Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia: findings from the REACH study

Social Activity Restriction and Psychological Health Among Caregivers of Older Adults With and Without Dementia

OBJECTIVES

We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups.

METHODS

Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers' age, gender, race, education, relationship to care recipient, and self-rated health.

RESULTS

Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting friends and family was associated with higher distress and lower well-being in non-dementia caregivers. Any activity restriction had stronger association with distress for caregivers of older adults with versus without dementia.

DISCUSSION

Findings highlight the need for tailored interventions based on caregivers' perceptions of meaningful social activities and dementia-friendly communities to promote social participation.

Grief in family carers of people living with dementia: A systematic review

OBJECTIVES

Grief research in family carers of people with dementia has increased. We aimed to report the prevalence of pre-death and post-death grief and to synthesize associated factors and the relationship between pre-death factors and post-death grief and services used to manage grief.

DESIGN

(Prospero protocol: CRD42020165071) We systematically reviewed literature from PsycINFO, MEDLINE, CINAHL, and ASSIA until April 2020. Effectiveness of intervention data and studies not written in English were excluded; qualitative studies were additionally excluded during study selection. Study quality was assessed using the Mixed Methods Appraisal Tool. Evidence was narratively summarized.

PARTICIPANTS

Family non-paid carers of somebody with any dementia type.

MEASUREMENTS

Validated measures of pre-death and/or post-death grief.

RESULTS

We included quantitative data from 55 studies (44 rated as high quality). Most included solely spouse or adult child carers. Forty-one studies reported pre-death grief, 12 post-death grief, and 6 service use; eight were longitudinal. 17% met the Prolonged Grief Disorder criteria pre-death (n = 1) and 6-26% (n = 4) of participants met the Complicated Grief criteria post-death. Being a spouse, less educated, caring for somebody with advanced dementia, and greater burden and depression were associated with higher pre-death grief. Lower education level and depression were predictive of higher post-death grief. Pre-death factors found to influence post-death grief were grief and depression. Limited service use evidence was reported.

CONCLUSION

Awareness of characteristics which increase the likelihood of higher grief can help identify those in need of support. Future research should focus on what supports or services are beneficial to grief experiences.

Spirituality and spiritual distress in neurologic illness

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.

Religion, Spirituality, and Coping During the Pandemic: Perspectives of Dementia Caregivers

Religious and spiritual (R/S) practices support individuals during difficult situations. The COVID-19 social distancing restrictions may have limited access to R/S practices for older adults with Alzheimer's disease related dementia (ADRD) and their caregivers, affecting coping and well-being. This qualitative study explored the impact of social distancing on R/S practices and coping in ADRD-caregiver dyads from the perspective of caregivers. Interviews were conducted with 11 family caregivers of older adults with ADRD residing in nursing homes (n = 4) or private homes (n = 7). Caregivers continued individual and started virtual R/S practices which improved their ability to cope. However, organized R/S practices were unavailable for those with ADRD, but they used prayer and read religious texts which noticeably improved their mood. Healthcare professionals' sharing of individual and community R/S resources available for ADRD-caregiver dyads could decrease anxiety and agitation, while improving their ability to cope with increased isolation.

Risk, Resilience, and the Two-Track Model of Dementia Grief Among Spouses of People Living With Cognitive Decline

Pre-death grief in the context of dementia caregiving is a significant risk factor for depression, burden, anxiety, and adjustment difficulties. The Two-Track Model of Dementia Grief (TTM-DG) provides a bifocal perspective addressing the nature of the emotional attachment to a loved one living with cognitive impairment, along with a medico-psychiatric perspective associated with stress, trauma, and change in life. The aims of the present study were to empirically validate the components of the model as to identify salutary and risk factors for maladaptive grief responses. Participants were 62 spouses of people living with cognitive impairment, and a control group of 32 spouses. All completed a battery of self-report questionnaires. Structural Equation Modeling yielded six variables consistent with the TTM-DG: partner's behavioral disorders; caregiver's burden; social support; physical health; attachment anxiety; and dementia grief as an outcome measure. Additional findings addressed participants at risk for grief difficulties. The findings provide empirical support for the utility of the TTM-DG in the identification of risk factors associated with maladaptive responses and pre-death grief following a spousal cognitive decline. The TTM-DG can assist in the formulation of evidence-based evaluations and interventions to assist spouses caring for their loved ones living with dementia.

Predicting depression in dementia caregivers: do religious/spiritual struggles play a role?

OBJECTIVES

Using a stress process framework model, the goal of this study was to address the current gap in our understanding of the prevalence and predictive power of specific types of religious/spiritual struggles for mental health outcomes in informal dementia caregivers.

METHOD

A convenience sample of 156 informal dementia caregivers completed a scale measuring six domains of religious/spiritual struggles, as well as other measures of primary stressors, background/contextual variables, and mental health outcome (depression).

RESULTS

Overall levels of religious/spiritual struggle were low, but 26 percent of the sample were classified as possible cases of clinically significant religious/spiritual struggle for at least one of the six domains. Of this group, 49 percent acknowledged struggles with ultimate meaning. Religious/spiritual struggles predicted greater self-reported depression over and above number of care recipient problem behaviors (primary stressor), caregiver sex, and caregiver personality (i.e. emotional stability). Although no individual domain of religious/spiritual struggle emerged as most salient, caregivers reported significantly more ultimate meaning struggles than demonic or interpersonal struggles.

CONCLUSION

Consistent with the stress process framework model, religious/spiritual struggles appeared to operate as a secondary stressor for informal dementia caregivers, adding predictive power to background/contextual factors and to primary stressors for the measured outcome of self-reported depression. One-fourth of the sample self-reported potentially clinically significant religious/spiritual struggles, with ultimate meaning struggles most commonly reported. Further research in this area may advance efforts to better equip both secular and religious professionals to provide evidence-based counsel to informal dementia caregivers.

The Impact of Caregiving Intensity and Religiosity on Spousal Caregivers' Health and Mortality in the US (2004-2014)

OBJECTIVES

Despite adverse physical and mental health outcomes related to caregiving, family caregivers also experience lower mortality rates compared to noncaregivers. However, research has not yet examined the role of caregiving intensity and religiosity with health and mortality among spousal caregivers.

