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Pitcho S, Heller O, Chun Y, Schwartz-Tayri TM, Grinstein-Weiss M. Optimism in dire times: The buffering role of optimism in the relationship between food insecurity and mental health during the COVID-19 pandemic. Heliyon 2024; 10:e30385. [PMID: 38720755 PMCID: PMC11076958 DOI: 10.1016/j.heliyon.2024.e30385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
Considering the need to gain a deeper understanding of the protective factors associated with coping with food insecurity, specifically in times of severe prolonged stress, the current longitudinal study seeks to examine the role of optimism in the relationship between food insecurity and adverse mental health outcomes during the COVID-19 pandemic. A three-wave longitudinal study involving 1921 Israeli adults was performed during the COVID-19 pandemic. Participants completed questionnaires assessing food insecurity, anxiety, depression, optimism, and socio-demographic characteristics. To explore the relationship between food insecurity and symptoms of anxiety and depression, as well as the moderating role of optimism in this relationship, we employed a set of panel regression models with individual fixed effects. Our results indicate that the degree and change in food insecurity over time were positively associated with both anxiety and depression symptoms, whereas the degree and change in optimism were negatively correlated. Optimism was found to moderate the association between food insecurity and anxiety symptoms over time, but not the association between food insecurity and depression symptoms. A subgroup analysis revealed that optimism moderated the relationship between food insecurity and anxiety and depression for women, but not for men; for married/coupled individuals but not for singles; for non-parents with regard to anxiety, and for parents with regard to depression. Our results highlight the need to practice and enhance optimism in times of great despair, uncertainty, and hardship, especially in situations of food insecurity where tangible change may take time.
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Affiliation(s)
| | - Oren Heller
- Social Policy Institute (SPI) Washington University in St. Louis, USA
| | - Yung Chun
- Social Policy Institute (SPI) Washington University in St. Louis, USA
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Chen CY, Chen JH, Ree SC, Chen CH, Yu SH. Attributional styles are associated with care burden in geriatric depression: older adults and their caregivers in Taiwan. Aging Clin Exp Res 2024; 36:106. [PMID: 38714627 PMCID: PMC11076353 DOI: 10.1007/s40520-024-02762-2] [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: 01/30/2024] [Accepted: 04/19/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND Given the rising prevalence of depression among older adults and the associated increase in caregiving responsibilities, understanding factors influencing caregiver burden is crucial. Previous research has not extensively explored the impact of caregivers' attributional styles, that is, how individuals interpret the causes of life events, on their care burden. AIM This study examined the relationship between caregivers' attributional styles and their care burden for older patients with depression. METHODS This cross-sectional study enrolled older adults aged ≥ 65 years diagnosed with depression and their caregivers. Depression was diagnosed according to the DSM-V criteria for Major Depressive Disorder or Persistent Depressive Disorder. Caregivers completed the Chinese Depression Caregiver Burden Scale (CDCBS) to assess care burden, the Hamilton Depression Rating Scale (HAM-D) to evaluate patient symptom severity, the Center for Epidemiological Studies Depression Scale (CES-D) for measuring caregivers' depression, and the Chinese Depression Patient Caregiver Attribution Style Scale (CDPCAS) to assess attributional styles. Hierarchical regression analysis was used to identify the factors independently associated with the caregiver's subjectively assessed care burden. RESULTS The sample included 146 caregivers of geriatric patients with depression. Most depression patients were women (74.7%) with a mean age of 74.3 years, whereas the mean age of caregivers was 57.7 years. Hierarchical regression analysis identified that caregivers' gender (β = - 0.14, p = .044), educational level (β = 0.19, p = .008), caregivers' own depression assessed by the Center for Epidemiological Studies Depression Scale (β = 0.41, p < .001), and attributional styles, particularly manipulation (β = 0.29, p < .001) and illness/stress attributional style (β = 0.23, p = .002) as independent factors associated with care burden. Patient symptom severity assessed using the Hamilton Depression Scale was not significantly correlated with care burden after controlling for attributional styles. CONCLUSIONS Certain attributional styles, particularly the manipulation and illness/stress attributional styles, significantly increased self-reported care burden. These findings highlight the need for educational resources to change the attribution style, along with support systems and accessible mental health services for caregivers to potentially ease the care burden.
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Affiliation(s)
- Ching-Yen Chen
- Department of Psychiatry, Chang Gung Hospital, Keelung, Taiwan
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jian-Hong Chen
- Department of Psychiatry, Chang Gung Hospital, Keelung, Taiwan
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Chun Ree
- Department of Psychiatry, Chang Gung Hospital, Keelung, Taiwan
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hui Chen
- Department of Nursing, Chang Gung Hospital, Keelung, Taiwan
| | - Sheng-Hsiang Yu
- Department of Psychology and Counseling, National Taipei University of Education, No. 134, Sec. 2, Heping E. Rd., Da'an Dist, Taipei, Taiwan.
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Wawrziczny E, Flinois B, Constant E, Brugallé E, Sokolowski C, Manceau C, Baille G, Defebvre L, Dujardin K, Antoine P. Dealing with the diagnosis of Parkinson's disease and its implications for couple functioning in the early stage: An interpretative phenomenological analysis. PLoS One 2024; 19:e0294240. [PMID: 38381728 PMCID: PMC10880977 DOI: 10.1371/journal.pone.0294240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/27/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND For couples facing Parkinson's disease, marital relationships are significantly impacted, even at the early stages of the disease. However, very few studies have explicitly explored the functioning of the couple and how both partners deal with Parkinson's disease. The aim of this study was to explore the experiences and strategies of couples facing Parkinson's disease in the early stage using dyadic interpretative phenomenological analysis. METHODS Fifteen couples agreed to participate in the study. Semistructured interviews were conducted with each partner separately regarding his or her individual experience with Parkinson's disease, the couple's history, the impact of the diagnosis on the functioning of the couple, and his or her projections for the future. RESULTS Three higher-order themes emerged from the analyses. The first theme, "Being tested by the diagnosis", highlights 4 dyadic configurations according to the individual's and the couple's capacity for adjustment following the diagnosis: "noncongruent", "collapsed", "relieved" and "avoidant". The second theme, "Talking about everything except the disease", underlines that communication about the disease is often avoided both within the couple and with relatives to protect the persons with Parkinson's disease or respect their wishes. The third theme, "Supporting each other", describes the different levels of harmony between the two partners in the management of daily life and symptoms and their relational impacts. CONCLUSION These results allow us to better understand the experiences of both partners and to highlight the importance of promoting better acceptance of the diagnosis by persons with Parkinson's disease to allow better communication between partners and with relatives. Such support prevents disease-specific distress and facilitates better adjustment in the later stages of the disease.
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Affiliation(s)
- Emilie Wawrziczny
- University of Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | | | - Emilie Constant
- University of Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Elodie Brugallé
- University of Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Céline Sokolowski
- University of Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Charlotte Manceau
- University of Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | | | - Luc Defebvre
- Regional and University Hospital Centre of Lille, Lille, France
| | - Kathy Dujardin
- Regional and University Hospital Centre of Lille, Lille, France
| | - Pascal Antoine
- University of Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
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Geerlings AD, Kapelle WM, Sederel CJ, Tenison E, Wijngaards-Berenbroek H, Meinders MJ, Munneke M, Ben-Shlomo Y, Bloem BR, Darweesh SKL. Caregiver burden in Parkinson's disease: a mixed-methods study. BMC Med 2023; 21:247. [PMID: 37424022 PMCID: PMC10332089 DOI: 10.1186/s12916-023-02933-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Providing informal care for a person with Parkinson's disease (PD) can be a demanding process affecting several dimensions of a caregiver's life and potentially causing caregiver burden. Despite the emerging literature on caregiver burden in people with PD, little is known about the inter-relationship between quantitative and qualitative findings. Filling this knowledge gap will provide a more holistic approach to develop and design innovations aiming at reducing or even preventing caregiver burden. This study aimed to characterize the determinants of caregiver burden among informal caregivers of persons with PD, in order to facilitate the development of tailored interventions that reduce caregiver burden. METHODS We conducted a cross-sectional study in The Netherlands using a sequential mixed methods approach, entailing a quantitative study of 504 persons with PD and their informal caregivers as well as a qualitative study in a representative subsample of 17 informal caregivers. The quantitative study included a standardized questionnaire of caregiver burden (Zarit Burden Inventory) and patient-related (Beck Depression Inventory, State-Trait Anxiety Inventory, Acceptance of Illness Scale, MDS-Unified Parkinson's Disease Rating Scale part II on motor functions in daily life, Self-assessment Parkinson's Disease Disability Score), caregiver-related (Brief Coping Orientation to Problems Experience Inventory, Caregiver Activation Measurement, Multidimensional Scale of Perceived Social Support) and interpersonal determinants (sociodemographic variables including among others gender, age, education, marital status and working status). The qualitative study consisted of semi-structured interviews. Multivariable regression and thematic analysis were used to analyse quantitative and qualitative data, respectively. RESULTS A total of 337 caregivers were women (66.9%), and the majority of people with PD were men (N = 321, 63.7%). The mean age of persons with PD was 69.9 (standard deviation [SD] 8.1) years, and the mean disease duration was 7.2 (SD 5.2) years. A total of 366 (72.6%) persons with PD had no active employment. The mean age of informal caregivers was 67.5 (SD 9.2) years. Most informal caregivers were female (66.9%), had no active employment (65.9%) and were the spouse of the person with PD (90.7%). The mean Zarit Burden Inventory score was 15.9 (SD 11.7). The quantitative study showed that a lack of active employment of the person affected by PD was associated with a higher caregiver burden. The qualitative study revealed cognitive decline and psychological or emotional deficits of the person with PD as additional patient-related determinants of higher caregiver burden. The following caregiver-related and interpersonal determinants were associated with higher caregiver burden: low social support (quantitative study), concerns about the future (qualitative study), the caregiving-induced requirement of restrictions in everyday life (qualitative study), changes in the relationship with the person with PD (qualitative study) and a problem-focused or avoidant coping style (both studies). Integration of both data strands revealed that qualitative findings expanded quantitative findings by (1) distinguishing between the impact of the relationship with the person with PD and the relationship with others on perceived social support, (2) revealing the impact of non-motor symptoms next to motor symptoms and (3) revealing the following additional factors impacting caregiver burden: concern about the future, perceived restrictions and limitations in performing daily activities due to the disease, and negative feelings and emotional well-being. Qualitative findings were discordant with the quantitative finding demonstrating that problem-focused was associated with a higher caregiver burden. Factor analyses showed three sub-dimensions of the Zarit Burden Inventory: (i) role intensity and resource strain, (2) social restriction and anger and (3) self-criticism. Quantitative analysis showed that avoidant coping was a determinant for all three subscales, whereas problem-solved coping and perceived social support were significant predictors on two subscales, role intensity and resource strain and self-criticism. CONCLUSIONS The burden experienced by informal caregivers of persons with PD is determined by a complex interplay of patient-related, caregiver-related and interpersonal characteristics. Our study highlights the utility of a mixed-methods approach to unravel the multidimensional burden experienced by informal caregivers of persons with chronic disease. We also offer starting points for the development of a tailored supportive approach for caregivers.
