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Lin X, Ward SA, Pritchard E, Ahern S, Gardam M, Brodaty H, Ryan J, McNeil J, Tsindos T, Wallis K, Jeon Y, Robinson S, Krysinska K, Ayton D. Carer-reported measures for a dementia registry: A systematic scoping review and a qualitative study. Australas J Ageing 2023; 42:34-52. [PMID: 36383194 PMCID: PMC10947070 DOI: 10.1111/ajag.13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Informal carers play a critical role in supporting people with dementia. We conducted a scoping review and a qualitative study to inform the identification and development of carer-reported measures for a dementia clinical quality registry. METHODS Phase 1-Scoping review: Searches to identify carer-reported health and well-being measures were conducted in three databases (MEDLINE, PsycINFO and Embase). Data were extracted to record how the measures were administered, the domains of quality-of-life addressed and whether they had been used in a registry context. Phase 2-Qualitative study: Four focus groups were conducted with carers to examine the acceptability of selected measures and to identify outcomes that were important but missing from these measures. RESULTS Phase 1: Ninety-nine carer measures were identified with the top four being the Zarit Burden Interview (n = 39), the Short-Form12/36 (n = 14), the Brief Coping Orientation to Problems Experienced scale and the Sense of Coherence scale (both n = 9). Modes of administration included face-to-face (n = 50), postal (n = 11), telephone (n = 8) and online (n = 5). No measure had been used in a registry context. Phase 2: Carers preferred brief measures that included both outcome and experience questions, reflected changes in carers' circumstances and included open-ended questions. CONCLUSIONS Carer-reported measures for a dementia clinical quality registry need to include both outcome and experience questions to capture carers' perceptions of the process and outcomes of care and services. Existing carer-reported measures have not been used in a dementia registry context and adaption and further research are required.
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Affiliation(s)
- Xiaoping Lin
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Stephanie A. Ward
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Centre for Healthy Brain Ageing (CHeBA), School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
- Department of Geriatric MedicineThe Prince of Wales HospitalRandwickNew South WalesAustralia
| | - Elizabeth Pritchard
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Susannah Ahern
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Madeleine Gardam
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
- Dementia Centre for Research Collaboration, School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - Joanne Ryan
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - John McNeil
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Tess Tsindos
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Kasey Wallis
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Yun‐Hee Jeon
- Susan Wakil School of Nursing and MidwiferyUniversity of SydneySydneyNew South WalesAustralia
| | - Sandra Robinson
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Karolina Krysinska
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Centre for Mental Health, School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Darshini Ayton
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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He J, Wang J, Zhong H, Guan C. The Effectiveness of Multi-Component Interventions on the Positive and Negative Aspects of Well-Being among Informal Caregivers of People with Dementia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6973. [PMID: 35742220 PMCID: PMC9222573 DOI: 10.3390/ijerph19126973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
The present review aims to examine whether multi-component interventions for informal caregivers of people with dementia are effective on positive and negative aspects of caregiver well-being. Eleven databases were searched from inception to 8 March 2021. Only randomized controlled trials reporting the effectiveness of multi-component intervention on positive and negative aspects of caregiver well-being were eligible. Endnote X7 (Thomson ResearchSoft, Stanford, CA, USA) was used for study selection and version 5.1.0 of Cochrane Collaboration's tool (Cochrane, London, UK) was applied for quality assessment. Review Manager (Revman) Version 5.3 (Cochrane, London, UK) was used for the meta-analysis, and if statistical synthesis was inappropriate, only narrative analysis was performed. A total of 31 RCTs with 3939 participants were included. Meta-analyses showed small to moderate effects on subjective well-being, depression, and burden of caregivers, and a moderate to high effect on caregiver anxiety. Due to insufficient data and vast heterogeneity, meta-analysis was not performed for other outcomes, such as resilience, competence, and empathy. This review suggests that individualized multi-component interventions for caregivers may be one of the ways to promote their well-being. Further research is needed to explore the impact of rigorously designed and personalized multi-component interventions on informal caregivers, especially on more positive indicators, as well as its long-term effects and sustainability.
