Elder care: a positive approach to caregiving

Internal and external resources, tiredness and the subjective well-being of family caregivers of older adults: a case study from western Thailand, Southeast Asia

This study examined the effects of several aspects of care-giving on the subjective well-being (SWB) of family caregivers of older adults. These aspects were comprised of external resources including social support, affection, and internal resources including confidence, positive appraisal and coping strategies, and tiredness. The level of happiness (0-10) was used as the gauge of SWB. The data were from a cross-sectional study of 270 primary family caregivers in western Thailand. Multiple regression models controlling for age, gender, kinship to care for recipients, self-rated health, duration and hours of care-giving were estimated. Both social support in terms of appreciation and admiration for care-giving, as opposed to such care being considered a caregivers' duty, as well as inner strength derived from a positive attitude and self-perceived ability in care-giving were positively associated with SWB. Tiredness had a significant negative association with SWB. The implications of these findings for policy and intervention programs are discussed.

Predicting self-esteem in informal caregivers of people with dementia: Modifiable and non-modifiable factors

While informal caregivers often feel burdened by the care for a person with dementia, they can also experience positive consequences due to caregiving; caregiver gains. One of these, relatively overlooked, caregiver gains is heightened self-esteem. We assessed the predictive ability of non-modifiable (caregiver sociodemographic- and dementia related-) and modifiable (psychological-) factors for caregiver self-esteem). A cross-sectional study in which 201 caregivers, who spent at least eight hours a week on caring for a community-residing person with dementia, completed a semi-structured interview and five questionnaires. One two-block (1: non-modifiable-; 2: modifiable variables) hierarchic multiple regression analysis was used to assess which variables predicted self-esteem. None of the non-modifiable variables significantly predicted self-esteem. Regarding the modifiable variables, depression and relationship quality with the person with dementia significantly predicted self-esteem (adjusted R² = .460, β = -.207, p = .015 and β = .632, p < .001 respectively). Caregivers who experience a better relationship quality with the person with dementia, and fewer depression symptoms, experience a higher level of self-esteem. Interventions focused on heightening self-esteem should strive to optimize these factors to enhance the lives of informal dementia caregivers.

Positive aspects of caregiving (PAC): scale validation among Chinese dementia caregivers (CG)

OBJECTIVES

This study validates the psychometric properties of the PAC scale among Hong Kong Chinese informal dementia caregivers.

METHODS

Three hundred and seventy-four caregivers responded to questionnaires including the Chinese version of the PAC scale, Center for Epidemiologic Studies Depression Scale (CES-D), Zarit Burden Interview (ZBI), occurrence of problem behaviors, caregiver bother, caregiver confidence, and self-rated health (SRH). Translation and back translation were conducted in translating the PAC scale.

RESULTS

Results of an exploratory principal component analysis (PCA) suggest two components in the 11-item Chinese PAC (C-PAC) scale, namely enriching life and affirming self. C-PAC demonstrates satisfactory reliability. Criteria-related validity of C-PAC is suggested by significant correlations with CES-D, SRH, occurrence of problem behaviors, caregiver bother, and caregiver confidence.

CONCLUSION

Our results support the psychometric properties of C-PAC among Hong Kong Chinese caregivers. This brief measure may help interventionists identify psychological resources of caregivers and capitalize these resources during strength-based interventions.

A spectrum of hidden morbidities among spousal caregivers for patients with cancer, and differences between the genders: a review of the literature

OBJECTIVE

To explore the spectrum of hidden morbidities and gender differences in the spousal caregiving experience with regard to cancer patients across the cancer trajectory, and to discuss directions for future research and the implications for interventions to improve the caregiving experience.

METHODS

A systematic search was conducted to identity articles published in English or Chinese from January 2000 to July 2012. Studies were located using an electronic search, a manual search, and an author search.

RESULTS

A total of 19 articles were identified and included in this review. This review of the literature revealed that female spousal caregivers, in general, experienced more mental morbidity (higher levels of distress, depression, and anxiety, lower levels of mental health), physical morbidity (lower physical health scores, poorer physical functioning, and loss of physical strength), and social morbidity (lower marital satisfaction and less social support) than male spousal caregivers.

CONCLUSIONS

This review of the literature revealed that spousal caregivers, particularly female spousal caregivers for cancer patients, are at a high risk of falling victim to a wide spectrum of hidden morbidities due to their caregiving experience. The cultural influences on the couples and their patterns of communication that influence the caregiving experience for cancer patients should be further explored. A tailored-made intervention for spousal caregivers, both males and females, in the context of cancer care should be developed to cater to the needs of this population, which suffers from a spectrum of hidden morbidities.

The relationship between self-efficacy and positive aspects of caregiving in Alzheimer's disease caregivers

OBJECTIVES

Positive aspects of the caregiving experience may buffer caregivers from the many negative psychological and physical consequences of caregiving. Understanding what factors relate to the recognition of positive aspects of caregiving is important for the enhancement of caregiver well-being. Self-efficacy is a potentially modifiable psychological construct that has been associated with positive thinking, improved control of negative affect, and enhanced motivation.

METHODS

This study examined the relationship between positive aspects of caregiving and self-efficacy among 57 family members caring for a loved one with Alzheimer's disease. Participant data was gathered through individual interviews conducted as a part of a larger randomized controlled trial of a caregiver intervention.

