1
|
Sofronas M, Carnevale FA, Macdonald ME, Bitzas V, Wright DK. "We are not the person we will be when these things happen:" Reflections on personhood from an ethnography of neuropalliative care. Nurs Inq 2024; 31:e12646. [PMID: 38838221 DOI: 10.1111/nin.12646] [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: 01/12/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
Neuropalliative care developed to address the needs of patients living with life-limiting neurologic disease. One critical consideration is that disease-related changes to cognition, communication, and function challenge illness experiences and care practices. We conducted an ethnography to understand neuropalliative care as a phenomenon; how it was experienced, provided, conceptualized. Personhood served as our conceptual framework; with its long philosophical history and important place in nursing theory, we examined the extent to which it captured neuropalliative experiences and concerns. Personhood contextualized complex losses, aligning the impact of functional and relational changes. Cognition, communication, and functional alterations stretched conceptions of personhood, insinuating it can be relational, fluid, adaptive. Although normative conceptions of personhood guided research and decision-making, ethical considerations suggested personhood could be transformed, remade. We consider the implications of our findings through three themes. First, we examine how literature on illness experience fails to integrate the realities of people living with and dying from neurologic disease; we counter this by interrogating the concept of experience. Second, we turn to Ricoeur's work on recognition to illuminate relational conceptions of personhood to inform care practices. Finally, we reflect on how personhood can bridge the gap left by functional changes, enhance relational engagement, and promote dignity at the end of life.
Collapse
Affiliation(s)
- Marianne Sofronas
- School of Nursing, University of Ottawa, Ottawa, Canada
- Ingram School of Nursing, McGill University, Montreal, Canada
| | | | | | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, Canada
- CIUSSS Centre Ouest de l'Ile de Montreal, Montreal, Canada
| | | |
Collapse
|
2
|
Oikonomou V, Gkintoni E, Halkiopoulos C, Karademas EC. Quality of Life and Incidence of Clinical Signs and Symptoms among Caregivers of Persons with Mental Disorders: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:269. [PMID: 38275549 PMCID: PMC10815690 DOI: 10.3390/healthcare12020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Caring for individuals with mental disorders poses significant challenges for caregivers, often leading to compromised quality of life and mental health issues such as stress, anxiety, and depression. This study aims to assess the extent of these challenges among caregivers in Greece, identifying which demographic factors influence their well-being. METHOD A total of 157 caregivers were surveyed using the SF-12 Health Survey for quality-of-life assessment and the DASS-21 questionnaire for evaluating stress, anxiety, and depression symptoms. t-tests, Kruskal-Wallis tests, Pearson's correlation coefficients, and regression analyses were applied to understand the associations between demographics, quality of life, and mental health outcomes. RESULTS The study found that caregivers, especially women and younger individuals, faced high levels of mental health challenges. Marital status, educational level, and employment status also significantly influenced caregivers' well-being. Depression was the most significant factor negatively correlating with the mental component of quality of life. The magnitude of the burden experienced by caregivers highlighted the urgency for targeted social and financial support, as well as strategic treatment programs that consider caregiver well-being. CONCLUSIONS Caregivers of individuals with mental disorders endure significant stress, anxiety, and depression, influencing their quality of life. Demographic factors such as age, gender, marital status, education, and employment status have notable impacts. Findings emphasize the need for society-wide recognition of caregivers' roles and the creation of comprehensive support and intervention programs to alleviate their burden, particularly in the context of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Vasiliki Oikonomou
- School of Social Sciences, Hellenic Open University, 26335 Patras, Greece; (V.O.); (E.C.K.)
| | - Evgenia Gkintoni
- Department of Psychiatry, University General Hospital of Patras, 26504 Patras, Greece
| | | | - Evangelos C. Karademas
- School of Social Sciences, Hellenic Open University, 26335 Patras, Greece; (V.O.); (E.C.K.)
- Department of Psychology, University of Crete, 74100 Rethymnon, Greece
| |
Collapse
|
3
|
Bratches RWR, Wall JA, Puga F, Pilonieta G, Jablonski R, Bakitas M, Geldmacher DS, Odom JN. Patient Portal Use Among Family Caregivers of Individuals With Dementia and Cancer: Regression Analysis From the National Study of Caregiving. JMIR Aging 2023; 6:e44166. [PMID: 38235767 PMCID: PMC10811454 DOI: 10.2196/44166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 01/19/2024] Open
Abstract
Background Family caregivers are often inexperienced and require information from clinic visits to effectively provide care for patients. Despite reported deficiencies, 68% of health systems facilitate sharing information with family caregivers through the patient portal. The patient portal is especially critical in the context of serious illnesses, like advanced cancer and dementia, where caregiving is intense and informational needs change over the trajectory of disease progression. Objective The objective of our study was to analyze a large, nationally representative sample of family caregivers from the National Study of Caregiving (NSOC) to determine individual characteristics and demographic factors associated with patient portal use among family caregivers of persons living with dementia and those living with cancer. Methods We conducted a secondary data analysis using data from the 2020 NSOC sample of family caregivers linked to National Health and Aging Trends Study. Weighted regression analysis by condition (ie, dementia or cancer) was used to examine associations between family caregiver use of the patient portal and demographic variables, including age, race or ethnicity, gender, employment status, caregiver health, education, and religiosity. Results A total of 462 participants (representing 4,589,844 weighted responses) were included in our analysis. In the fully adjusted regression model for caregivers of persons living with dementia, Hispanic ethnicity was associated with higher odds of patient portal use (OR: 2.81, 95% CI 1.05-7.57; P=.04), whereas qualification lower than a college degree was associated with lower odds of patient portal use by family caregiver (OR 0.36, 95% CI 0.18-0.71; P<.001. In the fully adjusted regression model for caregivers of persons living with cancer, no variables were found to be statistically significantly associated with patient portal use at the .05 level. Conclusions In our analysis of NSOC survey data, we found differences between how dementia and cancer caregivers access the patient portal. As the patient portal is a common method of connecting caregivers with information from clinic visits, future research should focus on understanding how the portal is used by the groups we have identified, and why.
Collapse
Affiliation(s)
- Reed W R Bratches
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Jaclyn A Wall
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Giovanna Pilonieta
- Department of Neurology, University of Alabama at Birmingham, BirminghamAL, United States
| | - Rita Jablonski
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - David S Geldmacher
- Department of Neurology, University of Alabama at Birmingham, BirminghamAL, United States
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| |
Collapse
|
4
|
Hoda W, Bharati SJ. Palliative care in neurology patients. Int Anesthesiol Clin 2023; 61:73-79. [PMID: 37249177 DOI: 10.1097/aia.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Wasimul Hoda
- Department of Superspeciality Anaesthesia, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Sachidanand J Bharati
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
| |
Collapse
|
5
|
Xiao F, Cao S, Xiao M, Xie L, Zhao Q. Patterns of home care and community support preferences among older adults with disabilities in China: a latent class analysis. BMC Geriatr 2023; 23:117. [PMID: 36869322 PMCID: PMC9983178 DOI: 10.1186/s12877-023-03830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/16/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Ageing in place is the preferred choice for most older adults worldwide. The role of the family as a core care resource has diminished as a result of changes in family structure, thus extending the responsibility for caring for older adults from within the family to outside it and requiring considerably more support from society. However, there is a shortage of formal and qualified caregivers in many countries, and China has limited social care resources. Therefore, it is important to identify home care patterns and family preferences to provide effective social support and reduce government costs. METHODS Data were obtained from the Chinese Longitudinal Healthy Longevity Study 2018. Latent class analysis models were estimated using Mplus 8.3. Multinomial logistic regression analysis was adopted to explore the influencing factors with the R3STEP method. Lanza's method and the chi-square goodness-of-fit test were used to explore community support preferences among different categories of families of older adults with disabilities. RESULTS Three latent classes were identified based on older adults with disabilities' characteristics (degree of disability, demand satisfaction), caregivers' characteristics (length of providing care, care performance) and living status: Class 1- mild disability and strong care (46.85%); Class 2- severe disability and strong care (43.92%); and Class 3- severe disability and incompetent care (9.24%). Physical performance, geographic region and economic conditions jointly influenced home care patterns (P < 0.05). Home visits from health professionals and health care education were the top two forms of community support that were most preferred by the older adults with disabilities' families (residual > 0). Families in the Class 3 subgroup preferred personal care support more than those in the other two subgroups (P < 0.05). CONCLUSION Home care is heterogeneous across families. Older adults' degrees of disability and care needs may be varied and complex. We classified different families into homogeneous subgroups to reveal differences in home care patterns. The findings can be used by decision-makers in their attempts to design long-term care arrangements for home care and to adjust the distribution of resources for the needs of older adults with disabilities.
Collapse
Affiliation(s)
- Feng Xiao
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Songmei Cao
- Department of Nursing, 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
| | - Liling Xie
- Department of Nursing, First Branch of 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.
| |
Collapse
|
6
|
Bélanger E, D’Silva J, Carroll MS, Van Houtven CH, Shepherd-Banigan M, Smith VA, Wetle TT. Reactions to Amyloid PET Scan Results and Levels of Anxious and Depressive Symptoms: CARE IDEAS Study. THE GERONTOLOGIST 2022; 63:71-81. [PMID: 35436334 PMCID: PMC9872765 DOI: 10.1093/geront/gnac051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Few studies have examined care partners' reactions to their loved ones receiving amyloid-β positron emission tomography (PET) scan results, which can be indicative of Alzheimer's disease. We explored care partners' reactions qualitatively, and checked the association of scan results and diagnostic category (dementia vs mild cognitive impairment [MCI]) with care partner anxious and depressive symptoms through quantitative analysis. RESEARCH DESIGN AND METHODS Using data from 1,761 care partners in the Caregivers' Reactions and Experience, a supplemental study of the Imaging Dementia Evidence for Amyloid Scanning study, we applied an exploratory sequential mixed-methods design and examined the reactions of 196 care partners to receiving amyloid PET scan results through open-ended interview questions. Based on the qualitative content analysis, we hypothesized there would be an association of care partners' depressive (Patient Health Questionnaire-2) and anxious (6-item State-Trait Anxiety Inventory) symptoms with scan results and diagnostic category which we then tested with logistic regression models. RESULTS Content analysis of open-ended responses suggests that when scan results follow the care partner's expectations, for example, elevated amyloid in persons with dementia, care partners report relief and gratitude for the information, rather than distress. Adjusted logistic regression models of survey responses support this finding, with significantly higher odds of anxiety, but not depressive symptoms, among care partners of persons with MCI versus dementia and elevated amyloid. DISCUSSION AND IMPLICATIONS Care partners of persons with MCI reported distress and had higher odds of anxiety after receiving elevated amyloid PET scan results than care partners of persons with dementia. This has the potential to inform clinical practice through recommendations for mental health screening and referrals.