METHODS

Data include spousal caregivers (n=5,214 person-wave observations) and noncaregivers (n=50,311 person-wave observations) from the Health and Retirement Study (2004-2014 waves). Multinomial logistic regression was used to explore how caregiving intensity and religiosity were associated with health and mortality among spousal caregivers, compared health and mortality between caregivers and noncaregiving peers, and examined gender differences in these mechanisms.

RESULTS

Greater religious salience and attending religious services, although dependent on gender and caregiving intensity, are protective for caregivers' health and mortality.

DISCUSSION

Religiosity may buffer adverse effects of caregiving on health and mortality for spousal caregivers. Continuation of prior religiosity may enhance positive aspects of caregiving and decrease caregiver burden.

Multidimensional Prayer Inventory: Psychometric Properties and Clinical Applications

Prayer is one of the most important aspects of religious/spiritual life. The psychological literature has identified various types of prayer and a few methods for measuring it. The Multidimensional Prayer Inventory (MPI) has received much attention from researchers since it allows for the capture of the most universal forms of prayer, characteristic of the Judeo-Christian tradition: Adoration, Confession, Thanksgiving, Supplication, and Reception. The aim of this article was to examine psychometric properties and clinical applications of the Polish MPI. In four studies, we established the internal structure of the MPI using Principal Component Analysis (PCA, study 1) and Confirmatory Factor Analysis (CFA, study 2), examined its validity and reliability in relation to religiousness (study 3), and analysed its clinical application (study 4). The Polish MPI has been confirmed as a reliable and valid measure of five types of prayer for use in research settings.

The Alter Program: A Nurse-Led, Dementia-Friendly Program for African American Faith Communities and Families Living With Dementia

Dementia is a stigmatizing condition requiring enhanced awareness and understanding. Churches are a trusted source of support for African Americans, a demographic disproportionately affected by dementia. However, many African American churches are not equipped with the knowledge and means to provide safe environments, resources, and spiritual and social support for their parishioners living with dementia and their families. This protocol is written to detail the design and implementation of a nurse-led, dementia-friendly congregation program, Alter. The Alter program was developed to increase dementia awareness, develop a supportive, faith-based dementia-friendly infrastructure, and create a community supporting the well-being of African Americans living with dementia and their families. Engagement in this program aims to improve brain health status of older adults, improve physical and mental health outcomes, reduce dementia stigma, and enhance personal agency. Improved outcomes for persons living with dementia translate into lower use of acute and emergency services due to more stability in community care. It is expected that the churches participating in this program will be recognized by their community as a great resource for dementia information and support. The long-term goal of the Alter program is to be widely adapted in various health systems to reduce health disparities associated with dementia in the African American community.

Religious coping and psychological well-being in Latino Alzheimer's caregivers

OBJECTIVES

Prior research has demonstrated the benefits of religion on caregiver well-being; however, less research exists on the processes underlying this relationship, particularly in Latino Alzheimer's disease (AD) families. This study's aim was therefore to explore the direct and indirect influences of positive religious coping (RC-P) and negative religious coping (RC-N) on caregivers' experiences of depression and anxiety.

METHODS

The data are from the Circulo de Cuidado Study baseline interviews; participant eligibility criteria were that the person identifies as being Latino, providing at least 5 h of care weekly, and their relative has an AD diagnosis and neuropsychiatric symptoms. In person at-home interviews were conducted in Spanish with 67 caregivers. Religious coping was assessed with the Brief RCOPE; depression and anxiety were measured with the Center for Epidemiological Studies Depression Scale-Spanish version and State Anxiety Inventory. Multivariate regression analyses, controlling for caregiving stressors, were used to test our core hypotheses.

RESULTS

As hypothesized, RC-N had significant direct effect on depression (p < 0.001) and anxiety (p < 0.001) as well as partially mediated the relationship between caregiver subjective stressor and depression (p < 0.01) and anxiety (p < 0.01). However, contrary to our hypothesis, RC-P did not have a direct or indirect effects on psychological well-being.

CONCLUSIONS

Our findings are consistent with other studies linking RC-N to poorer caregiver outcomes. Caregivers who questioned God's power, perceived God punishing them, or felt abandoned by God reported greater levels of depression and anxiety. The results suggest that caregivers experiencing religious distress may feel overwhelmed and view a more hopeless future.

Perception of grief responses: Are maladaptive grief responses and the stages of grief considered normal?

Literature indicates laypeople hold strong opinions about how persons should grieve. This study examined how individuals perceive normal grief. Participants across two distinct samples (Study 1: N = 510 via MTurk; Study 2: N = 210 via Qualtrics panels) completed the Perception of Grief Scale and Grief Expectations Questionnaire. Findings indicated participants endorsed maladaptive grief responses as normal relative to other responses to loss. Endorsement of maladaptive grief responses as normal predicted endorsement of grief work beliefs. If social expectations deem maladaptive grief to be normal, as this study suggests, bereaved individuals might implicitly push themselves to grieve maladaptively.

Religious Involvement, Depressive Symptoms, and Burden in Caregivers of Terminally Ill Patients

Caring for terminally ill patients can be emotionally burdensome. Previous research has demonstrated that caregiving is associated with anxiety and depression. Research on caregivers of terminally ill patients is limited by retrospective studies with small samples. This study aimed to (1) describe religiosity, religious coping, and depressive symptoms in caregivers of persons with amyotrophic lateral sclerosis or advanced cancer; (2) examine the relationship between religiosity and depressive symptoms in caregivers of persons with amyotrophic lateral sclerosis or advanced cancer; (3) examine the relationship between religious coping and depressive symptoms in caregivers of persons with amyotrophic lateral sclerosis or advanced cancer. A descriptive exploratory design was used to analyze data from a larger 5-year National Institutes of Health-funded multisite randomized controlled trial (the TAILORED study). Nearly half of the caregivers screened positive for depressive symptoms, and negative religious coping was associated with higher depressive symptoms (P < .001). Spouse caregivers reported higher depressive symptoms than nonspouse caregivers. Many caregivers experienced depression, which was mitigated by positive religious coping.

