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Håkansson T, Svensson H, Karlsson S. Living with a person with young onset dementia - spousal experience. Int J Qual Stud Health Well-being 2024; 19:2330233. [PMID: 38493492 PMCID: PMC10946261 DOI: 10.1080/17482631.2024.2330233] [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: 04/26/2023] [Accepted: 03/11/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Being of working age while at the same time needing to help a partner with young onset dementia has specific consequences for spouses. Research to date has been sparse concerning this particular group of spouses. The aim of the study was to explore spouses' everyday experiences when living with a person with young onset dementia. METHOD The study had a descriptive qualitative design with semi-structured interviews with nine spouses. The interviews were analysed using content analysis. RESULT The interviewed spouses experienced emotions that varied from feelings of loneliness, frustration, and worry to peace of mind. They said that they used coping strategies, which included adopting a positive mindset, adapting to inabilities, adopting an avoidant approach, and finding ways to recharge. Spouses also felt that they could use more support, both formal and informal. CONCLUSION The spouse of a person with young onset dementia has a range of emotional experiences and has resourceful ways of handling everyday life. Various types of support are offered to spouses, however, they seemed to desire more from health care services.
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Affiliation(s)
- Tania Håkansson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Hilda Svensson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Staffan Karlsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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2
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Wangliu Y, Chen JK. The mediating role of coping strategies between caregiving burden and pre-death grief among Chinese adult-child caregivers of dementia patients. J Adv Nurs 2024; 80:3679-3691. [PMID: 38380758 DOI: 10.1111/jan.16118] [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: 06/14/2023] [Revised: 01/15/2024] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
AIMS The objective of this study was to examine the relationship between caregiving burden and pre-death grief, with a specific focus on adult-child caregivers in mainland China. Additionally, the study explored whether coping strategies played a mediating role in this correlation. METHODS A convenience sample of 320 adult-child caregivers of older parents with dementia from Kunming, mainland China, was recruited for the study. Data were collected using the Chinese version of the Marwit-Meuser Caregiver Grief Inventory-Short Form, the Burden Scale for Family Caregivers, and the Ways of Coping Checklist-Revised. RESULTS Results using linear regression and multiple mediation analysis with Hayes' process model indicated that caregiving burden was positively related to pre-death grief and that active coping mediated the relationship between them. In the female group, active coping partially mediated the association between caregiving burden and pre-death grief, but in the male group, this mediating effect did not exist. CONCLUSION The study found evidence supporting the link between caregiving burden and pre-death grief among adult-child caregivers of older parents with dementia in mainland China. Furthermore, the caregiving burden prevented the use of active coping, and this decrease in coping increased the perception of pre-death grief. These associations only existed in the female group. IMPLICATIONS This paper presented the importance of active coping skills in the dementia caregiving process. IMPACT The findings of this study emphasize the necessity for health practitioners to provide targeted interventions regarding pre-death grief among dementia caregivers and strengthen caregivers' active coping strategies to reduce their pre-death grief. Community-based and personal care support services should be promoted to alleviate their caregiving burden. REPORTING METHOD We have adhered to the transparent reporting of evaluations with quantitative design statements and the corresponding checklist was followed. PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.
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Affiliation(s)
- Yiqi Wangliu
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Ji-Kang Chen
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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3
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Mason SL, Barker RA, Andresen K, Gracey F, Ford C. The meaning of apathy in Huntington's disease: A qualitative study of caregiver perspectives. Neuropsychol Rehabil 2024:1-30. [PMID: 39102382 DOI: 10.1080/09602011.2024.2384519] [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: 05/14/2024] [Accepted: 07/21/2024] [Indexed: 08/07/2024]
Abstract
Although one of the most prevalent and impactful features of Huntington's disease (HD), little is known about the impact of apathy on HD caregivers, although there is evidence it affects perceptions of distress and burden. Given the importance of the caregivers, we aimed to explore the lived experience of people supporting someone with HD and associated apathy. Semi-structured interviews were conducted with 11 caregivers and analysed using reflective thematic analysis, informed by a phenomenological framework. Five overarching themes were produced: (1) What even is apathy? (2) It makes my life harder: the practical impact of apathy, (3) They haven't forgotten me, but they have forgotten that they ever loved me, (4) I'm grieving for someone who hasn't died yet, and (5) I need a safe space to say what I really feel without fear of judgement. Inter-woven between these themes were complex narratives about the unspoken nature of HD, the invisibility of caregivers who felt trapped and unheard, and the one-sided nature of loving someone with the disease. Findings are discussed in relation to theoretical frameworks of anticipatory grief and ambiguous loss, and situated within the wider literature on caregiving for people with a neurodegenerative condition.
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Affiliation(s)
- Sarah Louise Mason
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Roger Alistair Barker
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
- NIHR Biomedical Research Centre, Cambridge University Hospitals Foundation Trust, Addenbrookes Hospital, Cambridge, UK
| | - Katie Andresen
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Fergus Gracey
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Catherine Ford
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
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4
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Mroz EL, Schwartz AE, Valeika S, Oettingen G, Marottoli R, David D, Hagaman A, Fedus D, Monin JK. "WOOP is my safe haven": A qualitative feasibility and acceptability study of the Wish Outcome Obstacle Plan (WOOP) intervention for spouses of people living with early-stage dementia. Int J Geriatr Psychiatry 2024; 39:e6092. [PMID: 38687142 DOI: 10.1002/gps.6092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES As symptoms emerge and worsen in people living with dementia, their spouses can benefit from behavioral interventions to support their adjustment as a care partner. The Wish Outcome Obstacle Plan (WOOP) intervention improves the well-being of spouses of people living with dementia early in the disease course, but intervention mechanisms and opportunities for improvement are unclear. The present study gave voice to spouses who participated in a trial of WOOP, describing how WOOP was incorporated into their lives and how it could be improved for future implementation. METHOD For this qualitative study, we conducted longitudinal semi-structured interviews among 21 spouses of people living with dementia (three interviews over three months; 63 interviews total). Codebook thematic analysis was performed. RESULTS Three meta-themes were derived: (1) assessing baseline strengths and limitations of WOOP, (2) learning from experience, and (3) fine-tuning and sustaining WOOP. Participants described how WOOP addressed their interpersonal and emotional stressors, their responses to behaviors of the person living with dementia, and their relationship quality. Considerations for future intervention delivery (e.g., solo vs. in group settings) and instructions (e.g., encouraging writing vs. thinking through the four steps of WOOP) were identified as areas of improvement. CONCLUSIONS WOOP was described as a practical, feasible, and desirable intervention for spouses at the early stages of their partner's dementia. Participants made WOOP easier to incorporate in their everyday lives by adapting the design into a mental exercise that they used as needed. Suggestions from participants specified how to make the everyday use of WOOP more feasible, sustainable, and applicable in a variety of contexts. TRIAL REGISTRATION ClinicalTrials.gov HIC 2000021852.