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Affiliation(s)
- Jinjie He
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
| | - Jing Wang
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
| | - Hongmei Zhong
- Department of Nursing, School of Medicine, Shihezi University, Shihezi 832002, China;
| | - Chengguo Guan
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
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Abstract
Dementia is recognised as the biggest health crisis of our time in terms of high personal and social costs and wider impact on health and social care systems. Increases in people living with dementia and multimorbidities presents critical challenges for homecare worldwide. Healthcare systems struggle to provide adequate home-care services, delivering limited care restricted to a single-condition focus. This study explored the experiences and expectations of homecare from the multiple perspectives of people living with dementia and multimorbidities and homecare workers providing support. Findings draw from qualititative semi-structured interviews with people with dementia (n=2), their partners (n=2), other partners or family carers (n=6) and homecare workers (n=26). Three themes are idenfiifed: (a) the preference for and value of home; (b) inadequate homecare provision and enhanced care-burden; (c) limited training and education. Despite continued calls for homecare investment, the focus on reduction in costs hides key questions and further dialogue required exploring how people with dementia can be supported to live independendently and flourish at-home. This study considers these complex experiences and care requirements through the prism of disability and human rights frameworks. This paper concludes with consideration of more recent human social rights debate. We critically dicuss what this may mean for people living with dementia and consider the implications for corequisite policy development to optimise available homecare support.
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Taib F, Beng KT, Chan LC. The Challenges, Coping Mechanisms, and the Needs of the Inhospital Parents Caring for Children with Life-limiting Neurological Disorders: A Qualitative Study. Indian J Palliat Care 2021; 27:483-489. [PMID: 34898942 PMCID: PMC8655653 DOI: 10.25259/ijpc_3_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Parents who have children with complex lifelong and life-limiting neurological conditions experienced many stresses and anxieties throughout their lives as caregivers. However, this information is still very limited. The study aimed to explore the challenges faced by parents with children who have complex neurological conditions, their coping strategies, needs, and expectations. Materials and Methods A semi-structured, in-depth interviews were conducted in the either Malay or English language among the parents of children with complex lifelong neurological conditions and have been on long-term in-patient hospital care. The interviews were audio-recorded and transcribed for thematic analysis. The qualitative study was conducted from October to November 2016 at the Paediatric Institute of Hospital Kuala Lumpur. Grounded theory was used to examine the qualitative data with inductive and deductive types of coding. The transcripts were read repeatedly to allow familiarity to the themes presented by the participants. Further discussions were conducted among the researchers to triangulate the information. Results A total of 11 parents were interviewed for this study. The thematic analysis resulted in 8 challenges: Physical wellbeing, Environment, Relationship, Financial, Occupational, Rational, Mental, and Spiritual. Coping strategies comprised problem focused issues related to the key challenges in the caregivers' context. Similar to the needs and expectations, the key themes were derived from the key understandings of the challenges and looking at the palliative care impacts for these children. Conclusion There are various challenges faced by parents of children with life-limiting neurological disorders. Physical, Environment, Relationship, Financial, Occupational, Rational, Mental, and Spiritual Wellbeing can be a platform for the assessment of the caregivers' needs and the planning for palliative care support.
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Affiliation(s)
- Fahisham Taib
- Department of Paediatrics, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Khoo Teik Beng
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Lee Chee Chan
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
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Etxeberria I, Salaberria K, Gorostiaga A. Online support for family caregivers of people with dementia: a systematic review and meta-analysis of RCTs and quasi-experimental studies. Aging Ment Health 2021; 25:1165-1180. [PMID: 32363901 DOI: 10.1080/13607863.2020.1758900] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Online interventions focused on mitigating the negative impact of care on family caregivers of people with dementia have become increasingly popular recently. The aim of this systematic review and meta-analysis was to analyze the effectiveness of these online support programs and to assess whether they do indeed enhance participants' wellbeing. A systematic literature search of 5 scientific databases was performed: PubMed, PsycInfo, CINAHL, Web of Science and Cochrane Library. Online interventions published between January 2014 and July 2018 targeted at informal family caregivers of people with dementia living at home were systemically reviewed. A total of 10 randomized controlled trials (RCTs) or studies with quasi-experimental designs were found. The characteristics of the interventions varied widely, as did their duration and results. In general, the effect size found was medium-small, despite the high methodological quality of the studies. The results reveal that online support interventions are a valid resource for improving caregivers' psychological wellbeing, including depression, anxiety, burden and caregiving competence. The best results were found for multi-component interventions: psychoeducation, training in psychological strategies and skills, professional support and online forums or support groups with other caregivers. The meta-analysis indicated that family caregivers' depression levels were reduced in the intervention group (Hedges' g = -0.21, 95% confidence interval of -0.410 to -0.025; z = -2.216: p = 0.027), although no significant differences were observed between the mean changes found in the intervention and control groups in relation to anxiety, burden or competence.Online interventions targeted at family caregivers can help improve their psychological wellbeing. Nevertheless, more randomized controlled trials are required, with rigorous methodological criteria, in order to provide further evidence of the utility of these interventions which seem to be effective.
