Predictive Factors for the Uptake of Coping Strategies by Spousal Dementia Caregivers: A Systematic Review

Video Conferencing Peer Support and Rarer Forms of Dementia: An Exploration of Family Carers' Positive Experiences

Little is known regarding the nuanced experiences of family carers for people living with rare dementias (PLWRD), with no known literature exploring their positive experiences of caring discussed within peer support group settings. This article explores family carers of PLWRD's positive experiences reported in video conferencing peer support groups. Six peer support group sessions involving a total of nine participants were qualitatively analysed using thematic analysis, guided by the conceptual framework of positive aspects of caring (CFPAC) (Carbonneau et al., 2010). Six themes were identified: (1) Protecting, maintaining, enjoying and finding strength in their relationship with the PLWRD; (2) Using tools and resources in response to challenges; (3) Positive impact of interactions and others' responses to the dementia; (4) Overcoming barriers to taking a break while maintaining their wellbeing, (5) Maintaining positive outlooks and showing psychological resilience in adversity; and (6) Attributing meaning to the caring role. This article highlights family carers of PLWRD's positive psychological, physical and social resources, balanced against the challenges of caring and maintaining their wellbeing, and identifies ways of promoting family carers' positive caring experiences and resources within healthcare and supportive settings.

Health literacy and eHealth literacy and their association with other caring concepts among carers of people with dementia: A descriptive correlational study

Health literacy (HL) and eHealth literacy (eHL) can facilitate carers of people with dementia (PwD) to search, find, assess and apply information related to dementia-specific issues from different resources. There is a lack of research with regard to HL and eHL among carers of PwD. The aim of this study is to identify the levels of HL and eHL among carers of PwD in Greece and Cyprus and to search for the associations with other caring concepts. This study followed a descriptive correlational design. In total, 174 primary informal carers of PwD, mostly women, over 45 years old and with more than 12 years of education and 67 secondary carers (family, friends or neighbours) participated in the study. Primary informal carers completed a face-to-face survey on the level of HL and eHL, internet use, dementia-specific internet use, care-giving self-efficacy, coping strategies, care-giving perceptions and social support. Primary informal carers reported a high level of eHL and HL. Carers with higher HL were more likely to report higher score of eHL, care-giving self-efficacy and lower score of problematic/dysfunctional coping. Higher score of eHeals-Carer "information seeking" was related with higher use of emotion-focused strategies. From this study, a positive message was received with regard to the role of HL and eHL in the everyday caring life. Non-for-profit organisations and healthcare professionals could integrate in their practice assessment tools and develop tailored training courses for carers enhancing low level of HL and eHL.

Avoidant coping as mediator of the relationship between rumination and mental health among family caregivers of Chinese breast cancer patients

INTRODUCTION

Family caregivers of cancer patients were often referred to the 'forgotten patients', yet little researches have been conducted on their mental health. Rumination might put family caregivers at risk for psychological distress during the caregiving, such as stress and anxiety. The aim of the present study was to explore the relationship between rumination, stress and anxiety among family caregivers of breast cancer patients in China and examine the mediating role of avoidant coping in this relationship.

METHODS

Face-to-face questionnaire interviews were conducted with a sample of 99 caregivers from the public oncology hospital. They were assessed with stress, anxiety, rumination and avoidant coping by Chinese Perceived Stress Scale, Zung's Self-Rating Anxiety Scale, Ruminative Responses Scale and Coping Strategy Indicator. Structural equation modelling was applied to assess the mediation analysis.

RESULTS

The reporting scores of participants indicated the incidence of anxiety was 17.2%. Rumination could directly predict stress (β = 0.58, p < 0.01) and anxiety (β = 0.46, p < 0.01) and also predict stress and anxiety via the mediator of avoidant coping (stress: β = 0.087, p < 0.01; anxiety: β = 0.109, p < 0.01).

CONCLUSIONS

The important role played by family caregivers in supporting breast cancer patients is well recognised. The findings suggested that rumination and avoidant coping may be two critical risk factors for family caregivers of breast cancer developing stress and anxiety. This study highlights the importance of preventing avoidant coping, which plays a critical role for developing interventions for this vulnerable group.

Preliminary investigation of predictors of distress in informal caregivers of patients with delirium superimposed on dementia

OBJECTIVE

Delirium superimposed on dementia (DSD) is common and associated with adverse outcomes. Current evidence indicates that some patients with dementia may recall delirium with distress for them and their caregivers. The aim of this study is to identify predictors of distress in informal caregivers of older patient with DSD.

METHODS

A total of 33 caregivers of 33 patients with DSD were interviewed 3 days after the resolution of delirium (T0) and at 1-month follow-up (T1) to describe their level of distress related to the delirium episode. A linear regression was used to identify predictors of caregivers' distress at T0 and T1 defined a priori: age, sex, level of education, employment status, delirium subtypes, delirium severity, type and severity of dementia, and the time spent with the patient during the delirium episode.