Collapse
Affiliation(s)
- Emmanuelle Bélanger
- Address correspondence to: Emmanuelle Bélanger, PhD, Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 South Main Street, 6th Floor, Providence, RI 02903, USA. E-mail:
| | - Jessica D’Silva
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Michaela S Carroll
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Valerie A Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Terrie T Wetle
- Center for Gerontology and Healthcare Research, Brown University, School of Public Health, Providence, Rhode Island, USA,Department of Health Services, Policy & Practice, Brown University, School of Public Health, Providence, Rhode Island, USA
| |
Collapse
|
7
|
Spatuzzi R, Vespa A, Fabbietti P, Ricciuti M, Rosati G, Guariniello L, Verrastro MAF, Attademo L, Giulietti MV. Elderly Helping Other Elderly: A Comparative Study of Family Caregiver Burden Between Patients With Dementia or Cancer at the End of Life. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:96-108. [PMID: 35245165 DOI: 10.1080/15524256.2022.2042459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A new reality is being observed around the world as the population ages: family caregivers, who are themselves older adults helping their ill older relatives. The aim of this study is to assess the burden of the older family caregiver assisting older patients in his or her end-of-life who are suffering from dementia or cancer. In this context, the elderly person is involved in the dual role of patient and caregiver. In this comparative study, a total of 87 older family caregivers (age ≥ 65 years) completed the Caregiver Burden Inventory (CBI) measurement. The sample was divided into 2 subgroups based on the individuals' advanced disease: Alzheimer's disease (AD) or cancer. Compared to cancer caregivers, the AD subgroup reported significantly higher scores in the CBI-emotional subscale (P = 0.006), confirmed by the evaluation of the generalized linear model (multivariate). There were no significant differences in the other CBI subscales and overall scores. According to the findings of this study, elderly who help elderly with AD are at a higher risk of experiencing an emotional burden than cancer caregivers. This data could be considered in designing interventions to reduce the caregiver burden of older family caregivers as they provide informal end-of-life care.
Collapse
Affiliation(s)
- Roberta Spatuzzi
- UOSD CSM Vulture-Melfese, Department of Mental Health, ASP Basilicata, Potenza, Italy
| | - Anna Vespa
- Clinic of Internal Medicine and Geriatrics, Scientific and Technological Area, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| | - Paolo Fabbietti
- Biostatistical Center, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| | | | - Gerardo Rosati
- Medical Oncology Unit, "San Carlo" Hospital, Potenza, Italy
| | - Lorella Guariniello
- UOSD CSM Vulture-Melfese, Department of Mental Health, ASP Basilicata, Potenza, Italy
| | | | - Luigi Attademo
- Department of Mental Health, Hospital Psychiatric Service of Diagnosis and Care at "San Carlo" Hospital, ASP Basilicata, Italian NHS, Italy
| | - Maria Velia Giulietti
- Clinic of Internal Medicine and Geriatrics, Scientific and Technological Area, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| |
Collapse
|
8
|
Kim B, Lee Y, Noh JW, Kim TH. Factors Associated with Health Check-up and Cancer Screening Participation among Family Caregivers of Patients with Dementia: A Cross-Sectional Study. BMC Public Health 2021; 21:1753. [PMID: 34565358 PMCID: PMC8474929 DOI: 10.1186/s12889-021-11768-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/10/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Providing care for patients with dementia can negatively influence the physical health and health behaviours of family caregivers. A better understanding of the factors associated with health check-up and cancer screening participation is vital for developing effective interventions. Thus, this study aimed to identify factors associated with health check-up and cancer screening participation among family caregivers of patients with dementia. METHODS This was a cross-sectional study that analysed the data of 2,414 family caregivers of patients with dementia collected by the Korea Community Health Survey in 2017. A binomial logistic regression analysis was performed to identify demographic, socioeconomic, and health status factors associated with health check-up and cancer screening participation among family caregivers of patients with dementia. RESULTS Health check-up and cancer screening rates among family caregivers of patients with dementia were 68.7% and 61.4%, respectively, which were significantly lower than the rates for individuals who were not caregivers of patients with dementia. Those with lower education levels had lower odds ratios (OR) for both health check-up (OR: 0.60) and cancer screening (OR: 0.59) participation. In addition, symptoms of depression were associated with lower participation (health check-up OR: 0.67; cancer screening OR: 0.65). CONCLUSIONS More targeted disease prevention and management strategies must be developed for family caregivers of patients with dementia, particularly those with depressive symptoms and lower education levels.
Collapse
Affiliation(s)
- Bomgyeol Kim
- Department of Public Health, Graduate School, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yejin Lee
- Department of Public Health, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jin-Won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yeonsedae-gil, Wonju-si, Gangwon-do, Republic of Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
9
|
Treml J, Schmidt V, Nagl M, Kersting A. Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review. Soc Sci Med 2021; 284:114240. [PMID: 34303292 DOI: 10.1016/j.socscimed.2021.114240] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer is one of the most common causes of death. The period of time between receiving a terminal diagnosis of cancer and the death of a loved one has been operationalized as pre-loss grief and, more recently, as preparedness for death. Originally, grief before loss was thought to have positive effects on the bereavement outcome, but some studies have revealed contradictory findings. This systematic review investigates definitions and measurement tools of pre-loss grief and preparedness for death, as well as the associations of both constructs with caregiver characteristics, pre-loss psychological aspects and post-loss adjustment among caregivers of people living with terminal cancer. METHODS PubMed/Medline, PsycINFO and Web of Science were searched for studies published up until October 2020. Quantitative empirical studies from peer reviewed journals were included if a measurement tool for pre-loss grief or preparedness for death was used and if they focused on adult caregivers of adult people with cancer in an end-of-life trajectory and were excluded when they were not written in English or were descriptive/qualitative studies. Quality assessment of all studies was performed. RESULTS Most studies used convenience samples and had a mean number of 725 participants. Overall, 16,326 participants in 35 articles were included and narratively synthesized. High levels of pre-loss grief, as well as low levels of perceived preparedness for death, were associated with poor post-loss adjustment (e.g., prolonged grief, depressive symptoms, etc.). CONCLUSIONS Caregivers with high levels of pre-loss grief and low levels of preparedness for the death of their loved one would benefit from targeted support for post-loss adjustment. Results are limited by an inconsistent operationalization of both constructs.
Collapse
Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Michaela Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| |
Collapse
|
10
|
Song Y, Carlson GC, McGowan SK, Fung CH, Josephson KR, Mitchell MN, McCurry SM, Teng E, Irwin MR, Alessi CA, Martin JL. Sleep Disruption Due to Stress in Women Veterans: A Comparison between Caregivers and Noncaregivers. Behav Sleep Med 2021; 19:243-254. [PMID: 32116050 PMCID: PMC7483161 DOI: 10.1080/15402002.2020.1732981] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective/Background: Sleep problems are common in women and caregiving for an adult is a common role among women. However, the effects of caregiving on sleep and related daytime impairment are poorly understood among women veterans. This study compared stress-related sleep disturbances, insomnia symptoms, and sleep-related daytime impairment between women veterans who were caregivers and those who did not have a caregiving role. Participants: Of 12,225 women veterans who received care in one Veterans Administration Healthcare System, 1,457 completed data on a postal survey (mean age = 51.7 ± 15.9 years). Two hundred forty three (17%) respondents (mean age 53.8 ± 12.7 years) were caregivers for an adult, predominantly for a parent, providing transportation. Methods: The survey included items that addressed insomnia symptoms, total sleep time, sleep-related daytime impairments, caregiving characteristics, self-rated health, pain, stress, body mass index, and demographic information. Results: In adjusted analyses, caregiver status did not directly predict sleep complaints alone. However, in multiple regression analyses, being a caregiver (odds ratio 1.7, p = .001) significantly predicted stress-related sleep disturbance, even after adjusting for age, pain, self-rated health, and other characteristics. Furthermore, being a caregiver (β = 3.9, p = .031) significantly predicted more symptoms of sleep-related daytime impairment after adjusting for age, pain, self-rated health, and other factors. Conclusions: Compared to noncaregivers, women veterans who were caregivers for an adult were more likely to report stress causing poor sleep, and more daytime impairment due to poor sleep. These findings suggest the need to target stress and other factors when addressing sleep disturbance among women veterans who are caregivers.
