Anxiety and depression in community-dwelling, Italian Alzheimer's disease caregivers

Resilience-enhancing interventions for family caregivers: A systematic review

OBJECTIVES

To synthesize interventions designed to enhance resilience in family caregivers (FCs).

METHODS

Electronic databases including PubMed, CINAHL, PsycINFO, and Scopus, were searched using index and keyword methods for articles published before January 2020. The review process followed the PRISMA review guidelines. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Six studies (seven articles) were included in this review. Quantitative evidence supports the benefits of psychoeducation, mindfulness-based intervention, and cognitive behavioral therapy (CBT)-based intervention but not expressive writing in improving in FCs' resilience. Four of the six included studies were randomized controlled trials. All included studies only met 40% to 60% of the MMAT criteria, indicating low to moderate levels of study quality.

CONCLUSION

This review showed emerging evidence that psychoeducation, mindfulness-based intervention, and CBT-based intervention may improve caregiver resilience. However, it remains unclear which intervention and what dosage is the most effective in promoting FCs' resilience. Due to the small number of relevant studies and a low-to-moderate level of overall study quality, more rigorous clinical trials are needed to strengthen the current limited evidence base for FC resilience interventions.

The "spillover effect" of long-term care insurance in China on spouses' health and well-being

This study examined the spillover effect of long-term care insurance (LTCI) on the health outcomes and well-being of spouses for Chinese middle and old-aged adults with expected LTC demand or actual care burdens. Using panel data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we investigated the impact of the introduction of LTCI pilots across several cities on old individuals by using the difference-in-differences (DID) approach. We found a spillover effect of LTCI on the health and well-being outcomes of spouses of middle and old-aged individuals with functional limitations. It might due to the fact that LTCI could relieve economic burden by reducing out-of-pocket medical expenditures, which further affects health and well-being of spouses. The spillover effect on health and well-being was found to be stronger for male spouses and low-educated spouses. Spouses of the individuals aged below 80 years old and those live without adult children were more likely to benefit from the introduction of LTCI. Moreover, providing combination benefits seems to make spouses better off than offering direct services. Therefore, the results implied that the expansion of LTCI not only helped the care recipients themselves but could also improve the health and well-being of the spouses of functionally impaired older adults.

Caregivers' willingness to pay for digital support services: Comparative survey

BACKGROUND

Considering the substantial information needs experienced by informal caregivers, the increased availability of digital support services for caregivers as well as the potential they offer, further understanding of caregivers' willingness to pay for digital support services is needed.

OBJECTIVE

The aim of this study is to identify associations between informal caregiver's characteristics and their willingness to pay for digital support services in two countries: Italy and Sweden.

METHODS

A sample of 378 respondents participated in a cross-sectional survey. Respondents were recruited by the Italian National Institute of Health and Science on Ageing and the Swedish Family Care Competence Centre. A two-part regression model was used. In the first part, logistic regression analysis was applied to investigate the association between willingness to pay and sets of independent variables (caregiver's demographics, caregiver's socioeconomic resources and caregiving context). In the second part, a generalized linear model (log-link and gamma distribution) was applied to determine the adjusted mean willingness to pay.

RESULTS

More than half of the participants from both countries of our study were willing to pay out of pocket for digital support services. A recommendation by a healthcare professional was the top factor that may motivate caregivers' willingness to pay an additional amount for a paid version of a digital support service. In both countries, the majority of the respondents believe that the government should allocate more funds for digital support services and for improving digital infrastructures. Caregiver' s gender, care recipient relationship to the caregiver, care duration, the total household income and the amount spent per month on professional caregiving services are all associated with willingness to pay. For every additional 10 Euro increase in the amount spent per month on professional caregiving services, the odds of willingness to pay an additional Euro for a digital support service increased by 0.60 % in the Italian sample (p= 0.002, 95% CI: 1.002, 1.009) and 0.31% in the Swedish sample (p=0.015, 95% CI: 1.006, 1.057).

CONCLUSIONS

Factors such as demographics, socioeconomic resources and the caregiving context may play a role in caregivers' willingness to pay for digital support services. The digital and social divide may negatively affect caregivers' willingness to pay for digital support services. Policy makers and insurance providers should consider innovative policies to fund digital support services that have been shown to be effective at supporting and improving caregivers' health outcomes via subsidies or other incentives. Future research that evaluates the cost-effectiveness of digital support services is needed in a context of a growing number of informal caregivers and ever scarcer resources.

Associations Between Dysfunctional Thoughts, Leisure Activities, and IL-6 in Caregivers of Family Members With Dementia

OBJECTIVE

Dementia caregiving is associated with negative physical health consequences, including inflammation processes. The objective of this study was to analyze the associations between dysfunctional thoughts, frequency of leisure activities, and interleukin 6 (IL-6) in a sample of dementia family caregivers.

METHODS

One hundred forty dementia caregivers participated in this cross-sectional study. The relationships among caregivers' dysfunctional thoughts, leisure activities, and IL-6 were adjusted for demographic characteristics, stressors, and physical and mental health indicators in a linear regression analysis.

RESULTS

Higher levels of dysfunctional thoughts ( t = -2.02, p = .045) were significantly associated with lower frequency of leisure activities. In turn, lower frequency of leisure activities was significantly associated with higher levels of IL-6 ( t = -2.03, p = .045). Dysfunctional thoughts were no longer significantly associated with IL-6 levels when both dysfunctional thoughts and leisure activities were included in the same model ( t = 1.78, p = .076). A significant indirect effect was found for the association between higher levels of dysfunctional thoughts and higher levels of IL-6 (standardized indirect effect = 0.036, bootstrap standard error = 0.026, 95% confidence interval = 0.0001-0.1000) through its association with fewer leisure activities.

CONCLUSIONS

Our findings suggest that the direct effect of caregivers' dysfunctional thoughts on IL-6 may be mediated by the impact on caregivers' frequency of leisure activities. Results suggest that training caregivers in reducing dysfunctional thoughts to thereby increase leisure activities may be useful in reducing inflammation.

Elderly Caregivers' Awareness of Caregiving Health Risks

The aim of this study was to assess the level of awareness of elderly primary caregivers of being at physical and mental health risk due to their caregiving role, as well as to examine the impact of sociodemographic characteristics, patient care characteristics, and situational variables on caregivers’ awareness. Data were collected by interview of a sample of primary caregivers aged 60+. A total of 202 primary caregivers responded positively, representing a response rate of 65% (202/311). We found a low−moderate level of awareness. The final multivariate regression analysis (F (12, 179) = 21.26, p < 0.000) revealed six variables, out of nearly 30, that are associated with a high percentage (59%) of the variability of caregivers’ awareness, namely caregiving burden, caregivers’ self-rated health, patient’s disease severity, caregiver gender, number of children, and familial relation to the patient. Action may be taken to raise caregivers’ awareness. Such interventions would possibly contribute to the quality of life and health of caregivers, enable the optimal treatment of the patient, and reduce the costs imposed on the health system and society in general.