Geographic distance and social isolation among family care-givers providing care to older adults in Canada

Family care-giving is associated with social isolation, which can lead to adverse health and wellbeing outcomes among family care-givers. The role of geographic distance in care-giver social isolation (CSI) is unclear and has received mixed research findings. Framed by the Ecological Model of Caregiver Isolation, this study examined the relationship between geographic distance and CSI, including the interaction between geographic distance and care-giving intensity for CSI. Linear regression and analysis of covariance were used to test these hypotheses using a sub-set of family care-givers from the 2012 Canadian General Social Survey (N = 2,881). Care-givers living a short distance from receivers reported lower levels of social isolation than co-resident, moderate-distance and long-distance care-givers. Being involved in higher-intensity care-giving as the primary care-giver, undertaking more care-giving tasks and providing care more frequently resulted in higher CSI scores. Long- and moderate-distance care-givers reported greater CSI than co-resident and short-distance care-givers only when providing higher-intensity care-giving. Employing a granulated measure of geographic distance positioned within an ecological framework facilitates an understanding of the nuanced association between geographic proximity and CSI. Furthermore, the identified interaction effects between geographic distance and care-giving intensity on CSI further explicate the complexity of care-giving experiences. The findings are relevant for programmes supporting care-givers in different contexts, especially distance care-givers.

Exploring Beliefs about Aging and Faith: Development of the Judeo-Christian Religious Beliefs and Aging Scale

This paper reports on the development of a novel 10-item scale that measures beliefs about aging as well as religious-based beliefs about aging. The Religious Beliefs and Aging Scale (RBAS) shows acceptable internal consistency (α = 0.74) and is bolstered by a strong correlation (r = 0.70) with the Brief Multidimensional Measure of Religiousness/Spirituality. Exploratory factor analysis elucidated two belief subscales: Afterlife (i.e., how age is experienced in the afterlife; α = 0.897) and Punishment (i.e., aging and dementia as a punishment for sin; α = 0.868). This scale can be used in research regarding end-of-life planning, ageism, and self-care practices.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Psychological interventions to foster resilience in healthcare professionals

BACKGROUND

Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence).

AUTHORS' CONCLUSIONS

For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

The Impact of Spirituality and Religiosity on Mental Health and Quality of Life of Patients with Active Crohn's Disease

We aim to investigate the association among religious/spiritual coping (RSC), quality of life (QOL), and mental health in patients with active Crohn's disease (CD). This cross-sectional study included 102 patients with active CD. Religious and spiritual beliefs were common among patients, being positive RSC higher than negative RSC. Negative coping was associated with mood disorders (depressive or anxiety symptoms) through the Hospital Anxiety and Depression Scale (β = 0.260, p < 0.01) but not with QOL (Inflammatory Bowel Disease Questionnaire) (β = - 0.105, p = NS) after adjustments. Positive coping and other religious/spiritual beliefs and behaviors were not associated with either QOL or mental health. This study suggests that a negative RSC is associated with worse mental health outcomes. This may detrimentally impact adaptations to deal with CD in the active phase, although patients generally tend to use more common positive strategies. These findings may increase the awareness of health professionals while dealing with spiritual beliefs in patients with CD.

Spousal Dementia Caregiving to Widowhood: Perceptions of Older Urban and Rural Widows

Older widows might experience poor health outcomes following their spousal dementia caregiving experience. Widows from rural areas with fewer resources may have worse health outcomes. Serial, qualitative interviews were conducted at baseline, 6-months and 12-months with 13 urban and nine rural older widows who cared for husbands with dementia. Perceptions of caregiving, widowhood, and resources were examined. Major themes were 24/7 Care, Watch the Man Go Down, Build a Network, Spiritual Support, No Regrets/Some Regrets, Time for Me Now, Loneliness, and Keep Reaching In. Compared to urban widows, rural widows had fewer emotional and tangible resources. All widows desired more support during spousal dementia caregiving and in their transition to widowhood. Nurses need to continue to support the transition from spousal dementia caregiving to widowhood and to test interventions unique to meeting the needs of urban and rural older women.

Complicated Grief of Immediate Family Caregivers: A Concept Analysis

Grieving is a normal reaction to loss; however, not everyone is able to recover from grief and adjust to a life after the loss. "Complicated grief" (CG) is a term used to describe intense and prolonged bereavement after the loss of a loved one that interferes with normal activities accompanied by destructive thoughts and behaviors. In practice and research, the concept of CG varies in definition and instruments used to measure. This concept analysis examines relevant research related to CG experienced by caregivers to provide a clear, comprehensive definition. Implications for nursing practice and research are explored.

Depressive mood and its risk factors, and persistent complex bereavement disorder among caregivers who received hospice care: A longitudinal study

This aims of this longitudinal study were to identify the risk factors of and depressive mood in caregivers who received hospice care 6 months after their patients' death, and the cutoff pint of the bereavement risk index, as well as, the prevalence of persistent complex bereavement disorder (PCBD). There were 30.28 and 4.59% of caregivers with depressive mood and PCBD, respectively. The risk factors included resistance to the reality of patients' death, anger, self-blame and guilt, support networks, and coping. The cutoff points of total bereavement risk index and five-item short form were 10/11 and 9/10, respectively.

Caregiver Burden and Desire for Institutional Placement-The Roles of Positive Aspects of Caregiving and Religious Coping

Based on stress coping theory, this study investigated whether and how positive aspects of caregiving (PAC) and religiosity buffered the association between caregiving burden and desire to institutionalize (DTI). Secondary data (N = 637) were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II project. Descriptive analysis, bivariate correlation, and multiple linear regressions were conducted. The results indicated that higher levels of caregiver burden, daily care bother, and Revised Memory and Behavioral Problem Checklist bother were all significantly associated with higher level of DTI. Both PAC and religious coping were negatively associated with DTI; however, only PAC was significant. Only the interaction between daily care bother and religious coping was significant, which indicated that the harmful effect of daily care bother on DTI was significantly buffered among those who have religiosity. Study findings have important implications for policy makers and for providers who serve dementia family caregivers.

