Predictors of the health-related quality of life of Chinese people with major neurocognitive disorders and their caregivers: The roles of self-esteem and caregiver's burden

Impact of the cough stimulation system on the care burden and life quality of caregivers of tetraplegics

OBJECTIVES

To determine caregiver burden and quality of life of primary family caregivers of participants with cervical SCI before and after use of the cough stimulation system (CSS).

DESIGN

Prospective assessment at four timepoints via questionnaire responses.

SETTING

Out-patient hospital, United States.

PARTICIPANTS

15 primary family caregivers of participants with cervical SCI completed questionnaires including a respiratory care burden index (n = 15) and a commonly employed caregiver burden inventory (n = 9), before and at the 6-month, 1-year and 2-year timepoints following use of the CSS.

RESULTS

SCI participants had significant clinical improvements in terms of restoration of an effective cough and ability to manage airway secretions with use of the CSS. Restoration of expiratory muscle function with use of the CSS also resulted in less caregivers (CG) stress, greater control of their participants' breathing problems, and improvement in quality of life. Results of the caregiver burden inventory demonstrated marked reductions in caregiver burden in development items, physical health and social relationship. Overall caregiver burden fell from 43.4 ± 13.8 pre-implant to 32.4 ± 7.9 (P = 0.06), 31.7 ± 10.5 (P = 0.05), and 26.5 ± 9.3 (P = 0.01) at the 6-month, 1-year and 2-year timepoints.

CONCLUSION

Use of the CSS by cervical SCI participants results in restoration of an effective cough with significant clinical benefits. While caregiver burden is very high in primary family caregivers, they derive marked improvement in caregiver burden and quality of life with implementation of this device.Trial registration: ClinicalTrials.gov identifier: NCT00116337.Trial registration: ClinicalTrials.gov identifier: NCT01659541.

The Association of Self-esteem With Caregiving Demands, Coping, Burden, and Health Among Caregivers of Breast Cancer Patients: A Structural Equation Modeling Approach

BACKGROUND

We investigated how caregiver self-esteem was associated with caregiving demands, coping, burden, and health.

OBJECTIVE

The aim of this study was to investigate how caregiver self-esteem is associated with caregiving demands, coping, burden, and health.

METHODS

Sixty-one caregivers of breast cancer patients were selected from a study conducted at a cancer clinic in the Southeastern region of the United States. Guided by the revised Stress and Coping Theory, a secondary analysis of cross-sectional data was conducted. We used structural equation modeling to analyze paths between caregiver self-esteem and caregiving demands (ie, hours spent on caregiving), coping, burden, and health.

RESULTS

Caregivers who effectively coped with stressful situations through strategies such as positive thinking, seeking social support, and problem solving were more likely to have higher levels of self-esteem; in turn, higher levels of self-esteem decreased caregiver burden and improved caregiver overall health.

CONCLUSIONS

This study highlights the importance of self-esteem among caregivers of breast cancer patients. Additional research is needed to provide more insight into the influence of coping strategies on caregiver self-esteem, as well as the role of caregiver self-esteem on caregivers' and patients' well-being.

IMPLICATION FOR PRACTICE

Healthcare providers need to consider caregiver self-esteem and other associated caregiver characteristics to identify caregivers at risk of higher perceived levels of burden and poor overall health.

No association of both serum pro-brain-derived neurotrophic factor (proBDNF) and BDNF concentrations with depressive state in community-dwelling elderly people

BACKGROUND

Brain-derived neurotrophic factor (BDNF) is involved in emotional and cognitive function. Low-BDNF levels occur in patients with depression, while proBDNF, a precursor of BDNF with the opposite physiological function, increases in major depression. However, it is unclear whether BDNF and proBDNF are associated with depression in the elderly. The present study aimed to investigate whether serum proBDNF and BDNF are associated with depressive state in community-dwelling elderly people.

METHODS

This was a cross-sectional study conducted in Kurogawa-cho Imari, Saga Prefecture, Japan, in people aged ≥65 years. Depressive state was assessed using the Geriatric Depression Scale-Short Form (Japanese version) (GDS). Of the 274 patients who undertook the GDS, those with a medical history affecting cognitive function were excluded, as were those with Mini-Mental State Examination score ≥ 24 or a Clinical Dementia Rating < 0.5. Further, we used delayed recall of 'logical memory A' from the Wechsler Memory Scale-Revised (LMII-DR) for memory assessment.

