Financial Strain, Employment, and Role Captivity and Overload Over Time Among Dementia Family Caregivers

The change of intimate relationship between people with Alzheimer's disease and their adult child caregivers: An interpretative phenomenological analysis

This study aims to explore the change of intimate relationship between people with Alzheimer's disease and their adult child caregivers as the disease progresses. Twelve adult child caregivers were recruited through purposive sampling. Explanatory phenomenological analysis was conducted to analyse data collected by semi-structured in-depth interviews. This study found a dynamically changing relationship between adult child caregivers and their parents with Alzheimer's disease during care giving that evolved with the progress of the disease. The relationship was the most intimate in the middle stage of the disease for most caregivers and a new reciprocal relationship developed due to caregiving. Caregivers experienced different degrees of self-growth when providing care, though caregiver burdens were common. The positive experience and perception of caregivers were important for improving the quality of life for adult child caregivers of people with Alzheimer's disease.

Backbone of Care: Lived Experiences of Family Caregivers of Stroke Survivors in Guadalupe, Cebu City

This study explored the lived experiences of five family caregivers of stroke survivors in a village in Cebu City, Philippines. Data was gathered through individual in-depth interviews and underwent interpretative phenomenological analysis. Three themes emerged: (1) Altruism of caregiving: Of self and family, (2) Victories in caregiving, and (3) Burdens of caregiving. Themes illustrated the duality of roles, overcoming difficulties of caregiving, and sources of motivation in caregiving. Findings indicate that a need for collaborative efforts and active involvement between the communities and occupational therapy with the healthcare system to provide programs and support to family caregivers.

Perceived neighborhood disorder, social cohesion, and depressive symptoms in spousal caregivers

OBJECTIVES

Prior research into the factors linked to mental health of caregivers of older adults have largely focused on individual- or household-level characteristics, but neighborhood supports and stressors may also matter for caregiver mental health. The current study fills this knowledge gap by examining the association of neighborhood social cohesion and disorder and depressive symptoms among spousal caregivers.

METHOD

We used data from the 2006 to 2016 waves of the Health and Retirement Study, which include 2,322 spousal caregivers. Negative binomial regression models were estimated to examine the association of perceived neighborhood social cohesion and disorder with depressive symptoms.

RESULTS

A higher level of perceived neighborhood social cohesion was associated with fewer depressive symptoms (b = -0.06, 95% CI: -0.10, -0.02). On the other hand, greater perceived neighborhood disorder was associated with more symptoms (b = 0.04, 95% CI: 0.01, 0.08). The association of perceived social cohesion with depressive symptoms remained even after controlling for perceived disorder, but neighborhood disorder was no longer associated with depressive symptoms after accounting for reported neighborhood social cohesion.

CONCLUSIONS

This study suggests neighborhood supports and stressors matter for caregiver well-being. Neighborhood-based social support may be particularly important for caregivers as they navigate the challenges caregiving for an aging spouse can bring. Future studies should determine if enhancing positive characteristics of the neighborhood promotes well-being of spousal caregivers.

Dementia Simulation for Family Caregivers of Persons With Dementia: A Scoping Review

BACKGROUND

Alzheimer's disease and related dementias are becoming increasingly prevalent worldwide. Persons with dementia receive substantial assistance from family caregivers over extended periods of time. Family caregivers of persons with dementia are twice as likely to report physical, emotional, and financial challenges related to caregiving compared with other types of family caregivers. Empathy has been demonstrated to improve caregivers' quality of life and their relationships with care recipients.

OBJECTIVE

This scoping review examines the current literature on the effects of dementia simulation on empathy levels in family caregivers of persons with dementia.

METHODS

A librarian-assisted search of 4 databases-PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, and Scopus-was conducted. Key terms included "dementia," "family caregivers," and "simulation." To broaden reference retrieval, "empathy" was not used as a key term but remained an inclusion criterion during reference screening. Data extraction of relevant references was completed.

RESULTS

The search yielded 212 citations. Seven eligible dementia simulation studies were identified, including 1 randomized controlled trial, 3 quasi-experimental studies, and 3 qualitative research studies. Only 3 of the 7 studies focused specifically on family caregivers of persons with dementia.

CONCLUSIONS

Qualitative data supported increased empathy in family caregivers, but quantitative findings on changes in empathy levels were inconclusive. Further research using quantitative or mixed-methods designs is necessary to support benefits of simulation on empathy for family caregivers of persons with dementia.