Collapse
Affiliation(s)
- Yeonsu Song
- School of Nursing University of California , Los Angeles, California
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System , North Hills, California
- David Geffen School of Medicine, University of California , Los Angeles, California
| | - Gwendolyn C Carlson
- Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System , North Hills, California
| | - Sarah Kate McGowan
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System , North Hills, California
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System , North Hills, California
- David Geffen School of Medicine, University of California , Los Angeles, California
| | - Karen R Josephson
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System , North Hills, California
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System , North Hills, California
| | - Susan M McCurry
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington , Seattle, Washington
| | - Edmond Teng
- School of Medicine, Stanford University , Palo Alto, California
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles, California
| | - Cathy A Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System , North Hills, California
- David Geffen School of Medicine, University of California , Los Angeles, California
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System , North Hills, California
- David Geffen School of Medicine, University of California , Los Angeles, California
| |
Collapse
|
11
|
Sousa L, Sequeira C, Ferré-Grau C, Graça L. 'Living Together With Dementia': preliminary results of a training programme for family caregivers. Scand J Caring Sci 2020; 35:86-95. [PMID: 31985859 DOI: 10.1111/scs.12821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 01/09/2020] [Indexed: 11/29/2022]
Abstract
The aim of this article was to present the preliminary results of a training programme for family caregivers of people with dementia at an early to moderate stage living at home - 'Living Together With Dementia'. In this randomised controlled trial, 27 family caregivers who met the inclusion criteria were recruited from the neurology outpatient consultation clinic of a hospital in the north of Portugal and randomised into two groups (control and experimental) between October 2015 and March 2016. The programme 'Living Together With Dementia' was applied to the participants of the experimental group. The strategies used, overload, difficulties and satisfaction of the caregivers were assessed at three different stages (at the beginning and end of the intervention, as well as at follow-up). For the data analysis, quantitative parametric measures were applied. The Health Ethical Commission of the Hospital Centre approved the study, and its protocol and Helsinki Declaration ethical principles were considered throughout the process. In the final assessment, an improvement in the overload and difficulties was confirmed, as was an increase in the caregivers' satisfaction level and an improvement in coping/problem-solving strategies. In the follow-up stage, the results tended to revert towards those of the initial assessment. The programme 'Living Together With Dementia' appeared to be a major contribution enabling family caregivers of people with dementia, although there is a need to develop an efficacy study using a more substantial sample. The programme contributed to a reduction in the overload and difficulties borne by the family caregivers of people with dementia at an early to moderate stage living at home and to increased caregiver satisfaction.
Collapse
Affiliation(s)
- Lia Sousa
- Superior School of Health, Vale do Ave. North Polytechnic Institute of Health, Nova de Famalicão, Portugal.,Portuguese Society of Mental Health Nursing Board Member, Porto, Portugal
| | - Carlos Sequeira
- Porto Nursing School, Coordinator Scientific Pedagogical Unit, "Management of Signs & Symptoms", Porto, Portugal.,Research Unit, CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carme Ferré-Grau
- Department of Nursing, University Rovira i Virgili, Tarragona, Spain
| | - Luís Graça
- Viana do Castelo Health School, Viana do Castelo, Portugal
| |
Collapse
|
12
|
Connelly DE, Verstaen A, Brown CL, Lwi SJ, Levenson RW. Pronoun Use during Patient-Caregiver Interactions: Associations with Caregiver Well-Being. Dement Geriatr Cogn Disord 2020; 49:202-209. [PMID: 32610328 PMCID: PMC7805608 DOI: 10.1159/000508095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Caring for a spouse with dementia can be extremely challenging. Many caregivers experience profound declines in well-being; however, others remain healthy. OBJECTIVE This study determined whether the personal pronouns used in interactions between persons with dementia (PWDs) and their spousal caregivers were associated with caregiver well-being. METHODS Fifty-eight PWDs and their spousal caregivers engaged in a 10-min conversation about an area of disagreement in a laboratory setting. Verbatim transcripts of the conversation were coded using text analysis software, and caregivers and PWDs each received scores for (a) I-pronouns, (b) you-pronouns, and (c) we-pronouns. Caregivers' well-being was assessed using a composite measure of depression, anxiety, burden, and strain. RESULTS Results revealed that less use of we-pronouns by caregivers and PWDs and greater use of I-pronouns by PWDs were -associated with lower caregiver well-being. CONCLUSIONS These findings indicate that less use of pronouns that refer to the couple (we-pronouns used by either partner) and greater use of pronouns that refer to the PWD (I-pronouns used by the PWD) are indicative of caregivers at heightened risk for lower well-being.
Collapse
Affiliation(s)
- Dyan E. Connelly
- Department of Psychology, University of California, Berkeley, CA US
| | - Alice Verstaen
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA US
| | - Casey L. Brown
- Department of Psychology, University of California, Berkeley, CA US
| | - Sandy J. Lwi
- VA Northern California Health Care System, Martinez, CA US
| | | |
Collapse
|
13
|
Perpiñá-Galvañ J, Orts-Beneito N, Fernández-Alcántara M, García-Sanjuán S, García-Caro MP, Cabañero-Martínez MJ. Level of Burden and Health-Related Quality of Life in Caregivers of Palliative Care Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4806. [PMID: 31795461 PMCID: PMC6926780 DOI: 10.3390/ijerph16234806] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/19/2019] [Accepted: 11/24/2019] [Indexed: 12/19/2022]
Abstract
The complexity of palliative care means that the emotional distress and burden that primary family caregivers suffer under can be particularly high. The objective of this study was to determine the level of burden endured by these primary family caregivers and to identify the variables that predict it in the caregiving relatives of people who require home-based palliative care. A descriptive-correlational cross-sectional study was conducted. Socio-demographic and clinical data were collected from caregivers through a self-administered questionnaire that included questions from the 12-Item Short Form Health Survey (SF-12), Zarit Caregiver Burden Interview (ZBI), Hospital Anxiety and Depression Scale (HADS), Brief Resilient Coping Scale (BRCS), Post Traumatic Growth Inventory (PTGI), and Fatigue Assessment Scale (FAS). A total of 77 caregivers participated; 66.2% were women, and the mean age was 61.5 years. Most (62.3%) were providing care to cancer patients. From among these data, the presence of anxiety as a clinical problem (48.1%), a high average fatigue score (FAS) of 23.0 (SD = 8.5), and the prevalence of intense overload (41.6%) stood out. We found statistically significant correlations between the variables of burden, fatigue, post-traumatic growth, anxiety, and depression, with the latter two being the main predictive variables of burden. In addition, caregiver burden was associated with a worsening of health. Identifying the factors that influence the appearance of overburden will allow the specific needs of careers to be assessed in order to offer them emotional support within the healthcare environment.
Collapse
Affiliation(s)
- Juana Perpiñá-Galvañ
- Department of Nursing, University of Alicante, 03690 Alicante, Spain; (J.P.-G.); (S.G.-S.); (M.J.C.-M.)
- Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO Foundation), 03010 Alicante, Spain;
| | - Núria Orts-Beneito
- Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO Foundation), 03010 Alicante, Spain;
| | - Manuel Fernández-Alcántara
- Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO Foundation), 03010 Alicante, Spain;
- Department of Health Psychology, University of Alicante, 03690 Alicante, Spain
| | - Sofía García-Sanjuán
- Department of Nursing, University of Alicante, 03690 Alicante, Spain; (J.P.-G.); (S.G.-S.); (M.J.C.-M.)
- Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO Foundation), 03010 Alicante, Spain;
| | | | - María José Cabañero-Martínez
- Department of Nursing, University of Alicante, 03690 Alicante, Spain; (J.P.-G.); (S.G.-S.); (M.J.C.-M.)
- Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO Foundation), 03010 Alicante, Spain;
| |
Collapse
|
14
|
Onandia-Hinchado I, Diaz-Orueta U. Health related quality of life in individuals with cognitive decline and discrepancies between patients and their proxies. Arch Gerontol Geriatr 2019; 85:103914. [PMID: 31352187 DOI: 10.1016/j.archger.2019.103914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/04/2019] [Accepted: 07/13/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE The goal was to measure Health Related Quality of Life (HRQoL) in individuals with different types of dementia, mild cognitive impairment (MCI) and healthy controls (HC), and assess agreement levels between participants and proxies. MATERIALS AND METHODS A sample of 136 participants were recruited; thirty-seven with Alzheimer's Disease Dementia (AD), 19 with Dementia with Lewy Bodies (DLB), 12 with Frontotemporal Dementia (FTD), 37 with MCI and 31 HC. HRQoL was measured via the 12-Item Short Form Health Survey, version 2 (SF-12-v2), separately for participants and proxies. Two groups (Individuals with cognitive decline versus healthy controls) were matched for sociodemographic variables. Differences for discrepancy rates between both groups were measured using t-test. Participant and proxy agreements were measured via Intraclass Correlation Coefficients (ICC). Linear regression analyses were performed to examine what variables explained better the variance observed. RESULTS Patients with DLB and FTD showed the lowest levels of HRQoL, while AD and HC showed the highest. No statistically significant differences were found between discrepancy scores from cognitive decline groups and healthy controls. ICC indicated high agreement between patients and proxies for the groups with cognitive decline, while agreements achieved in HC were lower and only in physical indices. GDS score accounted for 8.3% of the variance of proxies' rating on Mental Summary Composite Score (MSC). CONCLUSION HRQoL physical and mental summaries are more reliable in groups with cognitive decline. Healthy controls and their proxies show lower agreement, with proxies reporting lower levels than normal for some relevant indices.
Collapse
Affiliation(s)
- Iban Onandia-Hinchado
- Department of Psychology, University of the Basque Country, Donostia-San Sebastian, Spain.
| | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
| |
Collapse
|
15
|
Al-Janabi H, McLoughlin C, Oyebode J, Efstathiou N, Calvert M. Six mechanisms behind carer wellbeing effects: A qualitative study of healthcare delivery. Soc Sci Med 2019; 235:112382. [PMID: 31326132 DOI: 10.1016/j.socscimed.2019.112382] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/26/2019] [Accepted: 06/21/2019] [Indexed: 11/28/2022]
Abstract
Health and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic 'IMPACT'. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients.