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Affiliation(s)
- Emily L Mroz
- Department of Geriatrics, Yale School of Medicine, New Have, Connecticut, USA
| | - Anna E Schwartz
- Social and Behavioral Sciences, Yale School of Public Health, New Have, Connecticut, USA
| | - Sarah Valeika
- Social and Behavioral Sciences, Yale School of Public Health, New Have, Connecticut, USA
| | - Gabriele Oettingen
- Department of Psychology, New York University, New York, New York, USA
- Department of Political and Social Sciences, Zeppelin University Friedrichshafen, Friedrichshafen, Germany
| | - Richard Marottoli
- Department of Geriatrics, Yale School of Medicine, New Have, Connecticut, USA
| | - Daniel David
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Ashley Hagaman
- Social and Behavioral Sciences, Yale School of Public Health, New Have, Connecticut, USA
| | - Donna Fedus
- Borrow My Glasses, Madison, Connecticut, USA
| | - Joan K Monin
- Social and Behavioral Sciences, Yale School of Public Health, New Have, Connecticut, USA
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5
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Sánchez-Alcón M, Garrido-Fernández A, Cano-Rojas JM, Sánchez-Ramos JL, Ramos-Pichardo JD. Relationship between Depressive Symptoms, Caregiver Strain, and Social Support with Dementia Grief in Family Caregivers. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:643. [PMID: 38674288 PMCID: PMC11052144 DOI: 10.3390/medicina60040643] [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: 03/12/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Dementia grief in family caregivers of people with dementia refers to grieving prior to the death of the care recipient. It is related to psychosocial risk factors that may have a negative impact on the health of these family caregivers. This study aimed to describe the relationship between depressive symptoms, caregiver strain, and social support with dementia grief in family caregivers of people with dementia. Materials and Methods: A descriptive correlational cross-sectional study was conducted. A total of 250 family caregivers of people with dementia participated. Dementia grief was the main variable, and depressive symptoms, caregiver strain, and social support were assessed. Additionally, socio-demographic data were collected. Descriptive statistics were calculated, and a bivariate correlation analysis and a multiple linear regression analysis were performed for dementia grief. Results: Higher scores for dementia grief were found in women, in family caregivers of patients at advanced stages of dementia, and in family caregivers with a low level of education. High levels of depressive symptoms and caregiver strain and low levels of social support indicated greater intensity of dementia grief. Depressive symptomatology was the variable with the greatest influence on dementia grief. Caregiver strain and social support also related to dementia grief, but to a lesser extent. Conclusions: In family caregivers, depressive symptoms, caregiver strain, and social support are related to the intensity of dementia grief, with a greater influence of depressive symptoms. Moreover, being female, having a low level of education, and caring for a care recipient at an advanced stage of dementia are factors associated with increased dementia grief. Concerning study limitations, the sample was restricted, belonging to a specific region of Spain and to a Provincial Federation of associations. It is necessary to exercise caution in generalizing results due to the sociodemographic and geographical characteristics of the sample.
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Affiliation(s)
- Miriam Sánchez-Alcón
- Nursing Department, Nursing Faculty, University of Huelva, 21007 Huelva, Spain; (A.G.-F.); (J.L.S.-R.); (J.D.R.-P.)
| | - Almudena Garrido-Fernández
- Nursing Department, Nursing Faculty, University of Huelva, 21007 Huelva, Spain; (A.G.-F.); (J.L.S.-R.); (J.D.R.-P.)
| | - José María Cano-Rojas
- Provincial Federation of Associations of Family Caregivers of People with Alzheimer’s Disease and other Dementias of Huelva and Province, 21710 Huelva, Spain;
| | - José Luis Sánchez-Ramos
- Nursing Department, Nursing Faculty, University of Huelva, 21007 Huelva, Spain; (A.G.-F.); (J.L.S.-R.); (J.D.R.-P.)
| | - Juan Diego Ramos-Pichardo
- Nursing Department, Nursing Faculty, University of Huelva, 21007 Huelva, Spain; (A.G.-F.); (J.L.S.-R.); (J.D.R.-P.)
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6
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Ng YH, Jiao K, Suen MHP, Wang J, Chow AYM. The role of the social environment on dementia caregivers' pre-death grief: A mixed- methods systematic review. DEATH STUDIES 2024:1-20. [PMID: 38497324 DOI: 10.1080/07481187.2024.2329755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers' experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences.
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Affiliation(s)
- Yong Hao Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Margaret H P Suen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Waddington C, Flanagan K, Clements H, Harding E, van der Byl Williams M, Walton J, Crutch S, Stott J. Grief and loss in people living with dementia: a review and metasynthesis of qualitative studies. Aging Ment Health 2024; 28:408-421. [PMID: 37970882 DOI: 10.1080/13607863.2023.2280925] [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: 09/05/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES This review seeks to synthesise qualitative studies that focus on the experience of grief and loss in people living with dementia. METHODS Included studies were quality appraised, synthesised and analysed using inductive thematic analysis. RESULTS 19 studies were selected for inclusion in the final review and metasynthesis, including 486 participants (115 participants living with dementia, 152 family carers, 219 professionals). Five key dimensions of grief in people living with dementia were identified during the analysis process: grieving for the person I used to be, grieving for how others see me, grieving for the person I will become, grieving for those who have died and what helps me with my grief. CONCLUSION It is evident that people living with dementia can experience grief related to a range of previous, current and anticipated losses. Many of the studies included in this review did not directly include people living with dementia in their research and did not ask participants directly about their experience of grief and loss. As grief is a highly personal and individual experience, further research addressing the experience of grief that directly includes participants living with dementia is required, in order to improve awareness of grief-related needs and to develop and deliver support to meet these needs.
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Affiliation(s)
- Claire Waddington
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Katie Flanagan
- Centre for Ageing Population Studies, Primary Care and Population Health, University College London, London, UK
| | - Henry Clements
- Clinical Education and Health Psychology, University College London, London, UK
| | - Emma Harding
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | | | - Jill Walton
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Sebastian Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Joshua Stott
- ADAPT Lab, Clinical Education and Health Psychology, University College London, London, UK
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8
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Sánchez-Alcón M, Sosa-Cordobés E, Garrido-Fernández A, Sánchez-Ramos JL, Ramos-Pichardo JD. Psychometric properties of a Spanish version of the MM-CGI-SF in caregivers of people with dementia. J Am Geriatr Soc 2024; 72:201-208. [PMID: 37800646 DOI: 10.1111/jgs.18623] [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: 06/26/2023] [Revised: 08/24/2023] [Accepted: 09/09/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Caregivers of people with dementia may experience characteristic grief linked to present and anticipated losses before the physical death of the care recipient occurs, which is related to physical and mental health problems. The Marwit-Meuser Caregiver Inventory-Short Form (MM-CGI-SF) is an instrument that assesses this type of grief. Since there are no studies on an adaptation of the MM-CGI-SF to the Spanish population, the aim of the study was to evaluate its psychometric properties in a sample of caregivers of dementia patients. METHODS A cross-sectional study was carried out. The tool was translated and adapted into Spanish, which was administered to 250 caregivers of people with dementia in the province of Huelva, together with other related instruments. Descriptive statistics and internal consistency reliability were calculated using Cronbach's alpha, for the total questionnaire and for each subscale. A confirmatory factor analysis (CFA) was performed and the Spanish version of the MM-CGI-SF was correlated with the rest of the variables by calculating Spearman's correlation coefficient. RESULTS 80.4% of the participants were female and had high levels of caregiver grief (x ¯ = 64.62, SD = 14.86). Cronbach's alpha for the general questionnaire was 0.927 and between 0.822-0.854 for its subscales. The fit values of the CFA were: x2 = 202.033, degrees of freedom = 121, x2 /df = 1.670, TLI = 0.954, CFI = 0.963, SRMR = 0.047, RMSEA = 0.052; and all the correlations were statistically significant. CONCLUSIONS The Spanish version of the MM-CGI-SF shows adequate psychometric properties. Thanks to this instrument, health professionals may measure caregiver grief, get closer to the reality of dementia care, and evaluate the effectiveness of interventions to manage this grief.
