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Fuga H, Yamaoka E, Ishida N, Shitanda K, Hashimoto M, Matushita R. The relationship between psychological burden and providing assistance with taking medication among caregivers of patients with dementia: a cross-sectional study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2024; 32:377-383. [PMID: 38954838 DOI: 10.1093/ijpp/riae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Previous studies have examined the psychological burden of caregivers of patients with dementia. However, although many caregivers struggle to assist patients with dementia with medication management, the relationship between assisting such patients with taking their medicines and the caregiver psychological burden is understudied. Therefore, this study identified the association between caregivers' psychological burden and assisting patients with dementia with taking medication. METHODS A cross-sectional survey was conducted among caregivers of patients with dementia in Japan. The survey questionnaire included questions that assessed the symptoms of patients with dementia, their status of taking medication through medication assistance from caregivers, and caregivers' psychological burden using the Kessler Psychological Distress Scale and the Japanese version of the Perceived Stress Scale. KEY FINDINGS A total of 57 caregivers participated in the study. Higher Kessler Psychological Distress Scale scores were significantly associated with unsuccessful assistance with taking regular medication (β = 0.35, 95% confidence interval [CI]: 2.23-12.0, P < .05), depressive symptoms (β = 0.26, 95% CI: 0.10-8.53, P < .05), and irritability (β = 0.38, 95% CI: 2.71-11.5, P < .05). Likewise, higher scores on the Japanese version of the Perceived Stress Scale were significantly associated with irritability (β = 0.37, 95% CI: 1.87-12.5, P < .05) among patients with dementia. CONCLUSION The findings suggest that caregiver psychological burden is associated with unsuccessful assistance with taking regular medication for patients with dementia.
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Affiliation(s)
- Habuchi Fuga
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Ishikawa 920-1192, Japan
| | - Erika Yamaoka
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Ishikawa 920-1192, Japan
| | - Natsuko Ishida
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Ishikawa 920-1192, Japan
| | - Koji Shitanda
- The TEMARI GROUP, Spatel Co., Ltd., Kanazawa, Ishikawa, Japan
| | | | - Ryo Matushita
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Ishikawa 920-1192, Japan
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Collette C, Willhelm G, Del Bene VA, Aita SL, Marotta D, Myers T, Anderson J, Gammon M, Gerstenecker A, Nabors LB, Fiveash J, Triebel KL. Cognitive Dysfunction in Non-CNS Metastatic Cancer: Comparing Brain Metastasis, Non-CNS Metastasis, and Healthy Controls. Cancer Invest 2024; 42:671-681. [PMID: 39007916 DOI: 10.1080/07357907.2024.2371368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/30/2023] [Accepted: 06/19/2024] [Indexed: 07/16/2024]
Abstract
Limited research has compared cognition of people with non-central nervous system metastatic cancer (NCM) vs. metastatic brain cancer (BM). This prospective cross-sectional study was comprised 37 healthy controls (HC), 40 NCM, and 61 BM completing 10 neuropsychological tests. The NCM performed below HCs on processing speed and executive functioning tasks, while the BM group demonstrated lower performance across tests. Tasks of processing speed, verbal fluency, and verbal memory differentiated the clinical groups (BM < NCM). Nearly 20% of the NCM group was impaired on at least three neuropsychological tests whereas approximately 40% of the BM group demonstrated the same level of impairment.
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Affiliation(s)
- Christopher Collette
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Gabrielle Willhelm
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Victor A Del Bene
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Stephen L Aita
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Mental Health, VA Maine Healthcare System, Augusta, Maine, USA
| | - Dario Marotta
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Terina Myers
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Joseph Anderson
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Meredith Gammon
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Adam Gerstenecker
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - L Burt Nabors
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Radiation Oncology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - John Fiveash
- Department of Radiation Oncology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Kristen L Triebel
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Radiation Oncology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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Ye J, Huang Z, Liang C, Yun Z, Huang L, Liu Y, Luo Z. Thyroid dysfunction and risk of different types of dementia: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e39394. [PMID: 39183422 PMCID: PMC11346895 DOI: 10.1097/md.0000000000039394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/13/2024] [Accepted: 08/01/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The impact of thyroid function on the risk of various types of dementia, including Alzheimer's disease (AD) and vascular dementia (VD), remains unclear. This meta-analysis investigates the association between thyroid dysfunction and the risk of these dementia types, aiming to inform strategies for dementia prevention. METHODS A comprehensive search was conducted in PubMed, Embase, and the Cochrane Library for studies published up to February 2023, focusing on the risk of thyroid dysfunction in dementia. We excluded duplicates, studies without full text, those with incomplete data, animal studies, case reports, and reviews. Data analysis was performed using STATA 15.1 software. RESULTS Our analysis indicated that overt hyperthyroidism significantly increases the risk of all studied dementia types (OR = 1.18, 95% CI: 1.04-1.35). In contrast, overt hypothyroidism was associated with a decreased risk of AD (OR = 0.73, 95% CI: 0.55-0.98) and VD (OR = 0.71, 95% CI: 0.62-0.82). Subclinical hyperthyroidism also showed a significant association with an increased risk of any dementia (OR = 1.26, 95% CI: 1.09-1.46) and specifically VD (OR = 6.70; 95% CI: 1.38-32.58). CONCLUSION This study suggests that overt hypothyroidism may reduce the risk of dementia, including AD and VD, whereas overt and subclinical hyperthyroidism are linked to an increased risk. These findings highlight the importance of monitoring thyroid function as a preventative measure against dementia.
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Affiliation(s)
- Jianbo Ye
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhenxing Huang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chunfeng Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhang Yun
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lili Huang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yuping Liu
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zuojie Luo
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Beri V. The Mediating Role of Death Obsessions in the Relationship Between Caregiver Burden and Somatic Symptoms: A Study on the Informal Dementia Caregivers in India. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:1010-1025. [PMID: 35430910 DOI: 10.1177/00302228221090757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
This study aimed to analyze the relationship between the caregiver burden, death obsessions, and somatic symptoms; and whether the death obsessions are playing a mediating role in the relationship between the caregiver burden and somatic symptoms. The study was done on the informal dementia caregivers residing in India. Three questionnaires in a google form were circulated. The correlational and mediation analysis revealed that there was a significant and positive correlation between the caregiver burden, death obsessions, and somatic symptoms. Further, the death obsessions significantly mediated the relationship between caregiver burden and somatic symptoms.
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Affiliation(s)
- Vanshika Beri
- Department of Psychology, Amity Institute of Psychology and Allied Sciences, Noida, India
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5
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de-Moraes-Ribeiro FE, Moreno-Cámara S, da-Silva-Domingues H, Palomino-Moral PÁ, del-Pino-Casado R. Effectiveness of Internet-Based or Mobile App Interventions for Family Caregivers of Older Adults with Dementia: A Systematic Review. Healthcare (Basel) 2024; 12:1494. [PMID: 39120195 PMCID: PMC11311318 DOI: 10.3390/healthcare12151494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Global aging presents socioeconomic and health challenges. Dementia, a growing concern, affects millions of older adults, intensifying the burden on family caregivers. E-health interventions offer hope through technological solutions, although current research is limited. This study evaluated the effectiveness of internet-based or mobile app interventions for family caregivers of older adults with dementia. METHODOLOGY A systematic review with a narrative synthesis was conducted using databases (PubMed, CINAHL, Scopus, LILACS, and PsycInfo) and the bibliographies of retrieved articles, with no restrictions on time or language. RESULTS The search yielded 2092 results, of which 22 studies met the inclusion criteria, encompassing a total of 2761 family caregivers. Twenty-one different outcomes were evaluated and classified into three main types of interventions: psychoeducational, psychotherapeutic, and multicomponent. CONCLUSIONS The study highlights the importance of internet-based and mobile app interventions in supporting family caregivers of older adults with dementia. These interventions positively affect many aspects of caregiver well-being, suggesting their utility in addressing this group's emotional, social, and self-care needs.
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Affiliation(s)
| | - Sara Moreno-Cámara
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (S.M.-C.); (P.Á.P.-M.); (R.d.-P.-C.)
| | - Henrique da-Silva-Domingues
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (S.M.-C.); (P.Á.P.-M.); (R.d.-P.-C.)
| | - Pedro Ángel Palomino-Moral
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (S.M.-C.); (P.Á.P.-M.); (R.d.-P.-C.)
| | - Rafael del-Pino-Casado
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (S.M.-C.); (P.Á.P.-M.); (R.d.-P.-C.)
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Martis CS, Bhandary RP, Chandrababu R, Lakshmi R V, Bhandary PV, Noronha JA, Chakrabarty J, Tolson D, Devi ES. Caring burden and quality of life among the caregivers of people living with dementia - a cross-sectional study in Udupi district of Karnataka. Home Health Care Serv Q 2024; 43:191-204. [PMID: 38190733 DOI: 10.1080/01621424.2023.2301417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Dementia is a chronic disorder of the brain that affects cognitive performance. The caregivers of individuals with dementia experience a greater burden that affects their Quality of Life (QoL). This cross-sectional study conducted in India was designed to assess the caring burden and QoL among the caregivers of people with dementia, as well as to ascertain the relationship between QoL scores and burden. Our sample included 80 caregivers of people with dementia. Most of the caregivers (n = 59, 73.8%) had a higher level of caregiver burden. There was a negative correlation between caregiver burden scores and QoL. A higher level of caregiver stress and low QoL were experienced by caregivers of dementia patients. In developing countries like India, counseling, and education on home health care for people with dementia should be provided to reduce the burden and enhance the QoL of caregivers.
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Affiliation(s)
- Clarita Shynal Martis
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | | | - Ramesh Chandrababu
- Department of Medical Surgical Nursing, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Vani Lakshmi R
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Judith Angelitta Noronha
- Department of Obstetrics and gynaecological nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Jyothi Chakrabarty
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Debbie Tolson
- Alzheimer Scotland Centre for Policy and Practice, University of West of Scotland, Scotland, UK
| | - Elsa Sanatombi Devi
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
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Chien SC, Chang YH, Yen CM, Chen YE, Liu CC, Hsiao YP, Yang PY, Lin HM, Yang TE, Lu XH, Wu IC, Hsu CC, Chiou HY, Chung RH. Understanding and alleviating informal caregiver burden through the development and validation of a caregiver strain index-based model in Taiwan. BMC Geriatr 2024; 24:558. [PMID: 38918715 PMCID: PMC11200844 DOI: 10.1186/s12877-024-05136-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Quantifying the informal caregiver burden is important for understanding the risk factors associated with caregiver overload and for evaluating the effectiveness of services provided in Long-term Care (LTC). OBJECTIVE This study aimed to develop and validate a Caregiver Strain Index (CSI)-based score for quantifying the informal caregiver burden, while the original dataset did not fully cover evaluation items commonly included in international assessments. Subsequently, we utilized the CSI-based score to pinpoint key caregiver burden risk factors, examine the initial timing of LTC services adoption, and assess the impact of LTC services on reducing caregiver burden. METHODS The study analyzed over 28,000 LTC cases in Southern Taiwan from August 2019 to December 2022. Through multiple regression analysis, we identified significant risk factors associated with caregiver burden and examined changes in this burden after utilizing various services. Survival analysis was employed to explore the relationship between adopting the first LTC services and varying levels of caregiver burden. RESULTS We identified 126 significant risk factors for caregiver burden. The most critical factors included caregiving for other disabled family members or children under the age of three (β = 0.74, p < 0.001), the employment status of the caregiver (β = 0.30-0.53, p < 0.001), the frailty of the care recipient (β = 0.28-0.31, p < 0.001), and the behavioral symptoms of dementia in care recipients (β = 0.28-2.60, p < 0.05). Generally, caregivers facing higher burdens sought LTC services earlier, and providing home care services alleviated the caregiver's burden. CONCLUSION This comprehensive study suggests policy refinements to recognize high-risk caregivers better early and provide timely support to improve the overall well-being of both informal caregivers and care recipients.
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Affiliation(s)
- Shuo-Chen Chien
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Yu-Hung Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Chia-Ming Yen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, 632, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung City, 404, Taiwan
| | - Ying-Erh Chen
- Department of Risk Management and Insurance, Tamkang University, New Taipei City, 251, Taiwan
| | - Chia-Chun Liu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Yu-Ping Hsiao
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Ping-Yen Yang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Hong-Ming Lin
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Tsung-En Yang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Xing-Hua Lu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, 632, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, 110, Taiwan
| | - Ren-Hua Chung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan.