Collapse
Affiliation(s)
- Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Carol McLoughlin
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Richmond Rd, Bradford, BD7 1DP, UK
| | - Nikolaos Efstathiou
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, UK; NIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK
| |
Collapse
|
16
|
Otero P, Torres ÁJ, Vázquez FL, Blanco V, Ferraces MJ, Díaz O. Does the Disease of the Person Receiving Care Affect the Emotional State of Non-professional Caregivers? Front Psychol 2019; 10:1144. [PMID: 31156524 PMCID: PMC6529816 DOI: 10.3389/fpsyg.2019.01144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/30/2019] [Indexed: 11/26/2022] Open
Abstract
Research on mental health of non-professional caregivers has focused on caregivers of people with specific diseases, especially dementia. Less is known about caregivers of people with other diseases. The aims of this study were (a) to determine the caregivers’ emotional state in a random sample of caregivers of people in situations of dependency, (b) to analyze the association between each disease of the care-recipient (a variety of 23 diseases included in the International Classification of Diseases) and the emotional state of the caregiver, and (c) based on the theoretical model, to analyze the relationship of the different study variables in the appearance of the emotional distress of the caregiver. A sample of 491 non-professional caregivers was selected randomly (89.0% women, average age 55.3 years). Trained psychologists collected sociodemographic and care-related characteristics and evaluated the global emotional distress, somatic symptoms, anxiety-insomnia, social dysfunction, depression, probable mental disorder case, self-esteem, and social support. It was found that (a) the caregivers showed moderate emotional distress, and 33.8% presented a probable mental disorder. (b) Caring for a care-recipient with cat’s cry syndrome or epilepsy was related to suffering from social dysfunction, and caring for a care-recipient with autism was related to having a probable mental health case. (c) Social support mediated the relationship between social class, daily hours of care, monthly family income, self-esteem and global emotional distress. There is an important impact on the emotional state of the caregivers. This impact was similar in caregivers of care-recipients with different diseases, except in caregivers caring for a care-recipient with cat’s cry syndrome or epilepsy (related to social dysfunction), and in caregivers caring for a care-recipient with autism (related to having a probable mental health case).
Collapse
Affiliation(s)
- Patricia Otero
- Department of Psychology, University of A Coruña, A Coruña, Spain
| | - Ángela J Torres
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Fernando L Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanessa Blanco
- Department of Evolutive and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María J Ferraces
- Department of Social, Basic and Methodological Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Olga Díaz
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
17
|
Affiliation(s)
- Elizabeth C. Clipp
- Department of Medicine, Veterans Administration and Duke University Medical Centers, Durham, North Carolina
| | - Anthony J. Adinolfi
- Public Health Nurse, Durham County Health Department, Durham, North Carolina
| | - Lanna Forrest
- School of Public and Allied Health, East Tennessee State University, Johnson City, Tennessee
| | - Charles L. Bennett
- Lakeside Veterans Administration Medical Center, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
18
|
Kinsella G, Cooper B, Picton C, Murtagh D. Factors Influencing Outcomes for Family Caregivers of Persons Receiving Palliative Care: Toward an Integrated Model. J Palliat Care 2019. [DOI: 10.1177/082585970001600308] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Glynda Kinsella
- School of Psychological Science, Bundoora, Victoria, Australia
| | - Brian Cooper
- Department of Social Work and Social Policy, Bundoora, Victoria, Australia
| | - Cliff Picton
- Department of Social Work and Social Policy, Bundoora, Victoria, Australia
| | - Douglas Murtagh
- School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
19
|
Abstract
Palliative care is an approach to the care of patients, affected by serious illness, and their families that aims to reduce suffering through the management of medical symptoms, psychosocial issues, spiritual well-being, and setting goals of care. Patients and families affected by a neurodegenerative illness have significant palliative care needs beginning at the time of diagnosis and extending through end-of-life care and bereavement. We advocate an approach to addressing these needs where the patient's primary care provider or neurologist plays a central role. Key skills in providing effective palliative care to this population include providing the diagnosis with compassion, setting goals of care, anticipating safety concerns, caregiver assessment, advance care planning, addressing psychosocial concerns, and timely referral to a hospice. Managing distressing medical and psychiatric symptoms is critical to improving quality of life throughout the disease course as well as at end-of-life. Many symptoms are common across illnesses; however, there are issues that are specific to the most common classes of neurodegenerative illness, namely dementia, parkinsonism, and motor neuron disease. Incorporating a palliative approach to care, although challenging in many ways, empowers physicians to provide greater support and guidance to patients and families in making the difficult journey through a neurodegenerative illness.
Collapse
|
20
|
Shaffer KM, Garland SN, Mao JJ, Applebaum AJ. Insomnia among Cancer Caregivers: A Proposal for Tailored Cognitive Behavioral Therapy. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2018; 28:275-291. [PMID: 30245560 PMCID: PMC6147560 DOI: 10.1037/int0000105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Caregivers are relatives, friends, or partners who have a significant relationship with and provide assistance (i.e., physical, emotional) to a patient with often life-threatening, serious illnesses. Between 40 and 76 percent of caregivers for people with cancer experience sleep disturbance. This is thought to be due, in part, to the unique responsibilities, stressors, and compensatory behaviors endemic to caregiving that serve as precipitating and perpetuating factors of insomnia. Sleep disturbances are associated with significant alterations in one's mental and physical health. Once chronic, insomnia does not remit naturally. Cognitive-behavioral therapy for insomnia (CBT-I) is well-suited to address the multifaceted contributing factors unique to caregivers' sleep disturbance, yet only one intervention has tested a CBT-I informed intervention among cancer caregivers. Toward the goal of developing effective, tailored treatments for insomnia in caregivers, we address the distinct presentation of insomnia among cancer caregivers and describe key modifications to standard CBT-I that address these specific needs and enhance sensitivity and feasibility, modeled in a demonstrative case vignette. Future research must seek to provide a wide range of effective treatment options for this population, including internet-based, dyadic, and alternative integrative medicine treatments. Applicability of key modifications for caregivers of patients with other chronic illnesses is discussed. Establishing empirically-supported interventions for insomnia among cancer caregivers has the potential to enhance their quality of life and care provided, lead to improved bereavement outcomes, and attenuate the notable mental and physical health disparities present in this vulnerable population.
Collapse
Affiliation(s)
- Kelly M Shaffer
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences
| | - Sheila N Garland
- Memorial University, Departments of Psychology and Oncology, St. John's, NL, Canada
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Allison J Applebaum
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences
| |
Collapse
|
21
|
Karg N, Graessel E, Randzio O, Pendergrass A. Dementia as a predictor of care-related quality of life in informal caregivers: a cross-sectional study to investigate differences in health-related outcomes between dementia and non-dementia caregivers. BMC Geriatr 2018; 18:189. [PMID: 30139354 PMCID: PMC6108112 DOI: 10.1186/s12877-018-0885-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 08/16/2018] [Indexed: 11/17/2022] Open
Abstract
Background The objectives of this study with a large sample of informal caregivers (CG) were a) to compare health-related outcomes of CGs caring for a patient with dementia and those caring for a relative with another chronic disease and b) to check whether dementia is a predictor of CG’s care-related quality of life (QoL) in CarerQoL-7D. Methods This cross-sectional study involved self-reported data from 386 informal CGs who applied for an initial grade or upgrade of the care level of the care recipient at the Medical Service of Compulsory Health Insurance Funds of Bavaria (Germany). By obtaining data this way, systematic biases often associated with the acquisition of CGs were prevented. Bivariate and multiple analyses were conducted using a univariate covariance model (ANCOVA). Results Bivariate analyses showed significantly higher levels of subjective burden and lower QoL in the dementia group. No significant differences were found in terms of physical health and depressiveness, though there was a tendency suggesting higher levels of depressiveness in dementia CGs. Multiple analysis explaining QoL by dementia status after controlling for CG’s sex, age and employment status revealed a significant effect of dementia, suggesting caregiving for a dementia patient was associated with lower QoL. Conclusions Results of the study suggest that caring for a relative with dementia is associated with poorer health, i.e. greater levels of subjective burden and depressiveness, and predicts lower QoL in CGs. These findings emphasize the importance of specific interventions aiming to support informal CGs of dementia patients.
Collapse
Affiliation(s)
- Nina Karg
- Department of Psychiatry and Psychotherapy, Center for Health Service Research in Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany.
| | - Elmar Graessel
- Department of Psychiatry and Psychotherapy, Center for Health Service Research in Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Ottilie Randzio
- Medical Service of Compulsory Health Insurance Funds (MDK) of Bavaria, Haidenauplatz 1, D-81667, Munich, Germany
| | - Anna Pendergrass
- Department of Psychiatry and Psychotherapy, Center for Health Service Research in Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| |
Collapse
|
22
|
Koyanagi A, DeVylder JE, Stubbs B, Carvalho AF, Veronese N, Haro JM, Santini ZI. Depression, sleep problems, and perceived stress among informal caregivers in 58 low-, middle-, and high-income countries: A cross-sectional analysis of community-based surveys. J Psychiatr Res 2018; 96:115-123. [PMID: 29031131 DOI: 10.1016/j.jpsychires.2017.10.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/09/2017] [Accepted: 10/04/2017] [Indexed: 12/31/2022]
Abstract
Caregiving has been associated with adverse health outcomes. However, there is a paucity of multi-country, population-based studies on mental health outcomes of caregivers especially from low- and middle-income countries (LMICs). Thus, we assessed the association of caregiving with depression, sleep problems, and perceived stress in 10 high-, 27 middle-, and 21 low-income countries. Cross-sectional community-based data of the World Health Survey including 258,793 adults aged ≥18 years were analyzed. Multivariable logistic and linear regression analyses were conducted to explore the association of past 12-month caregiving with past 12-month DSM-IV depression, and past 30-day perceived stress [range 0 (low)-100 (high)] and severe/extreme sleep problems. Nearly 20% of the individuals were engaged in caregiving with particularly high rates observed in high-income countries (HICs) (e.g., Finland 43.3%). Across the entire sample, after adjustment for potential confounders, caregivers had a significantly higher likelihood of having depression (OR = 1.54; 95%CI = 1.37-1.73), sleep problems (OR = 1.37; 95%CI = 1.25-1.50), while their mean perceived stress score was 3.15 (95%CI = 2.46-3.84) points higher. These associations tended to be stronger in HICs. A greater number of caregiving activities was associated with a greater likelihood of depression, sleep problems, and perceived stress regardless of country income levels. In conclusion, caregiving has a negative impact on mental health worldwide with possibly greater effects in HICs. Given the growing contribution of caregivers in long-term care, interventions and policies to alleviate the mental health burden of caregivers are urgently needed to maintain sustainable and effective care practices.
Collapse
Affiliation(s)
- Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain.
| | - Jordan E DeVylder
- Graduate School of Social Service, Fordham University, 113 W 60th St, New York, NY 10009, USA.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom.
| | - André F Carvalho
- Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-140, CE, Brazil.