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Manevich A, Yehene E, Rubin SS. A case for inclusion of disordered Non-Death Interpersonal Grief as an official diagnosis: rationale, challenges and opportunities. Front Psychiatry 2023; 14:1300565. [PMID: 38161721 PMCID: PMC10757611 DOI: 10.3389/fpsyt.2023.1300565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Alexander Manevich
- Department of Psychology, Kinneret Academic College, Tzemach, Israel
- Department of Behavioral Sciences, Kinneret Academic College, Tzemach, Israel
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Einat Yehene
- School of Behavioral Sciences, Academic College Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Simon Shimshon Rubin
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Psychology, Max Stern Academic College of Emek Yezreel, Jezreel Valley, Israel
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Sánchez-Alcón M, Sánchez-Ramos JL, Garrido-Fernández A, Sosa-Cordobés E, Ortega-Galán ÁM, Ramos-Pichardo JD. Effectiveness of interventions aimed at improving grief and depression in caregivers of people with dementia: A systematic review and meta-analysis. Int J Ment Health Nurs 2023; 32:1211-1224. [PMID: 36971150 DOI: 10.1111/inm.13142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Caregivers of people suffering from dementia may go through a grieving process prior to the death of the cared-for person, which is related to mental health and physical problems. Interventions aimed at improving grief and depression are being used in response to these difficulties. The aim of this study was to synthesize and evaluate the evidence for the effectiveness of interventions aimed at improving the grief process in home-based caregivers of people with dementia with the aim of reducing grief and depression. A systematic review, including a meta-analysis, was designed. Following the PRISMA guideline, original articles were searched in the databases: Medline, WOS, Scopus and PsycINFO, up to September 2022. Articles that evaluated interventions aimed at improving the grief process in caregivers of people with dementia, whose care recipients were alive at the beginning of the study at minimum and living at home were selected. Grief and depression were considered outcome variables. A meta-analysis was carried out with a fixed effects model for these variables and for the domains of the Caregiver Grief Scale (CGS). Eight articles met the inclusion and exclusion criteria. Most of the interventions aimed at improving the grief process showed an improvement in grief and depression. The 'emotional pain' and 'absolute loss' domains of the CGS stood out with an improvement in these variables. Interventions aimed at improving the grief process are relatively effective in reducing grief and depression. Interventions that are even more effective and more robust studies are needed.
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Crawley S, Sampson EL, Moore KJ, Kupeli N, West E. Grief in family carers of people living with dementia: A systematic review. Int Psychogeriatr 2023; 35:477-508. [PMID: 35086600 DOI: 10.1017/s1041610221002787] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Grief research in family carers of people with dementia has increased. We aimed to report the prevalence of pre-death and post-death grief and to synthesize associated factors and the relationship between pre-death factors and post-death grief and services used to manage grief. DESIGN (Prospero protocol: CRD42020165071) We systematically reviewed literature from PsycINFO, MEDLINE, CINAHL, and ASSIA until April 2020. Effectiveness of intervention data and studies not written in English were excluded; qualitative studies were additionally excluded during study selection. Study quality was assessed using the Mixed Methods Appraisal Tool. Evidence was narratively summarized. PARTICIPANTS Family non-paid carers of somebody with any dementia type. MEASUREMENTS Validated measures of pre-death and/or post-death grief. RESULTS We included quantitative data from 55 studies (44 rated as high quality). Most included solely spouse or adult child carers. Forty-one studies reported pre-death grief, 12 post-death grief, and 6 service use; eight were longitudinal. 17% met the Prolonged Grief Disorder criteria pre-death (n = 1) and 6-26% (n = 4) of participants met the Complicated Grief criteria post-death. Being a spouse, less educated, caring for somebody with advanced dementia, and greater burden and depression were associated with higher pre-death grief. Lower education level and depression were predictive of higher post-death grief. Pre-death factors found to influence post-death grief were grief and depression. Limited service use evidence was reported. CONCLUSION Awareness of characteristics which increase the likelihood of higher grief can help identify those in need of support. Future research should focus on what supports or services are beneficial to grief experiences.
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Affiliation(s)
- Sophie Crawley
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
| | | | - Kirsten J Moore
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | - Nuriye Kupeli
- Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
| | - Emily West
- Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
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Lindauer A, Smith S, Gothard S, Mattek N, Tran L, Mooney A. 'There's no straight line…' a consumer-informed intervention for FTD family care partners: the STELLA-FTD pilot study. Aging Ment Health 2023; 27:2000-2010. [PMID: 37655616 PMCID: PMC10518812 DOI: 10.1080/13607863.2023.2250741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES Behavioral symptoms and communication challenges are particularly apparent in frontotemporal degenerative (FTD) dementias. There is a paucity of psychoeducation programming specifically tailored to the needs of families with FTD. We revised an existing intervention to meet the needs of these families. METHODS We used a quasi-experimental approach. In Phase 1, we sought consumer input about an existing intervention. In Phase 2, we modified the intervention based on the qualitative findings from Phase 1 and tested the revised intervention (STELLA-FTD) for feasibility, acceptability and early-stage efficacy. Outcome for Phase 2 included feasibility data and care partner reactivity to upsetting behaviors. Secondary outcomes included data from unobtrusive sleep monitoring. An inductive analysis of transcripts from the Phase 2 STELLA-FTD focus group provides guidance for future revisions. RESULTS Fifteen family care partners participated in the Phase 1 focus groups; sixteen care partners enrolled in Phase 2. Testing in Phase 2 revealed that the care partners found our consumer-informed revised intervention both feasible and acceptable. The post-intervention findings suggest STELLA-FTD has the potential to reduce care partner reactivity to upsetting behaviors and to decrease care partner burden. Sleep did not change over the 8-week intervention. CONCLUSIONS The revised STELLA-FTD intervention was found to be feasible and acceptable, and has potential to improve care partner burden for families living with FTD. Providing the intervention via telehealth maximized access and engaged rehabilitation specialists in providing disease management content. Future revisions will include examination of efficacy and mechanism of action (OHSU IRB # 00022721, ClinicalTrials.gov NCT05338710).