The Economic Burden of Adults with Major Depressive Disorder in the United States (2019)

INTRODUCTION

Previous societal burden estimations for major depressive disorder (MDD) often fail to account for several hidden cost components. This study provides a comprehensive evaluation of societal costs for adults with MDD in the United States (USA) in 2019. The potential impact of a more effective, rapid-acting MDD therapy vs standard of care on the economic burden of MDD was estimated to illustrate the utility of such a framework in evaluating new interventions.

METHODS

This study used a prevalence-based human capital approach. Incremental costs (2019 US dollars) per individual with MDD were derived from national survey inputs and published literature and included incremental healthcare costs and indirect costs. For each cost component, the societal costs were extrapolated by multiplying the per-patient costs by the number of individuals with MDD. The impact of a more effective, rapid-acting novel therapy on the economic burden of MDD was then simulated on the basis of these inputs.

RESULTS

In 2019, the number of adults with MDD in the USA was estimated at 19.8 million (62.7% female; 32.9% severe MDD), and the incremental societal economic burden of MDD was estimated at $333.7 billion ($382.4 billion in 2023 US dollars), or $16,854 per adult with MDD. The primary cost drivers were healthcare costs ($127.3 billion; 38.1%), household-related costs ($80.1 billion; 24.0%), presenteeism ($43.3 billion; 13.0%), and absenteeism ($38.4 billion; 11.5%). In the simulated scenario, a hypothetical novel therapy with a 50.0% early response rate was associated with a 7.7% reduction in the economic burden of MDD relative to standard of care over 12 months.

CONCLUSIONS

The economic burden of MDD is substantial and extends beyond healthcare costs, underscoring the impact of MDD across multiple aspects of life. Such a broad societal perspective should be considered in assessing the impact of the advent of effective, rapid-acting MDD therapies.

Validation of a Measure of Role Overload and Gains for End-of-Life Dementia Caregivers

OBJECTIVES

Caregiving stress process models suggest that heterogeneous contexts differentially contribute to caregivers' experiences of role overload and gains. End-of-life (EOL) caregivers, especially EOL dementia caregivers, facing unique challenges and care tasks, may experience role overload and gains in different ways than other caregivers. This study evaluates measurement invariance of role overload and gains between EOL caregivers and non-EOL caregivers and between EOL dementia and EOL non-dementia caregivers.

METHODS

We utilized role gains and overload data from 1,859 family caregivers who participated in Round 7 of the National Study of Caregiving. We ran confirmatory factor analyses to investigate the factorial structure across all caregivers and then examined the structure's configural, metric, and scalar invariance between (a) EOL caregivers and non-EOL caregivers and (b) EOL dementia and EOL non-dementia caregivers.

RESULTS

Across the entire sample, the two-factor overload and gains model had good fit (χ 2(19) = 121.37, p < .0001; RMSEA = .053, 90% CI = [.044, .062]; CFI = .954; TLI = .932). Tests of invariance comparing EOL caregivers to non-EOL caregivers and EOL dementia caregivers to EOL non-dementia caregivers maintained configural, metric, and partial scalar invariance. Latent mean comparisons revealed that EOL caregivers had higher role overload (p = .0002), but no different role gains (p = .45), than non-EOL caregivers. Likewise, EOL dementia caregivers had higher role overload (p = .05), but no different role gains (p = .42), than EOL non-dementia caregivers.

DISCUSSION

Results offer both a deeper theoretical understanding of end-of-life dementia caregivers' experiences of role overload and gains, and a practical tool to measure those experiences.

Caregiver Burden of Spinal Muscular Atrophy: A Systematic Review

OBJECTIVE

The objective of our study was to review, synthesize, and grade published evidence of caregiver burden of spinal muscular atrophy (SMA), a rare autosomal-recessive neuromuscular disease.

METHODS

We searched Embase and PubMed for full-text articles published from inception up until 28 February, 2022, reporting results from studies of caregiver burden (i.e., negative aspects of providing informal care) in SMA. Two investigators independently screened article titles and abstracts for eligibility, reviewed full-text versions of selected records, extracted the data, and assessed risk of bias using the Newcastle-Ottawa Scale. The evidence was synthesized to answer the following questions: (1) In which geographical settings have the caregiver burden of SMA been studied? (2) What aspects of the caregiver burden of SMA have been investigated? (3) What instruments have been used to measure the caregiver burden of SMA? (4) What is known of the caregiver burden of SMA? (5) How is the caregiver burden of SMA impacted by available disease-modifying drugs?

