The caregiving role following percutaneous coronary intervention

Protective Role of Caregiver Preparedness on the Relationship Between Depression and Quality of Life in Stroke Dyads

BACKGROUND AND PURPOSE

Depression and quality of life (QOL) have an interdependent and transactional nature in stroke survivor-caregiver dyads. While the strong relationship between depression and physical and emotional QOL in stroke survivor-caregiver dyads is well known, it is less clear if this relationship is moderated by caregiver preparedness, which could easily be targeted with interventions. In this study, we examined the moderating role of caregiver preparedness on the association between depression and QOL in stroke survivor-caregiver dyads.

METHODS

We used a longitudinal design with follow-ups every 3 months over a 1-year period. Considering the nonindependent nature of the data (survivors and their caregivers), we used multilevel modeling to analyze data at the dyad level. We implemented 4 longitudinal dyadic moderation models (one for each QOL domain: physical, psychological, social, and environmental) using hierarchical linear modeling.

RESULTS

A sample of 222 stroke survivor-caregiver dyads was analyzed. Stroke survivors were older (M=70.8, SD=11.9) than their caregivers (M=52.4, SD=13.1). Stroke survivors predominantly had an ischemic stroke, equally distributed by site. Caregivers were primarily female (66%), with a medium to high educational level (57%). Caregiver preparedness significantly moderated the association between survivor depression and survivor psychological (B=0.56, P<0.01) and environmental (B=0.58, P<0.01) QOL at baseline and social QOL over time (B=0.24, P<0.05). Similarly, caregiver preparedness significantly moderated the association between caregiver depression and caregiver physical (B=0.25, P<0.01) and environmental (B=0.18, P<0.05) QOL over time.

CONCLUSIONS

Caregiver preparedness has a positive influence on both members of the dyad. Assessment of stroke-caregiver preparedness could be helpful to motivate clinicians to develop and implement interventions for stroke survivor-caregiver dyads.

Family Caregiver Support of Patient Self-Management During Chronic, Life-Limiting Illness: A Qualitative Metasynthesis

Family caregivers play an integral role in supporting patient self-management, yet how they perform this role is unclear. We conducted a qualitative metasynthesis of family caregivers' processes to support patient self-management of chronic, life-limiting illness and factors affecting their support. Methods included a systematic literature search, quality appraisal of articles, data abstraction, and data synthesis to produce novel themes. Thirty articles met inclusion criteria, representing 935 international family caregivers aged 18 to 89 years caring for patients with various health conditions. Three themes characterized family caregivers' processes to support patient self-management: "Focusing on the Patient's Illness Needs," "Activating Resources to Support Oneself as the Family Caregiver," and "Supporting a Patient Living with a Chronic, Life-Limiting Illness." Factors affecting family caregivers' support included Personal Characteristics, Health Status, Resources, Environmental Characteristics, and the Health Care System. The family caregiver role in supporting patient self-management is multidimensional, encompassing three processes of care and influenced by multiple factors.

'Who Cares?' The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease and coronary artery disease: a mixed methods systematic review

OBJECTIVE

To assess the experiences of unpaid caregivers providing care to people with heart failure (HF) or chronic obstructive pulmonary disease (COPD) or coronary artery disease (CAD). Design Mixed methods systematic review including qualitative and quantitative studies. Data sources Databases searched: Medline Ebsco, PsycInfo, CINAHL Plus with Full Text, Embase, Web of Science, Ethos: The British Library and ProQuest. Grey literature identified using: Global Dissertations and Theses and Applied Sciences Index and hand searches and citation checking of included references. Search time frame: 1 January 1990 to 30 August 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion was limited to English language studies in unpaid adult caregivers (>18 years), providing care for patients with HF, COPD or CAD. Studies that considered caregivers for any other diagnoses and studies undertaken in low-income and middle-income countries were excluded. Quality assessment of included studies was conducted by two authors.

DATA ANALYSIS/SYNTHESIS

A results-based convergent synthesis was conducted.

RESULTS

Searches returned 8026 titles and abstracts. 54 studies-21 qualitative, 32 quantitative and 1 mixed method were included. This totalled 26 453 caregivers who were primarily female (63%), with median age of 62 years. Narrative synthesis yielded six concepts related to caregiver experience: (1) mental health, (2) caregiver role, (3) lifestyle change, (4) support for caregivers, (5) knowledge and (6) relationships. There was a discordance between paradigms regarding emerging concepts. Four concepts emerged from qualitative papers which were not present in quantitative papers: (1) expert by experience, (2) vigilance, (3) shared care and (4) time.

CONCLUSION

Caregiving is life altering and complex with significant health implications. Health professionals should support caregivers who in turn can facilitate the recipient to manage their long-term condition. Further longitudinal research exploring the evolution of caregiver experiences over time of patients with chronic cardiopulmonary conditions is required.

TRIAL REGISTRATION NUMBER

CRD42016053412.

The role of the family in supporting the self-management of chronic conditions: A qualitative systematic review

AIMS AND OBJECTIVES

To explore the contribution of family members in promoting and supporting the self-management of chronic conditions amongst adult family members.

BACKGROUND

The prevalence of chronic disease continues to grow globally. The role of the family in chronic condition management and support for self-management has received little attention.

DESIGN

A systematic review of qualitative literature using the Joanna Briggs Institute approach for qualitative systematic reviews.