Predictors of digital support services use by informal caregivers: a cross-sectional comparative survey

OBJECTIVES

Digital support services may provide informal caregivers with remote access to information and training about care issues. However, there is limited specific data on how factors such as demographics, socioeconomic resources and the caregiving context may influence caregivers' use of digital support services. The aim of this study is to identify associations between informal caregiver's characteristics and the use of the internet to access digital support services in two countries: Italy and Sweden.

SETTING AND PARTICIPANTS

A sample of 663 respondents who have access to the internet participated in a cross-sectional survey by completing the online questionnaire. Respondents were recruited by the Italian National Institute of Health and Science on Ageing and the Swedish Family Care Competence Centre.

PRIMARY AND SECONDARY OUTCOME MEASURES

Logistic regression analyses were performed to assess predictors of caregivers' frequent use of the internet to access digital support services.

RESULTS

Educational attainment (OR 3.649, 95% CI 1.424 to 9.350, p=0.007), hours per week spent caring (OR 2.928, 95% CI 1.481 to 5.791, p=0.002), total household income (OR 0.378, 95% CI 0.149 to 0.957, p=0.040), care recipient relationship to the caregiver (OR 2.895, 95% CI 1.037 to 8.083, p=0.042) and gender of care recipient (OR 0.575, 95% CI 0.356 to 0.928, p=0.023) were significant predictors in the multivariate analysis for the Italian caregivers group. Hours per week spent caring (OR 2.401, 95% CI 1.105 to 5.218, p=0.027) and age of caregiver (OR 2.237, 95% CI 1.150 to 4.352, p=0.018) were significant predictors in the multivariate analysis for the Swedish caregivers group.

CONCLUSIONS

Digital support services could be important tools to empower informal caregivers. When it comes to policy and practice in relation to caregivers, similarly to other broad vulnerable groups, there is no 'one-size-fits-all' approach, and it is therefore important to consider the specific characteristics and needs of both caregivers and care recipients.

The need for psychological, caregiver-centered intervention in the time of COVID-19

We focus attention on problems that are affecting the informal caregivers of patients with neurodegenerative disorders in the time of COVID-19. The pandemic is increasing difficulties in the management of the frailest people and their isolation is actually even more tangible than it was in the past. The social restrictions and the lockdown of many activities are putting the system of care provided by informal caregivers on the edge of collapse. We incite the scientific community to face these concerns and provide clinicians clear indications for assisting and supporting caregivers in the care of their relatives during this period. We suggest that e-health programs could become the ideal "environment" to favor the continuity of care for patients with neurodegenerative conditions and guarantee the required support to their caregivers, both directly in terms of psychological management and indirectly for helping them in disease management.

Self-reported symptoms of depression and anxiety among informal caregivers of persons with dementia: a cross-sectional comparative study between Sweden and Italy

Background

Around 50 million people worldwide are diagnosed with dementia and this number is due to triple by 2050. The majority of persons with dementia receive care and support from their family, friends or neighbours, who are generally known as informal caregivers. These might experience symptoms of depression and anxiety as a consequence of caregiving activities. Due to the different welfare system across European countries, this study aimed to investigate factors associated with self-reported depression and anxiety among informal dementia caregivers both in Sweden and Italy, to ultimately improve their health and well-being.

Methods

This comparative cross-sectional study used baseline data from the Italian UP-TECH (n = 317) and the Swedish TECH@HOME (n = 89) studies. Main outcome variables were the severity of self-reported anxiety and depression symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). HADS scores were investigated using descriptive and bivariate statistics to compare means and standard deviations. Linear regressions were used to test for associations between potential factors and self-reported symptoms of depression and anxiety.

Results

Italian informal caregivers reported more severe symptoms of depression and anxiety than Swedish caregivers. In Italy, a higher number of hours of caregiving was associated with anxiety symptoms (β = − 1.205; p = 0.029), being 40–54 years-old with depression symptoms (β = − 1.739; p = 0.003), and being female with symptoms of both depression (β = − 1.793; p < 0.001) and anxiety (β = 1.474; p = 0.005). In Sweden, a higher number of hours of caregiving and being < 39 years-old were associated with depression symptoms (β = 0.286; p < 0.000; β = 3.945; p = 0.014) and a higher number of hours of caregiving, the lack of additional informal caregivers and dementia severity were associated with anxiety symptoms (β = 0.164; p = 0.010; β = − 1.133; p = 0.033; β = − 1.181; p = 0.031).

Conclusion

Multiple factors are associated with self-reported symptoms of depression and anxiety among informal caregivers in Sweden and Italy. Factors found in this study partly differ between the two countries, suggesting the important role of cultural and social factors affecting the experience of caregiving. A deeper knowledge of these factors may increase the knowledge on potential protective and risk factors, provide information to policymakers and ultimately improve the psychological well-being of informal caregivers to people with dementia across Europe.

Anxiety in Informal Dementia Carers: A Meta-Analysis of Prevalence

Much of the carer literature has focused on depression and burden as primary outcomes and anxiety appear somewhat neglected. Providing evidence on the prevalence of carer anxiety is critical as it can enhance awareness among professionals, which in turn can lead to improved access to efficacious treatments. This meta-analysis updated the previous review conducted in 2007 to estimate the up-to-date prevalence of anxiety in informal carers for people with dementia. Literature searches were conducted in databases of published and unpublished literature. Events and sample size data were pooled using a random effects model to obtain an overall prevalence percentage. A total of 10 studies were included, resulting in a pooled estimate of anxiety prevalence at 32.1% (95% confidence interval: 20.6%-46.2%, P = .01). Significant heterogeneity was found, which was not reduced following sensitivity analysis. This study suggests anxiety is a prevalent difficulty experienced by dementia carers. Additional research recommendations and clinical implications are discussed.

Informal carers' experience and outcomes of assistive technology use in dementia care in the community: a systematic review protocol

BACKGROUND

Dementia is one of the greatest health and care priorities globally. Caring for persons with dementia is a challenge and often leads to negative psychological, physiological and financial consequences for informal carers (family members or friends). Many informal carers experience moderate to severe levels of burden. Advances in technology have the potential to assist persons with dementia and their carers, through assistive technology (AT) devices such as electronic medication dispensers, robotic devices and motion detectors. However, little is known about informal carers' experience and the impact of these technologies on them. This review aims to investigate the outcomes and experience of carers of persons with dementia, who live at home and use AT.