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Zhu X, Chen S, He M, Dong Y, Fang S, Atigu Y, Sun J. Life experience and identity of spousal caregivers of people with dementia: A qualitative systematic review. Int J Nurs Stud 2024; 154:104757. [PMID: 38552470 DOI: 10.1016/j.ijnurstu.2024.104757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The number of people with dementia is on the rise worldwide, and dementia care has become the focus of global health services. People with dementia are primarily cared for by informal caregivers, with spouses seen as a particularly vulnerable group. Focusing on the spousal caregiving experience and having a good caregiver identity contributes to group bonding and enhanced social support. OBJECTIVE To explore the dynamic changes that occur in the caregiving experience of spouse caregivers and explicate the identity of spouses during this process alongside its causes. DESIGN A qualitative systematic review. DATA SOURCE The following eight electronic databases were searched: PubMed, Web of Science (Core Collection), The Cochrane Library, Embase, CINAHL and CNKI, WanFang and Vip. REVIEW METHODS The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and Joanna Briggs Institute Reviewer's Manual criteria were used to report the results. Study screening and data extraction were conducted independently by two reviewers, and quality was assessed using the Joanna Briggs Institute's Qualitative Research Standard Assessment tool. Data synthesis was performed using thematic analysis. RESULTS A total of 15 studies were included and synthesized into three analytical themes: (1) attitudes and emotions toward dementia, (2) emotional ups and downs in dementia care, and (3) who am "I". In binary care, patience and marital responsibilities are identified as facilitators, while care burden and social isolation are identified as hindrances. In addition, gender differences were identified as influencers of identity. CONCLUSIONS In this review, spouse identity of people with dementia is complex and affects caregiving experience together with dementia cognition. Disease cognition, caregiving burden and social isolation are identified. Interventions for barriers are suggested to enhance social support.
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Affiliation(s)
- Xiangning Zhu
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Si Chen
- The First Bethune Hospital of Jilin University, No.126 Xinmin Street, Changchun 130021, Jilin, People's Republic of China
| | - Meng He
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Yueyang Dong
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Shuyan Fang
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Yiming Atigu
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
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Zhou J, Walker A. Adult children and older people's demand for community care services in urban China. Australas J Ageing 2024; 43:239-247. [PMID: 37792447 DOI: 10.1111/ajag.13242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES This paper has two objectives. First, it assesses whether the existing informal care provided by adult children has an impact on older people's propensity to demand community care services. Second, it compares the different statuses of sons and daughters in the formal/informal support trade-off. METHODS The paper is based on an analysis of data from the 2018 wave of the China Longitudinal Ageing Social Survey, within the framework of a revised version of Andersen's model, and applies multilevel models to analyse the effects of adult children's gender, numbers and the quality of their support, on older people's willingness to purchase community care services. RESULTS Older people who had sons as well as daughters demanded fewer services, while the number of sons increased service demand. Regarding sons, community care services compensated for economic support, daily life care and spiritual consolation, but did so only in respect of daily life care from daughters. CONCLUSIONS Many families have only one son or one daughter as a result of the one-child policy and therefore often require support from formal care services. Moreover, there is a distinct gender division and an influential filial culture governing the impact of services on the support provided by adult children. Because ageing in place depends on both informal family support and formal services, this key policy goal is at risk if the latter provides insufficient support to the former.
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Affiliation(s)
- Junshan Zhou
- School of Criminology, People's Public Security University of China, Beijing, China
| | - Alan Walker
- Department of Sociological Studies, The University of Sheffield, Sheffield, UK
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Dsouza SA, Ramachandran M, Bangera K, Acharya V. Assistive products to support daily time management of older persons with dementia in India: experiences and views of informal caregivers and occupational therapists. Disabil Rehabil Assist Technol 2024; 19:982-993. [PMID: 36346332 DOI: 10.1080/17483107.2022.2138995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/02/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The present study aimed to understand how informal caregivers and occupational therapists support daily time management (DTM) of older persons with dementia (PwD) and their views regarding assistive products for DTM, i.e., time management products (TMPs). METHODS The study involved a qualitative descriptive approach rooted in principles of naturalistic inquiry. Twelve caregivers of PwD and eight occupational therapists were interviewed. Conventional content analysis was performed. RESULTS Findings are described in three categories. The first category "current strategies to support DTM" described the low-tech strategies used for specific cognitive functions. The second category "factors influencing DTM and TMP" entailed factors related to the PwD (especially premorbid time management), the caregiver (multiple caregivers, attitude towards technology), the occupational therapist (impairment-oriented practice, limited resources and training in DTM) and the context (attitude towards time, poor awareness and knowledge of dementia, an expectation of recovery, negative societal attitudes towards devices, affordability/access). The third category "expectations from TMP" described the participants' expectations regarding device-related features (low-cost, easy to use, portable, low maintenance, customisable and useable across the disease continuum) and support for device use (maintenance, caregiver education). CONCLUSIONS The study provides contextually relevant recommendations and strategies to inform the provision, acceptance and adherence to DTM interventions and guide the development and prescription of indigenous TMP for PwD in India. Implications for rehabilitationAdoption of time management products (TMPs) for people with dementia in India requires an understanding of contextual factors, especially culturally influenced attitudes of persons with dementia and their family members towards time, assistive products and elders.Contextually relevant approaches and strategies are suggested to guide the provision of daily time management (DTM) interventions including TMPs for people with dementia and their families in India.It is imperative to assess the relevance, acceptance and feasibility of available TMPs for people with dementia and their families living in India and develop contextually relevant indigenous products.Occupational therapists working with people with dementia and their families would benefit from more opportunities for training and access to resources (including contextually relevant standardized assessments) to implement DTM interventions.
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Affiliation(s)
- Sebestina Anita Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Studies on Healthy Aging, Manipal Academy of Higher Education, Manipal, India
| | - Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health, Toronto, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Kshama Bangera
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Vinita Acharya
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Chen X, Zheng Y, Wang J, Yue B, Zhang X, Nakai K, Yan LL. Resting heart rate and risk of dementia: a Mendelian randomization study in the international genomics of Alzheimer's Project and UK Biobank. PeerJ 2024; 12:e17073. [PMID: 38500529 PMCID: PMC10946385 DOI: 10.7717/peerj.17073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/18/2024] [Indexed: 03/20/2024] Open
Abstract
Background Observational studies have demonstrated that a higher resting heart rate (RHR) is associated with an increased risk of dementia. However, it is not clear whether the association is causal. This study aimed to determine the causal effects of higher genetically predicted RHR on the risk of dementia. Methods We performed a two-sample Mendelian randomization analysis to investigate the causal effect of higher genetically predicted RHR on Alzheimer's disease (AD) using summary statistics from genome-wide association studies. The generalized summary Mendelian randomization (GSMR) analysis was used to analyze the corresponding effects of RHR on following different outcomes: 1) diagnosis of AD (International Genomics of Alzheimer's Project), 2) family history (maternal and paternal) of AD from UK Biobank, 3) combined meta-analysis including these three GWAS results. Further analyses were conducted to determine the possibility of reverse causal association by adjusting for RHR modifying medication. Results The results of GSMR showed no significant causal effect of higher genetically predicted RHR on the risk of AD (βGSMR = 0.12, P = 0.30). GSMR applied to the maternal family history of AD (βGSMR = -0.18, P = 0.13) and to the paternal family history of AD (βGSMR = -0.14, P = 0.39) showed the same results. Furthermore, the results were robust after adjusting for RHR modifying drugs (βGSMR = -0.03, P = 0.72). Conclusion Our study did not find any evidence that supports a causal effect of RHR on dementia. Previous observational associations between RHR and dementia are likely attributed to the correlation between RHR and other cardiovascular diseases.
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Affiliation(s)
- Xingxing Chen
- School of Public Health, Wuhan University, Wuhan, Hubei Province, China
- Duke Kunshan University, Global Health Research Center, Kunshan, Suzhou, China
| | - Yi Zheng
- The University of Tokyo, Department of Computational Biology and Medical Science, Kashiwa, Japan
| | - Jun Wang
- Huazhong University of Science and Technology, Department of Otorhinolaryngology of Union Hospital, Wuhan, Hubei Province, China
| | - Blake Yue
- School of Business and Law, Edith Cowan University, Perth, WA, Australia
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Xian Zhang
- Duke Kunshan University, Global Health Research Center, Kunshan, Suzhou, China
| | - Kenta Nakai
- The University of Tokyo, Department of Computational Biology and Medical Science, Kashiwa, Japan
- The University of Tokyo, The Institute of Medical Science, Tokyo, Japan
| | - Lijing L. Yan
- School of Public Health, Wuhan University, Wuhan, Hubei Province, China
- Duke Kunshan University, Global Health Research Center, Kunshan, Suzhou, China
- Duke University, Duke Global Health Institute, Durham, North Carolina, United States of America
- Peking University, Institute for Global Health and Management, Beijing, China
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12
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Hailu GN, Abdelkader M, Meles HA, Teklu T. Understanding the Support Needs and Challenges Faced by Family Caregivers in the Care of Their Older Adults at Home. A Qualitative Study. Clin Interv Aging 2024; 19:481-490. [PMID: 38500496 PMCID: PMC10946444 DOI: 10.2147/cia.s451833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
Background As the global population ages, the demand for family caregivers is expected to increase, underscoring the necessity to comprehend their support needs and challenges they face. However, caregiving often comes with various challenges and support needs that require attention. This study was aimed to gain an in-depth understanding of the support needs and challenges faced by family caregivers who provide care to their elderly loved ones at home. Methods The study was conducted in Mekelle City, Ethiopia from December 2022 to October 2023 using a phenomenology study design and purposive sampling technique. A total of twenty-two in-depth interviews were conducted using an open-ended guide. The interviews were transcribed verbatim, entered into ATLAS.ti8 software, translated, and analyzed using a thematic analysis. Results The study found that family caregivers face communication, financial, medication management, and transportation challenges in caring for elderly relatives at home. It also highlighted several key support needs of family caregivers in the care of elderly relatives at home. These includes financial assistance, training, access to information, and support from healthcare professionals. Limitations Qualitative research, by its nature, is subjective as it relies on the perceptions and interpretations of the participants. Moreover, in qualitative studies, researchers typically work with a limited number of participants, in qualitative studies, researchers typically work with a limited number of participants, resulting in conclusions that may not reflect the experiences of all family caregivers. Conclusion This qualitative study underscored the multitude of challenges faced by family caregivers in their role as primary caregivers for elderly relatives. The research also highlighted the pressing need for support systems that would address the physical, emotional, financial, and informational needs of these caregivers.
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Affiliation(s)
| | - Muntaha Abdelkader
- Department of Nursing, Mekelle University, Mekelle, Tigrai Region, Ethiopia
| | - Hailemariam Atsbeha Meles
- Department of Health Informatics, School of Public Health, Mekelle University, Mekelle, Tigrai Region, Ethiopia
| | - Tesfay Teklu
- Department of Nursing, Mekelle University, Mekelle, Tigrai Region, Ethiopia
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13
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Yang X, Zhang P, Jing S, Cheng Y, Cavaletto A. Logotherapy-Based Interventions for Chinese Family Caregivers of Older Adults with Dementia Through Online Groups: A Mixed-Methods Study. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-16. [PMID: 38461440 DOI: 10.1080/01634372.2024.2326689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024]
Abstract
Chinese family caregivers of people with dementia (PWD) can suffer from physical and psychological burden. This study aimed to examine the effects of logotherapy-based interventions on Chinese family caregivers of older adults with dementia to decrease caregiver burden. This mixed-methods study used a pre-experimental design with pre-posttests and semi-structured interviews. A purposive sample of 13 family caregivers from a suburban district in Shanghai was enrolled with (1) caregiver burden and (2) access and capability to use smart devices. Participants received eight online group logotherapy sessions with a focus on hope and meaning construction. Participants completed the Zarit Burden Interview, a 22-item measure of caregiver burden, before and after the intervention, and a 30-min semi-structured interview post-intervention. From the quantitative data, dementia caregivers reported severe caregiving burdens at the baseline (M = 54.77, SD = 9.33). Caregiver burden significantly decreased after the logotherapy-based intervention (M = 52.15, SD = 8.80, p < .001). Two themes pertaining to participants' experiences in intervention emerged from the qualitative data: (1) improved attitudes toward suffering, and (2) enhanced sense of meaning in life and hope. The cultural relevance of logotherapy to Chinese familism and Confucianism may further enhance its feasibility in the Chinese context.