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, via Giustiniani, 2 35128 Padova, Italy; Institute for Clinical Research and Education in Medicine, via Toffanin Junior, 2 35128 Padova, Italy.
| | - Josep M Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain.
| | - Ziggi I Santini
- The Danish National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, 1353 Copenhagen, Denmark.
| |
Collapse
|
23
|
Roland KP, Chappell NL. Caregiver Experiences Across Three Neurodegenerative Diseases: Alzheimer’s, Parkinson’s, and Parkinson’s With Dementia. J Aging Health 2017; 31:256-279. [DOI: 10.1177/0898264317729980] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: This article asks whether distinct caregiver experiences of Alzheimer’s disease (AD), Parkinson’s disease (PD), and Parkinson’s disease with dementia (PDD) spouses are accounted for by disease diagnosis or by a unique combination of symptoms, demands, support, and quality of life (QOL) cross disease groups. Method: One hundred five live-in spouse caregivers (71.4 ± 7 years) were surveyed for persons with AD (39%), PD (41%), and PDD (20%). A hierarchical cluster analysis organized caregivers across disease diagnosis into clusters with similar symptom presentation, care demands, support, and QoL. Results: Four clusters cut across disease diagnosis. “Succeeding” cared for mild symptoms and had emotional support. “Coping” managed moderate stressors and utilized formal supports. “Getting by with support” and “Struggling” had the greatest stressors; available emotional support influenced whether burden/depression was moderate or severe. The results remain the same when diagnostic category is added to the cluster analysis. Discussion: This study supports going beyond disease diagnosis when examining caregiver experiences.
Collapse
|
24
|
Al-Janabi H, Manca A, Coast J. Predicting carer health effects for use in economic evaluation. PLoS One 2017; 12:e0184886. [PMID: 28949969 PMCID: PMC5614532 DOI: 10.1371/journal.pone.0184886] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022] Open
Abstract
Background Illnesses and interventions can affect the health status of family carers in addition to patients. However economic evaluation studies rarely incorporate data on health status of carers. Objectives We investigated whether changes in carer health status could be ‘predicted’ from the health data of those they provide care to (patients), as a means of incorporating carer outcomes in economic evaluation. Methods We used a case study of the family impact of meningitis, with 497 carer-patient dyads surveyed at two points. We used regression models to analyse changes in carers’ health status, to derive predictive algorithms based on variables relating to the patient. We evaluated the predictive accuracy of different models using standard model fit criteria. Results It was feasible to estimate models to predict changes in carers’ health status. However, the predictions generated in an external testing sample were poorly correlated with the observed changes in individual carers’ health status. When aggregated, predictions provided some indication of the observed health changes for groups of carers. Conclusions At present, a ‘one-size-fits-all’ predictive model of carer outcomes does not appear possible and further research aimed to identify predictors of carer’s health status from (readily available) patient data is recommended. In the meanwhile, it may be better to encourage the targeted collection of carer data in primary research to enable carer outcomes to be better reflected in economic evaluation.
Collapse
Affiliation(s)
- Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Andrea Manca
- Centre for Health Economics, University of York, York, United Kingdom
- Department of Population Health, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Joanna Coast
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| |
Collapse
|
25
|
Shaffer KM, Kim Y, Carver CS, Cannady RS. Effects of caregiving status and changes in depressive symptoms on development of physical morbidity among long-term cancer caregivers. Health Psychol 2017; 36:770-778. [PMID: 28639819 PMCID: PMC5551905 DOI: 10.1037/hea0000528] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Cancer caregiving burden is known to vary across the survivorship trajectory and has been linked with caregivers' subsequent health impairment. Little is known, however, regarding how risk factors during long-term survivorship relate to vulnerability to caregivers' health during that period. This study examined effects of caregiving status and depressive symptoms on development of physical morbidity by 5 years postdiagnosis. METHOD Family caregivers (N = 491; Mage = 55.78) completed surveys at 2 (Time 1 [T1]) and 5 years (T2) after their care recipients' cancer diagnosis. Demographic and caregiving context variables known to affect caregivers' health were assessed at T1. Self-reported depressive symptoms and a list of physical morbid conditions were assessed at T1 and T2. Caregiving status (former, current, or bereaved) was assessed at T2. RESULTS Hierarchical negative binomial regression revealed that current caregivers at T2 (p = .02), but not those bereaved by T2 (p = .32), developed more physical morbid conditions between T1 and T2 compared with former caregivers, controlling for other variables. Independently, caregivers reporting either newly emerging or chronically elevated depressive symptoms at T2 (ps < .03), but not those whose symptoms remitted at T2 (p = .61), showed greater development of physical morbidity than did those reporting minimal depressive symptoms at both T1 and T2. CONCLUSIONS Results highlight the roles of long-term caregiving demands and depressive symptoms in cancer caregivers' premature physical health decline. Clinical attention through the long-term survivorship trajectory should be emphasized for caregivers of patients with recurrent or prolonged illness and to address caregivers' elevated depressive symptoms. (PsycINFO Database Record
Collapse
Affiliation(s)
- Kelly M. Shaffer
- University of Miami, Department of Psychology
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry & Behavioral Sciences
| | | | | | | |
Collapse
|
26
|
The relationship between caregiving self-efficacy and depressive symptoms in family caregivers of patients with Alzheimer disease: a longitudinal study. Int Psychogeriatr 2017; 29:1095-1103. [PMID: 28162131 DOI: 10.1017/s1041610217000059] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Caregiving for a relative with dementia has been associated with negative consequences for mental health. Self-efficacy has been shown to correlate negatively with depression but the long-term association between caregiver burden, caregiver self-efficacy, and depressive symptoms, remains still largely unexplored. The aim of the present study was to evaluate whether different self-efficacy domains partially mediated the relationship between caregiving burden and depression. METHODS A three-wave design was used, with initial assessment and follow-ups three months later and one year later. One hundred seventy caregivers of patients with AD responded to measures of caregiver burden, caregiving self-efficacy, and depressive symptoms. Data were analyzed by means of structural equation models. RESULTS The tested model provided support for the guiding hypothesis. Burden at the time of the first assessment (T1) significantly influenced depression one year later and the relationship between burden at time one and depressive symptoms one year later was partially mediated by self-efficacy for controlling upsetting thoughts. CONCLUSIONS The findings of the present study provide evidence that, along a considerable length of time, the effects of caregiver burden on depressive symptoms can be explained by the caregivers' efficacy beliefs in controlling upsetting thoughts related to the caregiving tasks. Interventions for caregivers of patients with AD may help them in tackling negative thoughts about the caregiving role.
Collapse
|
27
|
Boersma I, Jones J, Coughlan C, Carter J, Bekelman D, Miyasaki J, Kutner J, Kluger B. Palliative Care and Parkinson's Disease: Caregiver Perspectives. J Palliat Med 2017; 20:930-938. [PMID: 28520498 DOI: 10.1089/jpm.2016.0325] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Palliative care for Parkinson's disease (PD) is an emerging area of interest for clinicians, patients and families. Identifying the palliative care needs of caregivers is central to developing and implementing palliative services for families affected by PD. The objective of this paper was to elicit PD caregiver needs, salient concerns, and preferences for care using a palliative care framework. MATERIALS AND METHODS 11 PD caregivers and one non-overlapping focus group (n = 4) recruited from an academic medical center and community support groups participated in qualitative semi-structured interviews. Interviews and focus group discussion were digitally recorded, transcribed and entered into ATLAS.ti for coding and analysis. We used inductive qualitative data analysis techniques to interpret responses. RESULTS Caregivers desired access to emotional support and education regarding the course of PD, how to handle emergent situations (e.g. falls and psychosis) and medications. Participants discussed the immediate impact of motor and non-motor symptoms as well as concerns about the future, including: finances, living situation, and caretaking challenges in advanced disease. Caregivers commented on the impact of PD on their social life and communication issues between themselves and patient. All participants expressed interest and openness to multidisciplinary approaches for addressing these needs. CONCLUSIONS Caregivers of PD patients have considerable needs that may be met through a palliative care approach. Caregivers were receptive to the idea of multidisciplinary care in order to meet these needs. Future research efforts are needed to develop and test the clinical and cost effectiveness of palliative services for PD caregivers.
Collapse
Affiliation(s)
- Isabel Boersma
- 1 The Department of Neurology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Jacqueline Jones
- 2 The College of Nursing, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Christina Coughlan
- 1 The Department of Neurology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Julie Carter
- 3 The Department of Neurology, Oregon Health and Science University , Portland, Oregon
| | - David Bekelman
- 4 The Department of Internal Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado.,5 Departments of Medicine and Veterans Affairs Medical Center , Denver, Colorado
| | - Janis Miyasaki
- 6 The Division of Neurology, University of Alberta , Edmonton, Alberta
| | - Jean Kutner
- 4 The Department of Internal Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Benzi Kluger
- 1 The Department of Neurology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| |
Collapse
|
28
|
Allen AP, Curran EA, Duggan Á, Cryan JF, Chorcoráin AN, Dinan TG, Molloy DW, Kearney PM, Clarke G. A systematic review of the psychobiological burden of informal caregiving for patients with dementia: Focus on cognitive and biological markers of chronic stress. Neurosci Biobehav Rev 2016; 73:123-164. [PMID: 27986469 DOI: 10.1016/j.neubiorev.2016.12.006] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/28/2016] [Accepted: 12/09/2016] [Indexed: 12/18/2022]
Abstract
As the physiological impact of chronic stress is difficult to study in humans, naturalistic stressors are invaluable sources of information in this area. This review systematically evaluates the research literature examining biomarkers of chronic stress, including neurocognition, in informal dementia caregivers. We identified 151 papers for inclusion in the final review, including papers examining differences between caregivers and controls as well as interventions aimed at counteracting the biological burden of chronic caregiving stress. Results indicate that cortisol was increased in caregivers in a majority of studies examining this biomarker. There was mixed evidence for differences in epinephrine, norepinephrine and other cardiovascular markers. There was a high level of heterogeneity in immune system measures. Caregivers performed more poorly on attention and executive functioning tests. There was mixed evidence for memory performance. Interventions to reduce stress improved cognition but had mixed effects on cortisol. Risk of bias was generally low to moderate. Given the rising need for family caregivers worldwide, the implications of these findings can no longer be neglected.