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Affiliation(s)
- Angelika D Geerlings
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Willanka M Kapelle
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Charlotte J Sederel
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands.
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Arshinoff R, Roldan C, Balboni T. Spirituality and spiritual distress in neurologic illness. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:221-234. [PMID: 36599510 DOI: 10.1016/b978-0-12-824535-4.00004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neurologic illnesses present multiple challenges to patients and their families from the time of initial diagnosis and throughout their illness trajectory, including challenges related to accepting the diagnosis and its various impacts and anxiety about future living with their illness. Often patients and their families rely on their spirituality to cope with and to maintain meaning and dignity in the midst of disease. As a result, spiritual care provision is a critical component of holistic medical care to patients with neurologic illness. Spiritual care provision follows a generalist-specialist model, which requires all healthcare professionals involved in the care of patients facing serious illness to play a role in recognizing and addressing spiritual needs. This model is characterized by generalist spiritual care providers (e.g., nurses, physicians, social workers) who perform spiritual screenings through history taking. Chaplains function as specialist spiritual care providers and can address spiritual care more deeply. In addition, several developed psychotherapeutic approaches may be useful for patients with neurologic disease, and chaplains are especially trained to offer supportive spiritual care to patients with neurologic illnesses and their families and to work together with physicians and other members of the healthcare team as part of a holistic approach to care.
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Affiliation(s)
- Rena Arshinoff
- Department of Spiritual Care, Baycrest Center for Geriatrics, Division of Palliative Care, University of Toronto, Toronto, ON, Canada.
| | - Claudia Roldan
- Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Tracy Balboni
- Departments of Radiation Oncology and of Psychosocial Oncology and Palliative Care, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, United States
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Fleisher JE, Suresh M, Klostermann EC, Lee J, Hess SP, Myrick E, Mitchem D, Woo K, Sennott BJ, Witek NP, Chen SM, Beck JC, Ouyang B, Wilkinson JR, Hall DA, Chodosh J. IN-HOME-PDCaregivers: The effects of a combined home visit and peer mentoring intervention for caregivers of homebound individuals with advanced Parkinson's disease. Parkinsonism Relat Disord 2023; 106:105222. [PMID: 36446676 PMCID: PMC9825655 DOI: 10.1016/j.parkreldis.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Family caregivers of people with advanced Parkinson's Disease (PD) are at high risk of caregiver strain, which independently predicts adverse patient outcomes. We tested the effects of one year of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) with 16 weeks of peer mentoring on caregiver strain compared with usual care. METHODS We enrolled homebound people with advanced PD (PWPD) and their primary caregiver as IN-HOME-PD dyads. We trained experienced PD family caregivers as peer mentors. Dyads received four structured home visits focused on advanced symptom management, home safety, medications, and psychosocial needs. Starting at approximately four months, caregivers spoke weekly with a peer mentor for 16 weeks. We compared one-year change in caregiver strain (MCSI, range 0-72) with historical controls, analyzed intervention acceptability, and measured change in anxiety, depression, and self-efficacy. RESULTS Longitudinally, IN-HOME-PD caregiver strain was unchanged (n = 51, 23.34 (SD 9.43) vs. 24.32 (9.72), p = 0.51) while that of controls worsened slightly (n = 154, 16.45 (10.33) vs. 17.97 (10.88), p = 0.01). Retention in peer mentoring was 88.2%. Both mentors and mentees rated 100% of mentoring calls useful, with mean satisfaction of 91/100 and 90/100, respectively. There were no clinically significant improvements in anxiety, depression, or self-efficacy. CONCLUSIONS Interdisciplinary telehealth-enhanced home visits combined with peer mentoring mitigated the worsening strain observed in caregivers of less advanced individuals. Mentoring was met with high satisfaction. Future caregiver-led peer mentoring interventions are warranted given the growing, unmet needs of PD family caregivers. TRIAL REGISTRATION NCT03189459.
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Affiliation(s)
- Jori E Fleisher
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Madhuvanthi Suresh
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Ellen C Klostermann
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jeanette Lee
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Serena P Hess
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Erica Myrick
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Daniela Mitchem
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Katheryn Woo
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Brianna J Sennott
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Natalie P Witek
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Sarah Mitchell Chen
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - James C Beck
- Parkinson's Foundation, 1359 Broadway, Suite 1509, New York, NY, 10018, USA.
| | - Bichun Ouyang
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jayne R Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA; Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Deborah A Hall
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, 227 E. 30th Street, TRB 839, New York, NY, 10016, USA; VA New York Harbor Healthcare System, Medicine Service, 423 E. 23rd Street, New York, NY, 10010, USA.
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Whiteley N, Pluim CF, Split M, Cabrera Tuazon A, Moore RC, Irene Litvan, Lessig S, Filoteo JV, Schiehser DM. Prospective predictors of care partner burden and depression in Parkinson's disease. Int J Geriatr Psychiatry 2022; 37. [PMID: 35996353 DOI: 10.1002/gps.5795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Care partners who provide informal care to individuals with Parkinson's disease (PD) report higher levels of burden and depression; however, longitudinal research on these symptoms is scarce. The current study assessed changes in care partner burden and depression, and patient and care partner predictors of these symptoms over time. Such knowledge may provide important information for assessment and treatment of depression and burden in care partners of individuals with PD. RESEARCH DESIGN AND METHODS Participants were 88 PD patients without dementia and their self-identified care partner (n = 88). Care partners completed the Geriatric Depression Scale and Zarit Burden Interview. PD participants completed mood questionnaires and a motor exam at baseline and 2 year follow-up. Relationships among care partner burden and depression over time with patient and care partner predictors (i.e., demographic, mood, and disease characteristics) were assessed using correlations and regression analyses. RESULTS Care partner burden and depression significantly increased over an approximate 2 year period. Greater baseline disease severity predicted worsening of care partner burden (p = 0.028), while baseline patient depression predicted worsening of care partner depression (p = 0.002). CONCLUSIONS Results highlight differential impacts of specific PD symptoms on worsening care partner burden compared to depression; increased PD disease severity predicts increased burden, while patient mood predicts worsening of depression over time. Targeting PD disease severity and mood symptoms may prevent the progression of care partner burden and depression.
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Affiliation(s)
- Nicole Whiteley
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Celina F Pluim
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Molly Split
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, California, USA
| | - Stephanie Lessig
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, California, USA
| | - J Vincent Filoteo
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, California, USA
| | - Dawn M Schiehser
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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Yue L, Jia C, Hu B, Zhang Z, Bai M, Wang S, Yao N. Caregiving stress among family caregivers of older adults living with disabilities in China. Geriatr Nurs 2022; 47:226-231. [PMID: 35987148 DOI: 10.1016/j.gerinurse.2022.07.017] [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: 06/16/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to describe caregiving stress among family caregivers of Chinese older adults living with disabilities, and explore how care intensity, financial expenses, and care difficulties are associated with caregiving stress. METHODS Data of 220 older adult-caregiver dyads were collected from 6 urban districts and 6 rural counties from Shandong province, China. Descriptive analyses and multivariate ordinal logistic regression analyses were performed. RESULTS Family caregivers providing nine or more hours of care per day reported higher caregiving stress than those who provided fewer than nine hours. Caregivers who experienced insufficient care abilities, economic hardships, or time conflicts were more likely to report caregiving stress. Financial support provided to older adults was not associated with caregiving stress. CONCLUSIONS Family caregivers of Chinese older adults with disabilities are experiencing excessive caregiving stress. Social support groups and China's long-term care insurance system should be promoted to better assist family caregivers.