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Affiliation(s)
- Xuejing Yang
- East China University of Political Science and Law School of Social Work, Shanghai, China
| | - Peiyuan Zhang
- University of Maryland School of Social Work, Baltimore, Maryland, USA
| | - Shijie Jing
- East China University of Political Science and Law School of Social Work, Shanghai, China
| | - Yan Cheng
- East China University of Political Science and Law School of Social Work, Shanghai, China
| | - April Cavaletto
- University of Maryland School of Social Work, Baltimore, Maryland, USA
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14
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Ruff SM, Stevens L, Bressler L, Khatri R, Sarna A, Ejaz AM, Dillhoff M, Pawlik TM, Rose K, Cloyd JM. Evaluating the caregiver experience during neoadjuvant therapy for pancreatic ductal adenocarcinoma. J Surg Oncol 2024; 129:775-784. [PMID: 38063046 DOI: 10.1002/jso.27558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Neoadjuvant therapy (NT) is increasingly recommended for patients with localized pancreatic ductal adenocarcinoma (PDAC). Recent research has highlighted the significant treatment burden that patients experience during NT, but caregiver well-being during NT is poorly understood. METHODS A cross-sectional mixed-methods analysis of primary caregivers of patients with localized PDAC receiving NT was undertaken. All patients completed the Caregiver Quality of Life Index-Cancer (CQOLC) survey, while semi-structured interviews were conducted among a convenience sample of participants. RESULTS Among 28 caregivers, the mean age was 60.1 years, and most were patient spouses/significant others (71.4%). Patients had resectable (18%), borderline resectable (46%), or locally advanced (36%) PDAC with a mean treatment duration of 2.9 months at the time of their caregiver's enrollment. Most caregivers felt that they received adequate emotional/psychosocial support (80%) and understood the rationale for NT (93%). A majority (60%) reported that caregiving responsibilities impacted their daily lives and required a decrease in their work hours, leading to financial challenges (47%). While overall QOL was moderate (mean 83 ± 21.1, range 0-140), "emotional burden" (47.3 ± 20.9), and "positive adaption" (57.3 ± 13.9) were the lowest ranked CQOLC subsection scores. DISCUSSION Caregivers of patients with PDAC undergoing NT experience significant emotional symptoms and impact on their daily lives. Assessing caregiver needs and providing resources during NT should be a priority.
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Affiliation(s)
- Samantha M Ruff
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Lena Stevens
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Luke Bressler
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Rakhsha Khatri
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Angela Sarna
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Aslam M Ejaz
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mary Dillhoff
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Karen Rose
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Mehdipanah R, Briceño EM, Malvitz M, Chang W, Lewandowski-Romps L, Heeringa SG, Levine DA, Zahuranec DB, Langa KM, Gonzales XF, Garcia N, Morgenstern LB. Exploring Pathways to Caregiver Health: The Roles of Caregiver Burden, Familism, and Ethnicity. J Aging Health 2024:8982643241235970. [PMID: 38388008 PMCID: PMC11339238 DOI: 10.1177/08982643241235970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVES This study examines the associations of ethnicity, caregiver burden, familism, and physical and mental health among Mexican Americans (MAs) and non-Hispanic Whites (NHWs). METHODS We recruited adults 65+ years with possible cognitive impairment (using the Montreal Cognitive Assessment score<26), and their caregivers living in Nueces County, Texas. We used weighted path analysis to test effects of ethnicity, familism, and caregiver burden on caregiver's mental and physical health. RESULTS 516 caregivers and care-receivers participated. MA caregivers were younger, more likely female, and less educated compared to NHWs. Increased caregiver burden was associated with worse mental (B = -0.53; p < .001) and physical health (B = -0.15; p = .002). Familism was associated with lower burden (B = -0.14; p = .001). MA caregivers had stronger familism scores (B = 0.49; p < .001). DISCUSSION Increased burden is associated with worse caregiver mental and physical health. MA caregivers had stronger familism resulting in better health. Findings can contribute to early identification, intervention, and coordination of services to help reduce caregiver burden.
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Affiliation(s)
| | - Emily M. Briceño
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation; Ann Arbor, MI
| | - Madelyn Malvitz
- University of Michigan Medical School, Department of Neurology; Ann Arbor, MI
| | - Wen Chang
- University of Michigan Institute for Social Research; Ann Arbor, MI
| | | | | | - Deborah A. Levine
- University of Michigan Medical School, Department of Internal Medicine; Ann Arbor, MI
| | - Darin B. Zahuranec
- University of Michigan Medical School, Department of Neurology; Ann Arbor, MI
| | - Kenneth M. Langa
- University of Michigan Institute for Social Research; Ann Arbor, MI
- University of Michigan Medical School, Department of Internal Medicine; Ann Arbor, MI
- Veterans Affairs Ann Arbor Center for Clinical Management Research; Ann Arbor, MI
| | - Xavier F. Gonzales
- Texas A&M University-Corpus Christi, Department of Life Sciences; Ann Arbor, MI
| | - Nelda Garcia
- University of Michigan Medical School, Department of Neurology; Ann Arbor, MI
| | - Lewis B. Morgenstern
- University of Michigan, School of Public Health; Ann Arbor, MI
- University of Michigan Medical School, Department of Neurology; Ann Arbor, MI
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16
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Fidan Ö, Buker N, Savkin R, Sanlialp Zeyrek A. Does early or late discharge after total knee replacement affect the burden and stress of caregivers? Int J Orthop Trauma Nurs 2024; 52:101036. [PMID: 37423810 DOI: 10.1016/j.ijotn.2023.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Since patients may experience difficulties in their daily activities after total knee replacement surgery, the role of the caregiver is important in supporting the daily needs of the patients. Caregivers are involved in the day-to-day care activities of the patient during the recovery process, managing their symptoms and providing support. All these factors can affect the burden and stress of caregivers. METHODS It was aimed to compare the caregiver burden and stress of caregivers of total knee replacement patients who were discharged on the same day of surgery and at a later point. Data were collected from 140 caregivers by using the Bakas Caregiving Outcomes Scale, Zarit Caregiving Burden Scale, and Stress Coping Styles Scale. RESULTS There was no significant difference between on the same day of surgery discharge and later discharge in terms of care burden and stress of caregivers (p > 0.05). While the burden of care was mild to moderate (22.15 ± 13.76) on the same day of surgery discharge group, the burden of care in the later discharge group was very low (19.03 ± 13.65). CONCLUSION In order to reduce the care burden and stress levels of caregivers, it is important that nurses determine the problems related to caregiving and provide the necessary support.
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Affiliation(s)
- Özlem Fidan
- Faculty of Health Sciences Nursing Department, Pamukkale University, Denizli, Turkey.
| | - Nihal Buker
- Faculty of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey.
| | - Raziye Savkin
- Faculty of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey.
| | - Arife Sanlialp Zeyrek
- Faculty of Health Sciences Nursing Department, Pamukkale University, Denizli, Turkey.
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17
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Wang S, Qin J, Cheung DSK, Tyrovolas S, Leung SHI, Leung AYM, Davidson PM. E-bibliotherapy for improving the psychological well-being of informal caregivers of people with dementia: a randomized controlled trial protocol. BMC Nurs 2024; 23:84. [PMID: 38303009 PMCID: PMC10832133 DOI: 10.1186/s12912-024-01706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Providing informal care for individuals with dementia is frequently a challenging and demanding experience that can have detrimental effects on the psychological well-being of caregivers. Regrettably, community-based caregiver services often prove inadequate, highlighting the necessity for innovative approaches to support caregivers. AIM To test the efficacy of e-bibliotherapy in improving the psychological well-being of informal caregivers of people with dementia. METHOD The study is divided into two phases. In phase 1, the research team will co-design the e-bibliotherapy app with caregivers. In phase 2, a randomized controlled trial will be conducted among 192 informal caregivers of people with dementia in Hong Kong. Caregivers will be randomly assigned to either the e-bibliotherapy group or the control group using simple randomization. Outcome measures will encompass caregivers' psychological well-being, caregiving appraisal, mental health, saliva cortisol levels as an indicator of stress, and health-related quality of life for caregivers. Data will be collected at baseline, immediately post intervention, and 3 months and 6 months post intervention. General linear mixed model will be employed to analyze intervention effects. Qualitative interviews will be undertaken to explore caregiver experiences within this study and evaluate intervention acceptability using conventional content analysis methods. DISCUSSION This study represents a pioneering effort in utilizing e-bibliotherapy to enhance the psychological well-being of informal caregivers of individuals with dementia, addressing the existing gap in caregiver services and facilitating knowledge dissemination within the community. TRIAL REGISTRATION The trial has been registered on ClinicalTrial.gov (Ref: NCT05927805).
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Affiliation(s)
- Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Jing Qin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Stefanos Tyrovolas
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Sze Him Isaac Leung
- Department of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, China
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18
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Horne J, Donald L, Gracia R, Kentzer N, Pappas Y, Trott M, Vseteckova J. Supporting adult unpaid carers via an online dancing intervention: A feasibility/acceptability study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002798. [PMID: 38241209 PMCID: PMC10798499 DOI: 10.1371/journal.pgph.0002798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024]
Abstract
Unpaid carers often experience poor mental and physical health linked to their caring role. Engagement in physical activity has been shown to alleviate these negative health outcomes, but it is harder for carers to find the time, energy and space to exercise. This qualitative study, based in the UK, explored the feasibility of an online, dance-based physical activity intervention with six female unpaid carers. Five themes resulted from the thematic analysis of the pre- and post-intervention interviews: Perceived physical health benefits of the intervention; Perceived mental health benefits of the intervention; Satisfactoriness of the dance classes; Impact of caring responsibilities on participation; and Suggestions for future classes. Further research is required to measure the effectiveness of the dance intervention in improving mental and physical wellbeing with larger samples including a wider mix of carers in terms of gender, age and health conditions of the care recipients, as well as international samples. Future research should also consider the barriers that some carers may face when accessing an online intervention, and alternative forms of exercise that may appeal to other groups of carers (e.g., male carers, older adult carers).
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Affiliation(s)
- Joanna Horne
- School of Psychology and Counselling, The Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Louisa Donald
- School of Psychology, University of Bedfordshire, Luton, Bedfordshire, United Kingdom
| | - Rosaria Gracia
- School of Social Sciences and Global Studies, The Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Nichola Kentzer
- School of Education, Childhood, Youth and Sport, The Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, United Kingdom
| | - Mike Trott
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Jitka Vseteckova
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, Buckinghamshire, United Kingdom
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19
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Samari E, Yuan Q, Zhang Y, Jeyagurunathan A, Subramaniam M. Barriers to using eHealth/mHealth platforms and perceived beneficial eHealth/mHealth platform features among informal carers of persons living with dementia: a qualitative study. BMC Geriatr 2024; 24:30. [PMID: 38184551 PMCID: PMC10771641 DOI: 10.1186/s12877-023-04628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/20/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND New technologies have brought about a new age of technology-enabled aids that can equip informal carers with the relevant resources for better care. These include but are not limited to facilitating access to healthcare providers, knowledge of caring for persons living with dementia, and sources of support for carers' well-being. This qualitative study explores barriers to using eHealth/mHealth platforms and perceived beneficial eHealth/mHealth platform features among informal carers of persons living with dementia. METHODS An exploratory qualitative study design was employed. Semi-structured interviews were conducted among 29 informal carers of persons living with dementia in Singapore recruited via convenience and snowball sampling. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. RESULTS The participants in this study identified several barriers to using eHealth/mHealth platforms, including personal preference, apprehension, poor user experience and lack of skills. On the other hand, knowledge of dementia, caring for persons living with dementia and self-care, a list of resources, social support, location monitoring and alert systems, and the ability to manage appointments and transactions were valuable features for eHealth/mHealth platforms. CONCLUSIONS Despite the underutilisation of eHealth/mHealth platforms, carers expressed a keen interest in using them if they are functional and capable of reducing their care burden. The findings from this study can contribute to developing content and features for eHealth/mHealth interventions aimed at lightening carers' burden in their day-to-day caring routine.
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Affiliation(s)
- Ellaisha Samari
- Institute of Mental Health, Research Division, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Qi Yuan
- Institute of Mental Health, Research Division, 10 Buangkok View, Singapore, 539747, Singapore
| | - YunJue Zhang
- Institute of Mental Health, Research Division, 10 Buangkok View, Singapore, 539747, Singapore
| | - Anitha Jeyagurunathan
- Institute of Mental Health, Research Division, 10 Buangkok View, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Institute of Mental Health, Research Division, 10 Buangkok View, Singapore, 539747, Singapore
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20
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Rossi E, Marrosu F, Saba L. Music Therapy as a Complementary Treatment in Patients with Dementia Associated to Alzheimer's Disease: A Systematic Review. J Alzheimers Dis 2024; 98:33-51. [PMID: 38427477 DOI: 10.3233/jad-230852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background Alzheimer's disease (AD) is a complex condition that affects various aspects of a patient's life. Music therapy may be considered a beneficial supplementary tool to traditional therapies, that not fully address the range of AD manifestations. Objective The purpose of this systematic review is to investigate whether music therapy can have a positive impact on AD patients and on which symptoms. Methods The main research databases employed have been PubMed and Cochrane, using the keywords "dementia", "music therapy", "Alzheimer", "fMRI", "music", and "EEG". Results After removing duplicates and irrelevant studies, 23 were screened using set criteria, resulting in the final inclusion of 15 studies. The total number of participants included in these studies has been of 1,196 patients. For the fMRI analysis the search resulted in 28 studies on PubMed, two of which were included in the research; the total number of participants was of 124 individuals. The studies conducted with EEG were found using PubMed. The initial search resulted in 15 studies, but after a more accurate evaluation only 2 have been included in the analysis. Conclusions Even though the data currently available is not sufficient to draw conclusions supported by robust statistical power, the impact of music therapy on AD neuropsychiatric symptoms deserves great interest. Further research should be ushered, possibly multicentric studies, led with neuroimaging and other recent techniques, which can eventually open views on the music role in improving the cognitive status in AD.