RESULTS

The final sample consisted of 155 individuals (mean age 75.4 ± 6.8 years; 55 men, mean age 74.8 ± 5.9 years; 100 women, mean age 76.3 ± 7.1 years). In the GDS, 139 participants showed a normal score (0-4) and 16 showed depressive tendencies or depression (score: ≥ 5). After examining confounders of the GDS, logistic regression using categorical covariates showed a negative significant difference between depressive state and serum BDNF in the low-BDNF group only, with a positive correlation in the trend test. None of the analyses showed any association between GDS and proBDNF levels.

CONCLUSION

ProBDNF and BDNF levels seemed not to be associated with depressive state in community-dwelling elderly people.

Discrepancies Between Community-Dwelling Individuals with Dementia and Their Proxies in Completing the Cornell Scale for Depression in Dementia: A Secondary Data Analysis

Background

Depressive symptoms are common in people with dementia.

Purpose

This study examined the discrepancies in the ratings of depressive symptoms between people with dementia and their family caregivers, and the extent to which these discrepancies varied according to the functional status of people with dementia.

Participants and Methods

This study is a cross-sectional secondary analysis. Twenty-five people living with dementia (“participants”) and their family caregivers (“proxies”) participated as pairs in the study (participant mean age = 71.36, SD = 8.63; proxy mean age = 67.54, SD = 11.46). Data were collected in Victoria, Australia between May 2018 and May 2019. Participants were administered a semi-structured interview comprising the Cornell Scale for Depression in Dementia (CSDD). Proxies independently completed the CSDD and the Functional Activities Questionnaire (FAQ). A paired sample t-test was used to investigate differences in CSDD scores between participants and proxies. Kendall’s tau-b correlation was used to examine the relationship between FAQ scores and discrepancy scores of CSDD. Participants were then classified into either low or high functional impairment. Mann–Whitney U-test was used to examine whether the discrepancy scores of CSDD were similar between these two groups. Intraclass correlation coefficients were calculated to indicate the level of agreement between participants and proxies in each group.

Results

The CSDD scores of participants were significantly lower than proxies. The size of the discrepancy in CSDD scores was positively correlated with FAQ scores. The “high functional impairment” group had larger discrepancy scores and a lower level of agreement than the “low functional impairment” group.

Conclusion

The findings highlighted that relying on proxy CSDD scores may not reflect estimates of depressive symptoms by people with dementia. Hence, both perspectives need to be taken into account, particularly when the level of functional impairment in dementia is advanced.

Is caregiver quality of life predicted by their perceived burden? A cross-sectional study of family caregivers of people with spinal cord injuries

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To identify predictors of quality of life (QoL) among family caregivers of people with spinal cord injuries (SCI), considering caregiver and care recipient characteristics, and to evaluate the predictive value of caregiver burden (CB) on the QoL of family caregivers.

SETTING

Multicenter study in four spinal units across Italy.

METHODS

Secondary analysis of the data obtained during the validation of the Italian version of the Caregiver Burden Inventory in Spinal Cord Injuries (CBI-SCI) questionnaire. In all, 176 family caregivers completed a socio-demographic questionnaire, the Short Form-36, the CBI-SCI, and the Modified Barthel Index. A first linear regression analysis was performed to identify independent predictors of each domain of caregiver QoL. A second linear regression analysis including CBI-SCI was then performed to evaluate the predictive value of CB on caregiver QoL.

RESULTS

Participants reported reduced physical and mental QoL. Significant predictors of lower scores in physical dimensions of QoL were older age and female gender. Contextual factors following SCI, such as economic difficulties and the presence of a formal caregiver, significantly predicted emotional QoL in family caregivers. Identified predictors explained 13-32% of variance. CB was a significant predictor (p < 0.001) when added to all proposed models, increasing the explained variance from 7 to 26%.

CONCLUSION

Neither the clinical characteristics of, nor the relationship with care recipients predicted a worse caregiver QoL, whereas the CB did. The CB was a strong predictor of QoL among family caregivers and should be kept to a minimum to promote caregiver well-being.

Psychological predictors of 'living well' with dementia: findings from the IDEAL study

Objectives: Increasingly, research has explored how psychological resources enable adaptation to illness. However, it is unclear whether psychological resources protect against the potential negative effects on living well with a progressive and life-limiting condition such as dementia. This paper examines the association between psychological resources and the ability to 'live well' with dementia.Method: Data from 1547 people with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort were used. Multivariate linear regression was employed to examine the association between self-reported measures of psychological resources (self-efficacy, optimism and self-esteem) and indices of capability to 'live well' (quality of life, well-being and life satisfaction).Results: All three measures of psychological resources had positive and independent associations with indices of living well and the effect sizes were similar. Effect sizes reduced when accounting for shared variance between psychological resources, showing some overlap in these constructs.Conclusion: Self-efficacy, optimism and self-esteem were each associated with capability to 'live well'. Overlap between these three resources is evident and when combined they may provide greater resilience when dealing with the challenges of living with dementia. Interventions for people with dementia could seek to improve levels of these potentially-modifiable psychological resources.

