Cardiovascular Disease Incidence and Risk in Family Caregivers of Adults With Chronic Conditions: A Systematic Review

Caring for yourself while you care for someone else: a qualitative study exploring the mental and cardiovascular health behaviours of female carers of stroke survivors

PURPOSE

Female carers of stroke survivors may experience increased risk of developing chronic health issues, such as cardiovascular disease. This study aims to understand: (i) how female carers of stroke survivors manage their mental and cardiovascular health and (ii) the characteristics they would find helpful in an intervention to support their ability to manage their health and wellbeing.

MATERIALS AND METHODS

A qualitative descriptive design was used with data collected via semi-structured interviews and analysed using inductive thematic analysis.

RESULTS

Eighteen female carers of stroke survivors participated in the study. Three key themes were identified: (i) struggling to prioritise own health and wellbeing; (ii) new roles and responsibilities impact on self-care; and (iii) peer-support improves mental health and well-being. Carers described preferences for group interventions to include peer support and have flexible delivery to allow easy access to information. One-to-one sessions with different health professionals may also be useful at times through the caregiving journey.

CONCLUSIONS

These findings suggest that current interventions do not address cardiovascular risk self-management for female carers and provide insight into characteristics of interventions that may increase acceptability and feasibility of interventions to support long-term cardiovascular and mental health-promoting behaviours.

High Intensity Functional Training for People with Parkinson's & Their Care Partners: A Feasibility Study

PURPOSE

Various forms of exercise have proven health benefits for people with Parkinson's (pwPD) yet high intensity functional training (HIFT) has yet to be studied. The purpose of this study was to examine the feasibility, physical and psychosocial impacts of a HIFT program for pwPD and their care partners (CPs).

DESIGN

A single group, pre-post design with assessments before, in the middle (13 weeks), and after the 25-week intervention.

SETTING

Community fitness facility.

PARTICIPANTS

Fourteen pwPD (10 at Hoehn Yahr Stage ≤2, 4 females) and 10 CPs (5 females) were included (mean age = 71.5 (6.1)).

INTERVENTION

A 25-week HIFT program (≤49 exercise sessions, ≤75 min long).

MEASURES

Recruitment, retention, attendance, safety and exercise intensity (measured via session-Rating of Perceived Exertion (RPE)) was assessed in addition to cardiovascular endurance, lower extremity strength, walking speed, balance, exercise self-efficacy, balance confidence, social support for exercise and health-related quality of life.

ANALYSIS

Descriptive data was used to describe feasibility measures. Wilcoxon signed-rank test was used to compare pre- and post-program data. Effect size, r, was calculated.

RESULTS

Recruitment rates were ≥40% for pwPD and CPs and retention rates were 80% for pwPD and 62.5% for CPs. Average session attendance was 71.2% with 15 adverse events reported, including 7 non-injurious falls. Median session-RPE was 5 (IQR = 1) out of 10. PwPD demonstrated significant improvements in cardiovascular endurance, self-selected and fast walking speeds, balance and social support for exercise. CPs demonstrated significant improvements in cardiovascular endurance and lower extremity strength. Exercise self-efficacy, balance confidence and health-related quality of life did not significantly change for pwPD or CPs.

CONCLUSION

High intensity functional training appears feasible for pwPD and their CPs and may lead to health benefits. Healthcare providers should consider HIFT as another option to engage pwPD in community-based exercise.

The relationship of health activation with risk of future cardiovascular disease among rural family caregivers of patients with chronic illnesses

BACKGROUND

Family caregivers are at higher risk for developing cardiovascular disease (CVD) than non-caregivers. This risk is worse for those who live in rural compared to urban areas. Health activation, an indicator of engagement in self-care, is predictive of health outcomes and CVD risk in several populations. However, it is not known whether health activation is associated with CVD risk in rural caregivers of patients with chronic illnesses nor is it clear whether sex moderates any association.

OBJECTIVES

Our aims were to determine (1) whether health activation independently predicts 10-year CVD risk; and (2) whether sex interacts with health activation in the prediction of 10-year CVD risk among rural family caregivers (N = 247) of patients with chronic illnesses.