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Affiliation(s)
- Eleonora Rossi
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | | | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
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21
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van den Kieboom R, Snaphaan L, Mark R, van Assen M, Bongers I. The Effects of Neuropsychiatric Symptom Clusters in People with Dementia on Family Caregiver Burden. J Alzheimers Dis 2024; 100:1289-1298. [PMID: 38995773 PMCID: PMC11380262 DOI: 10.3233/jad-230972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Background Neuropsychiatric symptoms are a robust risk factor for caregiver burden in family dementia caregivers. By grouping these symptoms, clinical interpretations regarding neuropsychiatric symptoms may facilitated because different groups of symptoms may require a different approach for intervention, thereby reducing caregiver burden. Objective As clustering of neuropsychiatric symptoms could be clinically relevant, we aimed to explore the effects of these clusters on burden in family dementia caregivers. Methods 152 family dementia caregivers were included. Caregiver burden was measured using the Ervaren Druk door Informele Zorg (EDIZ)/Self-Perceived Pressure from Informal Care, a Dutch questionnaire. Caregivers also reported the neuropsychiatric symptoms and functional impairments in daily activities of the people with dementia they cared for. Multiple regression analyses were used in this cross-sectional study. Results Adjusted for functional impairments and sociodemographic variables, neuropsychiatric symptoms were associated with more caregiver burden (p < 0.001). However, this association did not differ between the three neuropsychiatric symptom clusters (p = 0.745). Conclusions Neuropsychiatric symptoms were associated with more family caregiver burden, but no conclusive evidence was found that this association differed for the three clusters. Clustering of neuropsychiatric symptoms is, however, worth exploring further in future studies with more participants. If specific links are found, these could be targeted in clinical practice in order to prevent, reduce and/or postpone caregiver burden.
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Affiliation(s)
- Robin van den Kieboom
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Archipel Zorggroep, Eindhoven, The Netherlands
| | - Liselore Snaphaan
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Research Unit Evidence Based Management of Innovation, Mental Health Care Institute Eindhoven, Eindhoven, The Netherlands
| | - Ruth Mark
- Department of Cognitive Neuropsychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Marcel van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Department of Sociology, Utrecht University, Utrecht, The Netherlands
| | - Inge Bongers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Archipel Zorggroep, Eindhoven, The Netherlands
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Thyrian JR, Boekholt M, Biernetzky O, Blotenberg I, Teipel S, Killimann I, Hoffmann W. Informal Caregivers of People with Dementia in Germany: Psychosocial Characteristics and Unmet Needs. J Alzheimers Dis 2024; 99:1235-1242. [PMID: 38759002 DOI: 10.3233/jad-231055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Background Caregivers of people with dementia living at home (CPwDh) are likely to be affected by a range of health problems. However, CPwDh are often regarded as accompanying persons and receive less attention in research and care. Little is known about this population and their needs in Germany. However, better knowledge of CPwDH is needed to design effective interventions. Objective The objective of this report is to describe the situation of CPwDh and highlight differences based on sex and living situation. Methods This was a cross-sectional analysis of the psychosocial characteristics of participants in the GAIN trial, a cluster-randomized, controlled intervention trial investigating the effectiveness of a care management program. A total of n = 192 CPwDh were recruited in GP offices, memory clinics or through public campaigns in the German federal state of Mecklenburg-Western Pomerania. The inclusion criteria were an age of 18 years or above, being a CPwDh, written informed consent. In a comprehensive digital assessment, psychosocial variables, burden, and care needs were assessed. Results Partners, women, and people living in the same household represented the majority of caregivers, and their mean number of needs was 8.7. Overall, participants indicated a mild to moderate burden. There are differences in burden based on sex and living situation, with caregivers living with people with dementia showing less burden and different psychosocial demographics. Conclusions There is a need for interventions to reduce caregivers' unmet needs in the CPwDh. Such interventions should consider differences in sex and living situation to better address individual caregiver needs.
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Affiliation(s)
- Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Melanie Boekholt
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Greifswald, Germany
| | - Olga Biernetzky
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
| | - Iris Blotenberg
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Greifswald, Germany
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
- Department for Psychosomatic and Psychotherapeutical Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ingo Killimann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
- Department for Psychosomatic and Psychotherapeutical Medicine, Rostock University Medical Center, Rostock, Germany
| | - Wolfgang Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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van de Schraaf SAJ. Vascular cognitive impairment: When memory loss is not the biggest challenge. DEMENTIA 2024; 23:152-171. [PMID: 37997896 PMCID: PMC10798009 DOI: 10.1177/14713012231214299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Vascular cognitive impairment is the second most common type of cognitive impairment. Care needs of community-dwelling people with vascular cognitive impairment and their caregivers have not been thoroughly studied. Therefore, we aimed to explore care needs of people with vascular cognitive impairment and their family caregivers. DESIGN A qualitative interview study. SETTING AND PARTICIPANTS Participants were purposefully sampled community-dwelling people with vascular cognitive impairment and their family caregivers. METHODS Interviews were audiotaped and transcribed verbatim. Analysis and data collection followed an iterative process, until data saturation was achieved. We conducted 18 interviews (nine people with vascular cognitive impairment and nine caregivers), concerning 13 unique people with vascular cognitive impairment. We analyzed the data using inductive thematic analysis following the Braun & Clark method. The study was reported in accordance with the COREQ criteria. FINDINGS Five themes were identified in the care needs reported by people with vascular cognitive impairment and family caregivers: (1) Specific information need with subtheme (1A) No memory problem, no dementia? (2) Being respected as a person, (3) Differing concerns about the future, (4) The roles of the caregiver and (5) Decisiveness from professional healthcare. CONCLUSIONS AND IMPLICATIONS The care needs of people with vascular cognitive impairment and their caregivers were affected by (a lack of knowledge about) the characteristic symptoms of this condition. Participants equated cognitive impairment or dementia to memory loss ("Alzheimerization"), although memory loss was not their biggest challenge. People with vascular cognitive impairment and caregivers preferred resolute and decisive healthcare professionals. These professionals activate the person with vascular cognitive impairment who lacks initiative and diminishe role conflict of the caregiver. Care for people with vascular cognitive impairment and their caregivers could be improved by providing tailored information, promoting awareness of neuropsychiatric symptoms, particularly apathy, and by healthcare professionals providing more guidance in decision-making.
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Affiliation(s)
- Sara AJ van de Schraaf
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Medicine for Older People, Amsterdam, Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Internal Medicine, Geriatric Medicine Section, Amsterdam, Netherlands
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Amiri P, Samadani M, Khazaee PR, Bahaadinbeigy K. Development of the Dardashna Checklist for Identifying Triggers of Behavioral Change in Individuals With Dementia: A Qualitative Study. J Gerontol Nurs 2024; 50:37-46. [PMID: 38170462 DOI: 10.3928/00989134-20231212-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The purpose of the current qualitative study was to describe the development of the Dardashna Checklist to clinically identify behavior change triggers in individuals with dementia. Semi-structured, in-depth, face-to-face interviews were conducted with four physicians and four experienced caregivers involved in the care of individuals with dementia. From analysis of participants' interviews, themes extracted included Triggers of Behavioral Change in Individuals With Dementia and Types of Behavioral Changes, using the checklist structure as a guide. The information gathered by this checklist conveys important messages to experienced physicians or caregivers who want to help less experienced caregivers or individuals with dementia. In this case, physicians' prescriptions and the responses of other experienced caregivers will be more targeted and useful. This checklist will help facilitate clinical care decisions, improve quality of life, reduce expenses and side effects of medications, and improve communication among persons with dementia, their caregivers, and health care providers. [Journal of Gerontological Nursing, 50(1), 37-46.].
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Bjørge H, Kvaal K, Ulstein I. Quality of Life and Relationships in Caregivers of People With Dementia. A Gender Perspective. Am J Alzheimers Dis Other Demen 2024; 39:15333175241276404. [PMID: 39159602 PMCID: PMC11334129 DOI: 10.1177/15333175241276404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
Home-dwelling people with dementia rely on their family members to be able to stay at home. This affects the family caregivers' quality of life (QoL). However, less is known about how male and female caregivers differ in their QoL. Our study aimed to investigate gender differences in caregivers' quality of life (QoL), whether emotional relationships influence QoL, and how their QoL changes over time. The study applied a cross-sectional and a longitudinal design to examine a total of 208 caregivers, 158 female and 50 male caregivers, and their family member with dementia. Regression analysis and t-tests were performed to identify what characteristics about caregivers and care receivers influence male and female QoL, and whether caregivers' QoL developed after one year. Both male and female caregivers' depression influenced their QoL. For females, their own social distress influenced their QoL, and for males, their experience of their care receivers' overemotional attitude influenced their QoL. From baseline to one-year follow-up their QoL decreased while their distress and experience of care receivers' emotional attitudes was stable. Significant gender-specific differences were found, indicating that gender must be considered when approving caregivers' needs and planning interventions for caregivers.
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Affiliation(s)
- Heidi Bjørge
- OsloMet – Oslo Metropolitan University, Faculty of Health, Institute of Nursing and Health Promotion, Oslo, Norway
| | - Kari Kvaal
- Inland Norway University of Applied Sciences, Faculty of Health and Social Sciences, Elverum, Norway
| | - Ingun Ulstein
- The Memory Clinic, Department of Geriatric Medicine, Oslo University Hospital Trust, Oslo, Norway
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Goldberg I, Sherwood P, Sereika SM, Donovan HS, Weimer J, Drappatz J, Boele F, Shi X, Loughan A. Predictors of Healthcare Utilization in Family Caregivers of Persons With a Primary Malignant Brain Tumor. J Neurosci Nurs 2023; 55:222-227. [PMID: 37782769 PMCID: PMC10754244 DOI: 10.1097/jnn.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
ABSTRACT BACKGROUND: Negative physical health results from the emotional stress of providing care to a family member with a primary malignant brain tumor; however, the downstream effects on caregivers' healthcare utilization (HCU) are unknown. This analysis examined associations between caregivers' emotional health and markers of HCU during the 6 months after patients' diagnoses. METHODS: Caregivers' self-report HCU data from a longitudinal study with 116 neuro-oncology caregivers were analyzed. Healthcare utilization was operationalized as number of prescription medications, reporting visits to primary care providers (PCPs), nature of PCP visit, number of comorbid conditions, and change in comorbid conditions. Potential predictors were caregivers' depressive symptoms (Center for Epidemiologic Studies-Depression Scale), hours providing care per day, mastery (Pearlin and Schooler), and burden (Caregiver Reaction Assessment). Logistic mixed effects modeling were used. RESULTS : Caregivers with higher levels of depressive symptoms ( P < .01), anxiety ( P = .02), burden related to schedule ( P = .02), and abandonment ( P < .01) were more likely to report worsening comorbid conditions. Those with higher mastery ( P = .02) were less likely to report worsening comorbid conditions. Caregivers who had a PCP visit and reported higher burden related to feelings of self-esteem ( P = .03) were more likely to report an illness-related visit. CONCLUSION : Findings suggest a relationship between neuro-oncology caregivers' emotional health and their HCU. Data highlight the importance of caregivers' PCPs identifying caregivers at risk for deteriorating health and increased HCU and intervene to ensure caregivers' self-care.