Collapse
Affiliation(s)
- Andrew P Allen
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Eileen A Curran
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Áine Duggan
- School of Medicine, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland
| | - Aoife Ní Chorcoráin
- Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| | - D William Molloy
- Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland
| | - Patricia M Kearney
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Gerard Clarke
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland.
| |
Collapse
|
29
|
Allen AP, Kennedy PJ, Dockray S, Cryan JF, Dinan TG, Clarke G. The Trier Social Stress Test: Principles and practice. Neurobiol Stress 2016; 6:113-126. [PMID: 28229114 PMCID: PMC5314443 DOI: 10.1016/j.ynstr.2016.11.001] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 12/19/2022] Open
Abstract
Researchers interested in the neurobiology of the acute stress response in humans require a valid and reliable acute stressor that can be used under experimental conditions. The Trier Social Stress Test (TSST) provides such a testing platform. It induces stress by requiring participants to make an interview-style presentation, followed by a surprise mental arithmetic test, in front of an interview panel who do not provide feedback or encouragement. In this review, we outline the methodology of the TSST, and discuss key findings under conditions of health and stress-related disorder. The TSST has unveiled differences in males and females, as well as different age groups, in their neurobiological response to acute stress. The TSST has also deepened our understanding of how genotype may moderate the cognitive neurobiology of acute stress, and exciting new inroads have been made in understanding epigenetic contributions to the biological regulation of the acute stress response using the TSST. A number of innovative adaptations have been developed which allow for the TSST to be used in group settings, with children, in combination with brain imaging, and with virtual committees. Future applications may incorporate the emerging links between the gut microbiome and the stress response. Future research should also maximise use of behavioural data generated by the TSST. Alternative acute stress paradigms may have utility over the TSST in certain situations, such as those that require repeat testing. Nonetheless, we expect that the TSST remains the gold standard for examining the cognitive neurobiology of acute stress in humans. The TSST is the human experimental gold standard for evaluating the neurobiology of acute stress. The HPA axis response to the TSST is higher in males and lower in older adults. Genotype and epigenetic factors moderate the neurobiological response to the TSST. Multiple adaptations of the TSST are available for different testing contexts.
Collapse
Affiliation(s)
- Andrew P Allen
- APC Microbiome Institute, Biosciences Building, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Paul J Kennedy
- APC Microbiome Institute, Biosciences Building, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Samantha Dockray
- School of Applied Psychology, Enterprise Centre, University College Cork, North Mall, Cork, Ireland
| | - John F Cryan
- APC Microbiome Institute, Biosciences Building, University College Cork, Cork, Ireland; Department of Anatomy & Neuroscience, Western Gateway Building, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Institute, Biosciences Building, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Gerard Clarke
- APC Microbiome Institute, Biosciences Building, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| |
Collapse
|
30
|
Abstract
This study tested a social support enhancement intervention for caregivers to relatives with Alzheimer’s disease. Theory and empirical research on life-course transitions and social support suggest that support from an experientially similar peer (i.e., a person who has undergone the same stressful transition) will lead to positive outcomes among caregivers. The intervention differed from previous programs for caregivers by isolating social support enhancement as the intervention mechanism, without simultaneously providing education, counseling, or direct services. Using a randomized, control-group design, no main effects were found. At the level of interactions, a modest buffering effect was found for persons in more stressful caregiving situations. However, the overall pattern of the results suggests that social support alone is not a sufficient intervention to improve the experience of caregivers. Implications for future research and planning of interventions are discussed.
Collapse
|
31
|
Lloyd J, Patterson T, Muers J. The positive aspects of caregiving in dementia: A critical review of the qualitative literature. DEMENTIA 2016; 15:1534-1561. [DOI: 10.1177/1471301214564792] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Positive aspects of caregiving in dementia have been identified as important in understanding the experiences of carers, yet the research base lacks clear definitions of key concepts. Qualitative research explores carers’ experiences of positive aspects of caregiving in rich detail which lends itself to supporting theory development. The aim of the present review was to critically evaluate the empirical findings of qualitative studies that have explored positive aspects of caregiving in dementia. A systematic search of the literature revealed 14 studies that met this aim. Carers described multiple positive dimensions of caregiving and identified several factors that were important in supporting their positive caregiving experience. The present review evidences a solid base of understanding of the positive aspects of caregiving in dementia from which concepts and theories can be further developed. Clinical and research implications are discussed.
Collapse
Affiliation(s)
- Joanna Lloyd
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, UK
| | - Tom Patterson
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, UK
| | - Jane Muers
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, UK
| |
Collapse
|
32
|
Stommel M, Collins CE, Given BA, Given C. Correlates of Community Service Attitudes Among Family Caregivers. J Appl Gerontol 2016. [DOI: 10.1177/073346489901800202] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article examines caregiver and care recipient characteristics associated with community service attitudes. Using Community Service Attitude Inventory subscales that were refined for use across populations, the relationship between caregiver gender, age, relationship, type of medical diagnosis, and scores on attitude subscales were investigated in a sample of 562 family caregivers. Attitudes toward services were found to be associated with caregiver gender, age, and diagnosis. Implications for research and practice are presented.
Collapse
|
33
|
Elnasseh AG, Trujillo MA, Peralta SV, Stolfi ME, Morelli E, Perrin PB, Arango-Lasprilla JC. Family Dynamics and Personal Strengths among Dementia Caregivers in Argentina. Int J Alzheimers Dis 2016; 2016:2386728. [PMID: 27413574 PMCID: PMC4931077 DOI: 10.1155/2016/2386728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/21/2022] Open
Abstract
This study examined whether healthier family dynamics were associated with higher personal strengths of resilience, sense of coherence, and optimism among dementia caregivers in Argentina. Caregivers are usually required to assist individuals with dementia, and family members have typically fulfilled that role. Personal strengths such as resilience, sense of coherence, and optimism have been shown to protect caregivers from some of the negative experiences of providing care, though the family-related variables associated with these personal strengths are largely unknown. Hierarchical multiple regressions investigated the extent to which family dynamics variables are associated with each of the caregiver personal strengths after controlling for demographic and caregiver characteristics. A sample of 105 caregivers from Argentina completed a set of questionnaires during a neurologist visit. Family dynamics explained 32% of the variance in resilience and 39% of the variance in sense of coherence. Greater family empathy and decreased family problems were uniquely associated with higher resilience. Greater communication and decreased family problems were uniquely associated with higher sense of coherence. Optimism was not found to be significantly associated with family dynamics. These results suggest that caregiver intervention research focused on the family may help improve caregiver personal strengths in Argentina and other Latin American countries.
Collapse
Affiliation(s)
- Aaliah G. Elnasseh
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA 23284, USA
| | - Michael A. Trujillo
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA 23284, USA
| | | | - Miriam E. Stolfi
- Instituto San Lucas Neurociencias, 1655 Paraguay, Santa Fe, Argentina
| | - Eliana Morelli
- Instituto San Lucas Neurociencias, 1655 Paraguay, Santa Fe, Argentina
| | - Paul B. Perrin
- Virginia Commonwealth University, 800 W. Franklin Street, P.O. Box 842018, Richmond, VA 23284, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
- Basque Foundation for Science (IKERBASQUE), Bilbao, Spain
| |
Collapse
|
34
|
MacCourt P, McLennan M, Somers S, Krawczyk M. Effectiveness of a Grief Intervention for Caregivers of People With Dementia. OMEGA-JOURNAL OF DEATH AND DYING 2016; 75:230-247. [DOI: 10.1177/0030222816652802] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we report on the structure and effectiveness of a grief management coaching intervention with caregivers of individuals with dementia. The intervention was informed by Marwit and Meuser’s Caregiver Grief Model and considered levels of grief, sense of empowerment, coping, and resilience using five methods of delivery. Results indicate that the intervention had significant positive effects on caregivers’ levels of grief and increased their levels of empowerment, coping, and resilience. The intervention was found to be effective across caregivers’ characteristics as well as across five delivery modalities. Through description of this intervention, as well as outcome, this research contributes to the body of knowledge about caregivers’ disenfranchised grief and ways to effectively address it.
Collapse
Affiliation(s)
- Penny MacCourt
- Centre on Aging, University of Victoria, Victoria, BC, Canada
| | | | - Sandie Somers
- Clinical Nurse Specialist, Island Health Authority, BC, Canada
| | - Marian Krawczyk
- Centre for Health Evaluation and Outcome Sciences at Providence Health, Vancouver, BC, Canada
| |
Collapse
|
35
|
Panyavin I, Trujillo MA, Peralta SV, Stolfi ME, Morelli E, Perrin PB, Lasa JP, Arango-Lasprilla JC. Examining the influence of family dynamics on quality of care by informal caregivers of patients with Alzheimer's dementia in Argentina. Am J Alzheimers Dis Other Demen 2015; 30:613-21. [PMID: 25824253 PMCID: PMC10852719 DOI: 10.1177/1533317515577129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This study examined the pattern of family dynamics of Argentinian individuals with dementia that most heavily influences the quality of care provided by family caregivers (CGs). METHOD One hundred and two CGs of individuals with Alzheimer's disease in Argentina participated in this study. The majority (75%) were female, with an average age of 57.8 years (standard deviation = 13.5) and had spent a median of 48 months (interquartile range [IQR]: 36.00-60.00) providing care to their family member with dementia, devoting a median of 60 hours (IQR: 50.00-80.00) per week to these duties. Caregivers completed Spanish versions of instruments assessing their family dynamics and quality-of-care provision. RESULTS Hierarchical regression analyses suggested that higher quality of informal care (Provide and Respect) was related to greater levels of empathy and reduced levels of overall dysfunction in CGs' families. Higher quality of care-Provide was also related to shorter duration of time (in months) spent providing care. CONCLUSION Dementia CG interventions in Latino populations would likely benefit from addressing difficulties experienced when providing care for a prolonged period of time, as well as programming or techniques to improve family dynamics, especially family empathy and general functioning, given the strong reciprocal influence of these factors on CG quality of care.