METHOD

MEDLINE, Embase, CINAHL, AMED, ALOIS, PsycINFO, Trial registries and OpenGrey databases will be searched for studies of any design that have investigated carer experience and/or outcomes of AT use for persons with dementia living at home. Manual searches from reference lists of relevant papers will also be undertaken. Outcomes of interest are carers' self-reported outcomes (which include perceived burden, quality of life and wellbeing) and carer experiences (such as usefulness, benefits and disadvantages of AT and impact on caregiver/care receiver relationship). Two independent reviewers will screen identified papers with pre-defined eligibility criteria and extract data using a bespoke extraction form. Discrepancies will be resolved in discussion with a third reviewer. A synthesis of eligible studies and summary will be provided.

DISCUSSION

A systematic review of quantitative, qualitative and mixed methods evidence of informal carers' experience of AT use in dementia in the community will be carried out. It is anticipated that this will highlight (1) investigations on impact of AT use on carers, (2) outcome measures and experience questionnaires that have been used and (3) the types of studies carried out so far on this topic. The results from the review will be presented in a summary matrix of common types (e.g. mobile phones, alarms) and uses (e.g. communication, safety, personal care) of AT in dementia care and also identify AT that is not usually available through government or health system funding.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017082268 .

Prevalence of depression and burden among informal care-givers of people with dementia: a meta-analysis

This meta-analysis examined the prevalence of depression and burden among informal care-givers of people with dementia (PwD) and compared the prevalence of depression between male and female, and spousal and non-spousal, care-givers. The quality of studies was evaluated and moderator variables explored. A search of six electronic databases (PsycARTICLES, PsycINFO, MEDLINE Complete, SCOPUS, Web of Science and ProQuest) was conducted from the first available date to the 31 October 2017. Inclusion criteria involved observational studies on the prevalence of burden or depression among informal care-givers of PwD. Forty-three studies were examined with a total of 16,911 participants. The adjusted pooled prevalence of depression was 31.24 per cent (95% confidence interval (CI) = 27.70, 35.01) and burden was 49.26 per cent (95% CI = 37.15, 61.46), although heterogeneity among prevalence estimates was high. Depression prevalence estimates differed according to the instrument used and the continent where the study was conducted. The odds of having depression were almost one and a half times higher in female compared to male care-givers. No significant difference was observed between spouses and non-spouses. Most studies had a medium risk of bias. Results suggest a great need within this population for interventions that are effective at reducing burden and depressive symptoms. It therefore appears imperative for dementia services that are not providing such interventions to do so.

A Conceptual-Theoretical-Empirical Structure for the Study of Alzheimer Informal Caregivers and Home Health Care Nursing Services

The purpose of this article is to describe the process used to create a conceptual-theoretical-empirical structure for a proposed study of policies for home health care nursing services for informal caregivers of persons with Alzheimer disease. The process consisted of linkage of the Conceptual Model of Nursing and Health Policy with Roy’s Adaptation Model to guide derivation of a middle-range theory of home health care nursing services for Alzheimer disease informal caregiving, and selection of appropriate empirical research methods.

The hidden cost of informal care: An empirical study on female caregivers' subjective well-being

Using data from the China Health and Nutrition Survey (CHNS), this study investigated the impact of informal care on female caregivers' subjective well-being in China. We found that informal care significantly reduced the subjective well-being of female caregivers using the instrumental variable (IV) ordered probit model. Our results revealed that the care effect on subjective well-being was more significant for rural caregivers than for urban caregivers. The more hours or more recipients care was provided for, the greater the negative impact on subjective well-being. Based on these findings, we further identified the two channels of 'wealth' and 'health' through which informal care lowered subjective well-being. These results have implications for policy makers in overcoming the challenges involved in constructing and developing a supportive system of informal care in China.

Effects of long-term care setting on spousal health outcomes

OBJECTIVE

To provide empirical evidence on the effects of home and community-based services (HCBS) (vs nursing home) use on spousal health.

DATA SOURCES

Merged data from the 1996 to 2012 Health and Retirement Study (HRS) and the Area Health Resource File (AHRF).

STUDY DESIGN

We assess the impact of HCBS use on spousal health. We use an instrumental variable (IV) approach to account for the potential endogeneity of the choice of care setting and reverse causality. Our instrument is the supply of skilled nursing home beds per 1000 people older than 65 years.

DATA EXTRACTION METHODS

Our sample includes spouses of HCBS or nursing home users, resulting in 8608 observations.

PRINCIPAL FINDINGS

We find that HCBS use leads to harmful effects on spousal physical health, which may be caused by increased informal care responsibilities. We also find improved spousal mental health, especially in depression symptoms, which may be caused by increased satisfaction.

CONCLUSIONS

We find evidence of both beneficial (mental health) and harmful (physical health) consequences for spouses of individuals receiving LTC at home relative to in an institution. Our results are important in estimating the potential cost and effectiveness of HCBS expansion.

[Feasibility and effects of a psychotherapeutic group intervention for caregiving relatives of people with dementia]

INTRODUCTION

Family caregivers of people with dementia (PwD) have a high burden and therefore are themselves at a high risk for psychiatric and somatic morbidities. Although individual psychotherapy has been shown to be a potentially effective treatment, it is rarely used by family caregivers. Possible reasons are poor accessibility and time restrictions on the side of the caregiver.

AIM

To test the efficacy of a short-term and low threshold psychotherapeutic group intervention for family caregivers of PwD with respect to mental stability of the caregivers.

MATERIAL AND METHODS

Data from a 12-week psychotherapeutic group intervention (10 participants each in the intervention and control groups) were analyzed. Main topics of the intervention were: personal limits, dysfunctional thoughts, emotions and resource activation. Primary endpoints were an increase of perceived self-efficacy and reduction of depressive symptoms using SWE and ADS questionnaires before, directly and 3 months after the end of the intervention.

RESULTS

A gain in perceived self-efficacy did not reach statistical significance, whereas depressive symptoms showed a statistically significant increase in the intervention group over time compared to the control group.

DISCUSSION

The intervention did not reach its primary endpoints. Possible reasons are the fact that the group was highly heterogeneous with respect to dementia etiology and the low number of participants. The short duration of the intervention may have reduced the potential of the program to address all urgent needs of the participants.

Associations Across Caregiver and Care Recipient Symptoms: Self-Organizing Map and Meta-analysis

Purpose of the Study

The main objective of this study was to reveal generalizable associations across caregiver burden (CGB), caregiver depression (CGD), care recipient cognitive ability (CRCA), and care recipient behavioral and psychological symptoms of dementia (BPSD).