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Kumar RG, Bollens-Lund E, Ornstein KA, Li J, Covinsky KE, Kelley AS. Health care utilization and costs in the years preceding dementia identification. Alzheimers Dement 2023; 19:5852-5859. [PMID: 37718630 PMCID: PMC10843256 DOI: 10.1002/alz.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION There is evidence that health care utilization increases after incident dementia, particularly after dementia diagnosis and toward the end of life; however, less is known about utilization in the years before dementia identification. METHODS In this retrospective cohort study we obtained data on n = 5547 beneficiaries from the Health and Retirement Study (HRS)-Medicare linked sample (n = 1241 with and n = 4306 without dementia) to compare longitudinal trends in health care costs and utilization in the 6 years preceding dementia identification relative to a confounder-balanced reference group without dementia. RESULTS We found that persons with dementia had a greater prevalence of outpatient emergency department (ED), inpatient hospital, skilled nursing, and home health use, and total health care costs in the years preceding dementia identification compared to their similar counterparts without dementia across a comparable timespan in later life. CONCLUSIONS This study provides evidence to suggest greater healthcare burden may exist well before clinical manifestation and identification of dementia. HIGHLIGHTS Several studies have documented the tremendous healthcare-related costs of living with dementia, particularly toward the end of life. Dementia is a progressive neurodegenerative disease, which, for some, includes a prolonged pre-clinical phase. However, health services research to date has seldom considered the time before incident dementia. This study documents that health care utilization and costs are significantly elevated in the years before incident dementia relative to a demographically-similar comparison group without dementia.
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Affiliation(s)
- Raj G. Kumar
- Department of Rehabilitation and Human Performance, Icahn
School of Medicine at Mount Sinai, New York, NY, 19067
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn
School of Medicine at Mount Sinai, New York, NY, 19067
| | - Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn
School of Medicine at Mount Sinai, New York, NY, 19067
| | - Jing Li
- The Comparative Health Outcomes, Policy, and Economics
(CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA,
98195
| | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University
of California, San Francisco, CA, 94143
- San Francisco Veterans Affairs Medical Center, San
Francisco, CA, 94121
| | - Amy S. Kelley
- Department of Geriatrics and Palliative Medicine, Icahn
School of Medicine at Mount Sinai, New York, NY, 19067
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Fernandes B, Alves S, Schmidt V, Bizarro AF, Pinto M, Pereira H, Marto J, Lourenço AM. Primary Prevention of Canine Atopic Dermatitis: Breaking the Cycle-A Narrative Review. Vet Sci 2023; 10:659. [PMID: 37999481 PMCID: PMC10674681 DOI: 10.3390/vetsci10110659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Canine atopic dermatitis (cAD) is a common and distressing skin condition in dogs, affecting up to 30% of the canine population. It not only impacts their quality of life but also that of their owners. Like human atopic dermatitis (hAD), cAD has a complex pathogenesis, including genetic and environmental factors. Current treatments focus on managing clinical signs, but they can be costly and have limitations. This article emphasizes the importance of preventing cAD from developing in the first place. Understanding the role of the skin's protective barrier is crucial, as its dysfunction plays a vital role in both hAD and cAD. hAD prevention studies have shown promising results in enhancing the skin barrier, but more research is needed to support more robust conclusions. While hAD primary prevention is currently a focal point of intensive investigation in human medicine, research on cAD primary prevention remains under-researched and almost non-existent. Pioneering effective prevention strategies for cAD holds immense potential to enhance the quality of life for both dogs and their owners. Additionally, it bears the promise of a translational impact on human research. Hence, further exploration of this crucial topic is not only relevant but also timely and imperative, warranting support and encouragement.
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Affiliation(s)
- Beatriz Fernandes
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1649-004 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1600-277 Lisbon, Portugal
| | - Susana Alves
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1649-004 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
| | - Vanessa Schmidt
- School of Veterinary Science, University of Liverpool, Liverpool L69 3GH, UK
| | - Ana Filipa Bizarro
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1649-004 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1600-277 Lisbon, Portugal
| | - Marta Pinto
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1649-004 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1600-277 Lisbon, Portugal
| | - Hugo Pereira
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1649-004 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
| | - Joana Marto
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1600-277 Lisbon, Portugal
| | - Ana Mafalda Lourenço
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1649-004 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
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Goto Y, Morita K, Suematsu M, Imaizumi T, Suzuki Y. Caregiver Burdens, Health Risks, Coping and Interventions among Caregivers of Dementia Patients: A Review of the Literature. Intern Med 2023; 62:3277-3282. [PMID: 36858522 PMCID: PMC10713358 DOI: 10.2169/internalmedicine.0911-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023] Open
Abstract
Over 55 million people reportedly suffer from dementia worldwide. In Japan, it is estimated that 1 in 5 people over 65 years old will have dementia by 2025, of which more than 20% will live with symptoms that require home/nursing care. Given the lack of effective medical treatments for dementia, informal caregivers play essential roles in allowing dementia patients to live with dignity. Our review focusing on caregiver burden showed that this burden has not been sufficiently addressed, despite having negative effects on caregivers' health, employment, and finances. It is important to consider non-pharmacological interventions that contribute to effective coping strategies for mitigating the caregiver burden. Online communication tools may be a viable intervention measure to educate caregivers on the importance of sharing resilient coping strategies to reduce their stress so that they can continue to provide care for their loved ones.
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Affiliation(s)
- Yasuyuki Goto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Japan
| | | | - Mina Suematsu
- Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, Japan
| | | | - Yusuke Suzuki
- Centre for Community Liason & Patient Consultations, Nagoya University Hospital, Japan
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Monahan Z, Shores D, Mack A, Bray N, Ford A, Hartwell M. Prevalence of depression among caregivers based on the condition and relationship of care recipient. J Affect Disord 2023; 340:442-447. [PMID: 37582463 DOI: 10.1016/j.jad.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Caregiver distress is the strain experienced by individuals providing care for people with chronic conditions which limit their self-sufficiency for tasks of daily living. Over 1 in 5 Americans are caregivers-a number expected to increase with an aging population. METHODS We performed a cross-sectional analysis using the 2021 Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC) to determine rates of depressive disorders among caregivers and associations between demographic and relational aspects of the care recipient. RESULTS The included sample size for analysis was 32,676, representing 17,274,935 US caregivers. We found that caregivers who were female, American Indian/Alaskan Native, race-not-listed, earning less than $15,000 a year, or did not complete high school, had higher rates of depression diagnosis. The rates of depression were higher among caregivers if the recipient had a mental or chronic respiratory condition, or if the recipient was their live-in partner. Rates of depression were lower for caregivers of their mother-in-law or spouse. LIMITATIONS Results were based on self-reported survey data, which are susceptible to social desirability bias. Diagnoses of depression may also be over or under reported across several demographic variables, which may confound results. CONCLUSION Our findings add to previous research showing that specific groups of caregivers are at higher risk for caregiver stress. Future qualitative research may elucidate underlying causes of depression among caregivers. Analysis into the risk factors for depression among caregivers is vital in providing effective therapeutic options for the caregiver.
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Affiliation(s)
- Zach Monahan
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America; Oklahoma State University Center for Health Sciences, Department of Healthcare Administration, Master of Science in Global Health Program, Tulsa, OK, United States of America.
| | - Dyani Shores
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Alyson Mack
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Natasha Bray
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Alicia Ford
- Oklahoma State University Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Tulsa, OK, United States of America
| | - Micah Hartwell
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America; Oklahoma State University Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Tulsa, OK, United States of America
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Akter J, Konlan KD, Nesa M, Ispriantari A. Factors influencing cancer patients' caregivers' burden and quality of life: An integrative review. Heliyon 2023; 9:e21243. [PMID: 38027739 PMCID: PMC10643105 DOI: 10.1016/j.heliyon.2023.e21243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
This integrative review assessed the factors influencing cancer patients' caregivers' burden and quality of life (QoL). Relevant studies were retrieved from five electronic databases and screened. After systematic screening by title, abstract, and full text, the review included 15 studies published between 2000 and 2022 and used an interpretive thematic synthesis design for analysis. Age (older), sex (male), high work requirements, relationships with patients, low-income levels, high subjective stress, patient dependency level, and trait anxiety were significantly associated with higher caregiver burden. Factors associated with the low QoL of caregivers were age (less than 35 years), caregiving role (more responsibility), relationship with patients (first-degree relative), low income, living in the same home with the patient, and higher social and family responsibilities. A moderate negative correlation (n = 6) was identified between the sum of the QoL scores and the burden. Future research should be integrated into identifying appropriate means to support caregivers of patients with chronic diseases, including cancer by segregating interventions to target specific caregiver populations.
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Affiliation(s)
- Jotsna Akter
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
- National Institute of Advanced Nursing Education and Research, Dhaka, Bangladesh
| | - Kennedy Diema Konlan
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Meherun Nesa
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
- National Institute of Advanced Nursing Education and Research, Dhaka, Bangladesh
| | - Aloysia Ispriantari
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
- Department of Nursing, Institute of Technology Science and Health RS dr Soepraoen, Malang, Indonesia
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Grewal KS, O'Connell ME, Kirk A, MacDonald SWS, Morgan D. Intraindividual variability measured with dispersion across diagnostic groups in a memory clinic sample. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:639-648. [PMID: 34455884 DOI: 10.1080/23279095.2021.1970552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Increased intraindividual variability (IIV) has been linked to outcomes such as cognitive decline and dementia, suggesting IIV might add valuable diagnostic information beyond traditional neuropsychological interpretation. We explored whether a subtype of IIV, dispersion, can provide additional information for dementia diagnosis. In a sample of memory clinic patients, three cognitive status groups were identified: subjective cognitive impairment (SCI; n = 85), amnestic mild cognitive impairment (a-MCI; n = 16), and dementia due to Alzheimer's disease (AD; n = 48). Dispersion was computed as intraindividual standard deviations across multiple neuropsychological measures within three cognitive domains (executive functioning; immediate and delayed memory) and was compared for each diagnostic group using profile analysis. Patients with AD and a-MCI demonstrated less dispersion than patients with SCI in delayed memory. Results support existing theoretic perspectives on cognitive variability and age-related cognitive decline but suggest floor effects underlie suppression of dispersion in amnestic cognitive presentations. Questions remain about the contribution of IIV beyond impressions of impairment versus no impairment in these constrained representations of cognitive domains. Future investigations should investigate variability in SCI groups against controls to examine whether observed dispersion similarities between SCI and a-MCI or AD in immediate memory and executive functioning are meaningful.
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Affiliation(s)
- Karl S Grewal
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
| | - Andrew Kirk
- Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
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Sugihara Y, Sugisawa H. Influence of medical care tasks on subjective burden and gain among older adults' family caregivers: structural equation modeling for testing the role of formal and informal support. BMC Geriatr 2023; 23:628. [PMID: 37803249 PMCID: PMC10559595 DOI: 10.1186/s12877-023-04348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The number of caregivers performing medical care tasks at home for older adults is expected to increase. Family caregivers, who are not healthcare professionals, are likely to find these activities difficult and burdensome. However, appropriate support may decrease the negative and increase the positive aspects of caregiving. This study investigated direct associations between caregivers providing medical care at home and their negative and positive appraisals of caregiving (burden and gain), indirect associations through healthcare professional support and informal support, and whether the associations between medical care tasks and caregivers' appraisals of caregiving differed based on the support received. METHODS Interview surveys were conducted in 2013, 2016, and 2019 in a Tokyo Metropolitan Area city with family caregivers of community-dwelling older adults who were certified as requiring care in Japan's long-term care insurance system. This study analyzed the combined data from each survey (n = 983). Structural equation modeling (SEM) analysis was utilized to examine direct associations between providing medical care and caregiver appraisals and indirect relationships through healthcare professional support and informal support. The modulating effects of these forms of support on the relationship between medical care and caregiver appraisals were assessed using multigroup SEM analyses. RESULTS Approximately 9% of family caregivers provided medical care at home. The results of SEM analyses, controlled for care recipients' physical and cognitive difficulties; caregivers' age, sex, and economic condition; and survey year, revealed no direct associations between providing medical care and caregivers' sense of burden and gain. They also did not reveal any indirect effects through either healthcare professional support or informal support. However, the results of multigroup SEM analyses indicated that caregivers providing medical care who used home-visit services by physicians and/or nurses, compared to those who did not, tended to exhibit a greater sense of gain. CONCLUSIONS These results suggest that family caregivers providing medical care at home can positively change their appraisals of caregiving if they receive appropriate support. Home medical care services provided by healthcare professionals can effectively support caregivers. Developing strategies and policies to make medical care services at home more accessible to caregivers is crucial.