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Affiliation(s)
- Lirong Yue
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, Shandong 250012, China
| | - Congxi Jia
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, Shandong 250012, China
| | - Bo Hu
- Care Policy and Evaluation Centre, London School of Economics and Political Science, WC2A 2AE, London, United Kingdom
| | - Zhenzhen Zhang
- Zhong Shan Hospital Xia Men University, Xiamen 361004, China
| | - Meng Bai
- Center for Disease Control, Wuzhong District, Suzhou 215128, China
| | - Shuangshuang Wang
- School of Public Administration, Southwest Jiaotong University, No. 111, North Section I, Second Ring Road, Chengdu 610031, China; Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts 02125, United States.
| | - Nengliang Yao
- Home-Centered Care Institute, Schaumburg, IL 60173, United States; School of Medicine, University of Virginia, Charlottesville, VA 22908, United States
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9
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Merizzi A, Biasi R, Zamudio JFÁ, Spagnuolo Lobb M, Di Rosa M, Santini S. A Single-Case Design Investigation for Measuring the Efficacy of Gestalt Therapy to Treat Depression in Older Adults with Dementia in Italy and in Mexico: A Research Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063260. [PMID: 35328948 PMCID: PMC8950193 DOI: 10.3390/ijerph19063260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023]
Abstract
Psychotherapy is one of the evidence-based clinical interventions for the treatment of depression in older adults with dementia. Randomised controlled trials are often the first methodological choice to gain evidence, yet they are not applicable to a wide range of humanistic psychotherapies. Amongst all, the efficacy of the Gestalt therapy (GT) is under-investigated. The purpose of this paper is to present a research protocol, aiming to assess the effects of a GT-based intervention on people with dementia (PWD) and indirect influence on their family carers. The study implements the single-case experimental design with time series analysis that will be carried out in Italy and Mexico. Six people in each country, who received a diagnosis of dementia and present depressive symptoms, will be recruited. Eight or more GT sessions will be provided, whose fidelity will be assessed by the GT fidelity scale. Quantitative outcome measures are foreseen for monitoring participants' depression, anxiety, quality of life, loneliness, carers' burden, and the caregiving dyad mutuality at baseline and follow-up. The advantages and limitations of the research design are considered. If GT will effectively result in the treatment of depression in PWD, it could enrich the range of evidence-based interventions provided by healthcare services.
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Affiliation(s)
- Alessandra Merizzi
- Centre for Socio-Economic Research on Aging, IRCCS INRCA-National Institute of Health and Science on Aging, Via Santa Margherita 5, 60124 Ancona, Italy;
- Correspondence:
| | - Rosanna Biasi
- Istituto di Gestalt HCC Human Communication Centre Italy, Via S. Sebastiano 38, 96100 Siracusa, Italy; (R.B.); (M.S.L.)
| | | | - Margherita Spagnuolo Lobb
- Istituto di Gestalt HCC Human Communication Centre Italy, Via S. Sebastiano 38, 96100 Siracusa, Italy; (R.B.); (M.S.L.)
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA-National Institute of Health and Science on Aging, Via Santa Margherita 5, 60124 Ancona, Italy;
| | - Sara Santini
- Centre for Socio-Economic Research on Aging, IRCCS INRCA-National Institute of Health and Science on Aging, Via Santa Margherita 5, 60124 Ancona, Italy;
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10
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Caregiver Burden and Quality of Life in Late Stage Parkinson’s Disease. Brain Sci 2022; 12:brainsci12010111. [PMID: 35053854 PMCID: PMC8773513 DOI: 10.3390/brainsci12010111] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
Parkinson’s disease (PD) is a chronic, progressive, neurodegenerative disease involving both motor and non-motor symptoms (NMS). In the late stage of the disease, Hoehn and Yahr (H&Y) stage IV-V, the symptomatology is often severe and patients become increasingly dependent on help in their daily life, resulting in an increased burden for the informal caregivers. To assess the implications of the caregiver burden, caregiver quality of life (QoL) was assessed in 74 informal caregivers to patients in late stage PD, by the Alzheimer’s Patient Partners Life Impact Questionnaire (APPLIQue), which has been found useful also in PD. The majority of caregivers were the spouse/partner. Individual items provided information on which aspects of caregiver burden were the most common, i.e., items: “feel guilty if not there (71% affirmed)”, “the situation wears me down” (65% affirmed) and “always on my mind” (61% affirmed). In simple linear regression analyses, male patient gender (p = 0.007), better cognition (p = 0.004), lower NMS burden (p = 0.012) and not being the partner (p = 0.022) were associated with better caregiver QoL. Multivariable linear regression analyses identified better cognition (p = 0.004) and male patient gender (p = 0.035) as independently associated with better informal caregiver QoL. Identifying and treating NMS as well as recognizing and alleviating caregiver burden seem essential to enhance QoL for both patients and caregivers in late stage PD.
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11
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Kalampokini S, Hommel ALAJ, Lorenzl S, Ferreira JJ, Meissner WG, Odin P, Bloem BR, Dodel R, Schrag AE. Caregiver Burden in Late-Stage Parkinsonism and Its Associations. J Geriatr Psychiatry Neurol 2022; 35:110-120. [PMID: 33094677 DOI: 10.1177/0891988720968263] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients in the late stages of parkinsonism are highly dependent on others in their self-care and activities of daily living. However, few studies have assessed the physical, psychological and social consequences of caring for a person with late-stage parkinsonism. PATIENTS AND METHODS Five hundred and six patients and their caregivers from the Care of Late Stage Parkinsonism (CLaSP) study were included. Patients' motor and non-motor symptoms were assessed using the UPDRS and Non-motor symptom scale (NMSS), Neuropsychiatric inventory (NPI-12), and caregivers' health status using the EQ-5D-3 L. Caregiver burden was assessed by the Zarit Burden Interview (ZBI). RESULTS The majority of caregivers were the spouse or life partner (71.2%), and were living with the patient at home (67%). Approximately half of caregivers reported anxiety/depression and pain/discomfort (45% and 59% respectively). The factors most strongly associated with caregiver burden were patients' neuropsychiatric features on the total NPI score (r = 0.38, p < 0.0001), total NMSS score (r = 0.28, p < 0.0001), caring for male patients and patients living at home. Being the spouse, the hours per day assisting and supervising the patient as well as caregivers' EQ-5D mood and pain scores were also associated with higher ZBI scores (all p < 0.001). CONCLUSION The care of patients with late stage parkinsonism is associated with significant caregiver burden, particularly when patients manifest many neuropsychiatric and non-motor features and when caring for a male patient at home.
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Affiliation(s)
- Stefania Kalampokini
- UCL Queen Square Institute of Neurology, 61554University College London, United Kingdom
| | - Adrianus L A J Hommel
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, 6029Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, 162199Paracelsus Medical University, Salzburg, Austria.,Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München-Klinikum Großhadern, Munich, Germany.,Department of Neurology, Agatharied Hospital, Hausham, Germany
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular 37809Universidade di Lisboa, Lisboa, Portugal
| | - Wassilios G Meissner
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France.,Institut des Maladies Neurodégénératives, 27086University de Bordeaux, Bordeaux, France.,Department of Medicine, University of Otago, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Per Odin
- Department of Neurology, 59568Lund University Hospital, Sweden
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, 6029Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Richard Dodel
- Department of Geriatric Medicine, University Duisburg-Essen, Germany.,Department of Neurology, Philipps-University Marburg, Germany
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12
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Ris I, Volken T, Schnepp W, Mahrer-Imhof R. Exploring Factors Associated With Family Caregivers' Preparedness to Care for an Older Family Member Together With Home Care Nurses: An Analysis in a Swiss Urban Area. J Prim Care Community Health 2022; 13:21501319221103961. [PMID: 35670066 PMCID: PMC9178975 DOI: 10.1177/21501319221103961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Home-dwelling older people with chronic diseases often need the support of informal and formal caregivers in order to continue living at home. Family members, however, need to be willing and prepared for caregiving together with home care nurses. Objectives: The purpose of this study was to explore factors associated with family caregivers’ preparedness to care for older home-dwelling adults who also receive home care nursing services. Methods: For this cross-sectional correlational study, a structured questionnaire was sent to family caregivers of adults aged 65 years or older receiving services from a community care agency. A total of 243 participants returned the questionnaire, of which 199 could be analyzed. Results: The stepwise backward regression model explained 29.1% of the variance of family caregivers’ preparedness. Mutuality was the most strongly associated factor with family caregivers’ preparedness whereas professional involvement of family caregiver in care process was important as well. Care intensity showed no significant impact. Conclusion: Nurses should support the whole family emotionally, and appreciate, admire, reinforce, and respect the caregivers’ situation. Home care nurses need to invest in helping families to find solutions, to strengthen their relationships between family members and the older person dwelling at home.
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Affiliation(s)
- Irène Ris
- ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur Schweiz, Switzerland.,Universität Witten/Herdecke, Fakultät für Gesundheit, Witten, Deutschland
| | - Thomas Volken
- ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur Schweiz, Switzerland
| | - Wilfried Schnepp
- Universität Witten/Herdecke, Fakultät für Gesundheit, Witten, Deutschland
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13
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Hulshoff MJ, Book E, Dahodwala N, Tanner CM, Robertson C, Marras C. Current Knowledge on the Evolution of Care Partner Burden, Needs, and Coping in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:510-520. [PMID: 33981783 DOI: 10.1002/mdc3.13201] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background Care partners support people with Parkinson's disease through a long journey ranging from independence to dependence for many daily tasks. Longitudinal studies are important to understand the evolution of this process and predictors of future needs of care partners. Methods A scoping review was conducted, searching PubMed for longitudinal studies examining care partner burden, needs or coping in Parkinson's disease published through May 2020. Results Eight observational studies and 19 interventional studies met the eligibility criteria. Longitudinal observation ranged from 7 weeks to 10 years, involving between six and 8515 care partners. All studies addressed care partner burden, while two and three studies respectively addressed needs and coping. Only one study related burden to specific stages or duration of disease. Results from identified studies show that care partners in Parkinson's disease are at risk for increasing burden over time. Multiple predictors of future burden have been identified related to the person with Parkinson's disease, the care partner, or an intervention. No studies examined the evolution of needs and coping in caregiving in Parkinson's disease. Conclusion The scarcity of longer term, observational research on the temporal evolution of burden and particularly needs and coping in caregiving for someone with PD is a main identified gap. Even within these observational studies, the impact of caregiving is not often reported. Longitudinal studies on these topics are needed to help understand their change over time and relation to each other, which can inform support planning for care partners.