METHODS

Health activation was measured using the Patient Activation Measure. The predicted 10-year risk of CVD was assessed using the Framingham Risk Score. Data were analyzed using nonlinear regression analysis.

RESULTS

Higher levels of health activation were significantly associated with decreased risk of developing CVD (p < 0.028). There was no interaction of sex with health activation on future CVD risk. However, male caregivers had greater risk of developing CVD in the next 10 years than female caregivers (p < 0.001).

CONCLUSIONS

We demonstrated the importance of health activation to future CVD risk in rural family caregivers of patients with chronic illnesses. We also demonstrated that despite the higher risk of future CVD among male, the degree of association between health activation and CVD risk did not differ by sex.

Nature-based virtual reality intervention to manage stress in family caregivers of allogeneic hematopoietic stem cell transplant recipients: a two-phase pilot study protocol

Millions of family members and/or friends in the U.S. serve as unpaid caregivers for individuals with chronic conditions, such as cancer. Caregiving for someone undergoing an intense allogeneic hematopoietic stem cell transplant (HSCT) is particularly demanding, with accompanying physical and psychological stress. Increased stress and stress-related symptoms could make it difficult for caregivers to fulfill their roles and could negatively impact the health status and quality of life of themselves and the recipients. Virtual reality (VR) is a promising technology increasingly used for treatment and wellness in various medical settings. There is growing evidence that studies have reported the positive effects of the VR intervention in managing and reducing stress among diverse populations in various clinical scenarios; however, no published studies have focused on family caregivers of patients with cancer. The study aims to assess the feasibility and acceptability of a four-week nature-based VR intervention and to examine the effectiveness of the VR intervention on stress in HSCT caregivers. This study comprises two phases. Phase I of the study will be a single-arm pre-post design focused on assessing the feasibility and acceptability of the VR intervention. Phase II of the study will be a prospective randomized controlled group design to examine the effectiveness of the VR intervention on perceived stress. Adults (≥ 18 years) who serve as primary caregivers for a person who will undergo an allogeneic HSCT will be recruited. Fifteen participants will be enrolled for Phase I and 94 participants for Phase II (Active VR arm N=47; Sham VR arm N=47). The nature-based immersive VR program contains 360° high-definition videos of nature scenes along with nature sounds through a head-mounted display (HMD) for 20 minutes every day for four weeks. Primary outcome is perceived stress measured by the Perceived Stress Scale. Secondary/exploratory outcomes are stress-related symptoms (e.g., fatigue, sleep disturbance) and physiological biomarkers (e.g., cortisol, alpha-amylase). The importance and innovativeness of this study consist of using a first-of-its-kind, immersive VR technology to target stress and investigating the health outcomes assessed by validated objective biomarkers as well as self-report measures of the nature-based intervention in the caregiver population.

Clinical trial registration

ClinicalTrials.gov, identifier NCT05909202.

Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan

PURPOSE OF REVIEW

Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women.

RECENT FINDINGS

For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.

Caregiving intensity and duration, cardiovascular disease, and race/ethnicity in family caregivers of persons with dementia

We investigated if caregiving intensity and duration affected cardiovascular disease (CVD) risks and diagnosis and whether the relationship differed by race and ethnicity in family caregivers (FCGs) of persons with dementia. We conducted a secondary analysis of the 2015-2020 CDC Behavioral Risk Factor Surveillance System data using a logistic regression analysis. A total of 6132 dementia FCGs were included. We found that the more time FCGs spent providing care per week (intensity) or over time (duration), the more likely they reported CVD risks and diagnosis. However, the associations between caregiving intensity and CVD risks and diagnosis did not differ by race and ethnicity, nor did the associations between caregiving duration and the outcomes. These findings suggest future studies should be conducted to develop preventive strategies for FCGs' cardiovascular health. Further work is needed to identify the impact of race and ethnicity on the relationship between caregiving conditions and CVD with larger samples of racial and ethnic minorities.