Crossing, Trudging and Settling: A phenomenological inquiry into lived experience of Asian family caregivers of older persons with dementia

Throughout Asian societies, family members often adopt the role of caregiving for older persons, providing essential care for loved ones with dementia. To date, there has been limited insight into the lived experience and meaning ascribed to the journey of these caregivers. This descriptive phenomenological study aims to explore the lived experience of Asian family caregivers of persons with dementia. Semi-structured face-to-face interviews were conducted with 16 family members caring for aged persons with dementia. Interviews were audio-recorded and data analysed using Colaizzi's technique. Analysis revealed the essential structure of a caregiver's journey with three major transitions, namely: (1) Crossing the threshold from ordinary world into caregiving world, (2) Trudging on the road of trials and obstacles, and (3) Settling into a new normalcy. Understanding the lived experience of Asian caregivers can help clinicians in targeting relevant support and information, and prepare new caregivers for the demands of their role.

Religiosity and Meditation Practice: Exploring Their Explanatory Power on Psychological Adjustment

There has been increased interest in the relationships between religiosity, meditation practice and well-being, but there is lack of understanding as to how specific religious components and distinct meditation practices could influence different positive and negative psychological adjustment outcomes. The aim of this study was to assess the explanatory power of religious beliefs and the practice of prayer, focused attention (FA), open monitoring (OM), and compassion meditation (CM) on psychological adjustment, taking into consideration a number of practice-related variables such as session length, frequency of practice and lifetime practice. Psychological adjustment was assessed by means of happiness, positive affect, depression, negative affect, and emotional overproduction. A cross-sectional design was used, with a final sample comprising 210 Spanish participants who completed an online assessment protocol. Hierarchical regressions were performed, including age, sex and psychotropic medication use in the first step as possible confounders, with the addition of religious beliefs and the practice of prayer, FA, OM, and CM in the second step. FA session length was related to all psychological adjustment outcomes: happiness (ΔR 2 = 0.09, p = 0.002; β = 0.25, p = 0.001), positive affect (ΔR 2 = 0.09, p = 0.002; β = 0.18, p = 0.014), depression (ΔR2 = 0.07, p = 0.004; β = -0.27, p < 0.001), negative affect (ΔR 2 = 0.08, p = 0.007; β = -0.27, p < 0.001) and emotional overproduction (ΔR 2 = 0.07, p = 0.013; β = -0.23, p = 0.001). CM session length was related to positive affect (β = 0.18, p = 0.011). CM practice frequency was associated with happiness (ΔR 2 = 0.06, p = 0.038; β = 0.16, p = 0.041). Lifetime practice of FA was related to happiness (ΔR 2 = 0.08, p = 0.007; β = 0.21, p = 0.030) and OM to emotional overproduction (ΔR 2 = 0.08, p = 0.037; β = -0.19, p = 0.047). Religious beliefs and prayer seemed to be less relevant than meditation practices such as FA, OM, and CM in explaining psychological adjustment. The distinct meditation practices might be differentially related to distinct psychological adjustment outcomes through different practice-related variables. However, research into other forms of institutional religiosity integrating social aspects of religion is required.

Dementia-friendly faith village worship services to support African American families: Research protocol

African American caregivers for persons living with dementia frequently experience emotional strain, burden, social isolation, and depression. One source of support for them when in distress is their church community. However, many African American churches do not have programs to support families and congregants living with dementia. Dementia often restricts persons living with dementia and their caregivers from attending church. Both become increasingly uncomfortable in church settings due to fear of embarrassment, uncertainty about the behavior of the person living with dementia, and shame. Church attendance and religion has been shown to be beneficial for caregivers and elders living with dementia. However, there is little work exploring how involvement in religious practices together (caregivers and persons living with dementia) might enhance the quality of life for these families. This protocol is written to detail the designing and testing of the feasibility and preliminary efficacy of a dementia-friendly faith village worship service. In the study, we will examine how dementia-friendly faith village worship services support the well-being of caregivers and care recipients in three African American churches through observation, interviews, and surveys. A sample of 30 dyads of African American caregivers and persons living with dementia will be asked to attend six modified worship services together over 6 months. In this study, we hope to demonstrate the significant role of churches in the lives of African American family caregivers and persons living with dementia and show that a faith-based, family-oriented approach can promote a greater quality of life for African American families living with dementia.

The application of palliative care in dementia

INTRODUCTION AND OBJECTIVE

Palliative care can be of great help to people with dementia during their old ages. The aim of this study was to assess the use of palliative care in patients with dementia.

METHODS

Search was conducted in PubMed, ScienceDirect, Google Scholar, and Scopus databases. A step-by-step approach was used to identify relevant studies, and related studies of were demarcated and other studies were excluded. This study has used empirical studies, review studies, and guidelines for health organizations in different countries.

RESULTS

A total of 65 sources were used, of which 24 were completely related to the subject of the study. In related studies, the use of various ways and means of palliative care to improve quality of life, reduce pain, and prevent falling in people with dementia is discussed.

DISCUSSION AND CONCLUSION

Palliative care can help people with dementia to improve their quality of life; however, more research is needed on the application and proper management of palliative care in patients with dementia.

The impact of dementia caregiving on self-care management of caregivers and facilitators: a qualitative study

BACKGROUND

Caregivers of patients with dementia or Alzheimer's disease (AD) face special health challenges due to the progressive nature of the disease. Self-care has crucial importance on individuals' management of life, health, and well-being. However, limited evidence is available on self-care management of dementia and AD caregivers. This study aimed to investigate the influence of caregiving on the self-care management of dementia and AD caregivers based on the caregivers' experience. In addition, the facilitators of caregivers' self-care management were assessed.

METHODS

A sample of 45 caregivers of patients with dementia or AD was recruited from a local community in the south-eastern USA. Semi-structured interviews were conducted. Data were transcribed verbatim and analyzed by the method of cross-case thematic analysis of qualitative data.