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Affiliation(s)
- Yoko Sugihara
- Department of Urban Science and Policy, Faculty of Urban Environmental Sciences, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo, 192-0397, Japan.
| | - Hidehiro Sugisawa
- Gerontology Program, J. F. Oberlin University Graduate School of International Studies, 1-1- 12 Sendagaya, Shibuya-ku, Tokyo, 151-0051, Japan
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Tran JT, Theng B, Tzeng HM, Raji M, Serag H, Shih M, Lee WCM. Cultural Diversity Impacts Caregiving Experiences: A Comprehensive Exploration of Differences in Caregiver Burdens, Needs, and Outcomes. Cureus 2023; 15:e46537. [PMID: 37927752 PMCID: PMC10625452 DOI: 10.7759/cureus.46537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background Many Americans are informal caregivers providing unpaid care for their loved ones living with chronic conditions, such as dementia and heart failure. As the US population continues to age and live longer with more complex chronic conditions, informal caregivers play an increasingly important role in the care of older adults with functional impairment and multiple comorbidities. Caregivers face many challenges in managing the health of themselves and their loved ones, including physical, emotional, and financial burdens, which may potentially vary by race and ethnicity. Therefore, it is critical to develop culturally tailored solutions, such as smart technology, aimed at improving the quality of life of informal caregivers and care recipients from diverse backgrounds. Methods Data were collected from a convenient sample of 69 informal caregivers in Texas who were members or volunteers for either the International Buddhist Progress Society-Dallas (IBPS Dallas) or University of Texas Medical Branch (UTMB). Caregivers answered questions about their caregiving experiences, including the type of care they provided, challenges they faced, and lessons learned. Responses were stratified by race/ethnicity (White, Hispanic, or Asian American) to assess for potential cultural differences in caregiving experiences. A chi-squared test and one-way analysis of variance (ANOVA) were conducted. Results White, Hispanic, and Asian American caregivers all reported high non-medical related needs. White, Hispanic, and Asian American care recipients all had a high degree of neurological disease and functional impairment. White and Hispanic caregivers were also more likely to offer emotional support (p=0.007) and financial support (p=0.025) than Asian American caregivers. Asian American caregivers reported greater worry about the health-related knowledge of their family members (p=0.040) than White and Hispanic caregivers. Hispanic (18.8%) and Asian American caregivers (12.5%) reported the least knowledge of caregiving-related government policies than White caregivers (43.2%) (p=0.025). Hispanic (18.8%) and Asian American caregivers (18.8%) also reported the least knowledge of available support programs and services for care recipients (p=0.001). Conclusions White, Hispanic, and Asian American informal caregivers vary in their types of worries, care provided, and challenges faced. Our study found that Asian American caregivers reported greater worry about the health-related knowledge of their family members than White and Hispanic caregivers. White caregivers were better at navigating government resources and caregiver support programs than Hispanic and Asian American caregivers. While race and ethnicity are potential factors for these observed differences, several other factors may have played a role, including age, gender, income, education, patient diagnosis, and disease severity. Future research should consider these factors and evaluate a larger and more diverse sample for more definitive racial and ethnic comparisons. Understanding disparities in caregiving experiences is a critical initial step to developing culturally appropriate interventions to reduce caregiving burden and promote the health and well-being of both patients and their informal caregivers from diverse backgrounds.
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Affiliation(s)
- Jessica T Tran
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Bunnarin Theng
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, USA
| | - Mukaila Raji
- Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston, USA
| | - Hani Serag
- Department of Internal Medicine, Division of Endocrinology, University of Texas Medical Branch, Galveston, USA
| | - Miaolung Shih
- Humanistic Buddhism Practice (HBP), Osher Lifelong Learning Institute at University of Texas Medical Branch, Galveston, USA
| | - Wei-Chen Miso Lee
- Department of Family Medicine, University of Texas Medical Branch, Galveston, USA
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Wu J, Williams A, Wang L, Kitchen P. A comparative analysis of carer-employees in Canada over time: a cross-sectional analysis of Canada's General Social Survey, 2012 and 2018. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:840-855. [PMID: 37165142 PMCID: PMC10484878 DOI: 10.17269/s41997-023-00762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES The aims of the study are to identify trends in the socio-demographic, health, and work profiles of Canadian carer-employees (CEs) over time, as well as the gender difference in the intensity of caring. METHODS Cross-sectional data from cycles 26 and 32, collected in 2012 and 2018 respectively, of the Canadian General Social Survey (GSS) were used. Logistic, multinomial logistic, and linear regressions were used to estimate how caregiving is associated with caregivers' health, well-being, and work in both cycles. Regressions from both cycles were then compared with chi-square tests for significant differences over time. RESULTS The proportion of male CEs grew between 2012 and 2018, and women were no longer more likely to be a CE. The intensity of care for female CEs was significantly increased from 2012 to 2018 as compared with their male counterparts. General health (2018: OR = 0.25[0.11, 0.61] vs. 2012: OR = 0.33[0.15, 0.72]) and life satisfaction ([Formula: see text] = -0.42[0.54, -0.30] vs. [Formula: see text] = -0.22[-0.30, -0.14]) were significantly worsened with respect to the role of CEs from 2012 to 2018. CONCLUSION Our study provides the evidence that CEs' health and well-being have worsened over time, especially for female CEs, indicating that the needs of CEs are growing at a faster rate than the supports available. The results are meaningful in informing and justifying the provision of CE supports at work in order to sustain CEs in the workplace, such as the carer-friendly workplace policies.
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Affiliation(s)
- Jerry Wu
- Department of Mathematics, University of Waterloo, Waterloo, ON, Canada
| | - Allison Williams
- School of Earth, Environment & Society, McMaster University, Hamilton, ON, Canada
| | - Li Wang
- Offord Center for Child Study & Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Peter Kitchen
- School of Earth, Environment & Society, McMaster University, Hamilton, ON, Canada
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Hochgraeber I, Köhler K, Stöcker H, Holle B. The dyadic relationship of family carers and people living with dementia - an umbrella review. Aging Ment Health 2023; 27:1965-1974. [PMID: 37390842 DOI: 10.1080/13607863.2023.2215191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/11/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVES The dyadic relationship of people living with dementia and their family carers is highly relevant when considering the stability of home-based care arrangements. There is a solid body of research that covers issues related to dyadic relationships. However, a synthesis of qualitative research is missing. Therefore, the aim of this review is to give an overview of the dyadic relationship, with the leading research question of what influences the dyadic relationship and how it can be maintained during the trajectory of the disease. METHODS We performed an umbrella review of qualitative literature on the basis of thematic synthesis and used the SoCA-Dem theory as a theoretical framework. Literature searches in the databases PubMed (MEDLINE), CINAHL, Scopus, and PsycInfo were performed from July to September 2020, additional papers were included until September 2022. We searched without timeframe restrictions and considered publications in English or German. RESULTS After a systematic database search, resulting in 1325 records, we included 12 reviews. Five analytical themes and 11 subthemes were identified. The analytical themes were 'change in the relationship', 'activities to maintain the relationship', 'continued togetherness', 'home as a place for enacting relationship', and 'influencing factors'. CONCLUSION The dyadic relationship is a complex and multifaceted phenomenon. It is characterized by family carers' attempts to continue togetherness using different strategies and is mainly influenced by the quality of the premorbid relationship and the mindset of the family carer.
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Affiliation(s)
- Iris Hochgraeber
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Kerstin Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Hannah Stöcker
- Faculty of Health, School of Psychology, Witten/Herdecke University, Witten, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
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Zhang Y, Zhou C, Yang S, Zhang Y, Ye Z, He P, Liu M, Wu Q, Qin X. Association of regular use of ibuprofen and paracetamol, genetic susceptibility, and new-onset dementia in the older population. Gen Hosp Psychiatry 2023; 84:226-233. [PMID: 37633120 DOI: 10.1016/j.genhosppsych.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Although the possible efficacy and adverse effects of paracetamol and ibuprofen on dementia are of global clinical and public health importance, to date, the relationship of the use of paracetamol and ibuprofen with incident dementia remains uncertain. We aimed to assess the prospective association of regular use of ibuprofen and paracetamol with new-onset dementia in an older population. METHODS This study included 212,968 participants from the UK Biobank, aged ≥60 years, with available data of ibuprofen, paracetamol use and without dementia at baseline. The primary outcome was new-onset all-cause dementia. The secondary outcomes included new-onset Alzheimer's disease and new-onset vascular dementia. RESULTS During a median follow-up of 12.3 years, 6407 (3.0%) participants developed new-onset all-cause dementia. Participants who regularly used paracetamol had a significantly higher risk of new-onset all-cause dementia (adjusted HR, 1.18; 95%CI: 1.10-1.26), compared with non-users. However, there was no significant association between regular use of ibuprofen and new-onset all-cause dementia (users vs. non-users; adjusted HR, 1.06; 95%CI: 0.97-1.16). Furthermore, APOE ε4 dosage and genetic risk scores (GRS) of Alzheimer's disease calculated by 25 single nucleotide polymorphisms did not significantly modify the relationship of regular use of paracetamol and ibuprofen with new-onset all-cause dementia (Both P-interactions >0.05). Similar results were found in the propensity score analysis. Similar findings were also observed for new-onset Alzheimer's disease and new-onset vascular dementia. CONCLUSIONS Regular use of paracetamol, but not ibuprofen, was associated with a significantly higher risk of new-onset dementia in the old population, regardless of genetic risks of dementia.
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Affiliation(s)
- Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Sisi Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Yanjun Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Qimeng Wu
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China.
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Min SH, Song J, Evans L, Bowles KH, McDonald MV, Chae S, Topaz M. Home Healthcare Patients With Distinct Psychological, Cognitive, and Behavioral Symptom Profiles and At-Risk Subgroup for Hospitalization and Emergency Department Visits Using Latent Class Analysis. Clin Nurs Res 2023; 32:1021-1030. [PMID: 37345951 PMCID: PMC11080676 DOI: 10.1177/10547738231183026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
One-third of home healthcare patients are hospitalized or visit emergency departments during a 60-day episode of care. Among all risk factors, psychological, cognitive, and behavioral symptoms often remain underdiagnosed or undertreated in older adults. Little is known on subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits. Our cross-sectional study used data from a large, urban home healthcare organization (n = 87,943). Latent class analysis was conducted to identify meaningful subgroups of older adults based on their distinct psychological, cognitive, and behavioral symptom profiles. Adjusted multiple logistic regression was used to understand the association between the latent subgroup and future hospitalization and emergency department visits. Descriptive and inferential statistics were conducted to describe the individual characteristics and to test for significant differences. The three-class model consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." Compared to Class 3, Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments. Significant differences were found in individual characteristics such as age, gender, race/ethnicity, and insurance. Home healthcare clinicians should consider the different latent subgroups of older adults based on their psychological, cognitive, and behavioral symptoms. In addition, they should provide timely assessment and intervention especially to those at-risk for hospitalization and emergency department visits.
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Affiliation(s)
- Se Hee Min
- Columbia University School of Nursing, New York, NY, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
| | - Sena Chae
- University of Iowa College of Nursing, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York, NY, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
- Data Science Institute, Columbia University, New York, NY, USA
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García-Martín V, de Hoyos-Alonso MC, Delgado-Puebla R, Ariza-Cardiel G, Del Cura-González I. Burden in caregivers of primary care patients with dementia: influence of neuropsychiatric symptoms according to disease stage (NeDEM project). BMC Geriatr 2023; 23:525. [PMID: 37644410 PMCID: PMC10463529 DOI: 10.1186/s12877-023-04234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caregiver burden is related to personal factors and patient characteristics and is greater when neuropsychiatric symptoms (NPSs) are present. OBJECTIVE Estimate the prevalence of burden among caregivers of dementia patients and its association with NPSs and identify NPSs causing greater caregiver distress according to dementia stage. METHODS A cross-sectional observational study in caregivers of noninstitutionalized dementia patients was conducted. Caregiver variables were sociodemographic, time of care, NPS-associated distress based on the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D) and burden based on the Zarit Burden Interview (ZBI). Patient variables were time since disease onset, Global Deterioration Scale (GDS) disease stage, functional assessment and NPS presence and intensity according to the Neuropsychiatric Inventory (NPI). The mean ZBI score, prevalence of burden and NPI-D score with 95% CIs at each dementia stage were estimated. Factors associated with burden were identified by multivariate analysis. RESULTS Of the 125 caregivers included, 77.6% were women, with a mean age of 60.7 (± 14.3) years; 78.4% (95%CI: 71.0; 86.0) experienced burden. The mean ZBI score was 12.3 (95%CI: 11.6; 12.9) and increased according to NPS number (p = 0.042). The NPSs causing the most burden were disinhibition (93.5%), irritability (87.3%) and agitation (86.1%). Agitation, apathy, and sleep disorders were the NPSs generating the greatest overall caregiver distress; depression (max NPI-D 1.9), hyperactivity (max NPI-D 2.1), and psychosis symptoms (max NPI-D 1.6) generated the greatest distress at stage GDS 3, stages GDS 4-5, and stages GDS 6-7, respectively. The NPI score (OR = 1.0, 95%CI 1.0; 1.1), intensity of irritability (OR = 1.2, 95%CI 1.0; 1.6), disinhibition (OR = 2.6, 95%CI 1.1; 5.8) and hyperactivity subsyndrome (OR = 1.1, 95%CI 1.0; 1.2) were associated with caregiver burden. Other associated factors were female gender (OR = 6.0, 95%CI 1.6; 22.8), ≥ 8 h daily care (OR = 5.6, 95%CI 1.4; 22.8), working outside the home (OR = 7.6, 95%CI 1.8; 31.8), living with the patient (OR = 4.5, 95%CI 1.1; 19.6), kinship (OR = 5.4, 95%CI 1.0; 28.2) and lower patient education (OR = 8.3, 95%CI 2.3; 30.3). CONCLUSIONS The burden on caregivers of dementia patients is high and associated with NPS presence and intensity. Disinhibition and irritability caused the highest burden. Depression, hyperactivity and psychosis produce more distress in mild, mild-moderate and severe dementia, respectively.