Design and Methods

Studies published between 2004 and 2014 and reporting CGB and/or CGD together with CRCA and/or BPSD were included. Only 95 out of 1,955 studies provided enough data for data clustering with the Self-Organizing Map (SOM) and 27 of them for meta-analyses based on correlation coefficients.

Results

Caregiver and care recipient symptoms were not tightly associated with each other, except for the CGB-BPSD interaction at the individual level. SOM emphasized the cluster comprising studies reporting low CGB, low CGD, high CRCA, and few BPSD. Meta-analyses indicated high heterogeneity between the original studies.

Implications

Relationships between caregiver and care recipient symptoms should be treated as situation-specific phenomena, at least when the symptoms are moderate at most. Dementia caregiving per se should not be understood as a source of stress and mental health problems. More systematic and coherent use of measures is necessary to enable a comprehensive analysis of caregiving.

The male familial caregiver experience of caring for persons with Alzheimer's disease from low socio-economic status: A South African perspective

The aim of this study was to explore the experiences of male familial caregivers of persons with Alzheimer’s disease from low socio-economic status using the ecological systems theory perspective. The data were obtained from 11 semi-structured interviews that were conducted with the familial caregivers of persons with Alzheimer’s disease. Data were analyzed using thematic analysis, where four main themes emerged, namely, relationship difficulties, understanding Alzheimer’s disease, support networks, and finding meaning and satisfaction in the caregiving role. Behavioral problems, erosion of the relationship with the significant other, familial conflict, experience of diagnosis, lack of information, lack of free time, and financial concerns were identified challenges facing caregivers. Provision of information, support groups, social support, community-based support, and finding meaning and satisfaction in the caregiving role were reported as resources that assist in caregiver coping. Men seem to be capable of providing effective care and are able to successfully manage in their caregiving role. Culture seems to play a significant role in help-seeking behavior and the approach to caregiving. The findings provide the basis for the specific needs of male caregivers that should be focused on in order to provide culturally appropriate services to enhance caregiver coping amongst male caregivers in similar settings.

A Psychometric Properties Evaluation of the Italian Version of the Geriatric Depression Scale

OBJECTIVE

The Geriatric Depression Scale (GDS) is an evaluation tool to diagnose older adult's depression. This questionnaire was defined by Yesavage and Brink in 1982; it was designed expressly for the older person and defines his/her degree of satisfaction, quality of life, and feelings. The objective of this study is to evaluate the psychometric properties of the Italian translation of the Geriatric Depression Scale (GDS-IT).

METHODS

The Italian version of the Geriatric Depression Scale was administered to 119 people (79 people with a depression diagnosis and 40 healthy ones). We examined the following psychometric characteristics: internal consistency reliability, test-retest reliability, concurrent validity, and construct validity (factor structure).

RESULTS

Cronbach's Alpha for the GDS-IT administered to the depressed sample was 0.84. Test-retest reliability was 0.91 and the concurrent validity was 0.83. The factorial analysis showed a structure of 5 factors, and the scale cut-off is between 10 and 11.

CONCLUSION

The GDS-IT proved to be a reliable and valid questionnaire for the evaluation of depression in an Italian population. In the present study, the GDS-IT showed good psychometric properties. Health professionals now have an assessment tool for the evaluation of depression symptoms in the Italian population.

Psychometric properties and relations with coping and family strain of the Health Services and Caregiver Experience questionnaire (HSCE): an outcome measure of informal caregivers' experience for inpatient care in Italy

Background

In the last decade, the number of patients supported by informal caregivers has substantially increased. In the Italian healthcare context, informal caregivers’ experience of care is a new under-recognized construct, and no assessment tool is available. Measuring caregivers’ experience is important since in Italy the relationship between doctors and patients/relatives is still considered asymmetrical. The current study presented development and initial psychometric properties of the Health Services and Caregiver Experience questionnaire (HSCE), a self-report tool of caregivers’ global experience for inpatient clinical care, including factor structure, reliability and its relations with measures of coping strategies and family strain.

Methods

The HSCE was administered to a total of 503 informal caregivers of inpatients admitted at an Italian University Hospital (mean age = 48.08 years, SD = 14.82, females = 61.40%). Family Strain Questionnaire-Short Form (FSQ-SF) and Coping Orientations to Problems Experience-New Italian Version (COPE-NVI) were administered to a subgroup of participants. First-grade relatives were 73.10%, whereas 13.20% were second-grade relatives and 13.70% were home-watch caregivers.

Results

Exploratory and confirmatory factor analyses showed a structure with a single factor, which explained 64.80% of the total variance. All the items had salient loadings. In the two subsamples, HSCE had excellent internal consistency (Cronbach’s alpha = 0.95–0.97). Positive moderate correlations were found between HSCE and FSQ-SF scores (r = 0.45, p < .05), between HSCE and COPE-NVI scale scores, including COPE-NVI positive attitude and COPE-NVI problem solving scores (rs’ range = 0.51–0.57, p < .05). Moreover, a positive large correlation between HSCE and COPE-NVI social support scores emerged (r = 0.72, p < .05). Correlations were not significant between HSCE scores and COPE-NVI turning to religion and avoidance strategies.

Conclusions

The HSCE resulted to have good psychometric properties. Better caregivers’ experience correlated with stronger family strain but also with better problem solving and social support. The study expanded knowledge on caregiver’s experience in Italy and indicated that HSCE is a valid and reliable tool to measure this under-recognized construct in Italy.

Relatives' burden of caring for people screened positive for dementia in primary care : Results of the DelpHi study

BACKGROUND

There is a lack of data describing caregiver burden in primary care where most (informal) caregiving is provided.

OBJECTIVE

The aims of the paper are to describe the burden of people caring for persons with dementia (PWD) in primary care in multiple dimensions and to analyze factors associated with specific dimensions of caregiver burden.

MATERIAL AND METHODS

Analyses are based on cross-sectional data of the general physician-based, cluster-randomized, controlled intervention trial DelpHi-MV (Dementia: life and person-centered help). A sample of n = 310 community dwelling PWD screened positive for dementia (DemTect < 9) and their caregivers provided sociodemographic and disease-related data, caregiver burden was assessed in 20 dimensions using the Berlin inventory on relatives' burden in dementia (Berliner Inventar zur Angehörigenbelastung - Demenz, BIZA-D).

RESULTS

Depending on the dimension of objective burden due to caring, between 71.3 % and 92.3 % of the caregivers reported an objective burden. The average burden ranged from 3.68 to 9.81 (scale range 0-16). The subjective burden due to caring ranged from 0.1 to 1.1 (scale range 0-4). Between 22.6 and 51.6 % of our sample indicated burdens due to perceived conflicts. Logistic regression models associating caregiver burden with specifics of PWD and caregivers reached statistical significance for nearly all dimensions of the BIZA-D. Functional and cognitive impairment were statistically significant factors in 12 out of 20 and 5 out of 20 dimensions, respectively.