Collapse
Affiliation(s)
- Ivan Panyavin
- Department of Methods and Experimental Psychology, University of Deusto, Bilbao, Spain
| | - Michael A Trujillo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Eliana Morelli
- Instituto de Neurociencias de San Lucas, Rosario, Argentina
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Javier Peña Lasa
- Department of Methods and Experimental Psychology, University of Deusto, Bilbao, Spain
| | - Juan Carlos Arango-Lasprilla
- Department of Methods and Experimental Psychology, University of Deusto, Bilbao, Spain Ikerbasque, Basque Foundations for Science, Bilbao, Spain
| |
Collapse
|
36
|
The adverse mental health of carers: Does the patient diagnosis play a role? Maturitas 2015; 82:134-8. [PMID: 26163076 DOI: 10.1016/j.maturitas.2015.06.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 06/13/2015] [Accepted: 06/16/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The adverse mental health effects of caring have been studied, frequently in carers of people with dementia. Less is known about the mental health of carers of people with other conditions. This study compared depression and burden in older carers looking after people with a variety of conditions. DESIGN, METHODS AND MEASURES Over 200 older carers interested in participating in the Improving Mood through Physical Activity in Carers and Care-recipient Trial were included in this cross-sectional study, using the Geriatric Depression Scale (GDS) and Zarit Burden Inventory (ZBI). RESULTS Overall there were 43% of carers who were depressed and a quarter of them reported moderate-to-severe burden. Carers of people with physical conditions had the highest levels of depression and burden. Patient diagnosis, hours spent caring, and burden were associated with depression, while hours spent caring and carer depression were associated with burden. These factors contributed approximately 25-30% of the variance of depression and burden, respectively. CONCLUSIONS The diagnosis of the patient was a factor associated with depression, and older carers of people with physical conditions were at the highest risk. It is important for clinicians to assess the mental health of all carers, regardless of the patient diagnosis.
Collapse
|
37
|
Kim HJ, Yang Y, Oh JG, Oh S, Choi H, Kim KH, Kim SH. Effectiveness of a community-based multidomain cognitive intervention program in patients with Alzheimer's disease. Geriatr Gerontol Int 2015; 16:191-9. [PMID: 25656505 DOI: 10.1111/ggi.12453] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to evaluate the efficacy of a multidomain program in patients with Alzheimer's disease (AD). METHODS A total of 53 patients with probable AD participated in the present study. The participants were classified to a cognitive programming group (n = 32) and control group (n = 21). Participants in the cognitive intervention program received multidomain cognitive stimulation including art, music, recollection and horticultural therapy, each period of intervention lasting 1 h. This program was repeated five times per week over a period of 6 months at the Seongdong-gu Center for Dementia. The Mini-Mental State Examination, the Korean version of Consortium to Establish a Registry for Alzheimer's Disease, Clinical dementia rating scales, and the Korean version of the Quality of Life-Alzheimer's Disease were used to evaluate cognitive ability at baseline and after intervention. After 6 months, cognitive abilities were compared between patients actively participating in cognitive intervention and the pharmacotherapy only group. RESULTS Patients receiving cognitive intervention showed significant cognitive improvement in the word-list recognition and recall test scores versus the control. There was no change in the overall Clinical dementia rating score, but the domain of community affairs showed a significant improvement in the cognitive intervention group. Quality of Life-Alzheimer's Disease of caregivers was slightly improved in the cognitive intervention group after 6 months. DISCUSSION Multidomain cognitive intervention by regional dementia centers has great potential in helping to maintain cognitive function in patients with dementia, increase their social activity and reduce depression, while enhancing the quality of life of caregivers.
Collapse
Affiliation(s)
- Hee-Jin Kim
- Seongdong-Gu Community Health Center, Seongdong-Gu Regional Center for Dementia, Seoul, Korea.,Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - YoungSoon Yang
- Department of Neurology, Veterans Hospital, Seoul Medical Center, Seoul, Korea
| | - Jeong-Gun Oh
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Seongil Oh
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hojin Choi
- Seongdong-Gu Community Health Center, Seongdong-Gu Regional Center for Dementia, Seoul, Korea.,Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Kyoung Hee Kim
- Seongdong-Gu Community Health Center, Seongdong-Gu Regional Center for Dementia, Seoul, Korea
| | - Seung Hyun Kim
- Seongdong-Gu Community Health Center, Seongdong-Gu Regional Center for Dementia, Seoul, Korea.,Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
38
|
Park S, Park M. Effects of Family Support Programs for Caregivers of People with Dementia - Caregiving Burden, Depression, and Stress: Systematic Review and Meta-analysis. J Korean Acad Nurs 2015; 45:627-40. [DOI: 10.4040/jkan.2015.45.5.627] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 04/28/2015] [Accepted: 07/04/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Seyeon Park
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Myonghwa Park
- College of Nursing, Chungnam National University, Daejeon, Korea
| |
Collapse
|
39
|
Abstract
ABSTRACTThe purpose of this study is to develop and extend our understanding of dementia care-giving by introducing a typology of informal care-giving across four different diseases. Care-giving factors were examined with respect to specific dementia presentation in mild cognitive impairment, Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease-associated dementia. Informal care-giving literature in the four diseases was systematically searched to identify specific disease symptoms and resultant care-giving strains and outcomes. Key concepts were extracted and grouped thematically. The first classification, ‘role-shift’, reflects care-giving where cognitive deterioration results in changing roles, uncertainty and relational deprivation among married partners. The second classification, ‘consumed by care-giving’, refers to those caring for persons with dementia-motor decline that greatly increases worry and isolation. Finally, in the ‘service use’ classification, formal support is needed to help care-givers cope with daily responsibilities and behaviour changes. In each case, the dementia presentation uniquely impacts care-giver strains. A major conclusion is that the same support to all care-givers under the umbrella term ‘dementia’ is unwarranted; the development of targeted support is required.
Collapse
|
40
|
Boersma I, Miyasaki J, Kutner J, Kluger B. Palliative care and neurology: time for a paradigm shift. Neurology 2014; 83:561-7. [PMID: 24991027 DOI: 10.1212/wnl.0000000000000674] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research.
Collapse
Affiliation(s)
- Isabel Boersma
- From the Departments of Neurology and Psychiatry (I.B., B.K.) and Internal Medicine (J.K.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Neurology (J.M.), University of Alberta, Edmonton, Canada
| | - Janis Miyasaki
- From the Departments of Neurology and Psychiatry (I.B., B.K.) and Internal Medicine (J.K.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Neurology (J.M.), University of Alberta, Edmonton, Canada
| | - Jean Kutner
- From the Departments of Neurology and Psychiatry (I.B., B.K.) and Internal Medicine (J.K.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Neurology (J.M.), University of Alberta, Edmonton, Canada
| | - Benzi Kluger
- From the Departments of Neurology and Psychiatry (I.B., B.K.) and Internal Medicine (J.K.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Neurology (J.M.), University of Alberta, Edmonton, Canada.
| |
Collapse
|
41
|
Sautter JM, Tulsky JA, Johnson KS, Olsen MK, Burton-Chase AM, Lindquist JH, Zimmerman S, Steinhauser KE. Caregiver experience during advanced chronic illness and last year of life. J Am Geriatr Soc 2014; 62:1082-90. [PMID: 24803020 PMCID: PMC4070184 DOI: 10.1111/jgs.12841] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the prevalence and predictors of caregiver esteem and burden during two different stages of care recipients' illnesses-advanced chronic illness and the last year of life. DESIGN Longitudinal, observational cohort study. SETTING Community sample recruited from outpatient clinics at Duke University and Durham Veterans Affairs Medical Centers. PARTICIPANTS Individuals with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease and their primary caregiver, retrospectively coded as chronic-illness (n = 62) or end-of-life (EOL; n = 62) care recipient-caregiver dyads. MEASUREMENTS Caregiver experience was measured monthly using the Caregiver Reaction Assessment, which includes caregiver esteem and four domains of burden: schedule, health, family, and finances. RESULTS During chronic illness and at the end of life, high caregiver esteem was almost universal (95%); more than 25% of the sample reported health, family, and financial burden. Schedule burden was the most prevalent form of burden; EOL caregivers (58%) experienced it more frequently than chronic-illness caregivers (32%). Caregiver esteem and all dimensions of burden were relatively stable over 1 year. Few factors were associated with burden. CONCLUSION Caregiver experience is relatively stable over 1 year and similar in caregivers of individuals in the last year of life and those earlier in the course of chronic illness. Schedule burden stands out as most prevalent and variable among dimensions of experience. Because prevalence of burden is not specific to stage of illness and is relatively stable over time, multidisciplinary healthcare teams should assess caregiver burden and refer burdened caregivers to supportive resources early in the course of chronic illness.
Collapse
Affiliation(s)
- Jessica M Sautter
- Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Novella JL, Boyer F, Jochum C, Jovenin N, Morrone I, Jolly D, Bakchine S, Blanchard F. Health Status in Patients with Alzheimer’s Disease: An Investigation of Inter-rater Agreement. Qual Life Res 2013; 15:811-9. [PMID: 16721641 DOI: 10.1007/s11136-005-5434-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of the present study was to examine the level of agreement between health status ratings provided by patients with Alzheimer's disease and by their proxies. BACKGROUND Because proxy-completed responses are often necessary in assessing health outcomes for the elderly, it is necessary to determine the feasibility and potential limitations of using proxies as a patient substitutes. METHODS To assess the potential utility of proxy responses on health status when subjects present a cognitive impairment, this study compared the responses of 70 subjects with Alzheimer's disease and those of their family and/or care provider proxy using the SF-36. Agreement between proxies and patients was measured by intraclass correlation coefficients (ICCs). RESULTS The proportion of exact agreement between patients and proxies on the 36 items ranged from 3.3 to 41.7%. Results reveal poor to moderate agreement between patient and proxy reports. Proxy reliability varied according to the relationship of the proxy to the index subject. Agreement decreased significantly with increasing severity of dementia and with increasing severity of Physical status (Katz ADL). Agreement was better for measures of functions that are directly observable and relatively poor for more subjective measures. CONCLUSIONS Our results confirm the importance of the information source used for patient health status.