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Affiliation(s)
- Max J Hulshoff
- Department of Neurology and Parkinson Center Radboud University Medical Center Nijmegen The Netherlands
| | - Elaine Book
- Pacific Parkinson's Research Centre University of British Columbia Vancouver British Columbia Canada
| | - Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neuroscience University of California - San Francisco, and Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Medical Center San Francisco California USA
| | | | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research Toronto Western Hospital Toronto Ontario Canada
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14
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Lo Monaco MR, Di Stasio E, Ricciardi D, Solito M, Petracca M, Fusco D, Onder G, Landi G, Zuccalà G, Liperoti R, Cipriani MC, Brisi C, Bernabei R, Silveri MC, Bentivoglio AR. What about the caregiver? A journey into Parkinson's disease following the burden tracks. Aging Clin Exp Res 2021; 33:991-996. [PMID: 32488473 DOI: 10.1007/s40520-020-01600-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate caregivers and patients characteristics related to different dimensions of burden in Parkinson's disease (PD). METHODS 55 pairs of PD patients and caregivers were recruited. The burden was evaluated with the Caregiver Burden Inventory (CBI). Multivariate analysis was applied to evaluate the impact of caregivers' and patients' characteristics on the varying aspects of burden. RESULTS ADL score was the dominant predictor for the total score and all dimensions of CBI, except for the social burden, which is strongly predicted by the motor severity of PD. As one can easily imagine, the Total CBI decreases as the ADL score increases. DISCUSSION An increased appreciation for characteristics of caregiver burden is a fundamental aspect of the patient's global evaluation. Clinicians may need to directly probe for these factors in the caregiver as they may not be elicited routinely.
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Affiliation(s)
- Maria Rita Lo Monaco
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Enrico Di Stasio
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Institute of Biochimica E Biochimica Clinica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diego Ricciardi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Marcella Solito
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Petracca
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Fusco
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Landi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Zuccalà
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Camilla Cipriani
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Caterina Brisi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Roberto Bernabei
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Anna Rita Bentivoglio
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Díaz A, Ponsoda JM, Beleña A. Optimism as a key to improving mental health in family caregivers of people living with Alzheimer's disease. Aging Ment Health 2020; 24:1662-1670. [PMID: 31960702 DOI: 10.1080/13607863.2020.1715342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The aim of the present work was to study the serial multiple mediating role of optimism, perceived social support and subjective burden in the relationship between objective burden and psychological distress in caregivers of people with Alzheimer´s Disease (AD).Method: One hundred and forty family caregivers of people living with AD were recruited from randomly selected Alzheimer Association Centres. They answered the General Health Questionnaire (GHQ), the Life Orientation Test-Revised (LOT-R), the Functional Social Support Questionnaire (DUKE.UNC), the Zarit Burden Interview (ZBI) and questions relating to gender, age and the amount of time spent on daily caregiving.Results: Results indicated that objective burden and subjective burden were both high in these caregivers. Optimism mediated on psychological distress through social support and through subjective burden with a full mediation role. When comparisons between indirect effects were performed, optimism was the mediator with the greatest effect between objective burden and psychological distress.Conclusion: This study highlights the indirect role of optimism and the advantages that interventions in optimism training in the early stages of the person with AD could produce. Thus, alleviating subjective burden and increasing perceived social support, which would lead to an improvement in the mental health of family caregivers of people with AD.
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Affiliation(s)
- Amelia Díaz
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
| | - José M Ponsoda
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain.,Association of Relatives and Friends of Alzheimer Disease Patients and Other Dependent Patients in Cocentaina Region, Alicante, Spain
| | - Angela Beleña
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
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16
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Karlstedt M, Fereshtehnejad SM, Aarsland D, Lökk J. Mediating effect of mutuality on caregiver burden in Parkinson's disease partners. Aging Ment Health 2020; 24:1421-1428. [PMID: 31140294 DOI: 10.1080/13607863.2019.1619165] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: Parkinson's disease (PD) is a complex neurodegenerative disorder with a broad list of motor and non-motor symptoms (NMS) that has been shown to affect the relationship quality (mutuality) and caregiver burden. However, little is known if the effect of motor and NMS on caregiver burden is mediated by mutuality. Therefore, the aim of this study was to explore if perceived mutuality by patients and partners mediates the effect of motor and NMS on caregiver burden.Methods: Data were collected from 51 dyads with one PD patient, including measures of motor signs, NMS, impaired cognition, patients' and partners' perceived mutuality, caregiver burden and dependency in activities in daily life (ADL). Structural equation model with manifest variables were applied to explore if patients' and partners' mutuality score mediated the effect of motor signs, NMS, ADL or impaired cognition on caregiver burden.Result: Our results suggest that having a partner with PD who is dependent in ADL or has impaired cognition decreases partners' mutuality which leads to elevated burden. Motor symptoms or other NMS were not associated with partners' mutuality or caregiver burden. Instead, increasing severity of motor symptoms decrease patients' mutuality in turn leading to lower level of partners' mutuality.Conclusion: Our findings enhance the understanding of the complexity of living with PD for the partner and suggest that clinical assessment should include evaluation of how PD symptoms influence the quality of the relationship between partners and patients.
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Affiliation(s)
- Michaela Karlstedt
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Dag Aarsland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Johan Lökk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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17
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Dlay JK, Duncan GW, Khoo TK, Williams-Gray CH, Breen DP, Barker RA, Burn DJ, Lawson RA, Yarnall AJ. Progression of Neuropsychiatric Symptoms over Time in an Incident Parkinson's Disease Cohort (ICICLE-PD). Brain Sci 2020; 10:E78. [PMID: 32024222 PMCID: PMC7071603 DOI: 10.3390/brainsci10020078] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/25/2020] [Accepted: 01/31/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cross-sectional studies have identified that the prevalence of neuropsychiatric symptoms (NPS) in Parkinson's disease (PD) ranges from 70-89%. However, there are few longitudinal studies determining the impact of NPS on quality of life (QoL) in PD patients and their caregivers. We seek to determine the progression of NPS in early PD. METHODS Newly diagnosed idiopathic PD cases (n = 212) and age-matched controls (n = 99) were recruited into a longitudinal study. NPS were assessed using the Neuropsychiatric Inventory with Caregiver Distress scale (NPI-D). Further neuropsychological and clinical assessments were completed by participants, with reassessment at 18 and 36 months. Linear mixed-effects modelling determined factors associated with NPI-D and QoL over 36 months. RESULTS Depression, anxiety, apathy and hallucinations were more frequent in PD than controls at all time points (p < 0.05). Higher motor severity at baseline was associated with worsening NPI-D scores over time (β = 0.1, p < 0.05), but not cognition. A higher NPI total score was associated with poorer QoL at any time point (β = 0.3, p < 0.001), but not changed in QoL scores. CONCLUSION NPS are significantly associated with poorer QoL, even in early PD. Screening for NPS from diagnosis may allow efficient delivery of better support and treatment to patients and their families.
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Affiliation(s)
- J. K. Dlay
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (J.K.D.); (G.W.D.); (R.A.L.)
| | - G. W. Duncan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (J.K.D.); (G.W.D.); (R.A.L.)
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - T. K. Khoo
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast 4222, Australia;
- School of Medicine, University of Wollongong, New South Wales 2522, Australia
| | - C. H. Williams-Gray
- John van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, UK; (C.H.W.-G.); (R.A.B.)
| | - D. P. Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH16 4UX, UK
| | - R. A. Barker
- John van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, UK; (C.H.W.-G.); (R.A.B.)
| | - D. J. Burn
- Faculty of Medical Sciences, Newcastle University & Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4HH, UK;
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - R. A. Lawson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (J.K.D.); (G.W.D.); (R.A.L.)
| | - A. J. Yarnall
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (J.K.D.); (G.W.D.); (R.A.L.)
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
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18
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Habermann B, Shin JY, Shearer G. Dyadic Decision-Making in Advanced Parkinson’s Disease: A Mixed Methods Study. West J Nurs Res 2019; 42:348-355. [DOI: 10.1177/0193945919864429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People with advanced Parkinson’s disease (PD) are living at home being cared for by a family member. Decisions about health care and living preferences are made in a family context. The aims of the study were to (a) examine the types and timing of the decisions being made by dyads (person with Parkinson’s [PWP] and caregiver) in advanced PD; and (b) explore perceived decision quality relative to specific decisions made. A mixed methods design of semi-structured dyad interviews followed by individual completion of decision measures twice at six months apart was utilized. Decisions involved obtaining more services in the home, moving into assisted living communities, maintaining as is, and initiating hospice. There was high decision quality as reflected by low decisional conflict and regret without statistical differences within the dyad. The findings provide insight into the nature of decisions dyads face and suggest ways that health care providers can support decision-making.
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Affiliation(s)
- Barbara Habermann
- School of Nursing, College of Health Sciences, University of Delaware, Newark, USA
| | - Ju Young Shin
- School of Nursing, College of Health Sciences, University of Delaware, Newark, USA
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19
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Kayser K, Acquati C. The influence of relational mutuality on dyadic coping among couples facing breast cancer. J Psychosoc Oncol 2019; 37:194-212. [PMID: 30822220 DOI: 10.1080/07347332.2019.1566809] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The study examined how a couple's capacity for mutuality as conceptualized by the Relational-Cultural Theory plays a role in their managing the stresses accompanying breast cancer. METHODS Eighty-six women treated for a primary, non-metastatic breast cancer and their partners completed measures of quality of life, relational mutuality, and dyadic coping. Demographic and clinical factors were self-reported. The relationship between mutuality and dyadic coping was evaluated using the Actor-Partner Interdependence Model (APIM). RESULTS Relational mutuality was positively associated with both the patients' and the caregivers' scores on common and positive dyadic coping. Similarly, relational mutuality was associated with both patients' and caregivers' reduced scores on avoidance of dyadic coping. CONCLUSIONS Relational mutuality emerges as a significant factor in our understanding about dyadic coping in the context of cancer and this study highlights the role it plays in dyadic coping behaviors. IMPLICATIONS The promotion of relational mutuality in couples coping with cancer-related stress should be a major focus in couple-based interventions.