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Affiliation(s)
- Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Samantha Smith
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Sarah Gothard
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Nora Mattek
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Leslie Tran
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Aimee Mooney
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
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Abstract
In this article, I address the experiences of family members of people with dementia, as they expressed the sensation of gradually losing the person with dementia. Based on ethnographic fieldwork in nursing homes in the Netherlands, and contributing to the anthropology of grief, I explore the co-existence of experiences of anticipatory grief and manifestations of care to maintain meaningful relations. I show how my interlocutors adapted to changing circumstances as the disease progressed, and in so doing found new ways to relate, as well as prepared for future losses and the expected end of life. I argue that anticipatory grief is temporal and relational, encompassing both present and future losses, and involving a continuous negotiation between the loss and the continuing relationship. I underscore the entanglement of loss and connection, showing how both exist parallel to, and may emerge from one another, and demonstrating how an anthropological approach to anticipatory grief can reveal the nuanced and equivocal character of experiences of illness and at the end of life.
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Affiliation(s)
- Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
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14
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Kokoszka L. Weathering the Storm of Caregiving for Persons with Alzheimer's Disease. Home Healthc Now 2023; 41:272-276. [PMID: 37682741 DOI: 10.1097/nhh.0000000000001195] [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: 09/10/2023]
Abstract
Alzheimer's disease (AD) is a progressive incurable disease affecting an individual's cognitive, behavioral, and physical systems. As individuals become more impaired, assistance is required and care may be provided by spouses, family members, or other close companions who serve as informal caregivers. To examine the perceptions and meaning of caring for a person with AD an interpretive descriptive study was used. Semistructured interviews were conducted with 13 informal caregivers. Data analysis revealed two themes: Grappling with the Responsibilities of Invisible Care and Weathering the Storm of Visible Care. Both themes relate to the stress and struggle of the visible and invisible roles of caregivers. The results of the study strengthen the need for home care clinicians to support caregivers who provide both visible and invisible care for persons with AD.
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Affiliation(s)
- Lori Kokoszka
- Lori Kokoszka, PhD, RN, is an Assistant Professor, Widener University, One University Place, Chester, Pennsylvania
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Stevens-Neck R, Walton J, Alterkawi S, Brotherhood EV, Camic PM, Crutch SJ, Gerritzen EV, Harding E, McKee-Jackson R, Rossi-Harries S, Street RE, van der Byl Williams M, Waddington C, Wood O, Moore KJ. A mixed methods evaluation of a program exploring predeath grief and loss for carers of people with rarer dementias. Int Psychogeriatr 2023:1-12. [PMID: 37128845 DOI: 10.1017/s1041610223000236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Predeath grief conceptualizes complex feelings of loss experienced for someone who is still living and is linked to poor emotional well-being. The Road Less Travelled program aimed to help carers of people with rarer dementias identify and process predeath grief. This study evaluated the feasibility, acceptability, and preliminary effectiveness of this program. DESIGN Pre-post interventional mixed methods study. SETTING Online videoconference group program for carers across the UK held in 2021. PARTICIPANTS Nine family carers of someone living with a rare form of dementia. Eight were female and one male (mean age 58) with two facilitators. INTERVENTION The Road Less Travelled is an online, facilitated, group-based program that aims to help carers of people with rarer dementias to explore and accept feelings of grief and loss. It involved six fortnightly 2-hour sessions. MEASUREMENTS We collected measures for a range of well-being outcomes at baseline (T1), post-intervention (T2), and 3 months post-intervention (T3). We conducted interviews with participants and facilitators at T2. RESULTS Participant attendance was 98% across all sessions. Findings from the semistructured interviews supported the acceptability of the program and identified improvements in carer well-being. Trends in the outcome measures suggested an improvement in quality of life and a reduction in depression. CONCLUSION The program was feasible to conduct and acceptable to participants. Qualitative reports and high attendance suggest perceived benefits to carers, including increased acceptance of grief, and support the need for a larger-scale pilot study to determine effectiveness.
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Affiliation(s)
- Rosie Stevens-Neck
- North East London NHS Foundation Trust, London, UK
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jill Walton
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Shaima Alterkawi
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Paul M Camic
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Esther V Gerritzen
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma Harding
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Roberta McKee-Jackson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Samuel Rossi-Harries
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rebecca E Street
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Millie van der Byl Williams
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Claire Waddington
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Olivia Wood
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Kirsten J Moore
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Parkville, Victoria, Australia
- Marie Curie Palliative Care Research Department, University College London, London, UK
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16
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Volle D. Dementia Care at the End of Life: A Clinically Focused Review. Am J Geriatr Psychiatry 2023; 31:291-303. [PMID: 36456444 DOI: 10.1016/j.jagp.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
With the geriatric population in the United States growing rapidly, the prevalence of dementia is expected to rise concomitantly. As dementia is an invariably progressive and terminal illness, planning for and managing end of life care in dementia is an important part of the overall process of dementia care. Unfortunately, this is often neglected outside of formal palliative and hospice medicine training programs and geriatric psychiatrists are left without preparation on how to manage, as well as counsel patients and families on, this important phase of dementia care. This review aims to explore the potential contributors to this historic disparity in geriatric education and care delivery, as well as its impact, while also attempting to shift the field's focus toward a palliative approach to dementia care. To begin to accomplish this, this review explores the natural illness history/disease trajectory of the various dementing illnesses, as well as the topic of prognostication as it pertains to the end of life for patients with dementia and how this information can be used in advanced care planning and symptom management.
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Affiliation(s)
- Dax Volle
- Department of Psychiatry (DV), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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Moore KJ, Crawley S, Fisher E, Cooper C, Vickerstaff V, Sampson EL. Exploring how family carers of a person with dementia manage pre-death grief: A mixed methods study. Int J Geriatr Psychiatry 2023; 38:e5867. [PMID: 36862574 DOI: 10.1002/gps.5867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Many family carers of a person with dementia experience pre-death grief. We aimed to identify strategies that help carers manage pre-death grief. We hypothesised that emotion and problem focussed styles would be associated with lower, and dysfunctional coping with higher grief intensity. METHODS Mixed methods observational study using structured and semi-structured interviews with 150 family carers of people with dementia living at home or in a care home. Most participants were female (77%), caring for a parent (48%) or partner/spouse (47%) with mild (25%), moderate (43%) or severe (32%) dementia. They completed the Marwit-Meuser Caregiver Grief Inventory Short Form and the Brief Coping Orientation to Problems Experienced (Brief-COPE) questionnaire. We asked carers to identify strategies used for managing grief. We recorded field notes for 150 interviews and audio-recorded additional interviews with a sub-sample of 16 participants. RESULTS Correlations indicated that emotion-oriented coping was associated with lower grief (R = -0.341), and dysfunctional coping with higher grief (R = 0.435), with a small association with problem-focused strategies (R = -0.109), partly supporting our hypothesis. Our qualitative themes broadly match the three Brief-COPE styles. Unhelpful strategies of denial and avoidance align with dysfunctional coping strategies. Psychological strategies (including acceptance and humour) and seeking support were consistent with emotion-focused strategies, but we did not identify a theme relating to problem-focused strategies. CONCLUSION Most carers identified multiple strategies for processing grief. Carers could readily identify supports and services that they found helpful for managing pre-death grief, yet current services appear under-resourced to meet growing demand. (ClinicalTrials.gov ID: NCT03332979).