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Affiliation(s)
- Igone Etxeberria
- Department of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, University of the Basque Country UPV/EHU, San Sebastián, Guipúzcoa, Spain
| | - Karmele Salaberria
- Department of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, University of the Basque Country UPV/EHU, San Sebastián, Guipúzcoa, Spain
| | - Arantxa Gorostiaga
- Department of Social Psychology and Behavioral Sciences Methods, Faculty of Psychology, University of the Basque Country UPV/EHU, San Sebastián, Guipúzcoa, Spain
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Hawkley L, Zheng B, Hedberg EC, Huisingh-Scheetz M, Waite L. Cognitive limitations in older adults receiving care reduces well-being among spouse caregivers. Psychol Aging 2020; 35:28-40. [PMID: 31985247 PMCID: PMC6989024 DOI: 10.1037/pag0000406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A large number of older adults have physical and/or cognitive challenges and require help to manage everyday activities. Many older adults receive care from a spouse. Over the long term, this has adverse consequences for caregiver health and well-being. Less is known about the outcomes associated with the early transition to becoming a spousal caregiver. Nor is it clear how mild-cognitive decline worsens caregiver outcomes. The present study uses dyadic data from 588 couples in the National Social Life, Health, and Aging Project to compare mental and social well-being in marital partners who became a spousal caregiver versus those who remained noncaregivers or became caregivers for someone other than a spouse between 2010 and 2015. Cognitive ability was assessed using a validated version of the Montreal Cognitive Assessment. Moderated Actor-Partner Independence Models revealed that becoming a caregiver was associated with an increase in perceived stress in both men and women, and an increase in anxiety among men. Partners' cognitive limitations moderated, in a dose-dependent fashion, the association between becoming a caregiver and changes in well-being. Specifically, becoming a caregiver was associated with increased support from friends for wives at lower levels of husband's cognitive ability, and with increased anxiety for husbands at lower levels of wife's cognitive ability. Associations were independent of demographic characteristics and physical limitations. We discuss the value of using population-based samples to study the transition to caregiving and implications for interventions during the early transition to a caregiving role for even modestly cognitively impaired partners. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Louise Hawkley
- Academic Research Centers, National Opinion Research Center (NORC) at the University of Chicago
| | - Boyan Zheng
- Academic Research Centers, National Opinion Research Center (NORC) at the University of Chicago
| | - E C Hedberg
- Academic Research Centers, National Opinion Research Center (NORC) at the University of Chicago
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago
| | - Linda Waite
- Department of Sociology, University of Chicago
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Chiu YC, Liao HC, Li CL, Lin CH, Hsu JL, Lin CY, Hsu WC. The mediating effects of leisure engagement on relationships between caregiving stress and subjective wellbeing among family caregivers of persons with cognitive impairment: A cross-sectional study. Geriatr Nurs 2019; 41:124-131. [PMID: 31699439 DOI: 10.1016/j.gerinurse.2019.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
Family caregivers of persons with cognitive impairment experience changes in reductions in leisure engagement, which can decrease their subjective wellbeing (leisure satisfaction, negative affect and positive affect). We recruited 100 dyads of patients with cognitive impairment and family caregivers by convenience sampling from outpatient memory clinics and daycare centers in northern Taiwan. Hierarchical regression analysis tested the mediating effects of leisure engagement on the relationship between caregiving stress and subjective wellbeing. Results indicated that the restorative experience of event/tourism activities (β = 0.23, p < .05) significantly mediated between caregiving stress and leisure satisfaction. In addition, the only significant mediator between caregiving stress and negative affect was leisure barriers (β = 0.21, p < .05). Both of the regression models explained 27% of the variance. Future development of leisure interventions should focus on reducing leisure barriers and providing event and tourism activities to the dyads. (146 words).