RESULTS

We identified 15 publications, covering samples from a total of ten countries (i.e., Australia, Canada, China, France, Germany, Romania, Spain, Turkey, the UK, and the USA), reporting estimates of caregiver burden derived using data recorded via surveys or interviews. The most common instruments used to measure caregiver burden were the Zarit Caregiver Burden Interview, the EQ-5D-5L, and the PedsQL Family Impact Model. Caregiving in SMA was found to be associated with reduced health-related quality of life, impaired family function, depression and anxiety, strain, and stress, as well as a substantial impact on work life and productivity. Evidence of the impact of disease-modifying drugs on caregiver burden in SMA was scarce.

CONCLUSIONS

Caregivers to patients with SMA were found to be subject to a significant burden, including impaired health-related quality of life, reduced work ability and productivity, and financial stress, and many devote a substantial proportion of their time to provide informal care. Yet, the current body of literature is relatively scarce and more research is needed to better understand the clinical implications of informal caregiving in SMA and the relationship between caregiver burden and SMA types, as well as the impact of new disease-modifying treatments. Our synthesis will be helpful in informing clinical and social support programs (e.g., the routine screening of depression among caregivers, as well as financial support schemes to help manage the long-term day-to-day care) directed towards families caring for patients with SMA.

Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia

Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.

Validation of depression determinants in caregivers of dementia patients with machine learning algorithms and statistical model

Introduction

Due to its increasing prevalence, dementia is currently one of the most extensively studied health issues. Although it represents a comparatively less-addressed issue, the caregiving burden for dementia patients is likewise receiving attention.

Methods

To identify determinants of depression in dementia caregivers, using Community Health Survey (CHS) data collected by the Korea Disease Control and Prevention Agency (KDCA). By setting "dementia caregiver's status of residence with patient" as a standard variable, we selected corresponding CHS data from 2011 to 2019. After refining the data, we split dementia caregiver and general population groups among the dataset (n = 15,708; common variables = 34). We then applied three machine learning algorithms: Extreme Gradient Boosting (XGBoost), Logistic Regression (LR), and Support Vector Classifier (SVC). Subsequently, we selected XGBoost, as it exhibited superior performance to the other algorithms. On the feature importance of XGBoost, we performed a multivariate hierarchical regression analysis to validate the depression causes experienced in each group. We validated the results of the statistical model analysis by performing Welch's t-test on the main determinants exhibited within each group.

Results

By verifying the results from machine learning via statistical model analysis, we found "sex" to highly impact depression in dementia caregivers, whereas "status of economic activities" is significantly associated with depression in the general population.

Discussion

The evident difference in causes of depression between the two groups may serve as a basis for policy development to improve the mental health of dementia caregivers.

Caring for a Relative with Dementia: Determinants and Gender Differences of Caregiver Burden in the Rural Setting

Dementia is a progressive disease that puts substantial strain on caregivers. Many persons with dementia (PwDs) receive care from a relative. Since male and female caregivers experience different issues related to stress, it is important to meet their different needs to prevent the early nursing home placement of PwDs. This study investigated the multifactorial aspects of caregiver burden and explored gender differences in caregiver burden in a rural setting. This was a cross sectional study that administered anonymous questionnaires to family caregivers of PwDs. Caregiver burden was assessed using the Burden Scale for Family Caregivers-short version. A path model was used to determine the multivariate associations between the variables. To reflect the multifaceted aspects of caregiver burden, we used Pearlin's model with its four dimensions. A total of 113 family caregivers responded to our survey. The overall burden of caregivers was moderate. According to the path model, gender differences were predictors of caregiver burden. The behaviour of the person with dementia and cohabitation had direct effects on caregiver burden. Our results suggest that the experiences of men and women caring for a PwD are different and highlight the need for tailored support in dementia care.

Caregivers' Use of Personal and Social Resourcefulness: Differences by Care Recipient Condition

Although family caregivers who use both the personal and social resourcefulness skills have the best health outcomes, it is unknown whether their tendency toward personal or social resourcefulness varies by their care recipient's condition. This cross-sectional study of existing data from 234 caregivers of persons with various conditions examined five item pairs from the Resourcefulness Scale^© with responses capturing personal and social resourcefulness in relation to anxiety, anger, sadness, indecision, and financial distress. Caregivers were categorized by the recipient's condition (amyotrophic lateral sclerosis, cancer, dementia, mental illness, Parkinson's disease, stroke, traumatic brain injury, other, or multiple conditions). Findings showed that across most groups, caregivers used both personal and social resourcefulness when angry, sad, or indecisive and personal resourcefulness when anxious or managing money. Caregivers of persons with cancer, traumatic brain injury, stroke, and mental illness differed. The findings provide a basis for future clinical trials across diverse caregiver groups.