functional and cognitive capacity) and caregivers (caregiver duration and self-rated health of caregivers) were collected. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS); depressive symptoms were assessed by the shortened 10 item version of Center for Epidemiological Studies Depression scale (CES-D); and the caregiver burden was assessed by the Zarit Burden Interview (ZBI). RESULTS The prevalence of depressive symptoms among caregivers was 37.7%. Higher levels of social support was negatively associated with lower depressive symptoms. This relationship was partially mediated by the caregiver burden, where higher levels of the caregiver burden were negatively associated with depressive symptoms. Furthermore, caregivers who were women, spent extended time in caregiving and were in poor health, reported significantly higher depressive symptoms. CONCLUSIONS Our results indicated that social support was negatively associated with depressive symptoms in family caregivers and in the caregiver burden. The caregiver burden partially mediated the social support-depressive symptoms association. Interventions for family caregivers should include increasing social support, health monitoring and structured interventions to reduce the caregiver burden and attenuate family caregivers' depressive symptoms.
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Affiliation(s)
- Yaqin Zhong
- School of Public Health, Nantong University, 9 Seyuan Road, Nantong, 210029 Jiangsu China
| | - Jian Wang
- Dong Furen Institute of Economic and Social Development, Wuhan University, 54 Dongsi Lishi Hutong, Beijing, 100010 China
| | - Stephen Nicholas
- School of Economics and School of Management, Tianjin Normal University, West Bin Shui Avenue, Tianjin, 300074 People’s Republic of China
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun Avenue North, Guangzhou, 510420 People’s Republic of China
- TOP Education Institute 1 Central Avenue Australian Technology Park, Eveleigh Sydney, NSW 2015 Australia
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2308 Australia
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Suitor JJ. Variations in the Path From Bench to Bedside in Translational Research on Caregiving. Innov Aging 2019; 3:igz042. [PMID: 31742238 PMCID: PMC6855361 DOI: 10.1093/geroni/igz042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- J Jill Suitor
- Department of Sociology, Purdue University, West Lafayette, Indiana
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