Collapse
Affiliation(s)
- J L Novella
- Department of Internal Medicine and Gerontology M4A, Hôpital Sébastopol, 51092, Reims Cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Vines AI, Demissie Z. Racial differences in social support and coping among family caregivers of patients with prostate cancer. J Psychosoc Oncol 2013; 31:305-18. [PMID: 23656257 DOI: 10.1080/07347332.2013.778931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
More than 60 million Americans are informal caregivers to adults, which can negatively affect their health. Data from 126 White and 62 African American female caregivers in North Carolina were analyzed to describe social support and coping among family caregivers of patients with prostate cancer and to assess for racial differences. Social support amount and some coping methods differed by race. There was no racial difference in social support satisfaction. Borderline significant difference in social support by health status was found and this differed by race. These racial differences should be explored further to better understand the availability of caregiving resources and their health effects.
Collapse
Affiliation(s)
- Anissa I Vines
- Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA.
| | | |
Collapse
|
44
|
Who cares? Managing obligation and responsibility across the changing landscapes of informal dementia care. AGEING & SOCIETY 2012. [DOI: 10.1017/s0144686x12000311] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
ABSTRACTThis paper explores the different ways in which informal carers for people with dementia negotiate their care-giving role across the changing organisational and spatial landscape of care. In-depth qualitative data are used to argue that the decisions of carers are socially situated and the result of negotiations involving individuals, families and wider cultural expectations. These decisions affect where care occurs. In addressing these issues this paper draws attention to the lack of choice some carers may have in taking on the care-giving role; how and why carers draw upon support; and the different expectations of the care-giver's capabilities across the different sites of care, specifically at home and in nursing homes. It concludes that research and policy attention should focus on how the expectations about the role and abilities of carers are affected by where, and how, care is delivered. In doing so this paper contributes to the emerging health geography literature on care-giving as well as developing the spatial perspective in the established gerontological literature.
Collapse
|
45
|
Guerra SR, Rodrigues SP, Demain S, Figueiredo DM, Sousa LX. Evaluating proFamilies-dementia: Adopting photovoice to capture clinical significance. DEMENTIA 2012; 12:569-87. [DOI: 10.1177/1471301212437779] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dementia is a challenging chronic illness that affects the patients and their families. Families often perform a full-time, specialised role, which requires expert knowledge and skills. This paper describes the evaluation of proFamilies-dementia (a programme developed to support families that care for a relative with dementia) using an innovative participatory methodology: photovoice, a qualitative method of research that uses photography and voice to access people’s experiences. The programme was evaluated in order to identify the positive and negative impacts of the intervention on individuals and families; the advantages and disadvantages of photovoice as a participatory tool were also captured. The sample consisted of six people from five families. Participants identified only positive impacts of the programme, including better emotional management, normalisation of feelings and increased focus on self-care. Photovoice facilitated access to the process of change initiated by proFamilies-dementia, described by a process of going beyond illness, negativity and loneliness.
Collapse
Affiliation(s)
- Sara R Guerra
- University of Aveiro, Portugal
- University of Aveiro, Portugal
| | | | - Sara Demain
- University of Southampton, UK
- University of Aveiro, Portugal
| | | | | |
Collapse
|
46
|
Lopes LDO, Cachioni M. Intervenções psicoeducacionais para cuidadores de idosos com demência: uma revisão sistemática. JORNAL BRASILEIRO DE PSIQUIATRIA 2012. [DOI: 10.1590/s0047-20852012000400009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Identificar modelos de intervenções psicoeducacionais e os seus efeitos em cuidadores de idosos com demência. MÉTODOS: Levantamento de estudos publicados entre janeiro de 2000 e abril de 2012 nas bases de dados PubMed, Web of Knowledge, Lilacs e SciELO, utilizando as seguintes palavras-chave "psychoeducational and caregiver", "cuidador e demência e psicoeducação" e "cuidador e intervenção". Apenas os artigos que denominavam a intervenção estudada como psicoeducação fazem parte do presente estudo. RESULTADOS: Foram encontrados 27 artigos com relatos acerca do impacto de intervenções psicoeducacionais em cuidadores de idosos com demência. Os resultados mais prevalentes desses estudos são: melhora do bem-estar dos cuidadores (37% dos estudos); aumento do uso de estratégias de enfrentamento (30%); diminuição de pensamentos disfuncionais (30%); aumento do conhecimento sobre os serviços disponíveis (19%); melhora da autoeficácia (15%); e aumento de habilidades para o cuidado (11%). A abordagem psicoeducacional descrita nos estudos é do âmbito informativo, cognitivo-comportamental, com técnicas de gerenciamento de estresse e de emoções; técnicas de resolução de problemas e apoio emocional. CONCLUSÃO: A intervenção psicoeducacional contribui significativamente para a melhora do bem-estar do cuidador, contudo ainda é necessária uma padronização dessa abordagem, em termos de estrutura, duração e conteúdos ministrados, para que haja evidências mais precisas do efeito desse tipo de intervenção.
Collapse
|
47
|
Lee YR, Sung KT, Kim YE. Effects of home-based stress management training on primary caregivers of elderly people with dementia in South Korea. DEMENTIA 2011. [DOI: 10.1177/1471301211421259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Concern about dementia among families caring for frail elderly is at an all-time high in South Korea wherein the number of seniors has greatly increased. Dementia disorders create considerable stress and cost to caregivers due to cognitive impairment, behavioral disorders, and rapid decreases in the functional capacities of patients. Families of dementia patients must be provided with an opportunity to deal effectively with their highly stressful situation. Currently available clinical services for caregivers, however, are strikingly sparse in South Korea. This study examines the effects of stress management training for Korean primary caregivers of dementia patients. Stress management training was provided in the homes of individual caregivers. Taking into consideration Korean caregivers’ strong tendency to provide care for elderly with dementia within the family setting, emphasis was placed on home-based individual training. Meeting caregivers in their own homes makes it possible to acquire great insight into and understanding of the caregiver on the stress-inducing situation in the home setting. The stress level for the experimental group was reduced significantly. Theoretical and practice implications of home-based training and cultural relevance of this type of training are discussed.
Collapse
Affiliation(s)
| | | | - Yang-E Kim
- Hanil University and Presbyterian Theological Seminary, South Korea
| |
Collapse
|
48
|
|
49
|
Wimo A, Jönsson L, Gustavsson A, McDaid D, Ersek K, Georges J, Gulácsi L, Karpati K, Kenigsberg P, Valtonen H. The economic impact of dementia in Europe in 2008-cost estimates from the Eurocode project. Int J Geriatr Psychiatry 2011; 26:825-32. [PMID: 21744385 DOI: 10.1002/gps.2610] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 07/06/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Care for demented people is very resource demanding, the prevalence is increasing and there is so far no cure. Cost of illness (CoI) studies are important by identifying the distribution of costs between different payers of care. The European Union (EU) funded the European Collaboration on Dementia (Eurocode) as part of the EU's 2005 work plan of the Community public health programme. Eurocode was administered by Alzheimer Europe. The aim was to describe the economic impact of dementia in Europe in 2008. METHODS Eurocode's new estimates for dementia prevalence were included in a cost model based on published European CoI papers. For countries where no CoI figures were available, imputation was used. RESULTS The total CoI of dementia in the EU27 in 2008 was estimated to be €160 billion (€22 000 per demented per year), of which 56% were costs of informal care. The corresponding costs for the whole Europe was €177 billion. In northern Europe, the direct costs are estimated to be considerabe, while the cost of informal care is the major cost component in southern Europe. The sensitivity analysis showed a range for total EU27 costs between €111 and 168 billion. CONCLUSIONS The estimated CoI in this study is higher than in previous studies. There are also large differences in different European regions. Notwithstanding the methodological challenges, the societal costs of dementia in Europe are very high which in turn have substantial resource impacts on the social and health care systems in Europe.
Collapse
Affiliation(s)
- A Wimo
- Alzheimeŕs Disease Research Center, NCS, Karolinska Institute, Stockholm, Sweden.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Harris GM, Durkin DW, Allen RS, DeCoster J, Burgio LD. Exemplary care as a mediator of the effects of caregiver subjective appraisal and emotional outcomes. THE GERONTOLOGIST 2011; 51:332-42. [PMID: 21350038 DOI: 10.1093/geront/gnr003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Exemplary care (EC) is a new construct encompassing care behaviors that warrants further study within stress process models of dementia caregiving. Previous research has examined EC within the context of cognitively intact older adult care recipients (CRs) and their caregivers (CGs). This study sought to expand our knowledge of quality of care by investigating EC within a diverse sample of dementia CGs. DESIGN AND METHODS We examined the relation between CG subjective appraisal (daily care bother, burden, and behavioral bother), EC, and CG emotional outcomes (depression and positive aspects of caregiving [PAC]). Specifically, EC was examined as a possible mediator of the effects of CG subjective appraisals on emotional outcomes. Using a bootstrapping method and an SPSS macro developed by Preacher and Hayes (2008 Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models), we tested the indirect effect of EC on the relation between CG subjective appraisals and CG emotional outcomes. RESULTS Overall, EC partially mediates the relation between the subjective appraisal variables (daily care bother, burden, and behavioral bother) and PAC. Results for depression were similar except that EC did not mediate the relation between burden and depression. This pattern of results varied by race/ethnicity. IMPLICATIONS Overall, CGs' perception of providing EC to individuals with dementia partially explains the relation between subjective appraisal and symptoms of depression and PAC. Results of this study suggest that interventions may benefit from training CGs to engage in EC to improve their emotional outcomes and quality of care.
Collapse
Affiliation(s)
- Grant M Harris
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487-0315, USA.
| | | | | | | | | |
Collapse
|