A Biomarker of Stress and Self-reported Caregiving Distress Predict Poor Quality of Life in Family Caregivers of Patients With Heart Failure

BACKGROUND

Family caregivers are at a high risk for low quality of life due to caregiving-related stress. Caregivers' stress is commonly assessed using self-reported measures, which reflect relatively subjective and long-term stress related to caregiving, but objective biological markers of stress are rarely used for caregivers. The purposes of this study were (1) to determine whether caregiver characteristics were associated with stress assessed using a stress biomarker (serum cortisol) and a self-reported caregiving distress measure (Caregiver Burden Inventory) and (2) to determine the predictability of both stress measures for quality of life in caregivers of patients with heart failure.

METHODS

Taiwanese family caregivers (N = 113; mean age, 54.5 years; 70.8% female) of patients with heart failure completed surveys including caregiving distress and quality of life measured by the Caregiver Burden Inventory and the Short Form-36 (physical and psychological well-being subscales), respectively, and provided blood samples for serum cortisol. Independent t tests, correlation, and hierarchical regression were conducted.

RESULTS

Single caregivers had higher serum cortisol levels than married caregivers (P = .002). Men had significantly higher serum cortisol levels than women (P = .010), but men reported lower caregiving distress than women (P = .049). Both serum cortisol (β = -0.32, P = .012) and caregiving distress (β = -0.29, P = .018) were significant predictors of quality of life in the physical well-being scale while controlling for caregivers' characteristics and depressive symptoms. Serum cortisol (β = -0.28, P = .026) and caregiving distress (β = -0.25, P = .027) also predicted quality of life in the psychological well-being scale.

CONCLUSIONS

Serum cortisol and self-reported caregiving distress have similar predictability for quality of life in family caregivers of patients with heart failure. Reducing stress and caregiving distress is critical to improving quality of life in this population.

Psychometric Properties of the Patient Activation Measure in Family Caregivers of Patients With Chronic Illnesses

BACKGROUND

The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own health is family caregivers of patients with chronic illnesses. The psychometric properties of the PAM have not been established in family caregivers.

OBJECTIVES

This study aimed to examine the psychometric properties of the PAM 10-item version (PAM-10) in a sample of family caregivers of patients with chronic illnesses. Our focus was on family caregivers' health activation of their own healthcare needs.

METHODS

We evaluated the internal consistency reliability of the PAM-10 in a sample of 277 family caregivers. Item-total correlations and interitem correlations were used to assess item homogeneity. Construct validity of the PAM-10 was examined using exploratory factor analysis and testing hypotheses on known relationships.

RESULTS

The PAM-10 demonstrated adequate internal consistency. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Construct validity of the instrument was supported. Factor analysis yielded two factors that explained 62.3% of the variance in the model. Lower levels of depressive symptoms were significantly associated with better activation, providing evidence of construct validity. Caregivers with high activation levels were significantly more likely to engage in and adhere to self-care behaviors such as regular exercise, eating a healthy diet, and engaging in stress reduction strategies.

DISCUSSION

This study demonstrated that the PAM-10 is a reliable and valid measure for family caregivers of patients with chronic illnesses to measure caregivers' health activation of their own healthcare needs.

Patterns of health-promoting behaviors and associated factors in family caregivers of people receiving cancer treatment: A latent class profile analysis

OBJECTIVE

Family caregivers tend to neglect their health while prioritizing the needs of their care recipients. Identifying subgroups of caregivers based on the patterns of health-promoting behaviors (HPBs) may help develop tailored interventions for them, yet little is known. The purpose of this study was: (1) to identify latent classes with distinct patterns of HPBs in family caregivers of people with cancer; and (2) to investigate factors associated with the latent class membership.

METHODS

We performed a cross-sectional data analysis using the baseline dataset from a longitudinal survey study that assessed HPBs of family caregivers of individuals who received cancer treatment at a national research hospital (N = 124). Latent class profile analysis was conducted to identify latent classes based on the subdomains of the Health-Promoting Lifestyle Profile II, followed by multinomial logistic regression analysis to investigate factors associated with the latent class membership.