RESULTS

As reported by the caregivers, caregiving negatively influenced their self-care management, including physical self-care and mental and social self-care. Both internal and external facilitators were found that can assist caregivers' self-care. Caregivers differ considerably in their demographic characteristics, caregiving tasks, and self needs.

CONCLUSION

Self-care management of dementia and AD caregivers can be largely affected by caregiving. Awareness, motivation, and knowledge of self-care, as well as knowledge of health-care resources, are important prerequisites for caregivers to achieve self-care management. Given the massive differences in caregiving situations, future intervention studies based on the specific needs of individual caregivers are warranted.

Spiritual and Religious Coping of Medical Decision Makers for Hospitalized Older Adult Patients

BACKGROUND

Critically ill adult patients who face medical decisions often delegate others to make important decisions. Those who are authorized to make such decisions are typically family members, friends, or legally authorized representatives, often referred to as surrogates. Making medical decisions on behalf of others produces emotional distress. Spirituality and/or religion provide significant assistance to cope with this distress. We designed this study to assess the role of surrogates' spirituality and religion (S/R) coping resources during and after making medical decisions on behalf of critically ill patients. The study's aim was to understand the role that S/R resources play in coping with the lived experiences and challenges of being a surrogate.

METHODS

Semistructured interviews were conducted with 46 surrogates by trained interviewers. These were audio-recorded and transcribed by research staff. Three investigators conducted a thematic analysis of the transcribed interviews. The codes from inter-rater findings were analyzed, and comparisons were made to ensure consistency.

RESULTS

The majority (67%) of surrogates endorsed belief in God and a personal practice of religion. Five themes emerged in this study. Personal prayer was demonstrated as the most important coping resource among surrogates who were religious. Trusting in God to be in charge or to provide guidance was also commonly expressed. Supportive relationships from family, friends, and coworkers emerged as a coping resource for all surrogates. Religious and nonreligious surrogates endorsed coping strategies such as painting, coloring, silent reflection, music, recreation, and reading. Some surrogates also shared personal experiences that were transformative as they cared for their ill patients.

CONCLUSION

We conclude that surrogates use several S/R and other resources to cope with stress when making decisions for critically ill adult patients. The coping resources identified in this study may guide professional chaplains and other care providers to design a patient-based and outcome-oriented intervention to reduce surrogate stress, improve communication, increase patient and surrogate satisfaction, and increase surrogate integration in patient care. We recommend ensuring that surrogates have S/R resources actively engaged in making medical decisions. Chaplains should be involved before, during, and after medical decision making to assess and address surrogate stress. An interventional research-design project to assess the effect of spiritual care on surrogate coping before, during, and after medical decision making is also recommended.

How religious and spiritual beliefs explain prolonged grief disorder symptoms

This study investigated the importance of religious and spiritual beliefs in daily life in explaining prolonged grief disorder (PGD) symptomatology. Participants were 588 bereaved adults who completed a questionnaire. The importance of spiritual beliefs in daily life explained a small to medium, significant 3% of variance in PGD symptoms, but religious beliefs in daily life did not. Individuals who placed moderate importance on spiritual beliefs in their daily life may experience more intense grief.

Qualitative Analysis of Faith Community Nurse-Led Cognitive-Behavioral and Spiritual Counseling for Dementia Caregivers

This article presents themes emerging from semistructured interviews with dementia family caregivers in rural communities who participated in an integrative, cognitive-behavioral and spiritual counseling intervention, and with faith community nurses (FCNs) who delivered the intervention. The primary objectives of the counseling intervention were to ameliorate dementia caregivers' depressive affect and the severity of their self-identified caregiving and self-care problems. The qualitative portion of the study was intended to elicit caregivers' and FCNs' perceptions of the benefits and drawbacks of the intervention. We conducted interviews with seven FCN/caregiver pairs 4 times during the 6-month counseling process, totaling 56 interviews. Themes emerging from the interviews included caregivers' perception of burden and care partners' problem behavior; formation of therapeutic alliance between FCNs and caregivers; problem-solving skills, tools, and resources; caregivers' use of problem-solving strategies; spirituality in caregiving and counseling processes; FCNs' prior professional experience; and caregiver and FCN time constraints.

The moderating effect of religiosity on caregiving burden and depressive symptoms in caregivers of patients with dementia

OBJECTIVES

This study explored whether religiosity/spirituality has a protective role against negative caregiving outcomes, in a large multicenter nationwide sample of caregivers of patients with dementia in South Korea. Additionally, this study was the first to examine whether religiosity/spirituality could affect caregiving outcomes according to the various religious affiliations of caregivers.

METHODS

The study was conducted on a sample of 476 caregivers of patients with dementia participated in the Clinical Research Center for Dementia of South Korea (CREDOS). We examined the moderating effect of each of the three dimensions of religiosity/spirituality (organizational religious activity, ORA; non-organizational religious activity, NORA; intrinsic religiosity, IR) on the relationship between activities of daily living (ADL) of patients with dementia and caregiving burden and depressive symptoms of caregivers, using a series of hierarchical regression analyses. In addition, these analyses were conducted according to the religious affiliations of the caregivers.

RESULTS

ORA, NORA, and IR of religiosity/spirituality alleviated the effect of ADL of patients on caregiving burden. ORA and IR moderated the relationship between ADL of patients and depressive symptoms of caregivers. These moderating effects of religiosity on caregiving outcomes were different according to various religious groups.

CONCLUSION

We have identified religiosity/spirituality as a protective factor for caregivers of patients with dementia. The sub-dimensions of religiosity as moderators were different by religious affiliations of caregivers. Further studies are needed to investigate the specific religiosity-related factors which could positively impact the mental health of the caregivers of patients with dementia by religions.

The association of personal importance of religion and religious service attendance with suicidal ideation by age group in the National Survey on Drug Use and Health

Religiosity has been shown to be inversely associated with suicidal ideation, but few studies have examined associations by age group. This study aimed to examine the association between religiosity with suicidal ideation by age group. This study used a large nationally representative sample of 260,816 study participants from the National Survey on Drug Use and Health. Religiosity was defined as self-reported importance of religious beliefs and frequency of religious service attendance. The association between religiosity and suicidal ideation was assessed by multivariable logistic regression analysis stratified by age group (18-25, 26-34, 35-49, 50-64, 65 or older). The importance of religious beliefs was inversely associated with suicidal ideation in all age groups. The association was the strongest in people aged 65 or older, followed by people aged 18-25. Religious service attendance was also inversely associated with suicidal ideation in people aged 65 or more when attendance was more than 25 times per year. These findings may be helpful to understand age in relation to the relationship between religiosity and suicidal ideation. Particular attention to religiosity among older adults as a protective factor for suicidal ideation may be helpful in clinical settings.