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Affiliation(s)
- Karen Kayser
- a Kent School of Social Work , University of Louisville , Louisville , Kentucky , USA
| | - Chiara Acquati
- b Graduate College of Social Work , University of Houston , Houston , Texas , USA
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20
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Hand A, Oates LL, Gray WK, Walker RW. The role and profile of the informal carer in meeting the needs of people with advancing Parkinson's disease. Aging Ment Health 2019; 23:337-344. [PMID: 29293027 DOI: 10.1080/13607863.2017.1421612] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many people with Parkinson's disease (PD) (PwP) require care from either informal or formal carers, due to worsening symptoms. Carer strain is a recognised consequence of caring. However there are few data on the role and profile of informal carers and if this impacts on carer strain. METHOD People with moderate to advanced PD, with an informal carer were invited to participate. Data regarding motor and non-motor symptoms of the participant, along with demographics, tasks and duration of caring and health issues of the carer were collected. RESULTS One-hundred and fifteen participants and their carer were recruited. Mean carer age was 70.7 years, 66.1% were female caring for a median of 16 hours per day. Over 80% provided help in housework and companionship activities, 63.2% with dressing and 49.1% with feeding. There was a significant relationship between disease stage and level of strain. Participant age, physical and cognitive disability were significantly associated with greater care need. High care need was associated with poor carer quality of life. CONCLUSIONS The care needs of PwP are considerable. To reduce carer strain and improve quality of life, carers' needs must be considered to enable them to carry on with their vital role.
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Affiliation(s)
- Annette Hand
- a Northumbria Healthcare NHS Foundation Trust , North Shields , Tyne and Wear, United Kingdom.,b Department of Nursing Midwifery and Health , Northumbria University , Newcastle upon Tyne , United Kingdom
| | - Lloyd Louis Oates
- a Northumbria Healthcare NHS Foundation Trust , North Shields , Tyne and Wear, United Kingdom
| | - William Keith Gray
- a Northumbria Healthcare NHS Foundation Trust , North Shields , Tyne and Wear, United Kingdom
| | - Richard W Walker
- a Northumbria Healthcare NHS Foundation Trust , North Shields , Tyne and Wear, United Kingdom
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21
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Solomon DN, Hansen L, Baggs JG. It's All About the Relationship: Cognitively Intact Mother-Daughter Care Dyads in Hospice at Home. THE GERONTOLOGIST 2018; 58:625-634. [PMID: 28329822 DOI: 10.1093/geront/gnw263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study Adult daughters providing care to aging, ill mothers comprise the most prevalent caregiving dyad. Little is known, however, regarding relationship quality and its impact on care in these dyads, particularly in the context of cognitively intact patients at end of life in hospice. This interpretive descriptive work privileges voices of terminally ill mothers and care-partnering daughters in the home hospice context. Specific aims were to describe and interpret how mothers and daughters: (a) perceive relationship quality and (b) perceive how relationships have developed over time through health, chronic illness, and hospice. Design and Methods Semistructured interviews were used to explore interdependent perceptions of relationship quality in 10 terminally-ill mother-adult daughter care dyads. A novel method of qualitative dyadic analysis was developed to analyze dyads in close parallel at both individual/descriptive and dyadic/interpretive levels, staying true to qualitative rigor. Results A relationship quality spectrum emerged, from Close Friendship to Doing My Duty dyads. Women in Close Friendships revealed concordant narratives and emotionally satisfying relationships; women in neutral or troubled relationships revealed discordant relational stories. In these latter dyads, mothers reported more positive narratives; daughters spoke of relational problems. Implications This work suggests deeper exploration of mother-daughter dyads within the hospice context and interventions at both individual and dyadic levels to serve relational needs of the dying and their families. The qualitative dyadic approach also offers utility for relational investigations of any dyad.
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Affiliation(s)
- Diane N Solomon
- School of Nursing, Oregon Health & Science University, Portland.,Private Psychiatry Practice, Oregon, Portland
| | - Lissi Hansen
- School of Nursing, Oregon Health & Science University, Portland
| | - Judith G Baggs
- School of Nursing, Oregon Health & Science University, Portland
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Goldman JG, Vernaleo BA, Camicioli R, Dahodwala N, Dobkin RD, Ellis T, Galvin JE, Marras C, Edwards J, Fields J, Golden R, Karlawish J, Levin B, Shulman L, Smith G, Tangney C, Thomas CA, Tröster AI, Uc EY, Coyan N, Ellman C, Ellman M, Hoffman C, Hoffman S, Simmonds D. Cognitive impairment in Parkinson's disease: a report from a multidisciplinary symposium on unmet needs and future directions to maintain cognitive health. NPJ Parkinsons Dis 2018; 4:19. [PMID: 29951580 PMCID: PMC6018742 DOI: 10.1038/s41531-018-0055-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 04/29/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
People with Parkinson's disease (PD) and their care partners frequently report cognitive decline as one of their greatest concerns. Mild cognitive impairment affects approximately 20-50% of people with PD, and longitudinal studies reveal dementia in up to 80% of PD. Through the Parkinson's Disease Foundation Community Choice Research Award Program, the PD community identified maintaining cognitive function as one of their major unmet needs. In response, a working group of experts across multiple disciplines was organized to evaluate the unmet needs, current challenges, and future opportunities related to cognitive impairment in PD. Specific conference goals included defining the current state in the field and gaps regarding cognitive issues in PD from patient, care partner, and healthcare professional viewpoints; discussing non-pharmacological interventions to help maintain cognitive function; forming recommendations for what people with PD can do at all disease stages to maintain cognitive health; and proposing ideas for how healthcare professionals can approach cognitive changes in PD. This paper summarizes the discussions of the conference, first by addressing what is currently known about cognitive dysfunction in PD and discussing several non-pharmacological interventions that are often suggested to people with PD. Second, based on the conference discussions, we provide considerations for people with PD for maintaining cognitive health and for healthcare professionals and care partners when working with people with PD experiencing cognitive impairment. Furthermore, we highlight key issues and knowledge gaps that need to be addressed in order to advance research in cognition in PD and improve clinical care.
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Affiliation(s)
- Jennifer G. Goldman
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL USA
| | | | | | - Nabila Dahodwala
- Department of Neurology, University of Pennsylvania, Philadelphia, PA USA
| | - Roseanne D. Dobkin
- Department of Psychiatry, Rutgers The State University of New Jersey, New Brunswick, NJ USA
| | - Terry Ellis
- Department of Physical Therapy and Athletic Training and Center for Neurorehabilitation, Boston University, Boston, MA USA
| | - James E. Galvin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL USA
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s disease, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | | | - Julie Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Robyn Golden
- Department of Health and Aging, Rush University Medical Center, Chicago, IL USA
| | - Jason Karlawish
- Department of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Bonnie Levin
- Department of Neurology, Division of Neuropsychology, University of Miami, Miami, FL USA
| | - Lisa Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD USA
| | - Glenn Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL USA
| | - Christine Tangney
- Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, Chicago, IL USA
| | - Cathi A. Thomas
- Department of Neurology, Boston University Medical Campus, Boston, MA USA
| | - Alexander I. Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ USA
| | - Ergun Y. Uc
- Department of Neurology, University of Iowa, and Neurology Service, Iowa City, Veterans Affairs Health Care Systen, Iowa City, IA USA
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"It Is Hard Work, But It Is Worth It": Patients and Spouses' Experiences of a Nursing Intervention to Promote Adjustment to Deep Brain Stimulation for Parkinson's Disease-A Feasibility Study. ANS Adv Nurs Sci 2018; 41:174-187. [PMID: 29727341 DOI: 10.1097/ans.0000000000000208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article evaluates the feasibility of a nursing intervention when adjusting to deep brain stimulation for Parkinson disease. Eight couples were included in the study. Main activities of the intervention were a diary and individualized meetings between nurses, patients, and spouses with a focus on everyday life and expectations to deep brain stimulation. All meetings were audio recorded and analyzed together with the content of the diary. The intervention was evaluated as feasible and experienced as meaningful. It supports the need for individualized care involving both patients and spouses and contributes to the development of an evidence-based nursing practice.
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Coping with Cognitive Impairment in People with Parkinson's Disease and Their Carers: A Qualitative Study. PARKINSONS DISEASE 2018; 2018:1362053. [PMID: 29850013 PMCID: PMC5911314 DOI: 10.1155/2018/1362053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/22/2018] [Indexed: 11/17/2022]
Abstract
Cognitive impairment is common in Parkinson's disease (PD). However, the psychosocial impact of living and coping with PD and cognitive impairment in people with PD and their carers have not been explored. This paper draws on a qualitative study that explores the subjective impact of cognitive impairment on people with PD and their carers. Thirty-six one-to-one interviews were completed; people with PD were from three groups: normal cognition, mild cognitive impairment, and dementia. Data collection and analysis were iterative, and verbatim transcripts were analysed using thematic analysis. Themes were interpreted in consultation with coping and adaptation theory. The analysis revealed four main themes: threats to identity and role, predeath grief and feelings of loss in carers, success and challenges to coping in people with PD, and problem-focused coping and finding meaning in caring. Our data highlight how cognitive impairment can threaten an individual's self-perception; the ostensible effects of cognitive impairment depended on the impact individual's perceived cognitive impairment had on their daily lives. For carers, cognitive impairment had a greater emotional impact than the physical symptoms of PD. The discussion that developed around protective factors provides possible opportunities for future interventions, such as psychological therapies to improve successful adjustment.