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Affiliation(s)
- Kirsten J Moore
- National Ageing Research Institute, Parkville, Victoria, Australia
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Medicine-Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sophie Crawley
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Emily Fisher
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
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Manevich A, Rubin SS, Katz M, Ben-Hayun R, Aharon-Peretz J. Risk, Resilience, and the Two-Track Model of Dementia Grief Among Spouses of People Living With Cognitive Decline. Gerontol Geriatr Med 2023; 9:23337214231171264. [PMID: 37342766 PMCID: PMC10278413 DOI: 10.1177/23337214231171264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/15/2023] [Accepted: 04/05/2023] [Indexed: 06/23/2023] Open
Abstract
Pre-death grief in the context of dementia caregiving is a significant risk factor for depression, burden, anxiety, and adjustment difficulties. The Two-Track Model of Dementia Grief (TTM-DG) provides a bifocal perspective addressing the nature of the emotional attachment to a loved one living with cognitive impairment, along with a medico-psychiatric perspective associated with stress, trauma, and change in life. The aims of the present study were to empirically validate the components of the model as to identify salutary and risk factors for maladaptive grief responses. Participants were 62 spouses of people living with cognitive impairment, and a control group of 32 spouses. All completed a battery of self-report questionnaires. Structural Equation Modeling yielded six variables consistent with the TTM-DG: partner's behavioral disorders; caregiver's burden; social support; physical health; attachment anxiety; and dementia grief as an outcome measure. Additional findings addressed participants at risk for grief difficulties. The findings provide empirical support for the utility of the TTM-DG in the identification of risk factors associated with maladaptive responses and pre-death grief following a spousal cognitive decline. The TTM-DG can assist in the formulation of evidence-based evaluations and interventions to assist spouses caring for their loved ones living with dementia.
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Affiliation(s)
- Alexander Manevich
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Behavioral Sciences, Kinneret Academic College, Tzemach, Israel
| | - Simon Shimshon Rubin
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Psychology, Max Stern Yezreel Valley College, Israel
| | - Michael Katz
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Rachel Ben-Hayun
- Cognitive Neurology Institute, Rambam Health Care Campus, Haifa, Israel
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19
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Risch AK, Mund M, Wilz G. The Caregiver Thoughts Scale: An Instrument to Assess Functional and Dysfunctional Thoughts about Caregiving. Clin Gerontol 2022:1-14. [PMID: 36528807 DOI: 10.1080/07317115.2022.2153775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Caregivers' care-related thoughts critically effect their well-being. Currently, there is a lack of validated measures to systematically assess caregivers' functional and dysfunctional thoughts. We therefore aimed to develop a measure of caregivers' thoughts that assesses not only their dysfunctional but also their functional thoughts in multiple domains. METHODS A pool of potential questionnaire items was generated from therapy sessions with caregivers and was rated by experts. A sample of 322 main family caregivers (Mage = 63.9 years) of a person with dementia then completed a set of 28 items about their care-related thoughts and a number of related measures at three measurement points. Items were then aggregated via a formative measurement approach based on theoretical considerations. Correlational analyses were used to examine the construct validity of the subscale scores. RESULTS The final 28-item scale assesses caregiving thoughts in four distinct domains: dysfunctional caregiving standards, self-care, dysfunctional assumptions about dementia, and acceptance. The correlational analyses demonstrated the subscales' construct validity, by showing that scale scores are meaningfully related to theoretically relevant constructs. CONCLUSIONS The Caregiving Thoughts Scale is a promising measure of caregivers' thoughts in four important domains. CLINICAL IMPLICATIONS The scale can be applied in clinical research settings.
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Affiliation(s)
- Anne Katrin Risch
- Institute of Psychology, Department of Counseling and Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Marcus Mund
- Institute of Psychology, Department of Personality Psychology and Psychological Assessment, University of Klagenfurt, Klagenfurt, Austria
| | - Gabriele Wilz
- Institute of Psychology, Department of Counseling and Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
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Manevich A, Rubin SS, Katz M, Ben-Hayun R, Aharon-Peretz J. The Two-Track Model of Dementia Grief and spousal response to illness and death. DEATH STUDIES 2022; 47:592-599. [PMID: 35993431 DOI: 10.1080/07481187.2022.2113479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This cross-sectional study examined the experiences of healthy spouses caring for their partners via the Two-Track Model of Dementia Grief thereby broadening our understanding of the functional and relational aspects of this process. The 122 participating older adults had spouses drawn from four groups: mild to moderate cognitive-impairment; advanced cognitive-impairment; deceased following dementia; and, healthy controls. They completed a battery of self-report measures. Results showed elevated scores on both tracks of the model for all affected groups. Assisting spouses of those living with cognitive-impairment begins with the earliest symptoms of decline and continues after the death of the loved one.
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Affiliation(s)
- Alexander Manevich
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Behavioral Sciences, Kinneret Academic College, Galilee, Israel
| | - Simon Shimshon Rubin
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Psychology, Max Stern Yezreel Valley College, Jezreel Valley, Israel
| | - Michael Katz
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Rachel Ben-Hayun
- Cognitive Neurology Institute, Rambam Health Care Campus, Haifa, Israel
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21
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Mahomed A, Pretorius C. Understanding the lived experiences of family caregivers of individuals with dementia in Soweto, a South African Township. DEMENTIA 2022; 21:2264-2287. [DOI: 10.1177/14713012221118441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study was undertaken to understand South African family caregivers’ lived experiences of individuals living with dementia in a predominantly Black African township. A homogenous sample of thirty family caregivers was recruited using purposeful sampling methods and interviewed using a semi-structured approach. Reflective Thematic Analysis (RTA) yielded four broad themes: Understanding Dementia, Struggles and Sacrifice, Mental Health and Protective Factors. Findings reflect how dementia is understood by family caregivers and their community, the struggles and sacrifices that they endure, the impact of caregiving on caregiver mental health and the protective factors that enable caregivers to cope, despite their difficulties. Our findings lead to new insights regarding dementia caregiving amongst family caregivers in South Africa. First, there appears to be a shift in perception – away from a cultural/spiritual paradigm – and a lack of pressure to conform to community conceptualizations of dementia among individual caregivers. Second, dementia caregiving had a negative effect on caregiver mental health and elicited stress, anxiety and grief reactions. Third, caregivers did not feel emotionally supported and expressed not receiving any assistance with their daily practical tasks. Fourth, before receiving a diagnosis, family caregivers were viewed as the perpetrators of abuse and/or neglect against their family members with dementia, instead of individuals with dementia being stigmatized by the community due to their behavioural symptoms. Additionally, help-seeking was not hindered by fear or stigma, but was motivated by caregiver distress as dementia-related behaviours began to manifest and caregivers feared being perceived as perpetrators of abuse. Psychoeducational interventions should be tailored to targeted population groups that are in need of further training to address the lack of awareness in communities, insufficient knowledge of dementia amongst healthcare professionals and the practical, emotional and psychological difficulties that family caregivers endure to facilitate mental health care and resilience.