State of the Science of Spirituality and Palliative Care Research Part II: Screening, Assessment, and Interventions

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part II of the SOS-SPC report addresses the state of extant research and identifies critical research priorities pertaining to the following questions: 1) How do we assess spirituality? 2) How do we intervene on spirituality in palliative care? And 3) How do we train health professionals to address spirituality in palliative care? Findings from this report point to the need for screening and assessment tools that are rigorously developed, clinically relevant, and adapted to a diversity of clinical and cultural settings. Chaplaincy research is needed to form professional spiritual care provision in a variety of settings, and outcomes assessed to ascertain impact on key patient, family, and clinical staff outcomes. Intervention research requires rigorous conceptualization and assessments. Intervention development must be attentive to clinical feasibility, incorporate perspectives and needs of patients, families, and clinicians, and be targeted to diverse populations with spiritual needs. Finally, spiritual care competencies for various clinical care team members should be refined. Reflecting those competencies, training curricula and evaluation tools should be developed, and the impact of education on patient, family, and clinician outcomes should be systematically assessed.

State of the Science of Spirituality and Palliative Care Research Part I: Definitions, Measurement, and Outcomes

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part I of the SOS-SPC two-part series focuses on questions of 1) What is spirituality? 2) What methodological and measurement issues are most salient for research in palliative care? And 3) What is the evidence relating spirituality and health outcomes? After describing current evidence we make recommendations for future research in each of the three areas of focus. Results show wide variance in the ways spirituality is operationalized and the need for definition and conceptual clarity in research in spirituality. Furthermore, the field would benefit from hypothesis-driven outcomes research based on a priori specification of the spiritual dimensions under investigation and their longitudinal relationship with key palliative outcomes, the use of validated measures of predictors and outcomes, and rigorous assessment of potential confounding variables. Finally, results highlight the need for research in more diverse populations.

Religion involvement and quality of life in caregivers of patients with schizophrenia in Latin-America

The aim of the study was to explore the relationship between religious involvement (RI) and quality of life (QoL) in caregivers of patients with schizophrenia, while adjusting for key confounding factors such as socio-demographic and clinical characteristics. This study was conducted in the public mental health services in Bolivia, Peru and Chile. The data collected included RI, socio-demographic information, clinical characteristic of the patients and caregiver's QoL using the S-CGQoL questionnaire. A multivariate analysis using multiple linear regressions was performed to determine variables potentially associated with QoL levels. Two hundred and fifty-three patients with their caregivers participated in the study. Caregivers' RI was not significantly associated with overall QoL nor its individual components. The only exception was an unexpected modest inverse association between RI and one QoL dimension (psychological and physical well-being). In contrast, the following caregivers' socio-cultural and economic factors were significantly associated with low QoL level of caregivers: being a mother, identifying with Aymara ethnicity and having lower family income. Among patients, the clinical characteristics of being woman, younger, and having lower age of onset and more severe symptoms was associated with lower QoL. Our study found that socio-cultural, economic and clinical factors were associated with caregivers' QoL.

Resourcefulness Training for Dementia Caregivers: Establishing Fidelity

Providing care for an elder with dementia can produce extreme stress that adversely affects caregiver health. Learning to be resourceful, which involves practicing resourcefulness skills using a journal or voice recorder, may reduce caregiver stress. However, before testing the effectiveness of journaling and voice recording as resourcefulness training (RT) practice methods, intervention fidelity should first be established. This pilot trial with 63 women dementia caregivers examined the fidelity of journaling and voice recording and whether allowing a choice between the methods affected RT intervention fidelity. Following RT, Resourcefulness Scale scores were similar for journal and recorder methods but higher for caregivers in the choice versus random condition. Patterns of RT skill use documented in journals or recordings were similar for choice and random conditions and for journal and recorder methods. The results support the implementation fidelity of RT that allows caregivers to choose a method to reinforce their resourcefulness skills.

Religious Involvement and Adaptation in Female Family Caregivers

OBJECTIVES

To examine the relationship between religious involvement (RI) and adaptation of women caring for family members with severe physical or neurological disability.

DESIGN

Two-site cross-sectional study.

SETTING

Community.

PARTICIPANTS

A convenience sample of 251 caregivers was recruited. RI and caregiver adaptation (assessed by perceived stress, caregiver burden, and depressive symptoms) were measured using standard scales, along with caregiver characteristics, social support, and health behaviors. Bivariate and multivariate analyses were conducted to identify relationships and mediating and moderating factors.

RESULTS

Religious involvement (RI) was associated with better caregiver adaptation independent of age, race, education, caregiver health, care recipient's health, social support, and health behaviors (B = -0.09, standard error = 0.04, t = -2.08, P = .04). This association was strongest in caregivers aged 58-75 and spouses and for perceived stress in blacks.

CONCLUSION

Religious involvement (RI) in female caregivers is associated with better caregiver adaptation, especially for those who are older, spouses of the care recipients, and blacks. These results are relevant to the development of future interventions that provide support to family caregivers.

Religious Involvement and Telomere Length in Women Family Caregivers

Telomere length (TL) is an indicator of cellular aging associated with longevity and psychosocial stress. We examine here the relationship between religious involvement and TL in 251 stressed female family caregivers recruited into a 2-site study. Religious involvement, perceived stress, caregiver burden, depressive symptoms, and social support were measured and correlated with TL in whole blood leukocytes. Results indicated a U-shaped relationship between religiosity and TL. Those scoring in the lowest 10% on religiosity tended to have the longest telomeres (5743 bp ± 367 vs. 5595 ± 383, p = 0.069). However, among the 90% of caregivers who were at least somewhat religious, religiosity was significantly and positively related to TL after controlling for covariates (B = 1.74, SE = 0.82, p = 0.034). Whereas nonreligious caregivers have relatively long telomeres, we found a positive relationship between religiosity and TL among those who are at least somewhat religious.