RESULTS

We found that self-efficacy accounted for a significant percentage of the variance in positive aspects of caregiving after controlling for other factors commonly associated with positive aspects of caregiving including caregiver demographics, care recipient neuropsychiatric symptoms, and caregiver depression.

CONCLUSIONS

Our results suggest that high self-efficacy relates to caregivers' perception of positive aspects of the caregiving experience.

Using the salutogenic approach to unravel informal caregivers' resources to health: theory and methodology

OBJECTIVES

This article describes the theoretical foundation and methodology used in a study intended to increase knowledge concerning informal caregivers' resources to health (in salutogenesis; General Resistance Resources, GRRs). A detailed description of how the approach derived from salutogenic theory was used and how it permeated the entire study, from design to findings, is provided. How participation in the study was experienced is discussed and methodological improvements and implications suggested.

METHOD

Using an explorative, mixed method design, data was collected through salutogenically guided interviews with 32 Swedish caregivers to older adults. A constant comparative method of analysis was used to identify caregiver-GRRs, content analysis was further used to describe how participation was experienced.

FINDINGS

The methodology unraveled GRRs caregivers used to obtain positive experiences of caregiving, but also hindrances for such usage contributing to negative experiences. Mixed data made it possible to venture beyond actual findings to derive a synthesis describing the experienced, communal context of the population reliant on these GRRs; Caregivinghood. Participating in the salutogenic data-collection was found to be a reflective, mainly positive, empowering and enlightening experience.

CONCLUSION

The methodology was advantageous, even if time-consuming, as it in one study unravelled caregiver-GRRs and hindrances for their usage on individual, communal and contextual levels. It is suggested that the ability to describe Caregivinghood may be essential when developing health-promoting strategies for caregivers at individual, municipal and national levels. The methodology makes such a description possible and suggested methodological improvements may enhance its usability and adaptability to other populations.

Development of a conceptual framework of positive aspects of caregiving in dementia

Research on family caregivers usually focuses more on stress and burden, especially in the context of looking after a person with dementia. This leads to fewer considerations of positive aspects of caregiving. Thus enhancing these positive aspects represents an innovative approach to caregivers’ support. Furthermore, these aspects need more conceptualization to underpin the development of such an approach. This article proposes a conceptual framework of the positive aspects of caregiving based on an integrative literature review. This conceptual framework provides a comprehensive model that should improve understanding of positive aspects of caregiving. It could also contribute to the development of innovative support programs based on the positive aspects instead of the negative aspects of caregiving.

The Positive Aspects of the Caregiving Journey With Dementia: Using a Strengths-Based Perspective to Reveal Opportunities

The increasing prevalence of dementia in older adults will increase the demands for care from families and the health care system. Caring for a relative with dementia is often viewed as burdensome and stressful in nature; however, of late, attention has been given to the positive aspects of the caregiving journey. The purpose of this article is to discuss the qualitative findings related to the positive aspects of family caregiving from a mixed methods study. A strengths-based perspective was used in the secondary analysis of six focus groups ( N = 36) and three personal interview transcripts of family caregivers to persons with dementia. Findings reveal that family caregivers can view their role as an opportunity to give back, to discover personal strengths, and to become closer to the care receiver. The results suggest that identifying and mobilizing caregiver strengths can be an effective strategy for supporting family caregivers in their role.

The Family Caregiver Program

How can family caregivers develop the knowledge and confidence necessary to be successful in providing care to their loved ones at home? This article describes a formal education program for family caregivers, created by Winchester Hospital's Community Health Institute in Massachusetts, to meet their needs. The article also describes a study that Winchester Hospital's Community Health Institute undertook to evaluate the effectiveness of this education program on increasing the skills and confidence of family caregivers.

Daily geographies of caregivers: mobility, routine, scale

The bulk of care provided to elderly people living in the community and needing assistance is provided informally by family and friends. This paper investigates themes from an interpretation of interviews with informal caregivers about their experiences of caring for a frail, ill, or disabled elderly person at home. These themes include mobility, routine, and inter-relationships of scale. The caregivers' narratives illustrate the interconnected nature of physical, material and social, emotional aspects of care, and the profound spatial and social impact of providing informal care to a family member on their everyday lives. These are often at odds with political and social constructions of what it means to care at home. Concepts of space, place, and time are shown to be a helpful framework through which to understand issues and experiences of caring. The social and the physical aspects of the many interconnected scales and places which caregivers negotiate on an everyday basis both shape and are shaped by caregiving.

Academic talk about dementia caregiving: a critical comment on language

A language that characterizes the work of informal caregivers as burdensome dominates the academic literature on dementia caregiving. Informal caregiving is a socially important activity of significant economic benefit that is both gendered female and primarily carried out by women. Words collocated with caregiving and caregivers were extracted from a sub-set of recent professional journal articles on dementia caregiving. Collocations were numerically described and grouped into three categories: (1) recipient (or what caregivers receive as a result of caregiving), (2) generative (what caregivers do or generate as a result of caregiving), and (3) demographic (the general context of caregivers and caregiving). Collocations in the recipient category were most numerous followed by demographic and generative collocations. Overall collocations suggested dementia caregiver/caregiving passivity in the context of an unrewarding, burdensome experience. Questions raised in relation to findings focus on whether the view of caregiving revealed may further inscribe oppressive practices related to disabilities, age, and gender roles.