CONCLUSION

This is first quantitative in-depth analysis of burden for caregiver of people screened positive for dementia in primary care in Germany. In general, caregiver burden was perceived as being low to moderate by caregivers and lower than reported from other settings.

The Continuous Confrontation of Caregiving as Described in Real-Time Online Group Chat

To date, our understanding of the caregiver experience has been informed primarily by guided inquiry in the form of interviews and surveys, yielding information that is limited by the scope of researchers questions. The intent of this study was to explore the experience of caring for a loved one with advanced-stage cancer by means of participant-determined communication, using interactive, text-based transcripts from synchronous online support groups. Grounded theory analysis of the group transcripts yielded the core category continuous confrontation, characterized by major challenges (unrelenting assault, a new us, and the costs of caregiving) and minor triumphs (refuelling and living more intentionally). This unique method of data collection allowed for an especially candid, intersubjective group account of what it is to be a caregiver for an ill loved one without compromising the details that caregivers themselves consider important.

DEPRESSÃO E INSUFICIÊNCIA RENAL CRÔNICA: UMA ANÁLISE PSICOSSOCIOLÓGICA

Este estudo objetivou apreender as representações sociais (RS) elaboradas por pacientes nefrológicos em tratamento da hemodiálise e por seus familiares acerca da depressão e da insuficiência renal crônica (IRC). A amostra foi não probabilística, com 52 participantes, dos quais 26 eram pacientes, submetidos a um questionário sociodemográfico, à Escala Hospitalar de Ansiedade e Depressão, (subescala de depressão) e a uma entrevista semiestruturada. Os dados foram coletados em três hospitais e processados pelo SPSS 19.0 e pelo Alceste, sendo analisados por meio da estatística descritiva e análise lexical. Verificou-se que a RS da depressão foi ancorada nos elementos psico/cognitivo, físico/orgânico e psicossocial, objetivada principalmente na tristeza e no isolamento. A IRC foi representada com base nas adversidades psicossociais vivenciadas pelos grupos de pertença investigados. Observou-se que esta doença foi ancorada no suporte familiar e espiritual, nas restrições hídricas e alimentares, sendo associada ao desconhecimento da hemodiálise.

The prevalence of psychological impact on caregivers of hospitalized patients: The forgotten part of the equation

Introduction: Despite the large number of caregivers suffering from various psychiatric disorders, research on psychological symptoms among caregivers of hospitalized patients is lacking in Saudi populations. Objectives: The objective of this study is to determine the prevalence of depression, anxiety and stress among caregivers of hospitalized Saudi patients. Methods: A cross-sectional study of depression, anxiety and stress among caregivers of hospitalized patients was conducted. Arabic speaking caregivers (n = 353) between the ages of 14 and 80 years were included in the study. The Depression Anxiety Stress Scales (DASS-21) test (Arabic version) was used to measure the three psychological symptoms. Results: The study has shown high rates of depression, anxiety and stress among caregivers (72.8%, 76.5%, and 61.5%, respectively). Depression was found to be associated with long-term hospital stay (81.4% vs. 69.3%; p-value = 0.021) and family caregivers (75.4% vs. 46.9%, p-value = 0.001). Anxiety was found to be associated with family caregivers (78.8% vs. 53.1%; p-value = 0.001). The three psychological symptoms were higher among those with an age above 20 years old (p-value < 0.05). Multivariate logistic models show the risk of the psychological symptoms increased with low-income, higher education, immediate relation to the patient, and older caregivers. Conclusions: The findings suggest that the prevalence of depression, anxiety and stress symptoms were very common among caregivers. The results showed that approximately 8 out of 10 caregivers suffer from at least one psychiatric disorder. Older, low socioeconomic status, and well-educated caregivers were identified as being at higher risk of developing psychiatric symptoms.

Depression, anxiety and quality of life in caregivers of long-term home care patients

Family caregivers of patient in long-term care facilities often have high rates of stress, burden and psychological illness. A descriptive study was carried out with 63 caregivers. Caregivers were asked to complete a demographic questionnaire, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Short form 36 (SF-36), which measures health related quality of life (QoL). The majority of caregivers were female (79.4%), and most often the daughter of the patient in long-term care (47.6%). The mean BDI score of the sample was 18.8, and the mean BAI score was 20.0. Almost all the mean scores referring to the QoL were decreased (lower than 50), with the exception of mental health. On the SF-36 questionnaire, the lowest scores were observed on the role-emotional, role-physical, social functioning and vitality scales of the SF-36.

Effect of yoga therapy on anxiety and depressive symptoms and quality-of-life among caregivers of in-patients with neurological disorders at a tertiary care center in India: A randomized controlled trial

CONTEXT

The concerns of caregivers of patients with neurological disorders have been a felt need for a long time, with many of them experiencing significant psychiatric morbidity.

AIMS

This study aimed to find the effect of yoga in reducing anxiety and depression, as well as improving quality-of-life in caregivers of patients with neurological disorders.

SETTINGS AND DESIGN

The study was conducted using a randomized controlled design, with yoga intervention and waitlisted controls.

METHODOLOGY

SIXTY CONSENTING CAREGIVERS OF INPATIENTS IN NEUROLOGY WARDS WERE RANDOMIZED INTO TWO GROUPS: Yoga and control. Demographic variables except years of education and length of caretaking were comparable in the two groups, as also baseline scores of anxiety, depression and quality-of-life. A specific yoga module comprising yogāsanas, prāṇāyāma, and chanting was taught to the participants in the yoga group by the researcher. At follow-up 43 patients (yoga n=20 and control group n=23) were available. Two-way repeated measures analysis of variance was used to test the change from pre-test to post-test scores within and between groups. Analysis of covariance was performed to compare the post-test scores between the groups adjusting for education and length of caretaking.

RESULTS

Following one month intervention of yoga therapy, there was a significant (P<0.001) decrease in anxiety and depression scores, as well as improved quality-of-life among the participants in the yoga group as compared with the control group.

CONCLUSION

This study highlights the usefulness of a yoga intervention for caregivers of inpatients with neurological problems. The small sample size and lack of blinding were some of the limitations of this study.