Effect of Self-Efficacy on Quality of Life in People With Mild Cognitive Impairment and Mild Dementia: The Mediating Roles of Depression and Anxiety

OBJECTIVES

To examine the mediating effects of depression and anxiety in the relationship between self-efficacy and quality of life among people with mild cognitive impairment (MCI) or mild dementia.

METHOD

A total of 196 patients diagnosed with MCI or dementia due to Alzheimer disease completed structured measures of self-efficacy, quality of life, and depressive and anxiety symptoms. We examined direct and mediated effects by fitting structural equation models to data.

RESULTS

Our analyses supported that the effects of self-efficacy on quality of life may be partially mediated by depression and anxiety. Both anxiety and depression had significant mediating effects, with depression showing a stronger effect.

CONCLUSION

These results suggest that increased self-efficacy may have a positive effect on quality of life in people with MCI or dementia-partly by reducing depression and anxiety. These findings may have important practical implications for tailoring therapeutic interventions.

Disability and health-related quality of life are associated with restricted social participation in young adults with juvenile idiopathic arthritis

OBJECTIVES

To describe a cohort of Finnish juvenile idiopathic arthritis (JIA) patients, to recognize those young adults who are at risk of becoming socially restricted by their long-term rheumatic disease, and to assess which areas of self-rated health-related quality of life (HRQoL) are associated with the emergence of restricted social participation.

METHODS

A total of 195 young adults with JIA completed questionnaires addressing demographics, health behaviour, physical activity, functional ability, HRQoL, depressive symptoms, and self-esteem. Patients were classified as having non-restricted social participation if they were engaged in studying, working, maternity leave, or military service, and restricted social participation if they were unemployed or on disability pension.

RESULTS

Of the patients, 162 (83%) were considered as having non-restricted social participation and 33 (16%) restricted social participation. Among patients with restricted social participation, five (15%) were on disability pension and 28 (85%) were unemployed. Patients with restricted social participation participated less in leisure-time non-physical activities (p = 0.033), felt more disturbed during their leisure time (p = 0.010), had lower self-esteem (p = 0.005), and had higher disability scores (p = 0.024). HRQoL scores revealed statistically significant differences between the groups: physical functioning (p = 0.043), social functioning (p = 0.016), and emotional well-being (p = 0.049) were all lower in patients with restricted social participation.

CONCLUSIONS

Socially restricted patients showed a higher degree of disability, and lower levels of physical functioning, self-esteem, emotional well-being, and social functioning. These patients should be recognized earlier and interventions provided to enhance their social participation.

Association of Lower Spiritual Well-Being, Social Support, Self-Esteem, Subjective Well-Being, Optimism and Hope Scores With Mild Cognitive Impairment and Mild Dementia

Introduction: Positive psychology (PP) constructs contribute significantly to a better quality of life for people with various diseases. There are still few studies that have evaluated the evolution of these aspects during the progression of dementia. Objective: To compare the scores for self-esteem, life satisfaction, affect, spirituality, hope, optimism and perceived support network between elderly people with mild cognitive impairment (MCI), mild dementia and moderate dementia and control group. Methods: Cross-sectional study. The sample consisted of 66 healthy controls, 15 elderly people with MCI, 25 with mild dementia and 22 with moderate dementia matched by age, gender, and schooling. The instruments used were: Spirituality Self Rating Scale (SSRS), Rosenberg Self-Esteem Scale, Medical Outcomes Study's Social Support Scale, Life Satisfaction Scale (LSS), Positive and Negative Affect Schedule (PANAS), Revised Life Orientation Test (LOT-R), and Adult Dispositional Hope Scale (ADHS). Results: The scores for spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism, negative affect, and hope differed significantly between the groups (p < 0.05). The individuals with MCI and mild dementia had lower spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism and hope scores, and higher negative affect scores compared with the controls. The scores for PP constructs did not differ between the group of people with moderate dementia and the control group. Conclusion: Dementia was found to impact several PP constructs in the early stages of the disease. For individuals with greater cognitive impairment, anosognosia appears to suppress the disease's impact on these constructs.