Religiosity and quality of life: a dyadic perspective of individuals with dementia and their caregivers

OBJECTIVES

Dyadic coping theory purports the benefit of joint coping strategies within a couple, or dyad, when one dyad member is faced with illness or stress. We examine the effect of religiosity on well-being for individuals with dementia (IWDs). In particular, we look at the effect of both dyad members' religiosity on perceptions of IWDs' quality of life (QoL). Neither of these issues has been extensively explored.

METHOD

One hundred eleven individuals with mild-to-moderate dementia and their family caregivers were interviewed to evaluate IWDs' everyday-care values and preferences, including religious preferences. Using an actor-partner multi-level model to account for the interdependent relationship of dyads, we examined how IWD and caregiver ratings of religiosity (attendance, prayer, and subjective ratings of religiosity) influence perceptions of IWDs' QoL.

RESULTS

After accounting for care-related stress, one's own religiosity is not significantly related to IWDs' or caregivers' perceptions of IWD QoL. However, when modeling both actor and partner effects of religiosity on perceptions of IWDs' QoL, caregivers' religiosity is positively related to IWDs' self-reports of QoL, and IWDs' religiosity is negatively associated with caregivers' perceptions of IWDs' QoL.

CONCLUSION

These findings suggest that religiosity of both the caregiver and the IWD affect perception of the IWD's QoL. It is important that caregivers understand IWDs' values concerning religion as it may serve as a coping mechanism for dealing with dementia.

Depressed Affect and Dimensions of Religiosity in Family Caregivers of Individuals with Dementia

Religiosity and mood have long been recognized as associated, but some patterns of associations suggest complex relationships. Using a multidimensional measure of religiosity, we explored the possibility that dimensions of religiosity may have (1) different strengths of association and (2) directions of association with depressed mood. We measured five dimensions of religiosity in 1227 family caregivers of persons with dementia, testing associations of each dimension to caregivers' depressive symptoms. In zero-order associations, higher scores on each religiosity dimension were associated with lower depression. Yet in hierarchical multiple regressions models, adjusting for other religiosity dimensions, different dimensions showed either no independent association, an independent association, or an inverse association with depressed mood. Frequency of prayer reversed directions of association-showing higher depression in caregivers who prayed more. Findings underscore the complex and sometimes bidirectional association between depressed mood and religiosity and argue for recognition of distinct dimensions of religiosity.

Cancer family caregiver depression: are religion-related variables important?

OBJECTIVE

Prevalence estimates for clinical depression among cancer family caregivers (CFC) range upwards to 39%. Research inconsistently reports risk for CFC depressive symptoms when evaluating age, gender, ethnicity, or length of time as caregiver. The discrepant findings, coupled with emerging literature indicating religiosity may mitigate depression in some populations, led us to investigate religion-related variables to help predict CFC depressive symptoms.

METHODS

We conducted a cross-sectional study of 150 CFC. Explanatory variables included age, gender, spousal status, length of time as caregiver, attendance at religious services, and prayer. The outcome variable was the Center for Epidemiological Studies Depression Scale score.

RESULTS

Compared with large national and state datasets, our sample has lower representation of individuals with no religious affiliation (10.7% vs. 16.1% national, p = 0.07 and 23.0% state, p = 0.001), higher rate of attendance at religious services (81.3% vs. 67.2% national, p < 0.001 and 30.0% state, p < 0.001), and higher rate of prayer (65.3% vs. 42.9% national, p < 0.001; no state data available). In unadjusted and adjusted models, prayer is not significantly associated with caregiver depressive symptoms or clinically significant depressive symptomology. Attendance at religious services is associated with depressive symptoms (p = 0.004) with an inversely linear trend (p = 0.002).

CONCLUSION

The significant inverse association between attendance at religious services and depressive symptoms, despite no association between prayer and depressive symptoms, indicates that social or other factors may accompany attendance at religious services and contribute to the association. Clinicians can consider supporting a CFC's attendance at religious services as a potential preventive measure for depressive symptoms.

An Exploratory Study of Grief and Health-Related Quality of Life for Caregivers of People With Dementia

The aim of this qualitative study was to explore key positive and negative factors that impact on grief resolution and health outcomes of caregivers who were caring, or had cared, for a family member with dementia who had died. The study was a scoping study and involved face-to-face interviews with these family caregivers (N = 13). Results indicated a complex interaction of issues (many unique to dementia caregiving) which in different combinations acted as protective or risk factors for caregiver outcomes. Interaction of individual characteristics, role appraisal, value of intrinsic and extrinsic resources, and experiences with health professionals during the caregiving period and around the death of their relative were shown to have the most influence on caregiver outcomes. Psychological resilience and satisfaction with caregiving were protective against negative outcomes while unresolved grief was a risk factor. These findings highlight the potential benefits of multicomponent, holistic dementia caregiver interventions.

Do trust-based beliefs mediate the associations of frequency of private prayer with mental health? A cross-sectional study

Significant associations of private prayer with mental health have been found, while mechanisms underlying these associations are largely unknown. This cross-sectional online study (N = 325, age 35.74, SD 18.50, 77.5 % females) used path modeling to test if trust-based beliefs (whether, when, and how prayers are answered) mediated the associations of prayer frequency with the Anxiety, Confusion, and Depression Profile of Mood States-Short Form scales. The association of prayer and depression was fully mediated by trust-based beliefs; associations with anxiety and confusion were partially mediated. Further, the interaction of prayer frequency by stress was associated with anxiety.

Exploring spirituality in family caregivers of patients with primary malignant brain tumors across the disease trajectory

PURPOSE/OBJECTIVES

To determine whether the perceived level of spirituality in family caregivers of patients with primary malignant brain tumors (PMBTs) changes across the disease trajectory.

DESIGN

Ongoing descriptive, longitudinal study.

SETTING

Southwestern Pennsylvania.