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Abstract
Despite the importance of both members of the adult patient-care partner dyad, a majority of research on illness management is focused on the patient or the care partner. The basic principle of the Theory of Dyadic Illness Management is that illness management is a dyadic phenomenon; the theory focuses extensively on the dyad as an interdependent team. The way dyads appraise illness as a unit influences the ways in which they engage in behaviors to manage illness together in a recursive fashion that influences dyadic health. Optimizing the health of both members of the dyad is a goal of the theory. In turn, the health of the dyad can feedback to influence how they appraise and manage illness together. Finally, dyadic illness management is an inherently variable process that is influenced by several contextual factors. Supportive evidence and implications for practice and future research are presented.
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26
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Dahodwala N, Shah K, He Y, Wu SS, Schmidt P, Cubillos F, Willis AW. Sex disparities in access to caregiving in Parkinson disease. Neurology 2018; 90:e48-e54. [PMID: 29196580 PMCID: PMC10681055 DOI: 10.1212/wnl.0000000000004764] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/22/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare access to caregiving between men and women with Parkinson disease (PD). METHODS This was a cross-sectional and longitudinal study among participants with PD enrolled in the National Parkinson Foundation Parkinson's Outcomes Project from 2009 to 2014 at 21 international sites. The primary outcome measures were presence of a caregiver at the baseline visit, caregiver burden as measured by the Multidimensional Caregiver Strain Index (MCSI) at baseline, and time to first paid caregiver. RESULTS A total of 7,209 participants (63% men, 37% women) with PD were evaluated. Men had a mean age of 66.0 (SD 9.8) years, and women had a mean age of 66.9 (SD 9.7) years. More men than women had a caregiver (88.4% vs 79.4%, p < 0.0001). Caregivers of men reported greater strain than those of women (MCSI score 19.9 vs 16.4, p < 0.0001). These differences persisted after controlling for age, disease stage, number of comorbidities, cognitive and mobility measures, and health-related quality of life. In addition, the odds of caregiver accompaniment at baseline visit were lower for women compared to men (odds ratio 0.76, 95% confidence interval [CI] 0.67-0.86), and women had a faster rate to using a paid caregiver than men (hazard ratio 1.76, 95% CI 1.35-2.28) after controlling for potential confounders. CONCLUSIONS Informal caregiving resources are lower for women than men with PD, despite the finding that their caregivers report less strain than those of men. In addition, women are more likely to use formal, paid caregivers. Strategies to improve access to caregiving, particularly for women, are needed.
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Affiliation(s)
- Nabila Dahodwala
- From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL.
| | - Krunal Shah
- From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL
| | - Ying He
- From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL
| | - Samuel S Wu
- From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL
| | - Peter Schmidt
- From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL
| | - Fernando Cubillos
- From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL
| | - Allison W Willis
- From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL
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27
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Mosley PE, Moodie R, Dissanayaka N. Caregiver Burden in Parkinson Disease: A Critical Review of Recent Literature. J Geriatr Psychiatry Neurol 2017; 30:235-252. [PMID: 28743212 DOI: 10.1177/0891988717720302] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Burden is a negative psychological state induced in caregivers by the demands of providing care to a person with an illness or a disability. Managing caregiver burden in Parkinson disease (PD) is significant because informal caregivers make a substantial contribution to the well-being of persons with PD, incurring financial, social, and personal losses. Failure to recognize and manage caregiver burden may lead to burnout and premature institutionalization of the person with PD. We conducted a comprehensive literature review to identify and summarize factors that may amplify burden, including motor and nonmotor symptoms of PD, caregiver psychiatric symptoms, and caregiver coping style. We review instruments designed to sample the construct of burden among caregivers and evaluate interventions that may reduce burden, either by directly targeting caregivers or by treating PD symptoms associated with burden. We aim to provide a concise synopsis of these issues for the clinician or researcher working with this population in order to facilitate recognition of caregiver burden, provide accurate assessment, administer appropriate interventions, and stimulate further research in this area.
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Affiliation(s)
- Philip E Mosley
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,2 Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,3 Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,4 School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Rebecca Moodie
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nadeeka Dissanayaka
- 5 UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia.,6 School of Psychology, University of Queensland, St Lucia, Queensland, Australia.,7 Department of Neurology, Royal Brisbane & Woman's Hospital, Herston, Queensland, Australia
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28
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Altschuler A, Liljestrand P, Grant M, Hornbrook MC, Krouse RS, McMullen CK. Caregiving and mutuality among long-term colorectal cancer survivors with ostomies: qualitative study. Support Care Cancer 2017; 26:529-537. [PMID: 28844086 DOI: 10.1007/s00520-017-3862-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The cancer caregiving literature focuses on the early phases of survivorship, but caregiving can continue for decades when cancer creates disability. Survivors with an ostomy following colorectal cancer (CRC) have caregiving needs that may last decades. Mutuality has been identified as a relationship component that can affect caregiving. This paper discusses how mutuality may affect long-term ostomy caregiving. METHODS We conducted semi-structured, in-depth interviews with 31 long-term CRC survivors with ostomies and their primary informal caregivers. Interviewees were members of an integrated health care delivery system in the USA. We used inductive theme analysis techniques to analyze the interviews. RESULTS Most survivors were 71 years of age or older (67%), female (55%), and with some college education (54%). Two thirds lived with and received care from spouses. Caregiving ranged from minimal support to intimate assistance with daily ostomy care. While some survivors received caregiving far beyond what was needed, others did not receive adequate caregiving for their health care needs. Low mutuality created challenges for ostomy caregiving. CONCLUSIONS Mutuality impacts the quality of caregiving, and this quality may change over time, depending on various factors. Emotional feedback and amplification is the proposed mechanism by which mutuality may shift over time. Survivorship care should include assessment and support of mutuality as a resource to enhance health outcomes and quality of life for survivors with long-term caregiving needs and their caregivers. Appropriate questionnaires can be identified or developed to assess mutuality over the survivorship trajectory.
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Affiliation(s)
- Andrea Altschuler
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Petra Liljestrand
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Marcia Grant
- City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA
| | - Mark C Hornbrook
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
| | - Robert S Krouse
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA
- Cpl. Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave., Philadelphia, PA, 19104, USA
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
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Liu HY, Yang CT, Wang YN, Hsu WC, Huang TH, Lin YE, Liu CY, Shyu YIL. Balancing competing needs mediates the association of caregiving demand with caregiver role strain and depressive symptoms of dementia caregivers: A cross-sectional study. J Adv Nurs 2017; 73:2962-2972. [DOI: 10.1111/jan.13379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center; Chang Gung University; Taoyuan Taiwan
| | - Ching-Tzu Yang
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yu-Nu Wang
- Department of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Wen-Chuin Hsu
- Dementia Center; Department of Neurology; Chang Gung Memorial Hospital; Taoyuan Taiwan
- School of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Tzu-Hsin Huang
- Department of Nursing; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Yueh-E Lin
- Department of Nursing; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chin-Yi Liu
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yea-Ing L. Shyu
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Traumatological Division; Department of Orthopedics; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Nursing; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
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30
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Pan Y, Jones PS, Pothier P. The Relationship Between Mutuality and Health-Related Quality of Life in Adult Child Caregivers in China. JOURNAL OF FAMILY NURSING 2017; 23:366-391. [PMID: 28795855 DOI: 10.1177/1074840717718540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The strain inherent in caregiving relationships between adult children and aging parents is a prominent issue in contemporary China due to a combination of demographic and socioeconomic changes. The purpose of this study was to explore how mutuality, a positive quality of caregiving relationships, contributes to the physical health and mental health (health-related quality of life [HRQoL]) of adult child caregivers [ACCs] of parent stroke survivors. A cross-sectional correlational study was conducted on a nonproportional quota sample of 126 ACCs, using questionnaires of demographics, the 15-item Mutuality Scale, and the Second Version of the Standard 12-Item Health Survey (SF-12v2). Higher mutuality was found to be correlated with better caregiver physical health and mental health. However, after adjusting for the covariates, mutuality significantly explained 4.6% of the variance of caregiver physical health (β = .22, ΔR2 = .046, p < .01) but it did not significantly explain the variance of caregiver mental health. Although multiple factors correlate with Chinese family caregivers' HRQoL, this was the first study exploring the impact of caregiver-care receiver dyadic relationships on caregiver HRQoL in mainland China by using a mutuality scale with SF-12v2. Despite the fact that the Chinese tradition of filial piety can facilitate mutuality, socioeconomic changes and legislation that require adult children to care for aging parents appear to create high stress among family caregivers. Higher levels of mutuality contribute to better physical health in Chinese family caregivers. Therefore, culturally appropriate family nursing strategies and social policies in China could enhance caregiver mutuality and potentially promote their HRQoL, in particular physical health.
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Affiliation(s)
- Yuqin Pan
- 1 Jinhua Polytechnic, Zhejiang Province, China
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Karlstedt M, Fereshtehnejad SM, Winnberg E, Aarsland D, Lökk J. Psychometric properties of the mutuality scale in Swedish dyads with Parkinson's disease. Acta Neurol Scand 2017; 136:122-128. [PMID: 27781261 DOI: 10.1111/ane.12706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The 15-item mutuality scale (MS) has been used in several neurological conditions assessing the quality of relationship associations with negative effects of the caregiving situation. The aim of this study was to translate the original MS into Swedish and assess its psychometric properties in Parkinson's disease (PD). MATERIALS AND METHODS Following the forward-backward translation method, the scale was evaluated regarding linguistic correctness at a conceptual level and user-friendliness. The scale was filled out by a sample of 50 care dyads where one was having PD. Scale assumptions and scale structure were evaluated using floor/ceiling effect and principal component analyses (PCA) with promax rotation. Internal consistency was evaluated using Cronbach's alpha and mean inter-item correlation coefficients. RESULTS The Swedish MS was evaluated as user-friendly and relevant by the participants. The scale demonstrated no floor/ceiling effect and showed high internal consistency (α≥0.93) with a mean inter-item correlation coefficient of ≥0.5. Through the PCA, a two factor solution emerged, which accounted for 67% and 64% of the variance of the MS score by PD-partners and PD-patients, respectively. However, some variables were complex and discarded in the final solution. CONCLUSION Our findings provide initial support of the Swedish MS as a user-friendly and useful instrument with acceptable psychometric properties even though more research is needed to evaluate the existence of subscales.