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Affiliation(s)
- Yi-Chen Chiu
- School of Nursing, College of Medicine, Chung Gung University, No. 259, Wen-Hwa 1st Rd., Kwei-Shan, Taoyuan, 33302, Taiwan; Healthy Aging Research Center, Chung Gung University, Taoyuan, Taiwan; Department of Neurology and Dementia Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Hsu-Chun Liao
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chia-Lin Li
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hung Lin
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jung-Lung Hsu
- Department of Neurology and Dementia Center, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | | | - Wen-Chuin Hsu
- Department of Neurology and Dementia Center, Chang Gung Memorial Hospital, Linkou, Taiwan
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Bayly M, Morgan D, Kosteniuk J, Elliot V, Froehlich Chow A, Peacock S, McLean A, O’Connell ME. Protocol for a systematic review on interventions for caregivers of persons with mild cognitive impairment and early dementia: does early stage intervention improve caregiver well-being and ability to provide care? BMJ Open 2019; 9:e028441. [PMID: 31079088 PMCID: PMC6530328 DOI: 10.1136/bmjopen-2018-028441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Caregivers of persons with dementia and mild cognitive impairment (MCI) are at risk of decreased well-being. While many interventions for caregivers exist, evidence is sparse regarding intervention timing and effectiveness at an early stage of cognitive decline. Our systematic review aims to answer the following questions: (1) Do interventions for caregivers of persons with early stage dementia or MCI affect their well-being and ability to provide care? (2) Are particular types of caregiver interventions most effective during early stage cognitive decline? (3) How does effectiveness differ when early and later interventions are directly compared? (4) Do effects of early stage caregiver intervention vary based on care recipient and caregiver characteristics (eg, sex, type of dementia)? METHODS AND ANALYSIS The databases MEDLINE, EMBASE, PSYCINFO and CINAHL, as well as grey literature databases, will be searched for English language studies using search terms related to caregiver interventions and dementia/MCI. Abstracts and full texts will be screened by two independent reviewers; included studies must assess the effects of an intervention for caregivers of persons with early stage dementia or MCI on caregiver well-being or ability to provide care. Intervention, study and participant characteristics will be extracted by two independent reviewers, along with outcome data. Risk of bias will be assessed using the Cochrane risk of bias tool (for controlled trials with and without randomisation). Interventions will be grouped by type (eg, psychoeducational) and a narrative synthesis is planned due to expected heterogeneity, but a meta-analysis will be performed where possible. The Grading of Recommendations, Assessment, Development and Evaluations approach will be used to inform conclusions regarding the quality of evidence for each type of intervention. ETHICS AND DISSEMINATION Findings from this review will be disseminated via conferences and peer-reviewed publication, and a summary will be provided to the Alzheimer Society. PROSPERO REGISTRATION NUMBER CRD42018114960.
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Affiliation(s)
- Melanie Bayly
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Debra Morgan
- Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Julie Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Valerie Elliot
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Amanda Froehlich Chow
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | | | - Allen McLean
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Miller LM, Kaye JA, Lyons KS, Lee CS, Whitlatch CJ, Caserta MS. Well-being in dementia: a cross-sectional dyadic study of the impact of multiple dimensions of strain on persons living with dementia and their family care partners. Int Psychogeriatr 2019; 31:617-626. [PMID: 30722800 PMCID: PMC6579645 DOI: 10.1017/s104161021800203x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTBackground and Purpose:The impact of dementia-related stressors and strains have been examined for their potential to threaten the well-being of either the person with dementia or the family care partner, but rarely have studies considered the dyadic nature of well-being in dementia. The purpose of this study was to examine the dyadic effects of multiple dimensions of strain on the well-being of dementia care dyads. METHODS Using multilevel modeling to account for the inter-relatedness of individual well-being within dementia care dyads, we examined cross-sectional responses collected from 42 dyads comprised of a hospitalized patient diagnosed with a primary progressive dementia (PWD) and their family care partner (CP). Both PWDs and CPs self-reported on their own well-being using measures of quality of life (QOL-Alzheimer's Disease scale) and depressive symptoms (Center for Epidemiological Studies Depression Scale). RESULTS In adjusted models, the PWD's well-being (higher QOL and lower depressive symptoms) was associated with significantly less strain in the dyad's relationship. The CP's well-being was associated with significantly less care-related strain and (for QOL scale) less relationship strain. CONCLUSIONS Understanding the impact of dementia on the well-being of PWDs or CPs may require an assessment of both members of the dementia care dyad in order to gain a complete picture of how dementia-related stressors and strains impact individual well-being. These results underscore the need to assess and manage dementia-related strain as a multi-dimensional construct that may include strain related to the progression of the disease, strain from providing care, and strain on the dyad's relationship quality.
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Affiliation(s)
- Lyndsey M. Miller
- The University of Utah, College of Nursing. 10 South 2000 East, Salt Lake City, Utah 84112, USA
| | - Jeffrey A. Kaye
- Oregon Health & Science University, Department of Neurology, Layton Aging & Alzheimer’s Disease Center, Portland, OR, USA
| | - Karen S. Lyons
- Oregon Health & Science University, School of Nursing, Portland, OR, USA
| | - Christopher S. Lee
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Carol J. Whitlatch
- Benjamin Rose Institute on Aging / Center for Research and Education, Cleveland, OH, USA
| | - Michael S. Caserta
- The University of Utah, College of Nursing & Center on Aging, Salt Lake City, UT, USA
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