RESULTS

Three latent classes were identified: a high level of HPB (Class 1, 25.8%); a moderate level of HPB (Class 2, 53.2%); and a low level of HPB (Class 3, 21.0%) of HPBs. Controlling for caregiver age and sex, caregiver burden due to lack of family support, perceived stress, self-efficacy and body mass index were factors associated with the latent class membership.

CONCLUSIONS

HPBs of our caregiver sample appeared in relatively stable patterns at different levels. Higher caregiver burden and perceived stress and lower self-efficacy were associated with the lower practice of HPBs overall. Our findings may serve as a reference for screening caregivers who need support and developing person-centered interventions.

Competencia del cuidar y sobrecarga del cuidador de la persona con enfermedad crónica hospitalizada

Objetivo: Describir la competencia del cuidar y su asociación con la sobrecarga del cuidador familiar de la persona con enfermedad crónica. Método: Estudio cuantitativo descriptivo, transversal, muestreo por conveniencia. Se aplicó la ficha de caracterización de la díada, Instrumento CUIDAR y Zarit. 102 cuidadores de personas con enfermedades crónicas en las áreas hospitalarias, que cumplían los criterios de inclusión. Resultados: Predominan las mujeres como cuidadores, nivel de escolaridad bajo, sobrecarga en un 56,8%, alto nivel de competencia para cuidar 68,6%. Relación estadísticamente significativa con la variable sobrecarga y la calificación global de la competencia CUIDAR así como con sus dimensiones: Conocimiento, Unicidad, Anticipación. Conclusión: La competencia de cuidar se asocia con la sobrecarga del cuidador de personas con enfermedad crónica no transmisible. Por lo tanto, Enfermería tiene la responsabilidad de identificar las necesidades del cuidador e intervenirlas para contribuir en la transición hacia el rol de cuidador en el egreso del paciente al hogar. 

Effects of a yoga-based stress reduction intervention on stress, psychological outcomes and cardiometabolic biomarkers in cancer caregivers: A randomized controlled trial

Caregiving stress is a risk factor for cardiometabolic disease. Therefore, integrating cardiometabolic biomarkers into caregiving research provides a more comprehensive assessment of an individual’s health and response to an intervention. The objective of this study was to examine the effects of a yoga-based stress reduction intervention on stress, psychological outcomes, and cardiometabolic biomarkers in cancer caregivers. This prospective randomized controlled trial enrolled family caregivers of adult patients who underwent an allogeneic HSCT at the National Institutes of Health (NIH) Clinical Center. All subjects received usual care education. Participants in the intervention group received an Iyengar yoga intervention self-administered over six weeks using an audio recording file. The primary outcome was perceived stress (measured using the NIH toolbox Perceived Stress). The secondary outcomes were psychological factors (depression and anxiety measured using PROMIS® Depression and Anxiety), and cardiometabolic biomarkers measured by nuclear magnetic resonance spectroscopy. A total of 50 family caregivers (mean [SD] age, 44.9 [15.2] years; 42 [84.0%] women) were randomized, 25 to the intervention group and 25 to the control group. No group differences were noted in stress, depression, and anxiety. Significant interaction effects between group and time were found in large TRL-P (F(1,43) = 10.16, p = 0.003) and LP-IR (F(1,42) = 4.28, p = 0.045). Post-hoc analyses revealed that the levels of large TRL-P (mean difference = 1.68, CI = [0.86, 2.51], p< .001) and LP-IR (mean difference = 5.67, CI = [1.15, 10.18], p = 0.015) significantly increased over time in the control group but while remained stable in the intervention group (mean difference = -0.15, CI = [-0.96, 0.66], p = 0.718; mean difference = -0.81, CI = [-5.22, 3.61], p = 0.714, respectively). Even when perceptions of psychological distress remain unchanged, incorporating gentle yoga poses and breathing exercises may reduce the risk of cardiometabolic disease in caregivers by inhibiting the development of insulin resistance. Standard lipids of cardiometabolic risk do not appear to be robust enough to detect short-term early changes of cardiometabolic risk in caregivers.

Trial registration: ClinicalTrials.gov Identifier: NCT02257853.