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Affiliation(s)
- M. Karlstedt
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| | - S. M. Fereshtehnejad
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| | - E. Winnberg
- Department of Health Care Sciences; Ersta Sköndal University College; Stockholm Sweden
| | - D. Aarsland
- Division of Neurogeriatrics; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| | - J. Lökk
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
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Kluger BM, Fox S, Timmons S, Katz M, Galifianakis NB, Subramanian I, Carter JH, Johnson MJ, Richfield EW, Bekelman D, Kutner JS, Miyasaki J. Palliative care and Parkinson's disease: Meeting summary and recommendations for clinical research. Parkinsonism Relat Disord 2017; 37:19-26. [DOI: 10.1016/j.parkreldis.2017.01.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 12/01/2016] [Accepted: 01/10/2017] [Indexed: 12/25/2022]
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Yue XD, Hiranandani NA, Jiang F, Hou Z, Chen X. Unpacking the Gender Differences on Mental Health: The Effects of Optimism and Gratitude. Psychol Rep 2017; 120:639-649. [PMID: 28558535 DOI: 10.1177/0033294117701136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mental health studies show that women are likely to score higher on subjective well-being and higher on depression than men. To verify this, the present study collected a sample of 5648 undergraduates in 55 universities in China. Results showed that women reported higher optimism, gratitude, subjective well-being, and depression than men, and that optimism and gratitude mediated the relationship between gender and mental health (subjective well-being and depression). By its implication, women were more likely to be optimistic and grateful, and as such they tended to experience higher subjective well-being and depression simultaneously. This also implies that gender differences on mental health could also be a dispositional issue as well as a socialization one.
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Affiliation(s)
| | | | - Feng Jiang
- Central University of Finance and Economics, Beijing, China
| | - Zhenhu Hou
- Inner Mongolia Agricultural University, Hohhot, China
| | - Xiaohua Chen
- Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Pucciarelli G, Buck HG, Barbaranelli C, Savini S, Simeone S, Juarez-Vela R, Alvaro R, Vellone E. Psychometric Characteristics of the Mutuality Scale in Stroke Patients and Caregivers. THE GERONTOLOGIST 2016; 56:e89-98. [DOI: 10.1093/geront/gnw083] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/30/2016] [Indexed: 11/14/2022] Open
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35
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Solomon DN, Hansen L, Baggs JG, Lyons KS. Relationship Quality in Non-Cognitively Impaired Mother-Daughter Care Dyads: A Systematic Review. JOURNAL OF FAMILY NURSING 2015; 21:551-578. [PMID: 26307098 DOI: 10.1177/1074840715601252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
More than 60 million Americans provide care to a family member; roughly two thirds are women providing care to aging mothers. Despite the protective nature of relationship quality, little attention has been given to its role in mother-daughter care dyads, particularly in mothers without cognitive impairment. A systematic appraisal of peer-reviewed, English language research was conducted. Nineteen articles met criteria. When relationship quality is positive, mother-daughter dyads enjoy rewards and mutuality, even when conflict occurs. Daughters grow more emotionally committed to mothers' over the care trajectory, despite increasing demands. Daughters' commitment deepens as mothers physically decline, and mothers remain engaged, emotional partners. When relationship quality is ambivalent or negative, burden, conflict, and blame conspire, creating a destructive cycle. Avenues for continuing study, including utilizing the dyad as the unit of analysis, troubled dyads, longitudinal assessment, and end of life context, are needed before interventions to improve mother-daughter relationship quality may be successfully implemented.
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Affiliation(s)
- Diane N Solomon
- Oregon Health & Science University, Portland, USA Private Psychiatry Practice, Portland, OR, USA
| | - Lissi Hansen
- Oregon Health & Science University, Portland, USA
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Bidwell JT, Vellone E, Lyons KS, D'Agostino F, Riegel B, Juárez-Vela R, Hiatt SO, Alvaro R, Lee CS. Determinants of Heart Failure Self-Care Maintenance and Management in Patients and Caregivers: A Dyadic Analysis. Res Nurs Health 2015; 38:392-402. [PMID: 26355702 DOI: 10.1002/nur.21675] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 12/20/2022]
Abstract
Disease self-management is a critical component of maintaining clinical stability for patients with chronic illness. This is particularly evident in the context of heart failure (HF), which is the leading cause of hospitalization for older adults. HF self-management, commonly known as HF self-care, is often performed with the support of informal caregivers. However, little is known about how a HF dyad manages the patient's care together. The purpose of this study was to identify determinants of patient and caregiver contributions to HF self-care maintenance (daily adherence and symptom monitoring) and management (appropriate recognition and response to symptoms), utilizing an approach that controls for dyadic interdependence. This was a secondary analysis of cross-sectional data from 364 dyads of Italian HF patients and caregivers. Multilevel modeling was used to identify determinants of HF self-care within patient-caregiver dyads. Patients averaged 76.2 (SD = 10.7) years old, and a slight majority (56.9%) was male, whereas caregivers averaged 57.4 (SD = 14.6) years old, and about half (48.1%) were male. Most caregivers were adult children (48.4%) or spouses (32.7%) of patients. Both patients and caregivers reported low levels of HF maintenance and management behaviors. Significant individual and dyadic determinants of self-care maintenance and self-care management included gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and optimize outcomes.
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Affiliation(s)
- Julie T Bidwell
- PhD Student, School of Nursing, Oregon Health & Science University, Mail code: SN-2N, 3455 SW US Veterans Hospital Road, Portland, OR, 97239-2941, USA
| | - Ercole Vellone
- Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Karen S Lyons
- Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Fabio D'Agostino
- Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- Professor, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Raúl Juárez-Vela
- Research Fellow, Faculty of Health Science, University of San Jorge, Zaragoza, Spain
| | - Shirin O Hiatt
- Research Associate, School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Rosaria Alvaro
- Research Associate, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Christopher S Lee
- Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA
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Santos-García D, de la Fuente-Fernández R. Factors contributing to caregivers' stress and burden in Parkinson's disease. Acta Neurol Scand 2015; 131:203-10. [PMID: 25212106 DOI: 10.1111/ane.12305] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE To analyze the main determinants of burden and stress in caregivers of Spanish Parkinson's disease (PD) patients. METHODS One-hundred and twenty-one non-demented patients with PD (57.9% males; 70.9 ± 8.2 years old) were included in this cross-sectional, monocenter, evaluation study. Caregivers (n = 121; 71.9% females; 60.2 ± 15 years old) were assessed using the Zarit Caregiver Burden Inventory (ZCBI) and Caregiver Strain Index (CSI). Multiple linear regression methods were used to evaluate factors contributing to caregivers' stress and burden: (i) PD motor dysfunction (ON-state Hoehn & Yahr/Unified Parkinson's Disease Rating Scale [UPDRS] part III and motor complications [UPDRS part IV]); (ii) Mood (Beck Depression Inventory [BDI]); (iii) Non-motor symptoms (Non-Motor Symptoms Scale [NMSS]); (iv) Disability (Schwab & England Activities of Daily Living Scale [ADLS]); and (v) Socio-demographic and other disease-related variables. RESULTS Zarit Caregiver Burden Inventory and CSI mean scores were 16 ± 13.9 and 2.1 ± 2.3, respectively. High correlation was found between ZCBI and CSI (r = 0.819; P < 0.0001). Moderate to severe burden (ZCBI > 40) was present in 9.1% of caregivers; 5.8% had high levels of stress (CSI ≥ 7). Moderate to strong correlations were observed between patient-related variables (Hoehn&Yahr, UPDRS-III, UPDRS-IV, BDI, NMSS, and ADLS) and ZCBI and CSI (P < 0.0001). Linear regression methods showed that ADLS had the strongest influence on ZCBI and CSI, followed by BDI on ZCBI. CONCLUSIONS Disability (ADLS) and mood (BDI) of patients with PD are the main factors contributing to burden and stress in caregivers.
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Affiliation(s)
- D. Santos-García
- Section of Neurology; Complejo Hospitalario Universitario de Ferrol (CHUF); Hospital A. Marcide; Ferrol Spain
| | - R. de la Fuente-Fernández
- Section of Neurology; Complejo Hospitalario Universitario de Ferrol (CHUF); Hospital A. Marcide; Ferrol Spain
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Crist JD, Pasvogel A, Hepworth JT, Koerner KM. The impact of a telenovela intervention on use of home health care services and Mexican American older adult and caregiver outcomes. Res Gerontol Nurs 2015; 8:62-76. [PMID: 25594360 DOI: 10.3928/19404921-20150105-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/14/2014] [Indexed: 11/20/2022]
Abstract
A two-group randomized controlled trial tested a telenovela intervention (i.e., a culturally congruent videotaped dramatization with guided dialogue) to increase Mexican American older adults' and family caregivers' awareness of and confidence in home health care services (HHCS), thereby increasing use of HHCS and improving older adult and caregiver outcomes. Both groups had significant increases in awareness of and confidence in HHCS. The intervention group used HHCS more than the control group (91.1% versus 71.2% of total visits authorized); however, this was not a statistically significant difference (p = 0.18). Use of HHCS was associated with increased older adult and caregiver mutuality (i.e., the quality of the older adult-caregiver relationship) and decreased caregiving burden and depression. The predictive role and measurement of awareness and ways to improve the intervention are discussed. Findings are especially important with today's focus on transitional care to keep older adults at home and prevent unnecessary readmissions.