Prediction of burden in family caregivers of patients with dementia: a perspective of optimism based on generalized expectancies of control

The aim of this study was to investigate the predictors of burden for informal caregivers of patients with dementia. Based on a multidimensional approach of the optimism model proposed by Palenzuela, we assessed the moderating role of generalized expectancies of control (GEC) between caregiver stress and burden. A total of 130 patients with dementia and their main family caregivers were assessed from different rural areas of the province of Salamanca (Spain). Patients with dementia underwent a protocol to assess dementia stage, cognitive-functional impairment and behavioural symptoms. Meanwhile, the 20-item Battery of Generalized Expectancies of Control Scales of Palenzuela was completed by the family caregivers. Clinical variables of patients with dementia (progression and behavioural disorders) and GEC (success, self-efficacy, contingency, helplessness and luck) were considered as potential predictors of burden in the hierarchical regression analysis. The Zarit Burden Interview (ZBI) Scale was used as an outcome measure. The results indicated that the clinical variables could not predict burden in caregivers significantly; however, beliefs in personal abilities (self-efficacy) and internal locus of control (contingency) explained up to 32% of the variance in the ZBI scores. Family caregivers with high expectancies of self-efficacy and contingency are less vulnerable to stress. This research supports a base for interventions with informal caregivers and further study.

Salivary cortisol and immunoglobulin A: responses to stress as predictors of health complaints reported by caregivers of offspring with autistic spectrum disorder

In the caregiving model of chronic stress, few studies have been conducted with young middle-aged samples and no data exists about acute stress response in this population. To extend knowledge in this issue, health complaints and psychological, endocrine, and immunological responses to stress have been assessed in a cross-sectional sample of 41 parents of offspring with autistic spectrum disorder (ASD) in comparison with 37 non-caregiver parents. Salivary cortisol and immunoglobulin A (IgA) levels were measured before, during, and after a mental psychosocial stressor, while mood and state anxiety were evaluated before and after the stress. Health complaints, personality traits, socio-economic status, and characteristics of the care recipient were assessed. Caregivers reported more health complaints showing buffered cortisol and IgA responses and greater increases in fatigue to acute stress than the controls. In terms of predictive power of health complaints, IgA levels, care status, and severity of the care recipient are especially relevant for caregivers. Results strongly suggest a dysregulation in the immune and hormonal stress-induced responses in middle-aged caregivers, with immune component and care characteristics as the main modulators of health complaints. A deficit in the adaptive capability of stress response is plausible in this population, emphasizing the need to consider family approaches when planning protocols for assistance to ASD patients.

Disengagement coping partially mediates the relationship between caregiver burden and anxiety and depression in caregivers of people with Alzheimer's disease. Results from the MÁLAGA-AD study

BACKGROUND

Caring for people with Alzheimer's disease can be considered stressful and demand adjustment strategies. While various variables have been associated with caregiver anxiety and depression, a possible mediator role of coping strategies adopted by caregivers between caregiver burden and anxiety and depression is still unclear. We hypothesized that caregivers with clinically significant anxiety and depression were more likely to use disengagement coping strategies that non-anxious and non-depressed caregivers.

METHODS

This study involved 80 Alzheimer disease patients and their primary caregivers. Patients were evaluated using the Mini Mental State Examination, the Bayer Activities of Daily Living Scale, the Global Deterioration Scale and the Neuropsychiatric Inventory. Caregivers were evaluated with the Caregiver Burden Interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Coping Strategies Inventory. We conducted a series of multiple linear regressions to determine the relationship between caregiver burden and caregiver anxiety and depression, and if the coping strategies mediated this relationship.

RESULTS

Using more disengagement (β=0.270, p<0.001) and less engagement coping (β=-0.310, p<0.001) were predictors for anxiety scores. Using more disengagement (β=0.250, p<0.001) and less engagement coping (β=-0.261, p<0.001) were predictors for depression scores.

LIMITATIONS

This study was a cross-sectional design, so the direction of causality should be strengthened by a longitudinal study.

CONCLUSIONS

Most caregivers reported higher anxiety and depression levels and this was partially mediated by their dysfunctional coping strategies.

Compassion fatigue: an application of the concept to informal caregivers of family members with dementia

Introduction. Compassion fatigue is a concept used with increasing frequency in the nursing literature. The objective of this paper is to identify common themes across the literature and to apply these themes, and an existing model of compassion fatigue, to informal caregivers for family members with dementia. Findings. Caregivers for family members with dementia may be at risk for developing compassion fatigue. The model of compassion fatigue provides an informative framework for understanding compassion fatigue in the informal caregiver population. Limitations of the model when applied to this population were identified as traumatic memories and the emotional relationship between parent and child, suggesting areas for future research. Conclusions. Research is needed to better understand the impact of compassion fatigue on informal caregivers through qualitative interviews, to identify informal caregivers at risk for compassion fatigue, and to provide an empirical basis for developing nursing interventions for caregivers experiencing compassion fatigue.

The Experience of Quality of Life for Caregivers of People With Alzheimer’s Disease Living in Sardinia, Italy

Purpose:This study explored the meaning of quality of life (QOL) for Sardinian caregivers of people affected with Alzheimer’s disease and factors improving and worsening their QOL. Design: The phenomenological method was used to study 41 Alzheimer’s disease caregivers living on the western coast of Sardinia, Italy. Interviews were conducted and analyzed using Cohen, Kahn, and Steeves’s approach. Findings: Extracted themes were the following: unity and cooperation in the family; freedom/independence; having time for themselves; serenity/tranquility; and well-being and health. Caregivers identified factors that they believed worsened or improved their QOL. Family was particularly important for these caregivers. Discussion and Practice Implications: This study reinforces previous research about cultural influence on QOL and emphasizes the importance of nurses being culturally sensitive. Since Sardinia is a rural region, these findings may be useful for nurses working with caregivers in other rural settings.

Anxiety and depression in caregivers are associated with patient and caregiver characteristics in Alzheimer's disease

OBJECTIVE

The aim of this study is to know the prevalence of anxiety and depression in caregivers of patients with Alzheimer's disease (AD) and assess the association of caregiver burden (CB) with characteristics of both patients and caregivers.

METHOD

Sociodemographic and clinical variables have been obtained (patients: age, gender, marital status, years of education, duration and severity of dementia, psychiatric disorders, previous history, and use of psychoactive and antidementia drugs; caregivers: age, gender, relationship with patient, and marital status). Cognition was assessed with Mini Mental State Examination (MMSE); severity of dementia was assessed with Global Deterioration Scale (GDS); caregiver burden was assessed with Hamilton Depression Rating Scale (HDRS), State-Trait Anxiety Inventory (STAI), and the number of hours of attention to the basic activities of daily-living (H-BADL).

RESULTS

More than 50% of caregivers have shown high anxiety and depression scores. Patients with longer duration of dementia, greater severity of dementia, and lower education levels significantly differ in anxiety and depression mean scores.