SAMPLE

50 family caregivers of patients with PMBT.

METHODS

Caregivers and care recipients were recruited at time of diagnosis. Participants were interviewed at two subsequent time points, four and eight months following diagnosis.

MAIN RESEARCH VARIABLES

Care recipients' symptoms, neuropsychologic status, and physical function, as well as caregiver social support.

FINDINGS

Results showed no significant difference in spirituality scores reported at baseline and eight months (p = 0.8), suggesting that spirituality may be a stable trait across the disease trajectory.

CONCLUSIONS

Spirituality remains relatively stable along the course of the disease trajectory. Reports of caregiver depressive symptoms and anxiety were lower when paired with higher reports of spirituality.

IMPLICATIONS FOR NURSING

Clinicians can better identify caregivers at risk for negative outcomes by identifying those who report lower levels of spirituality. Future interventions should focus on the development and implementation of interventions that provide protective buffers such as increased social support.

KNOWLEDGE TRANSLATION

Spirituality is a relatively stable trait. High levels of spirituality can serve as a protective buffer from negative mental health outcomes. Caregivers with low levels of spirituality may be at risk for greater levels of burden, anxiety, and stress.

Religious Coping in Caregivers of Family Members With Dementia

The degree of depression experienced by caregivers of individuals with dementia was examined in relation to religious coping strategies, religious practice, and spirituality in the framework of the stress and coping model. Caregivers of 191 persons with dementia completed the Religious Coping Scale, self-report measures of religious practices and spirituality, burden, and depression. There was no evidence that any religious coping strategy or religious practice moderated the relationship between caregiving stress and depression. Certain types of religious coping strategies had a direct effect on depression. Higher levels of religious coping working with God were associated with decreased depression, whereas higher levels of religious coping working through God were associated with increased depression. Higher burden, lower overall caregiver health rating, and worse reactions to memory and behavior problems were associated with higher levels of depression. Frequency of prayer and the importance of spirituality were weakly associated with lower levels of depression.

Improving quality-of-life outcomes for patients with cancer through mediating effects of depressive symptoms and functional status: a three-path mediation model

AIMS AND OBJECTIVES

To test a hypothetical three-path mediation model evaluating the effects of functional status and depressive symptoms on the relationship between fatigue and quality of life in patients with cancer on the basis of the Theory of Unpleasant Symptoms.

BACKGROUND

Patients with cancer often experience two or more concurrent, interrelated, mutually influential symptoms. Multiple unpleasant symptoms that have been proposed as mediating variables affecting quality of life in a model proposed in recent cancer studies are scanty.

DESIGN

This study was a cross-sectional, descriptive, correlational design.

METHODS

Three hundred and twenty-six patients with cancer from oncology clinics were recruited in Taiwan between 2010-2011. Mediation models were tested and confirmed by applying structural modelling using Analysis of Moment Structures and the joint significance test.

RESULTS

Fatigue affects patient quality of life directly or indirectly through functional status and depressive symptoms. These two mediating variables exhibited direct effects on quality of life. A path analysis approach revealed that 47·28 and 67·70% of the total effects of functional status and depressive symptoms, respectively, on the quality-of-life mediation models are attributable to 29·6 and 44·7% of the total effects between fatigue and quality of life, which mediated through two mediators, respectively.

CONCLUSION

Quality of life may be enhanced by simultaneously improving physiological and psychological factors.

RELEVANCE TO CLINICAL PRACTICE

An understanding of mediating effects is valuable in nursing care of patients with cancer, particularly in the early phase of treatment or in newly diagnosed stages I-III or recently treated patients with cancer in different disease stages.

Mental disorders, religion and spirituality 1990 to 2010: a systematic evidence-based review

Religion/spirituality has been increasingly examined in medical research during the past two decades. Despite the increasing number of published studies, a systematic evidence-based review of the available data in the field of psychiatry has not been done during the last 20 years. The literature was searched using PubMed (1990-2010). We examined original research on religion, religiosity, spirituality, and related terms published in the top 25 % of psychiatry and neurology journals according to the ISI journals citation index 2010. Most studies focused on religion or religiosity and only 7 % involved interventions. Among the 43 publications that met these criteria, thirty-one (72.1 %) found a relationship between level of religious/spiritual involvement and less mental disorder (positive), eight (18.6 %) found mixed results (positive and negative), and two (4.7 %) reported more mental disorder (negative). All studies on dementia, suicide, and stress-related disorders found a positive association, as well as 79 and 67 % of the papers on depression and substance abuse, respectively. In contrast, findings from the few studies in schizophrenia were mixed, and in bipolar disorder, indicated no association or a negative one. There is good evidence that religious involvement is correlated with better mental health in the areas of depression, substance abuse, and suicide; some evidence in stress-related disorders and dementia; insufficient evidence in bipolar disorder and schizophrenia, and no data in many other mental disorders.

The relationship of religious involvement indicators and social support to current and past suicidality among depressed older adults

Elderly people, particularly those with major depression, are at the highest risk for suicide than any other age group. Religious involvement is associated with a range of health outcomes including lower odds of death by suicide. However, not much is known about the effects of religious involvement on suicidal ideation in the elderly or which aspects of religiosity are beneficial. This study examined the relative influence of various conceptualizations of religious involvement, above and beyond the protective effects of social support, on current and past suicidality among depressed older adults. Participants were 248 depressed patients, 59 years and older, enrolled in the Neurocognitive Outcomes of Depression in the Elderly study. A psychiatrist assessed current suicidal ideation using the suicidal thoughts item from the Montgomery-Asberg Depression Rating Scale. Past history of suicide attempts, four religious involvement indicators, social support indicators, and control variables were assessed via self-report. Church attendance, above and beyond importance of religion, private religious practices, and social support, was associated with less suicidal ideation; perceived social support partially mediated this relationship. Current religious practices were not predictive of retrospective reports of past suicide attempts. Church attendance, rather than other religious involvement indicators, has the strongest relationship to current suicidal ideation. Clinicians should consider public religious activity patterns and perceived social support when assessing for other known risk and protective factors for suicide and in developing treatment plans.