RESULTS

Caregivers were mostly female (81%), 59 (± 13.0) years old on average. The predictors of distress at T0 were the patient's severity of both dementia and delirium. Moderate dementia was associated with lower distress, whereas higher delirium severity was associated with greater distress. At 1-month follow-up, the predictors of distress were the age of caregiver and time spent in care; the distress level was higher when caregivers were older, and they spent less time with their loved one.

CONCLUSIONS

These preliminary findings underline the importance of providing continuous training and support for the caregivers, especially in coping strategies, in order to improve the care of DSD patients and prevent the caregivers' distress in long time period.

The Role of Mutuality and Coping in a Nurse-Led Cognitive Behavioral Intervention on Depressive Symptoms Among Dementia Caregivers

The current study explored whether mutuality and coping predicted and/or mediated the effect of a nurse-led cognitive behavioral intervention (NLCBI) on depressive symptoms of caregivers of persons with dementia. The intervention group (n = 56) received five monthly in-home nurse-led cognitive behavioral sessions and consultation calls after each session. The control group (n = 56) received five monthly short general conversations with the nurse interventionist. Questionnaires on study variables and demographics were collected at baseline, end of intervention, and 2-month follow up. Improved mutuality (β = -0.75, p = 0.049) and active coping (β = -2.06, p = 0.0001) and decreased passive coping (β = 1.43, p = 0.001) were found to predict the reduction of depressive symptoms among caregivers in the NLCBI. However, none of these variables mediated the interventional effect. Regular mental health nursing interventions are suggested to focus on enhancing mutuality and active coping and decreasing passive coping to maintain caregivers' mental health.

TARGETS

Caregivers of persons with dementia.

INTERVENTION DESCRIPTION

Nurse-led cognitive behavioral sessions and subsequent consultation calls.

MECHANISMS OF ACTION

Impacted caregivers' reappraisals, thus improving their active coping skills and mutuality and decreasing their passive coping, which directly reduced their depressive symptoms.

OUTCOMES

Mutuality, active coping, and passive coping played a predicting, but not mediating, role in the effect of the NLCBI. [Res Gerontol Nurs. 2019; 12(1):44-55.].

Iterating a framework for the prevention of caregiver depression in dementia: a multi-method approach

ABSTRACTBackground:Dementia caregiving is often stressful and depression in family caregivers is not uncommon. As caregiver depression can have significant effects, there is a need for preventive efforts which are consistent with the extensive literature. We sought to consolidate the wide range of evidence (using a multi-method approach) into a simple framework that can guide the prevention of caregiver depression.

METHODS

Using multiple logistic regression, we derived the predictors of caregiver depression from an empirical dataset containing key information and depression scores (based on the Center-for-Epidemiological-Studies-Depression-Scale) of 394 family caregivers. We then chose an underpinning theory as the foundation of the framework, and conducted an umbrella systematic review to find possible links between the derived predictors and the theory. Last, we compared the iterated framework with known interventions for caregiver depression in recent literature to assess whether the framework could map meaningfully with the known interventions.

RESULTS

Significant predictors of caregiver depression included primary caregiver (odds ratio, OR = 1.53), severe dementia (OR = 1.40), and behavioral problems (OR = 3.23), lower education (OR = 1.77), and spousal caregivers (OR = 1.98). The integrated framework derived focuses on four strategic areas: physical-care demands of persons with dementia (PWD), behavioral problems of PWD, caregiving competency, and loss and grief of caregivers. This framework is supported by known interventions for caregiver depression in recent literature.

CONCLUSIONS

By consolidating a broad range of evidence, we iterated a framework to aid the understanding and prevention of caregiver depression in dementia. The framework offers an approach to prevention which is simple, systematic, and reflective of the extensive literature.

Effect of caregiver characteristics on dementia management strategies

Caregiving has an important influence on the prognosis of dementia, particularly regarding the management strategy implemented. Therefore, evaluating which characteristics of caregivers can influence the choice of a particular strategy for managing dementia is needed.

Objective

To evaluate the association between characteristics of caregivers and their management strategies as applied to patients with dementia.

Methods

A cross-sectional study involving 45 professional caregivers from two nursing homes in Porto Alegre, Brazil, was conducted. Age, gender, education, years as a caregiver, income, burden, depressive and anxiety symptoms and dementia management strategies were evaluated for all participants. Pearson's or Spearman's correlation tests were applied according to the variable distribution (parametric or non-parametric). Bivariate correlation analysis was applied. P<0.05 was considered statistically significant.

Results

There was a significant and moderate positive correlation between burden measured by the Zarit Burden Interview and criticism measured by the Dementia Management Strategies Scale (Spearman's rho = 0.555, p < 0.001). No other correlations were observed.

Conclusion

Among the caregiver characteristics that directly affect the approach to managing dementia, high caregiver burden was found to be associated with high criticism, an authoritative way of managing dementia. This exploratory study indicated that a possible way of decreasing negative dementia management is to reduce caregiver burden.