CONCLUSION

The presence of CB in AD patients is strongly associated with the duration and severity of dementia and the educational level of patients. The results of this study should encourage researchers and clinicians working with elderly persons to consider these modifiable psychological states.

Quality of life and depression in carers of patients with early onset dementia

OBJECTIVE

To investigate the quality of life (QoL) and depression and its correlates in carers living with early onset dementia (EOD) patients.

METHOD

The subjects were 49 carers, either married to or cohabiting with EOD patients, 38 with Alzheimer's disease and 11 with other types of dementia. The Quality of Life - Alzheimer Disease scale (QoL-AD) and Geriatric Depression Scale-15 items (GDS-15) were used.

RESULTS

The mean QoL score for the carers was 37.9 (SD 5.5) and the mean GDS-15 score 5.1 (SD 2.9). Linear regression analyses with QoL and GDS-15 score as dependent variables were performed. Increased age of the carer (B = 0.32) and greater insight of the patients (B = -0.186) were significantly associated with a better QoL for the carer. Being married (B = 2.10), having children together with the patient (B = 1.61) and being the carer of a patient with cardiovascular disease (B = 2.28) were associated significantly with a higher GDS-15 score, whereas being the carer of a patient who received domiciliary nursing care (B = -2.29) was significantly associated with a lower GDS-15 score.

CONCLUSION

The QoL for carers of EOD patients corresponds positively with the increased age of carers and with patients' insight into their condition. Increased depressive symptomatology in carers was associated with being married, having offspring and caring for a patient with dementia and a co-morbid cardiovascular disease. A reduction in depression was seen in carers when the patients received domiciliary nursing care.

Clinical progression of moderate-to-severe Alzheimer's disease and caregiver burden: a 12-month multicenter prospective observational study

BACKGROUND

Prospective studies on the clinical progression of Alzheimer's disease (AD) and its relationship to caregiver burden are needed to improve illness management and use of resources.

METHODS

This national, multicenter, observational study evaluated 1235 moderate to severe AD patients under routine care in Spain. Baseline cross-sectional sociodemographic and clinical data, and changes from baseline to month 12 of various neuropsychological tests and clinical ratings, including Blessed Dementia Scale, Mini-mental State Examination (MMSE), Hughes Clinical Dementia Rating sum-of-boxes (CDR-SB), Clinical Global Impression of Change (CGIC) and Zarit Caregiver Burden scales, were recorded and comprehensively analyzed.

RESULTS

Baseline data were in accordance with characteristics consistently reported to influence AD risk regarding anthropometrics, sociocultural features and comorbidities. Significant progressive functional impairments (i.e. in routine activities and essential daily tasks) and cognitive (i.e. MMSE and CDR-SB) impairments were found at month 12. However, patients' behavior and caregivers' burden improved slightly, but significantly, corroborating the major influence of behavioral symptoms on caregivers' distress. Caregivers showed significantly lower burden with patients with higher levels of education and, to a lesser extent, when patients received AD-specific medication. Physicians accurately detected AD clinical evolution as their CGIC ratings significantly correlated with all tests.

CONCLUSIONS

These findings reinforce previous AD knowledge and add data on the clinical course of advanced stages of AD. Caregiver burden depended more on patients' behavioral alterations than on their functional or cognitive declines; and it was diminished by their patients having higher levels of education and being treated with AD-specific medications. Research into unexplored factors that might reduce caregiver burden, ultimately benefiting both patients and caregivers, is encouraged.

Stress affects carers before patient's first visit to a memory clinic

OBJECTIVE

To measure and compare the burden on spousal carers of patients with and without dementia who were consulting a memory clinic for the first time.

METHODS

We included 413 dyads of patients and their spousal carers consulting a memory clinic for the first time. Of them 276 had a diagnosis of Cognitive Impairment No Dementia (CIND) and 137 had a dementia diagnosis. The burden of care was measured with the Relative Stress Scale (RSS). The gender of patients and their spouses was recorded and measures of cognition, depression and functional capacity of the patients were included in the analysis.

RESULTS

Of all carers, 27.6% had a score on the RSS of above 23, indicating a moderate to severe burden. The corresponding score for carers of patients with CIND was 20.3%, compared to 42.2% for those with dementia. However, in a linear regression analysis with RSS as the dependent variable, the dementia diagnosis variable was not significant. Three variables were significant (p < 0.05) and has explained 34% of the variance of the score on the RSS, impaired function in activities of daily living (ADL) was the most important variable (beta 0.56), followed by female gender of carers (beta 0.19) and the extent of the symptoms of depression observed in the patients (beta 0.10).

CONCLUSION

Carers of both CIND and dementia patients when attending a memory clinic for initial diagnostic assessment experience high levels of stress. Impaired function in ADL in patients is the strongest predictor of this stress.

The caregiver's burden of Alzheimer patients: differences between live-in and non-live-in

The objective of our study was to describe the burden of a sample of 208 live-in/non-live-in caregivers of patients with Alzheimer's disease (AD). We analyzed the statistical correlation between Caregiver Burden Inventory (CBI) and the live-in/non-live-in caregiver status, and between the ''objective burden,'' the cognitive deterioration, functional ability, and psychic and behavioral disorders. Using analysis of variance (ANOVA), the live-in groups of caregivers were compared to each subscale and to the total CBI. Living with a patient causes a bigger burden associated to the ''developmental and physical burden,'' which is affected more by the functional impairment than by the cognitive-behavioral aspect. Understanding the aspects of this burden in the initial-intermediate phase of the disease and being able to monitor it over time could contribute to improving the interventions already in place, which affect burden, stress, and quality of life of caregivers and their sick family members.

Relationship between perceived burden of caring for a family member with Alzheimer's disease and decreased participation in meaningful activities

ABSTRACT Objective: This study examines the relationship between caring for a family member with Alzheimer's disease (AD) and activity participation.

METHOD

A 34-item caregiver questionnaire including items measuring the perceived caregiving burden and the level of participation in meaningful activities was completed by 54 caregivers.

RESULTS

A significant negative correlation (r = -.56, p <.0001) was demonstrated between the two variables: caregiving burden and participation in meaningful activities.

DISCUSSION AND CONCLUSION

An increased perception of burden is related to a decrease of participation in desired occupations among family caregivers of people with AD. The findings can help occupational therapy practitioners develop interventions aiming at improving caregivers' quality of life through enhancing opportunities for meaningful occupations.