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Leiknes I, Lien UT, Severinsson E. The Relationship among Caregiver Burden, Demographic Variables, and the Clinical Characteristics of Patients with Parkinson’s Disease—A Systematic Review of Studies Using Various Caregiver Burden Instruments. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.510091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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40
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Abendroth M. Development and Initial Validation of a Parkinson’s Disease Caregiver Strain Risk Screen. J Nurs Meas 2015; 23:4-21. [DOI: 10.1891/1061-3749.23.1.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Family caregivers face potential strain in caring for persons with Parkinson’s disease because of the unpredictability of symptom presentation. The Caregiver Strain Risk Screen (CSRS) was developed and tested for initial validation. Methods: Instrument item development was guided by focus-group and interview data and a theoretical conceptualization of caregiver strain risk in caregivers of persons with Parkinson’s disease. Caregivers of persons with Parkinson’s disease (N = 217) provided data. Results: Principal components analysis supported a 28-item instrument with 4 factors: self-preservation, nursing home consideration, coping through spirituality, and coping through formal support. Conclusion: The 28-item CSRS demonstrated acceptable validity and reliability in measuring the construct. Research using a new sample is underway to further psychometrically test and validate the CSRS through confirmatory factor analysis.
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McCarthy MJ, Lyons KS. Incongruence between stroke survivor and spouse perceptions of survivor functioning and effects on spouse mental health: a mixed-methods pilot study. Aging Ment Health 2015; 19:46-54. [PMID: 24831861 DOI: 10.1080/13607863.2014.913551] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This pilot study investigated stroke survivors' and caregiving spouses' individual perspectives on survivor cognitive and physical functioning and the extent to which incongruence between partners' perceptions affects spouse depressive symptoms and overall mental health. METHOD Mixed-methods, with quantitative survey data from 35 couples and qualitative interview data from a subsample of 13 couples being collected and analyzed using paired t-tests, multiple regression with survivor-spouse discrepancy scores as predictors of spouse depressive symptoms, and interpretive-description techniques. RESULTS Quantitative data indicated that spouses rated survivor cognitive functioning as significantly worse than survivors rated their own and that survivor-spouse discrepancy scores for physical functioning were significantly associated with spouse depressive symptoms. Qualitative data enhanced understanding about the nuances of partner incongruence and the ramifications of partner incongruence for spouse mental health. CONCLUSION Partner incongruence has an impact on spouse depressive symptoms and overall mental health. Interventions targeted at survivor-spouse dyads and focused on improving communication between partners about survivor abilities may be effective for improving the mental health of spousal caregivers.
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Affiliation(s)
- Michael J McCarthy
- a School of Social Work, College of Allied Health Sciences , University of Cincinnati , Cincinnati , OH , USA
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42
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Davis LL, Chestnutt D, Molloy M, Deshefy-Longhi T, Shim B, Gilliss CL. Adapters, strugglers, and case managers: a typology of spouse caregivers. QUALITATIVE HEALTH RESEARCH 2014; 24:1492-500. [PMID: 25189535 PMCID: PMC4350575 DOI: 10.1177/1049732314548879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although family home care problems are frequently described in the health care literature, the ways in which families and other informal caregivers manage those problems are not often addressed. We conducted a descriptive analysis of interviews in which spouses caring for a partner with Alzheimer's or Parkinson's disease were asked to describe difficult home care problems and how they managed those problems. Analysis of these interviews indicated three recurring management styles. Adapters told stories about applying pre-existing skills to manage home care problems. Strugglers told stories of reoccurring home care problems for which they had few or no management strategies. Case managers' interview stories focused on the challenges of finding and coordinating home care services. These findings suggest that caregiving burden might be influenced more by the caregiver's management style than the demands of the care situation. Suggestions for tailoring support programs for the three types of caregivers are proposed.
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Affiliation(s)
| | | | | | | | - Bomin Shim
- Seattle Pacific University, Seattle, Washington, USA
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Greenwell K, Gray WK, van Wersch A, van Schaik P, Walker R. Predictors of the psychosocial impact of being a carer of people living with Parkinson's disease: a systematic review. Parkinsonism Relat Disord 2014; 21:1-11. [PMID: 25457815 DOI: 10.1016/j.parkreldis.2014.10.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/10/2014] [Accepted: 10/10/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Caring for a person with Parkinson's disease (PwP) can have a variety of negative consequences that may challenge their ability to continue their caring role. It is still unknown why some individuals adapt better than others in response to such burdens. This review is the first to synthesize and evaluate the evidence on the predictive factors of psychosocial outcomes in PwP carers. METHODS Studies which identified predictors of psychosocial outcomes for unpaid carers were included. PsychINFO, EMBASE, AMED, BNI and CINAHL databases were searched, supplemented by scanning of references lists of included studies and relevant journals from 2008 onwards. Quality was assessed using the NICE methodology checklist for prognostic studies. RESULTS Twenty-nine studies were included in the review, providing a low-level of evidence. Carer burden was investigated in 18 studies and mental health and quality of life (QoL) in seven studies each. PwP non-motor symptoms and QoL and carer depression were consistently identified as predictors for at least one psychosocial outcome. Demographics and disease factors were consistently found not to be predictors. Carer involvement and protective factors (e.g. social support, personality) demonstrated promising findings but studies were too few or factors measured inconsistently. CONCLUSION Confident conclusions could not be drawn regarding the most important predictors that should be targeted in psychosocial interventions due to methodological weaknesses and lack of theoretical testing across the current literature. Future research should build upon psychological theory to gain a better understanding of the mechanisms that explain how carers adapt to caregiving.
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Affiliation(s)
- Kate Greenwell
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK.
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK
| | - Anna van Wersch
- School of Social Sciences and Law, Teesside University, Middlesbrough, UK
| | - Paul van Schaik
- School of Social Sciences and Law, Teesside University, Middlesbrough, UK
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK; Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
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Dyadic relational resources and role strain in family caregivers of persons living with dementia at home: A cross-sectional survey. Int J Nurs Stud 2014; 51:593-602. [DOI: 10.1016/j.ijnurstu.2013.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 08/29/2013] [Accepted: 09/06/2013] [Indexed: 11/20/2022]
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Leigh ES, Wikman A, Molloy GJ, Randall G, Steptoe A. The psychosocial predictors of long-term distress in partners of patients with acute coronary syndrome. Psychol Health 2014; 29:737-52. [DOI: 10.1080/08870446.2014.882921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Oguh O, Kwasny M, Carter J, Stell B, Simuni T. Caregiver strain in Parkinson's disease: National Parkinson Foundation Quality Initiative Study. Parkinsonism Relat Disord 2013; 19:975-9. [DOI: 10.1016/j.parkreldis.2013.06.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 05/28/2013] [Accepted: 06/25/2013] [Indexed: 11/26/2022]
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47
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Park EO, Schumacher KL. The state of the science of family caregiver-care receiver mutuality: a systematic review. Nurs Inq 2013; 21:140-52. [PMID: 23617406 DOI: 10.1111/nin.12032] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 10/26/2022]
Abstract
This review critically examines the current state of the science on the concept of family caregiver-care receiver mutuality, summarizes accomplishments and gaps and identifies directions for future theory development and research. Mutuality between family caregivers and care receivers is of increasing interest to researchers. However, no analysis of the current state of the science of this important concept has been published. Our literature search revealed 34 research articles that met inclusion criteria. The studies were assessed in terms of conceptualization of mutuality, instrument development, populations studied, research designs and methods and findings. Significant scientific progress during the past 30 years includes the development of clear definitions and new instruments, expansion of research beyond the clinical populations in which mutuality was first studied, the use of a variety of research designs, and increasingly sophisticated methods of data analysis. Growing evidence suggests that mutuality is associated with caregiver emotional health outcomes and may decrease over time in the context of chronic illness. Directions for future research include development of new theoretical frameworks grounded in relational theory, development of theory on the dynamics of mutuality over time, exploration of mutuality in diverse cultures and populations, and intervention studies aimed at enhancing mutuality.
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Affiliation(s)
- Esther O Park
- Nursing Department, New Jersey City University, Jersey City, NJ, USA
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48
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Factors influencing quality of life in caregivers of people with Parkinson's disease and implications for clinical guidelines. PARKINSONS DISEASE 2012; 2012:190901. [PMID: 23316414 PMCID: PMC3539412 DOI: 10.1155/2012/190901] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/26/2012] [Accepted: 11/12/2012] [Indexed: 11/17/2022]
Abstract
The quality of life (QoL) of informal caregivers can be adversely affected by a number of factors. This issue, however, has not been well explored for carers of people with Parkinson's (PwP), with research largely restricted to the assessment of caregiver burden and caregiver strain. This study aims to determine the main influences on carer QoL in this population and consider results in the context of current clinical guidelines for the management of Parkinson's disease (PD). Carers completed the newly validated PDQ-Carer, and PwP completed the PDQ-39. The sample comprised 238 carers (mean age 68.20 years) and 238 PwP (mean age 71.64). Results suggest multiple influences on caregiver QoL. These include carer age, gender, health status, and duration of the caregiving role. PwP levels of mobility and cognitive impairment are also significant influences on carer QoL. Not only should practitioners and service providers be particularly aware of the heightened impact of PD on carers over time and as PwP symptoms deteriorate, but this should also be reflected in clinical guidelines for the management of PD.
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Carter J, Lyons K, Lindauer A, Malcom J. Pre-death grief in Parkinson's caregivers: A pilot survey-based study. Parkinsonism Relat Disord 2012; 18 Suppl 3:S15-8. [DOI: 10.1016/j.parkreldis.2012.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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50
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Li Q, Mak Y, Loke A. Spouses' experience of caregiving for cancer patients: a literature review. Int Nurs Rev 2012; 60:178-87. [DOI: 10.1111/inr.12000] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Y.W. Mak
- School of Nursing; The Hong Kong Polytechnic University; Kowloon; Hong Kong; China
| | - A.Y. Loke
- School of Nursing; The Hong Kong Polytechnic University; Kowloon; Hong Kong; China
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