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Affiliation(s)
- Victoria García-Martín
- Epidemiology and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Madrid, Spain.
| | - M Canto de Hoyos-Alonso
- Pedro Laín Entralgo Health Care Center, Primary Care Management, Madrid Health Service, Alcorcón, Madrid, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
| | - Rosalía Delgado-Puebla
- Primary Care Management, Horta Health Care Center, Catalonia Health Service, Barcelona, Catalonia, Spain
| | - Gloria Ariza-Cardiel
- Family and Community Medicine Teaching Unit Oeste, Primary Care Management, Madrid Health Service, Móstoles, Madrid, Spain
| | - Isabel Del Cura-González
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Alcorcón, Madrid, Spain
- Ageing Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Instituto Investigación Sanitaria Gregorio Marañón IiSGM, Madrid, Spain
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Paulson D, McClure N, Wharton T, Gendron E, Allen Q, Irfan H. Caregiver Preparedness: A Therapeutic Mechanism and Moderating Factor on Outcomes for the Savvy Caregiver Program. Clin Gerontol 2023:1-15. [PMID: 37530457 PMCID: PMC10834848 DOI: 10.1080/07317115.2023.2242357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Evidence-based interventions for dementia caregivers, such as the Savvy Caregiver Program (SC), seek to address skills and knowledge deficits, caregiver burden, depressive symptoms, and grief. Little research has examined mechanisms by which these interventions accomplish their goals. Caregiver preparedness may be a possible mechanism by which caregiver interventions may confer benefits. METHODS The sample included 76 dementia caregivers who completed the 6-session SC. Participants completed the Anticipatory Grief Scale, Center for Epidemiological Studies-Depression Scale, the Preparedness for Caregiving Scale, and the Zarit Burden Interview-Short Form. RESULTS A repeated measures ANOVA was utilized to determine the interaction between baseline scores and pre-post change in caregiver preparedness. Analysis significantly predicted caregiver burden, (F(1) = 6.68, p=.012, partial η2=.10), depressive symptom endorsement, (F(1) = 6.41, p=.014, partial η2=.09, and anticipatory grief, (F(1) = 6.22, p=.02, partial η2=.1), post-treatment. CONCLUSIONS Pre-post change in caregiver preparedness significantly predicted pre-post change across measures of caregiver burden, depressive symptom endorsement, and anticipatory grief. Findings suggest that caregiver preparedness may be one mechanism by which the SC confers positive outcomes. These findings provide an empirical and theoretical basis for tailoring future dementia caregiver interventions. CLINICAL IMPLICATIONS Clinical Interventions may seek to improve caregiver preparedness and subsequent outcomes through utilization of programs like SC.
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Affiliation(s)
- Daniel Paulson
- Department of Psychology, University of Central Florida, Alzheimer's and Dementia Resource Center, Orlando, Florida, USA
| | - Nicole McClure
- Department of Psychology, University of Central Florida, Orlando, Florida, USA
| | - Tracy Wharton
- Principal Research Scientist, National Network of Public Health Institutes, Washington, USA
| | - Edith Gendron
- Chief Operating Officer of ADRC, Winter Park, Florida, USA
| | - Quinn Allen
- Psychology, University of Central Florida, Orlando, USA
| | - Hanya Irfan
- Health Sciences, University of Central Florida, Orlando, USA
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Theng B, Tran JT, Serag H, Raji M, Tzeng HM, Shih M, Lee WCM. Understanding Caregiver Challenges: A Comprehensive Exploration of Available Resources to Alleviate Caregiving Burdens. Cureus 2023; 15:e43052. [PMID: 37680399 PMCID: PMC10480575 DOI: 10.7759/cureus.43052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Aging is associated with significant alterations in physical, cognitive, and emotional functions, predisposing older adults to multimorbidity and functional dependence that necessitate assistance with the activity of daily living (ADL) and medical care from caregivers. With a substantial increase in the aging population comes a growing demand for caregivers, particularly informal caregivers who provide unpaid care to older adults with complex needs. However, they face substantial physical, emotional, and financial burdens as they balance caregiving with their family and job demands. AIM This study aimed to explore key challenges faced by caregivers and the resources they need to address their caregiving burden. Additionally, we wanted to identify whether the number of years of caregiving is associated with their burden. These study findings will inform the design and development of our smartphone app which aims to alleviate the burden of diseases for older adults and the burden of caregiving for caregivers. METHODS From October to December 2022, we invited 80 self-reported caregivers for an anonymous online survey. The caregivers were located in three cities (Galveston, Houston, and Dallas in Texas) and were affiliated with the International Buddhist Progress Society-Dallas (IBPS Dallas) and the University of Texas Medical Branch (UTMB) Osher Lifelong Learning Institute (OLLI). The collected data were subjected to content analysis through systematic examination for meaningful patterns, themes, and insights. Individual characteristics and caregiving experiences were divided by years of care: 0-4 vs. 5+ years to investigate whether the caregiving burden was affected by the duration of caregiving. RESULTS The results showed several important insights, including gender dynamics and traditional norms, the advanced age of caregivers, and the prevalent health conditions they are managing. Caregivers' roles ranged from medical (insurance and medication assistance, etc.) at 63.8% to the provision of non-medical related resources (basic needs, utility, transportation, financial assistance, etc.) at 96.3%. Caregiving is also associated with some positive outcomes, such as changes in knowledge and skills (77.5%) with more confidence in ADL support tasks and a deepening of caregiver/care recipient dyad relationships (56.3%). Some faced challenges in navigating complex healthcare and social service systems and others experienced neglect and received inadequate support from the government-supported social services (33.8%). However, there is no significant variation between those with 0-4 and 5+ years of experience across all identified themes, suggesting that the burdens and resource needs of caregivers can manifest early on and are likely to persist beyond the five-year mark. CONCLUSION Our findings reveal that the number of caregiving years does not significantly influence the types of caregiving burden experienced by caregivers or the resources they require. This indicates the need for providing long-term support to older adults with chronic conditions from the early stage, while also emphasizing the critical role of immediate assistance for caregivers to alleviate caregiving burden. A free-of-charge technology like our smartphone app has the potential to effectively reduce stress for caregivers, offering them support at any time and place. Future studies will focus on evaluating the outcomes of caregivers after utilizing our app.
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Affiliation(s)
- Bunnarin Theng
- Radiology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Jessica T Tran
- Medicine, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Hani Serag
- Department of Internal Medicine - Endocrinology, University of Texas Medical Branch, Galveston, USA
| | - Mukaila Raji
- Department of Internal Medicine - Geriatrics & Palliative Medicine, University of Texas Medical Branch, Galveston, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, USA
| | - Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, USA
| | - Miaolung Shih
- Artificial Intelligence, Humanistic Buddhism Practice (HBP), Osher Lifelong Learning Center, University of Texas Medical Branch, Galveston, USA
| | - Wei-Chen Miso Lee
- Department of Family Medicine, University of Texas Medical Branch, Galveston, USA
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Rapley JM, Camic PM, Brotherhood E, Crutch SJ, Harding E. Video Conferencing Peer Support and Rarer Forms of Dementia: An Exploration of Family Carers' Positive Experiences. QUALITATIVE HEALTH RESEARCH 2023; 33:884-896. [PMID: 37395095 PMCID: PMC10426248 DOI: 10.1177/10497323231172880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Little is known regarding the nuanced experiences of family carers for people living with rare dementias (PLWRD), with no known literature exploring their positive experiences of caring discussed within peer support group settings. This article explores family carers of PLWRD's positive experiences reported in video conferencing peer support groups. Six peer support group sessions involving a total of nine participants were qualitatively analysed using thematic analysis, guided by the conceptual framework of positive aspects of caring (CFPAC) (Carbonneau et al., 2010). Six themes were identified: (1) Protecting, maintaining, enjoying and finding strength in their relationship with the PLWRD; (2) Using tools and resources in response to challenges; (3) Positive impact of interactions and others' responses to the dementia; (4) Overcoming barriers to taking a break while maintaining their wellbeing, (5) Maintaining positive outlooks and showing psychological resilience in adversity; and (6) Attributing meaning to the caring role. This article highlights family carers of PLWRD's positive psychological, physical and social resources, balanced against the challenges of caring and maintaining their wellbeing, and identifies ways of promoting family carers' positive caring experiences and resources within healthcare and supportive settings.
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Wang Y, Luo X, Long X, Shao Y, Zhang S, Zhang Y, Wang Y. Association between housework and the risk of dementia among older Chinese adults: a prospective cohort study. Front Psychol 2023; 14:1228059. [PMID: 37554140 PMCID: PMC10406521 DOI: 10.3389/fpsyg.2023.1228059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES Physical activity (PA) is known to improve physical functioning and mental health and to reduce the incidence of dementia. However, studies of the effects of non-recreational PA on the incidence of dementia, especially in East Asian populations, remain limited. In this study, we evaluate the association of doing housework with the risk of dementia among participants in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). METHODS The analysis was conducted with data from 7,237 CLHLS participants age over 65 obtained in 2008/2009, 2011/2012, 2014, and 2018. The frequency of housework performance was classified into four groups. A Cox proportional-hazards model was used to examine the association of the baseline housework frequency with the incidence of dementia, with adjustment for demographic and socioeconomic characteristics and lifestyle and health conditions. RESULTS The adjusted multivariate model showed that the incidence of dementia was lower among participants who did housework almost every day than among those who rarely or never did housework (hazard ratio = 0.49; 95% confidence interval, 0.39-0.61). The subgroup and sensitivity analyses yielded similar results. CONCLUSION A high frequency of housework performance was associated with a reduced incidence of dementia among older Chinese adults, especially those who did not exercise regularly. The encouragement of engagement in housework would be a cost-effective measure promoting healthy aging in the Chinese population.
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Affiliation(s)
- Yuanlong Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xinxin Luo
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xiangyun Long
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yuan Shao
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
| | - Song Zhang
- Anning Mental Rehabilitation Hospital, Changchun, China
| | - Yingli Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yongjun Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
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Aksin OZ, Bilgic B, Guner P, Gunes ED, Kuscu K, Ormeci EL, Sayin S, Eser HY. Caregiver support and burden drive intention to engage in a peer-to-peer exchange of services among caregivers of dementia patients. Front Psychiatry 2023; 14:1208594. [PMID: 37484665 PMCID: PMC10359163 DOI: 10.3389/fpsyt.2023.1208594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The number of people diagnosed with dementia is increasing, creating significant economic burden globally. With the progression of the disease, patients need a caregiver whose wellbeing is important for continuous care. Providing respite as a service, through sharing the responsibility of caregiving or support for the caregiver, is a costly initiative. A peer-to-peer online support platform for dementia caregivers, motivated by the sharing economy, putting exchange of knowhow, resources, and services at its center, has the potential to balance cost concerns with a search for respite. The aim of this research is to assess caregivers' intention to engage in peer-to-peer exchange. Methods A survey including sociodemographic, technology use, and caregiving variables, structured questionnaires (Zarit caregiver burden, WHO brief quality of life scale, ADCS-ADL and chronic stress scale) were administered, January 2018-May 2019, in the dementia outpatient clinic of a university hospital, to a convenience sample of n = 203 individuals identifying themselves as primary caregivers. A path analysis exploring the drivers of an intention to engage in peer-to-peer service exchange was conducted. Results In the path model, caregivers experiencing higher caregiver burden showed higher intention to engage (0.079, p < 0.001). Disease stage had no effect while patient activities of daily living, chronic social role related stressors of the caregiver and general quality of life were significant for the effect on the caregiver burden. Existing household support decreased the caregiver burden, affecting the intention to engage. Caregivers who can share more know-how demonstrate a higher intention to engage (0.579, p = 0.021). Caregiver technology affinity (0.458, p = 0.004) and ability and openness to seek professional help for psychological diagnoses (1.595, p = 0.012) also increased intention to engage. Conclusion The model shows caregiver burden to be a major driver, along with caregiver characteristics that reflect their technology affinity and openness to the idea of general reciprocity. Existing support for obtaining knowhow and exchanging empathy have a direct effect on the intention to engage. Given the scarcity of caregiver support in the formal care channels, the identified potential of enlarging informal support via a peer-to-peer exchange mechanism holds promise.