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22
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Gilsenan J, Gorman C, Shevlin M. Explaining caregiver burden in a large sample of UK dementia caregivers: The role of contextual factors, behavioural problems, psychological resilience, and anticipatory grief. Aging Ment Health 2022:1-8. [PMID: 35881027 DOI: 10.1080/13607863.2022.2102138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Dementia caregiver burden is a significant public health concern, affecting both the wellbeing of caregivers and their care-recipients. This study investigated a range of variables associated with caregiver burden in a large sample of UK dementia caregivers. Clinical characteristics and novel psychological constructs were used - including anticipatory grief and psychological resilience. Anticipatory grief refers to the process of experiencing loss prior to the death of a significant person. METHOD Caregivers of persons with dementia (N = 530) completed a survey obtaining the Zarit-Burden Interview (ZBI-SF) and other psychological and demographic/caregiving-related factors. RESULTS Findings illustrate that 71% of the sample experienced high levels of caregiver burden and around 95% met the criteria for clinically significant levels of burden. A regression model explained 49% of the variance in subjective caregiver burden; contextual factors (care-recipients living situation, frequency of caregiving), behavioural challenges in the care-recipient (memory-related problem behaviours), caregiver psychological resilience and caregiver anticipatory grief (heartfelt long & sadness, worry & felt isolation) were all significant variables. Caregiver anticipatory grief, followed by psychological resilience, had the strongest association with burden. CONCLUSION Caregiver anticipatory grief and psychological resilience, have a significant interaction with the clinical presentation of the dementia sufferer in explaining subjective caregiver burden. More grief and resilience-focused interventions targeting both the practical and emotional challenges are imperative to reduce burden and thus to ensure caregiver wellbeing.
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Affiliation(s)
- Jane Gilsenan
- School of Psychology, Ulster University, Coleraine, United Kingdom of Great Britain and Northern Ireland
| | - Colin Gorman
- School of Psychology, Ulster University, Coleraine, United Kingdom of Great Britain and Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, United Kingdom of Great Britain and Northern Ireland
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23
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Waddington C, Harding E, Brotherhood EV, Davies Abbott I, Barker S, Camic PM, Ezeofor V, Gardner H, Grillo A, Hardy C, Hoare Z, McKee-Jackson R, Moore K, O'Hara T, Roberts J, Rossi-Harries S, Suarez-Gonzalez A, Sullivan MP, Edwards RT, Van Der Byl Williams M, Walton J, Willoughby A, Windle G, Winrow E, Wood O, Zimmermann N, Crutch SJ, Stott J. The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation. JMIR Res Protoc 2022; 11:e35376. [PMID: 35857375 PMCID: PMC9350818 DOI: 10.2196/35376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/10/2023] Open
Abstract
Background People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic. Objective We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups. Methods We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed. Results The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions. Conclusions The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population. International Registered Report Identifier (IRRID) DERR1-10.2196/35376
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Affiliation(s)
- Claire Waddington
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Emma Harding
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Emilie V Brotherhood
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Ian Davies Abbott
- Dementia Services Development Centre, Bangor University, Bangor, United Kingdom
| | - Suzanne Barker
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Paul M Camic
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Victory Ezeofor
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Hannah Gardner
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Adetola Grillo
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON, Canada
| | - Chris Hardy
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Zoe Hoare
- School of Health Sciences, Bangor University, Bangor, United Kingdom
| | - Roberta McKee-Jackson
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Kirsten Moore
- Division of Psychiatry, University College London, London, United Kingdom
| | - Trish O'Hara
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Jennifer Roberts
- Dementia Services Development Centre, Bangor University, Bangor, United Kingdom
| | - Samuel Rossi-Harries
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Aida Suarez-Gonzalez
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Mary Pat Sullivan
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON, Canada
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | | | - Jill Walton
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Alicia Willoughby
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Gill Windle
- Dementia Services Development Centre, Bangor University, Bangor, United Kingdom
| | - Eira Winrow
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Olivia Wood
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Nikki Zimmermann
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Sebastian J Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Joshua Stott
- Psychology and Language Sciences, University College London, London, United Kingdom
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Hovland CA, Fuller KA. African American Family Caregivers Share How they Prepared for the Death of an Older Adult with Dementia: A Pilot Study of Hospice Care in A Nursing Home. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:129-145. [PMID: 35226595 DOI: 10.1080/15524256.2022.2042458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The focus of this pilot study was to ascertain how bereaved African American caregivers prepared for the death of an older family member who died from a dementia-related diagnosis and the role of hospice care; an area with little research to date. Because African American older adults in the United States are at greater risk than Caucasian older adults for dementia-related health problems though less likely to be diagnosed, treated, or to enroll in hospice services, this exploratory study asked questions of the family caregivers' experiences in preparing for the death. Purposive criterion sampling was used to identify six African American bereaved caregivers whose family member lived in a nursing home (five who were enrolled in hospice services) who were extensively interviewed, with the use of conventional content analysis of the transcripts to identify the findings. Because of the limited sample size, themes identified were considered preliminary and may help guide ongoing and further research. Five primary themes revealed ways caregivers prepared: accepting reality; "I just kind of knew;" person with dementia "was ready;" "spending time;" and, getting your "business in order." All caregivers believed it was important to be prepared for the death, with the five who received hospice services reporting that they were prepared. Further research is needed to explore these preliminary findings of African American caregivers of family members with dementia at end-of-life to further inform social work and hospice team care.
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Affiliation(s)
- Cynthia A Hovland
- School of Social Work, Cleveland State University, Cleveland, Ohio, USA
| | - Kimberly A Fuller
- School of Social Work, Cleveland State University, Cleveland, Ohio, USA
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25
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Singer J, Roberts KE, McLean E, Fadalla C, Coats T, Rogers M, Wilson MK, Godwin K, Lichtenthal WG. An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliat Med 2022; 36:581-608. [PMID: 35196915 PMCID: PMC10098140 DOI: 10.1177/02692163221074540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist. AIM This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity. DESIGN A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254). RESULTS One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies. CONCLUSIONS We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Elisabeth McLean
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Carol Fadalla
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | | | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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She H, Man Y. Anticipatory Burden in Adult-Child Caregivers: A Concept Analysis. Healthcare (Basel) 2022; 10:healthcare10020356. [PMID: 35206970 PMCID: PMC8872093 DOI: 10.3390/healthcare10020356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
This study aims to analyze the concept of anticipatory burden in adult-child caregivers. A systematic literature review was performed using four databases, Pubmed, CINAHL, PsycINFO and Medline, with the keywords of “anticipatory burden” and “anticipated burden”. Simplified Wilson’s classic concept analysis modified by Walker and Avant was employed to identify the attributes, antecedents and consequences of anticipatory burden in the adult-child caregivers. Eighteen articles were analyzed. Attributes of anticipatory burden in adult-child caregivers were found to be: (1) subjective burden, (2) anticipation, (3) overestimation, (4) inability, and (5) family relationship. Antecedents were identified as: (1) potential care recipients, (2) caregiving willingness, and (3) a lack of resources. Consequences included: (1) prediction of caregiving willingness, (2) impacts on caregivers’ health, (3) intervention promotion, and (4) behavioral changes. As the adult-child caregiver is one of the main types of family caregivers for the fast-growing aging population, it is important to understand the attributes, antecedents, and consequences of their anticipatory burden. Based on the results of this study, resources such as intervention, policy, and counseling services are recommended to help adult-child caregivers lower their anticipatory burden and get better prepared for providing family care.