Caring for mom and neglecting yourself? The health effects of caring for an elderly parent

We examine the physical and mental health effects of providing care to an elderly mother on the adult child caregiver. We address the endogeneity of the selection in and out of caregiving using an instrumental variable approach, using the death of the care recipient and sibling characteristics. We also carefully control for baseline health and work status of the adult child. We explore flexible specifications, such as Arellano-Bond estimation techniques. Continued caregiving over time increases depressive symptoms and decreases self-rated health for married women and married men. In addition, the increase in depressive symptoms is persistent for married women. While depressive symptoms for single men and women are not affected by continued caregiving, there is evidence of increased incidence of heart conditions for single men, and that these effects are persistent. Robustness checks indicate that these health changes can be directly attributable to caregiving behavior, and not due to a direct effect of the death of the mother. The initial onset of caregiving has modest immediate negative effects on depressive symptoms for married women and no immediate effects on physical health. Negative physical health effects emerge 2 years later, however, suggesting that there are delayed effects on health that would be missed with a short recall period. Initial caregiving does not affect health of married men.

Prevalence of stress, anxiety and depression in with Alzheimer caregivers

BACKGROUND

Alzheimer's disease presents a social and public health problem affecting millions of Italians. Those affected receive home care from caregivers, subjected to risk of stress.The present investigation focuses on stress, anxiety and depression in caregivers.

METHODS

Data on 200 caregivers and their patients were collected using a specific form to assess cognitive, behavioural, functional patient (MMSE, and ADL-IAD) and caregiver stress (CBI). The relationship between stress, depression and disease has been assessed by means of a linear regression, logistic analysis which reveals the relationship between anxiety, stress and depression and cognitive problems, age, the patient's income.

RESULTS

The caregivers are usually female (64%), mean age of 56.1 years, daughters (70.5%), pensioners and housewives (30%), who care for the sick at home (79%). Of these, 53% had little time for themselves, 55% observed worsening of health, 56% are tired, 51% are not getting enough sleep. Overall, 55% have problems with the patient's family and/or their own family, 57% at work. Furthermore, 29% feel they are failing to cope with the situation as they wish to move away from home. The increase in the degree of anxiety and depression is directly proportional to the severity of the illness, affecting the patient (r = 0.3 stress and depression r = 0.4 related to CBI score). The memory disorders (OR = 8.4), engine problems (OR = 2.6), perception disorders (OR = 1.9) sick of the patient with Alzheimer's disease are predictive of caregiver stress, depression is associated with the presence of other disorders, mainly behavioural (OR = 5.2), low income (OR = 3.4), patients < 65 years of age (OR = 2.9).

CONCLUSION

The quality of life of caregivers is correlated with the severity of behavioural disorders and duration of the Alzheimer's disease. The severity of the disease plays an important role in reorganization of the family environment in families caring for patients not institutionalised. It is important to promote measures to soften the impact that the patient has on the caregiver, and that, at the same time, improves the quality of life of the patient.

Quality of life for caregivers of people with Alzheimer's disease

AIM

This paper is a report of a study to describe the meaning of quality of life for caregivers of patients with Alzheimer's disease and to identify factors that affect their quality of life.

BACKGROUND

The burden for informal caregivers and change in their quality of life can lead to patients being placed in nursing homes. Factors found to worsen caregivers' quality of life include strained finances, poor family functioning, difficult patient behaviour, financial burdens and the amount of time caregivers spend caring for family members with Alzheimer's disease.

METHOD

A hermeneutic phenomenological design was used to study 32 informal caregivers of patients with Alzheimer's disease. Data were collected using interviews between November 2004 and June 2005.

FINDINGS

Caregivers associated good quality of life with serenity, tranquility, psychological well-being, freedom, general well-being, good health and good financial status. Factors that caregivers said improved their quality of life were good health of the patient, independence from the patient, and more help in caregiving. Factors that worsened their quality of life were worries about the future and progression of the patient's illness and stress.

CONCLUSION

Our findings may help healthcare professionals have a deeper understanding of the meaning caregivers give to quality of life and thereby aid in the design of strategies to maintain or improve quality of life. Intervention research is needed for caregivers in countries where this has not yet been performed. Researchers should also investigate whether different types of caregivers (spouse, adult child and friend) have different needs or problems.

Associations between caregiver-perceived delirium in patients with cancer and generalized anxiety in their caregivers

BACKGROUND

Delirium, a common complication of advanced cancer, may put caregivers at risk for poor mental health outcomes. We looked for a relationship between caregiver-perceived delirium in a patient with advanced cancer and rates of caregiver psychiatric disorders.

METHODS

Using cross-sectional data from 200 caregivers of patients with cancer with a life expectancy of less than 6 months, we determined the frequency of caregiver-perceived delirium, which was defined as caregivers who reported witnessing the patient "confused, delirious" on the Stressful Caregiving Response to Experiences of Dying (SCARED) weekly or more often. We tested for associations between caregiver-reported delirium and presence of caregiver mental disorders, using the Structured Clinical Interview for the DSM-IV to diagnose mental disorders and caregiver burden, as measured by the caregiver burden scale (CBS).

RESULTS

Of the 200 caregivers who completed the SCARED, 38 (19.0%) reported seeing the patient "confused, delirious" at least once per week in the month prior to study enrollment and 7 (3.5%) met criteria for generalized anxiety (GA). Caregivers of patients with caregiver-perceived delirium were 12 times more likely to have GA (odds ratio [OR] 12.12; p < 0.01). The relationship between caregiver-perceived delirium and caregiver GA persisted after adjusting for caregiver burden and exposure to other stressful patient experiences (OR = 9.99; p = 0.04).

CONCLUSIONS

This is the first report of an association between caregiver-perceived delirium and a caregiver mental health outcome. Further studies, using improved measures of delirium, are needed.

Levels of stress and intervention preferences of caregivers of brain tumor patients

The purpose of this pilot study was to assess the level of stress experienced by caregivers of brain tumor patients and to examine both their interest in and preferences for stress reduction programs. Using a convenience sample of 60 adult caregivers, we distributed a study questionnaire that examined the caregivers' level of stress, beliefs, past experiences, and preferences in regard to stress reduction programs. A majority of respondents reported elevated stress levels (72%), believed that stress reduction techniques can help reduce stress (87%), and were interested in learning about programs to reduce stress (81%). Overall, most participants wanted to receive information about stress reduction programs (65%) and were interested in programs such as exercise (73%) and massage (66%) as methods to reduce stress. Concerning mode and format preferences, 46% indicated that they could participate in a program at least twice a week, and 70% could participate in a program for an interval of 30 minutes or more. Ninety percent of the caregivers preferred programs that could be undertaken in their own homes either alone (37%), with a spouse (35%), or with the brain tumor patient for whom they were providing care (28%). Overall, 44% of caregivers sampled were interested in participating in the various stress reduction programs presented to them in this study. These data provide further evidence that caregivers experience elevated levels of stress and are willing to learn more about and participate in programs to reduce stress.