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Affiliation(s)
- O. Zeynep Aksin
- College of Administrative Sciences and Economics, Koc University, Istanbul, Türkiye
| | - Basar Bilgic
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Perihan Guner
- Department of Nursing, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Türkiye
| | - Evrim D. Gunes
- College of Administrative Sciences and Economics, Koc University, Istanbul, Türkiye
| | - Kemal Kuscu
- Department of Psychiatry, School of Medicine, Koc University, Istanbul, Türkiye
| | | | - Serpil Sayin
- College of Administrative Sciences and Economics, Koc University, Istanbul, Türkiye
| | - Hale Yapici Eser
- Department of Psychiatry, School of Medicine, Koc University, Istanbul, Türkiye
- Research Center for Translational Medicine, Koc University, Istanbul, Türkiye
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Osstyn SL, Handels R, Boots LMM, Balvert SCE, Evers SMAA, de Vugt ME. The effectiveness and health-economic evaluation of "Partner in Balance," a blended self-management program for early-stage dementia caregivers: study protocol for a cluster-randomized controlled trial. Trials 2023; 24:427. [PMID: 37349828 DOI: 10.1186/s13063-023-07423-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Informal caregivers of people with dementia are crucial in dementia care. However, they are insufficiently supported and report caregiver burdens, which urges the need for cost-effective interventions aimed at supporting caregivers. This paper presents the design of a study evaluating the effectiveness, cost-effectiveness, and cost-utility of a blended self-management program for early-stage dementia caregivers. METHODS/DESIGN A pragmatic, cluster randomized controlled trial with a shared control group will be conducted. Participants will be informal caregivers of people with early-stage dementia and will be recruited by local care professionals. Randomization will be carried out at the level of the care professional level in a ratio of 35% to 65% (control arm vs. intervention arm). Participants in the control arm will receive care as usual and the intervention arm will receive the blended care self-management program "Partner in Balance" within a usual care setting in the Netherlands. Data will be collected at baseline and at 3-, 6-, 12-, and 24-month follow-ups. The primary outcome for effectiveness (part 1) is care management self-efficacy. For the health-economic evaluation (part 2) total care costs and the quality of life for individuals with dementia (cost-effectiveness) and quality-adjusted life years (cost-utility) will be the base case analysis. Secondary outcomes (parts 1 and 2) will include depression, anxiety, perceived informal caregiving stress, service-use self-efficacy, quality of life, caregivers' gain, and perseverance time. A process evaluation (part 3) will investigate the internal and external validity of the intervention. DISCUSSION In this trial, we plan to evaluate the effectiveness, cost-effectiveness, and cost-utility of "Partner in Balance" among informal caregivers of people with dementia. We expect to find a significant increase in care management self-efficacy, and the program to be cost-effective, and provide valuable insights to stakeholders of "Partner in Balance." TRIAL REGISTRATION ClinicalTrials.gov, NCT05450146. Registered on 4 November 2022.
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Affiliation(s)
- Sander L Osstyn
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
| | - Ron Handels
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
| | - Lizzy M M Boots
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
| | - Sanne C E Balvert
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
- Centre of Economic Evaluations & Machine Learning, Trimbos Institute, Utrecht, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands.
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Muijres P, Weitkamp K, Bodenmann G, Jenewein J. Discrepancies in dyadic coping: associations with distress and quality of life in couples facing early stage dementia. Front Psychol 2023; 14:1056428. [PMID: 37292502 PMCID: PMC10246685 DOI: 10.3389/fpsyg.2023.1056428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/30/2023] [Indexed: 06/10/2023] Open
Abstract
Objectives Due to an aging population, the number of persons living with dementia (PWDs) is increasing worldwide. Romantic partners, as informal caregivers (IC) of PWDs, are often adopting additional tasks. The concept of dyadic coping (DC) addresses how couples cope with stress together. For dyadic coping to be successful, efforts of both partners should be equal. The current study examines how discrepancies in PWDs and ICs perspectives on DC relate to distress and quality of life in each partner within couples facing early stage dementia (ESD). Methods A total of 37 mixed-sex couples including one partner with ESD completed self-report questionnaires. Discrepancies in reciprocity (comparing provided or received levels of DC between partners), equity (each partner balancing own levels received and provided), and congruence (the agreement about levels of DC exchanged between partners) and their covariation with distress and quality of life (QoL) of each partner were measured. Results Both partners indicated a discrepancy in reciprocity: PWDs reported receiving more DC than ICs reported receiving, which was associated with higher QoL in PWDs and lower QoL in ICs. Inequities were found in ICs only, who reported receiving less DC, than providing. No relation between inequities and distress or QoL was found. ICs reported more incongruencies than PWDs did, which was associated with higher QoL and less depression in partners. Discussion A redivision of tasks and roles in the early stage of dementia is associated with different experiences and views between partners. Whereas ICs take over most household and care tasks within the couple, their effort was considered less helpful by PWDs than by ICs. A high care burden is associated with a compromised quality of ICs' social life and living conditions. The clinical implications of the results are discussed.
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Affiliation(s)
- Peter Muijres
- University of Zurich, Department of Psychology, Clinical Psychology for Children/Adolescents and Couples/Families, Zurich, Switzerland
| | - Katharina Weitkamp
- University of Zurich, Department of Psychology, Clinical Psychology for Children/Adolescents and Couples/Families, Zurich, Switzerland
| | - Guy Bodenmann
- University of Zurich, Department of Psychology, Clinical Psychology for Children/Adolescents and Couples/Families, Zurich, Switzerland
| | - Josef Jenewein
- Private Clinic Hohenegg, Meilen, Switzerland
- Department of Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
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Ehtewish H, Mesleh A, Ponirakis G, De la Fuente A, Parray A, Bensmail I, Abdesselem H, Ramadan M, Khan S, Chandran M, Ayadathil R, Elsotouhy A, Own A, Al Hamad H, Abdelalim EM, Decock J, Alajez NM, Albagha O, Thornalley PJ, Arredouani A, Malik RA, El-Agnaf OMA. Blood-Based Proteomic Profiling Identifies Potential Biomarker Candidates and Pathogenic Pathways in Dementia. Int J Mol Sci 2023; 24:ijms24098117. [PMID: 37175824 PMCID: PMC10179172 DOI: 10.3390/ijms24098117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023] Open
Abstract
Dementia is a progressive and debilitating neurological disease that affects millions of people worldwide. Identifying the minimally invasive biomarkers associated with dementia that could provide insights into the disease pathogenesis, improve early diagnosis, and facilitate the development of effective treatments is pressing. Proteomic studies have emerged as a promising approach for identifying the protein biomarkers associated with dementia. This pilot study aimed to investigate the plasma proteome profile and identify a panel of various protein biomarkers for dementia. We used a high-throughput proximity extension immunoassay to quantify 1090 proteins in 122 participants (22 with dementia, 64 with mild cognitive impairment (MCI), and 36 controls with normal cognitive function). Limma-based differential expression analysis reported the dysregulation of 61 proteins in the plasma of those with dementia compared with controls, and machine learning algorithms identified 17 stable diagnostic biomarkers that differentiated individuals with AUC = 0.98 ± 0.02. There was also the dysregulation of 153 plasma proteins in individuals with dementia compared with those with MCI, and machine learning algorithms identified 8 biomarkers that classified dementia from MCI with an AUC of 0.87 ± 0.07. Moreover, multiple proteins selected in both diagnostic panels such as NEFL, IL17D, WNT9A, and PGF were negatively correlated with cognitive performance, with a correlation coefficient (r2) ≤ -0.47. Gene Ontology (GO) and pathway analysis of dementia-associated proteins implicated immune response, vascular injury, and extracellular matrix organization pathways in dementia pathogenesis. In conclusion, the combination of high-throughput proteomics and machine learning enabled us to identify a blood-based protein signature capable of potentially differentiating dementia from MCI and cognitively normal controls. Further research is required to validate these biomarkers and investigate the potential underlying mechanisms for the development of dementia.
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Affiliation(s)
- Hanan Ehtewish
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Areej Mesleh
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation (QF), Doha P.O. Box 24144, Qatar
| | - Alberto De la Fuente
- Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Aijaz Parray
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Ilham Bensmail
- Proteomics Core Facility, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Houari Abdesselem
- Proteomics Core Facility, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Marwan Ramadan
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Shafi Khan
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Mani Chandran
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Raheem Ayadathil
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Ahmed Elsotouhy
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
- Department of Clinical Radiology, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha P.O. Box 24144, Qatar
| | - Ahmed Own
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
- Neuroradiology Department, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Hanadi Al Hamad
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Essam M Abdelalim
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Julie Decock
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Translational Cancer and Immunity Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Nehad M Alajez
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Translational Cancer and Immunity Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Omar Albagha
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Paul J Thornalley
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Abdelilah Arredouani
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation (QF), Doha P.O. Box 24144, Qatar
| | - Omar M A El-Agnaf
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
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Jaldin MA, Balbim GM, Colin SJ, Marques IG, Mejia J, Magallanes M, Rocha JS, Marquez DX. The influence of Latino cultural values on the perceived caregiver role of family members with Alzheimer's disease and related dementias. ETHNICITY & HEALTH 2023; 28:619-633. [PMID: 36036081 DOI: 10.1080/13557858.2022.2115018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES We explored how Latino cultural values play a role in perceived caregiving experiences. DESIGN We conducted a qualitative study that used individual, in-depth, semi-structured interviews with middle-aged and older Latinos who were primary caregivers of family members with Alzheimer's disease and related dementias (ADRD). The interview guide consisted of questions about participants' perceptions of family caregiving and interrelationships between the caregiver and care recipient. The interviews were recorded, translated, and transcribed verbatim. We performed direct content analysis. RESULTS Participants were caregivers, 50-75 years old (n = 16), and the majority were female. We identified four cultural values that were salient to participants' caregiving experiences: (a) familismo, (b) fatalismo (c) marianismo, and (d) machismo. CONCLUSION Latino cultural values influenced the role of caregiving and caregiving roles of family members with ADRD. Future research should consider these values as they affect different familial and health dynamics.
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Affiliation(s)
- Michelle A Jaldin
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Guilherme M Balbim
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Stephanie J Colin
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Isabela G Marques
- Division of Rheumatology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jasmine Mejia
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Judith S Rocha
- Social Work Program, College of Arts and Sciences, Northeastern Illinois University, Chicago, IL, USA
| | - David X Marquez
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Peterson A, Largent EA, Lynch HF, Karlawish J, Sisti D. Journeying to Ixtlan: Ethics of Psychedelic Medicine and Research for Alzheimer's Disease and Related Dementias. AJOB Neurosci 2023; 14:107-123. [PMID: 36476106 DOI: 10.1080/21507740.2022.2148771] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
In this paper, we examine the case of psychedelic medicine for Alzheimer's disease and related dementias (AD/ADRD). These "mind-altering" drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; the impact of "ego dissolution" on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards' orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations.
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Affiliation(s)
| | | | | | | | - Dominic Sisti
- University of Pennsylvania Perelman School of Medicine
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50
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Gao X, Wang K, Sun F, De Fries CM, Xu F, Huang P, Feng Y. Associates of Perceived Quality of Life in Chinese Older Adults Living with Cognitive Impairment. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:368-380. [PMID: 35855574 DOI: 10.1080/01634372.2022.2103865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study is to examine perceived quality of life in Chinese older adults living with cognitive impairment and explore its associations with caregivers' characteristics. Questionnaires were administered in person to 271 caregiver-care recipient dyads from urban communities in mainland China in 2019. We used the 40-item Alzheimer's Disease-related Quality of Life tool and asked caregiver respondents to indicate care recipients' life conditions. The questionnaire asked caregivers about their sociodemographic characteristics, levels of informal social support, caregiver burden, and depressive symptoms. Caregivers' higher levels of caregiver burden (β = > -0.19, p < .01) and depressive symptoms (β = > -0.19, p < .01) amongst caregivers were significantly associated with lower quality of life among care recipients. Informal support from relatives and friends to caregivers did not significantly affect quality of life of care recipients. The results suggested that reducing caregivers' burden and depressive symptoms are essential to promote quality of life of care recipients. Formal support from health professionals, service organizations, and communities are urgently called to promote the wellbeing of Chinese families affected by cognitive impairment.
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Affiliation(s)
- Xiang Gao
- School of Sociology, Huazhong University of Science and Technology, Wuhan, China
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Carson M De Fries
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Fang Xu
- Department of internal medicine, Huazhong University of Science and Technology Hospital, Wuhan, Hubei, China
| | - Peijun Huang
- School of Sociology, Huazhong University of Science and Technology, Wuhan, China
| | - Yali Feng
- University Library, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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