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Affiliation(s)
- Hangying She
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA
- Correspondence:
| | - Yuncheng Man
- Case School of Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
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Fisher E, Crawley S, Sampson EL, Cooper C, Jones R, Anantapong K, Moore K. Practical and emotional preparation for death: A mixed methods study investigating experiences of family carers of people with dementia. DEMENTIA 2022; 21:934-956. [PMID: 35125034 PMCID: PMC9003776 DOI: 10.1177/14713012211066674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background When family carers are more prepared for the end of the life of a person they care for, they report improved bereavement outcomes. Few studies have explored how carers prepare for the death of a person with dementia. We aimed to explore how carers for people with all stages of dementia experience preparing for end of life care and death. Methods This was a mixed methods cross-sectional study. Family carers of people with dementia (n = 150) completed a structured interview with validated scales, alongside questions about death preparedness and advance decisions. A sub-sample (n = 16) completed qualitative interviews exploring their experiences of planning for end of life. We fitted logistic regression models to explore associations with preparedness, and thematically analysed qualitative data. Results We addressed practical and emotional preparation separately for 143 participants. Fifty seven percent of participants were very practically prepared for death, while only 29% were very emotionally prepared. Male carers were more likely than female carers to report being very emotionally and practically prepared. Higher engagement with healthcare professionals was associated with feeling very practically prepared; although we found that formal discussions of end of life care issues with healthcare professionals did not impact carers’ feelings of preparation. Higher levels of dementia severity and carer depression were associated with feeling very emotionally prepared. Three qualitative themes related to practical and emotional preparation were identified: (1) ambiguity and uncertainty; (2) support from the system; and (3) how death is perceived by the carer. Conclusions While most carers felt practically prepared for death, emotional preparation was much lower. Further research is needed to understand how engagement with healthcare professionals or other forms of social or emotional support could help carers, particularly female carers, to emotionally prepare for their relative’s death.
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Affiliation(s)
- Emily Fisher
- Research Department of Clinical, Educational and Health Psychology, 4919University College London, London, UK
| | - Sophie Crawley
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust
| | - Claudia Cooper
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; Division of Psychiatry, 325312University College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry, 325312University College London, London, UK
| | - Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; National Ageing Research Institute, Parkville, Victoria, Australia
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Gilsenan J, Gorman C, Shevlin M. Exploratory factor analysis of the caregiver grief inventory in a large UK sample of dementia carers. Aging Ment Health 2022; 26:320-327. [PMID: 33148009 DOI: 10.1080/13607863.2020.1839856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Anticipatory grief (AG) is the process of experiencing loss prior to the death of a significant person. Coping with this multifaceted experience in the context of dementia caregiving is a relatively novel, yet significant area in caregiving literature. The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) and its abbreviated MM-CGI-Short-Form (MM-CGI-SF) is the most widely used scale measuring AG. However, limited research has employed robust analytical strategies to assess its dimensional structure. This study employed contemporary factor analytical techniques to assess the dimensional structure of the MM-CGI/SF. METHOD Caregivers of persons with dementia (n = 508) completed a survey containing MM-CGI/SF and other associated psychological measures. Exploratory factor analysis was employed to compare eight alternative factor analytical models to determine the optimal model. Internal-consistency reliability was assessed by Cronbach's α and construct validity was assessed by Spearman's correlation-coefficient. RESULTS The best fitting model was the MM-CGI-SF three factor model (Personal Sacrifice and Burden, Heartfelt Sadness and Longing and Worry and Felt Isolation). The MM-CGI-SF three factor model demonstrated internal consistency reliability and factor correlations with associated psychological measures indicated construct validity. CONCLUSION The MM-CGI-SF three factor model demonstrated adequate fit and utility, however, the Worry and Felt Isolation subscale needs further replication and revision to assess its dimensionality. The MM-CGI-SF is the more useful tool due to its brevity and better model fit.
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Affiliation(s)
- Jane Gilsenan
- School of Psychology, Ulster University, Coleraine, UK
| | - Colin Gorman
- School of Psychology, Ulster University, Coleraine, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
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Scher C, Crawley S, Cooper C, Sampson EL, Moore KJ. Usefulness and acceptability of an animation to raise awareness to grief experienced by carers of individuals with dementia. DEMENTIA 2022; 21:363-379. [PMID: 34465234 DOI: 10.1177/14713012211041259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Many carers of individuals with dementia experience high levels of grief before and after the death of the person with dementia. This study aimed to determine the usefulness, acceptability, and relevance of an animation developed to raise awareness to grief experienced by carers of people with dementia. METHODS This research had a cross-sectional survey design. We contacted carers of people with dementia over the phone or email. Participants evaluated the animation through an online or paper-based survey. We used descriptive statistics and analysed qualitative data using thematic analysis. We required a sample of 40 carers to adequately power the study with a target of 75% of carers finding the animation useful, acceptable, and relevant. RESULTS 31/78 carers approached evaluated the animation. Ninety-four percent of participants found the animation relevant to their situation, meeting our target. However, we fell short of this target for usefulness (68%) and acceptability (73%). The qualitative responses suggested that participants felt the animation could help improve the understanding of grief among carers, family, friends, and healthcare professionals. Carers also shared that the animation would be most useful for carers of newly diagnosed people with dementia. CONCLUSION Most carers of people with dementia in this study reported that the animation was useful, acceptable, and relevant. Dissemination of the resource may be useful for the majority of carers, with the caveat that a few carers may find it distressing and need to be referred for further support.
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Affiliation(s)
- Clara Scher
- Rutgers University School of Social Work, New Brunswick, NJ, USA.,Division of Psychiatry, 384708University College London, London, UK
| | - Sophie Crawley
- Marie Curie Palliative Care Research Department, 325312University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, 4919University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, 4919University College London, London, UK.,Barnet, Enfield and Haringey Mental Health Trust, London, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, 4919University College London, London, UK.,National Ageing Research Institute, Parkville, VIC, Australia
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30
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Park J, Levine H, Galvin JE. Factor structure of Pre‐Loss Grief‐12 in caregivers of people living with dementia. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12322. [PMID: 35846160 PMCID: PMC9270640 DOI: 10.1002/trc2.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022]
Abstract
Introduction The objective was to develop and refine a version of the Prolonged‐Loss Grief‐12 (PG‐12) specific to caregivers of people living with dementia. Confirmatory factor analysis (CFA) was performed to test the fit of the data from the caregivers and to assess the factor structure of the PG‐12 in order to evaluate pre‐loss grief accurately by identifying relevant items and eliminating items that are not appropriate for caregivers of persons with dementia. Methods A total of 699 eligible caregivers of persons living with dementia (PLWDs) were recruited through relevant dementia associations and organizations. The e‐mail for recruitment provided potential participants with information about the study and detailed instructions on how to participate by following a link to the online survey. Secondary analysis was based on the survey data. CFA was conducted via the Full Information Maximum Likelihood estimation method to test the unidimensional model of PG‐12 in the study population. Standard procedures were used to establish the parameters in the factor loading, factor variance‐covariance, and uniqueness matrices. Results The initial model was modified to develop a better fitting model and to detect misfitting parameters in the PG‐12 by deleting irrelevant items for the PLWD's caregiver. The adjusted dementia‐specific 10‐item version (PG‐10‐D) had significantly improved fit indices. An overall assessment of fit indicated that the model adequately approximated the data. Factor loadings ranged from 0.53 to 0.85. Discussion We found that the dementia‐specific, unidimensional PG‐10‐D, modifying the original PG‐12, may be useful and parsimonious in assessing and quantifying pre‐loss grief in dementia caregivers. Future studies are needed to further test its validity and reliability. Highlights First study to evaluate a dementia‐specific 10‐item version (PG‐10‐D) of the Prolonged‐Loss Grief‐12 (PG‐12). PG‐10‐D is useful in assessing and quantifying pre‐loss grief in caregivers. PG‐10‐D could be an early identifier of caregivers at risk for pre‐loss grief. PG‐10‐D could be the standard measure for effective intervention for caregivers.