METHODS

Ovid (MEDLINE, CINAHL and PsycINFO) were searched for the period of database inception-2016. The QARI (Qualitative Assessment and Review Instrument) critical appraisal instrument was used to assess the quality of each study. Using the Joanna Briggs Institute-QARI data extraction tool, findings related to the family role in the self-management of chronic conditions were extracted and each finding rated according to Joanna Briggs Institute-QARI levels of credibility. Findings were categorised and synthesised to produce a final set of aggregated findings.

RESULTS

Families were key in constructing an environment that was conducive to family engagement and support. Adaptation within the family included maintaining cohesion between family members, normalisation and contextualisation of the chronic condition.

CONCLUSIONS

Whilst evidence on the value of the family in promoting positive health outcomes is clear, research on how families can specifically support the self-management of chronic conditions is emerging.

RELEVANCE TO CLINICAL PRACTICE

Family adaptability has been found to be the most powerful predictor of carer depression. Families may need support to change their home and family organisation to adapt to the challenges they face overtime. Change in roles and subsequent adaptation can be stressful, even for those family members at a distance. Nurses working in hospital and community settings can play an important role in assessing how families are adapting to living with chronic illness and to explore strategies to cope with challenges in the home setting.

Reducing the risk of heart disease among Indian Australians: knowledge, attitudes, and beliefs regarding food practices - a focus group study

BACKGROUND

Australia has a growing number of Asian Indian immigrants. Unfortunately, this population has an increased risk for coronary heart disease (CHD). Dietary adherence is an important strategy in reducing risk for CHD. This study aimed to gain greater understanding of the knowledge, attitudes and beliefs relating to food practices in Asian Indian Australians.

METHODS

Two focus groups with six participants in each were recruited using a convenience sampling technique. Verbatim transcriptions were made and thematic content analysis undertaken.

RESULTS

Four main themes that emerged from the data included: migration as a pervasive factor for diet and health; importance of food in maintaining the social fabric; knowledge and understanding of health and diet; and elements of effective interventions.

DISCUSSION

Diet is a complex constructed factor in how people express themselves individually, in families and communities. There are many interconnected factors influencing diet choice that goes beyond culture and religion to include migration and acculturation.

CONCLUSIONS

Food and associated behaviors are an important aspect of the social fabric. Entrenched and inherent knowledge, attitudes, beliefs and traditions frame individuals' point of reference around food and recommendations for an optimal diet.

Psychometric properties of the Caregiver Preparedness Scale in caregivers of stroke survivors

OBJECTIVE

To evaluate the psychometric characteristics of the Caregiver Preparedness Scale (CPS) in caregivers of stroke survivors.

BACKGROUND

Caregiver preparedness can have an important impact on both the caregiver and the stroke survivor. The validity and reliability of the CPS has not been tested for the stroke-caregiver population.

METHODS

We used a cross-sectional design to study a sample of 156 caregivers of stroke survivors. Construct validity of the CPS was evaluated by confirmatory factor analysis (CFA). Internal consistency and test-retest reliability were also evaluated.

RESULTS

Caregivers were, on average, 54 year old (SD = 13.2) and most were women (64.7%). CFA supported the unidimensionality of the scale (comparative fit index = 0.98). Reliability was also supported: item-reliability index and item-total correlations above 0.30; composite reliability index = 0.93; Cronbach's alpha = 0.94; factor score determinacy = 0.97; and test-retest reliability = 0.92.

CONCLUSION

The CPS is valid and reliable in caregivers of stroke survivors. Scores on this scale may assist health-care providers in identifying caregivers with less preparedness to provide specific interventions.

Effect of gender, caregiver, on cholesterol control and statin use for secondary prevention among hospitalized patients with coronary heart disease

Women with coronary heart disease (CHD) are consistently less likely than men with CHD to be at low-density lipoprotein (LDL) cholesterol goals, and the reasons for the gender gap are not established. We studied 2,190 patients with CHD or equivalent (34% women, 42% racial/ethnic minority) who participated in the Family Cardiac Caregiver Investigation to Evaluate Outcomes (FIT-O) Study and had baseline lipid data to determine whether having a paid or informal caregiver was independently associated with adherence to LDL cholesterol goals (<100, <70 mg/dl) and statin use and to determine if the association varied by gender. Caregiver status was assessed by standardized questionnaire and lipid levels/statin use were obtained from a hospital-based informatics system. Associations between caregiving and LDL cholesterol and statin use were assessed in univariate and multivariable models and the interaction was evaluated in gender stratified models. Men with CHD were more likely to be at LDL cholesterol goals <100 and <70 mg/dl and on statins than women with CHD (79% vs 69%, p <0.001; 48% vs 36%, p <0.001; 73% vs 67%, p = 0.004, respectively). No significant association was observed between LDL cholesterol <100 mg/dl and informal caregiving or between paid caregiving and lipid goals or statin use. Having an informal caregiver was associated with having an LDL cholesterol <70 mg/dl (p = 0.016), which remained significant after adjustment in multivariable models (odds ratio 1.25, 95% confidence interval 1.00 to 1.56). Multivariable association between informal caregiving and LDL cholesterol was significant in men (odds ratio 1.37, 95% confidence interval 1.04 to 1.80) but not women. In conclusion, there was a significant association between informal caregiving and LDL cholesterol control that was limited to men with informal caregivers.