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Affiliation(s)
- Juyoung Park
- Phyllis & Harvey Sandler School of Social Work College of Social Work & Criminal Justice Florida Atlantic University Boca Raton Florida USA
| | - Hannah Levine
- Charles E. Schmidt College of Medicine Florida Atlantic University Boca Raton Florida USA
| | - James E. Galvin
- Comprehensive Center for Brain Health Department of Neurology University of Miami Miller School of Medicine Miami Florida USA
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31
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Fee A, Hanna J, Hasson F. Pre-loss grief experiences of adults when someone important to them is at end-of-life: A qualitative systematic review. DEATH STUDIES 2021; 47:1-15. [PMID: 34751635 DOI: 10.1080/07481187.2021.1998935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pre-loss grief can be experienced by relatives before impending death; however, limited understanding exists about the impact of pre-loss grief on bereavement. This systematic review aimed to synthesize qualitative research evidence reporting adults' experiences of pre-loss grief within cancer care. Thirteen studies were selected, and three key themes identified. Findings indicate that relatives transitioned through lived experiences during end-stage cancer, and that meanings attached to these experiences influenced how they experienced pre-loss grief. Limited formal support was identified to navigate these experiences; however, context was seen as important, and skilled healthcare practitioners and physical environment were key to facilitating preparedness.
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Affiliation(s)
- Anne Fee
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
| | - Jeff Hanna
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
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32
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Kartoz CR, Wells M, Hammell P. Measuring Anticipated Loss of Aging Parents: Development of the Parent Anticipatory Loss Scale. J Nurs Meas 2021; 30:21-39. [PMID: 34518421 DOI: 10.1891/jnm-d-20-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Research indicates non-caregiving adult children with aging parents experience anticipatory loss for parents that consists of feelings of gratitude, sadness, and worry. The purpose of this research was to develop the Parent Anticipatory Loss Scale. METHODS Interview data from non-caregiving adult children and extant literature formed the basis for creating items measuring three components of Parent Anticipatory Loss. Expert content validity was established prior to administering the survey to a convenience sample of non-caregiving (N = 315), mostly Caucasian (n = 182, 57.6%) men (n = 202, 63.9%). The crowdsourcing platform, Mechanical Turk, provided an innovative method for sample recruitment. RESULTS Questions were eliminated as indicated during analysis, yielding a 19-item scale (α = 0.93) with three subscales (α = 0.897 for Gratitude, α = 0.841 for Sadness, and α = 0.833 for Worry). Exploratory factor analysis (Varimax rotation) showed gratitude accounted for 46% of the variance, with sadness and worry accounting for 9.5% and 5.3%. CONCLUSIONS The Parent Anticipatory Loss scale demonstrates good initial reliability and validity and can be used to measure anticipatory loss for aging parents. Further testing with cross cultural samples is warranted.
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33
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Park J, Galvin JE. Pre-Loss Grief in Caregivers of Older Adults with Dementia with Lewy Bodies. J Alzheimers Dis 2021; 82:1847-1859. [PMID: 34219734 DOI: 10.3233/jad-210616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pre-loss grief increases as dementia advances. Caregivers who experience pre-loss grief face risks to their own physical and psychological health. OBJECTIVE The study examined factors associated with pre-loss grief in caregivers of older adults with dementia with Lewy bodies (DLB) to determine whether overall caregiver experiences differ based on the stages of DLB in care recipients. The study also compared pre-loss grief in caregivers of DLB patients with that in caregivers of patients with Alzheimer's disease (AD) and other dementias. METHOD Using a cross-sectional design, 714 caregivers of older adults with dementia (488 DLB, 81 AD, 145 other dementias) completed an online survey on pre-loss grief. Multivariate linear regression identified risk factors associated with pre-loss grief and analysis of variance examined whether pre-loss grief in caregivers differed significantly based on type of dementia or stage of DLB. RESULTS Being the caregiver of a spouse, lower level of caregiver well-being, lower psychological well-being of the caregiver, and higher level of burden were associated (p < 0.005) with increased pre-loss grief in caregivers of older adults with DLB. There was no significant difference in caregiver burden, well-being, or depression according to the various stages of DLB (mild, moderate, severe, deceased) in the care recipients. There was no significant difference in pre-loss grief in caregivers of DLB care recipients compared to caregivers of patients with other dementias. CONCLUSION Assessment of DLB caregivers and appropriate interventions should be conducted to reduce their burden and emotional distress to decrease the incidence of pre-loss grief.
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Affiliation(s)
- Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, The Florida Atlantic University, Boca Raton, FL, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Lindauer A, Messecar D, McKenzie G, Gibson A, Wharton W, Bianchi A, Tarter R, Tadesse R, Boardman C, Golonka O, Gothard S, Dodge HH. The Tele-STELLA protocol: Telehealth-based support for families living with later-stage Alzheimer's disease. J Adv Nurs 2021; 77:4254-4267. [PMID: 34288013 DOI: 10.1111/jan.14980] [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: 04/11/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
AIMS We aim to establish the feasibility and acceptability of the Tele-STELLA (Support via Telehealth: Living and Learning with Advancing Alzheimer's Disease and Related Dementias) intervention. We will also assess the efficacy of the intervention in reducing the frequency of behavioural symptoms of dementia as well as family Care Partner reactivity to the symptoms. DESIGN This is a multi-component, quasi-experimental study that focuses on facilitating effective management of behavioural symptoms that occur in the later stages of dementia. METHODS Family Care Partners (n = 124) for persons with Alzheimer's disease will participate in two 8-week videoconferencing components that address behavioural symptoms-in both the persons with Alzheimer's disease and their Care Partners. In the first component ('Nova'), Care Partners work with one nurse for an hour/week for 4 weeks, then they join a small group for another 4 weeks. In the second component ('Constellation'), Care Partners work in a larger group to hone skills and knit supportive relationships. Behavioural symptom frequency and Care Partner reactivity to the behaviours will be measured prior to, during and after the intervention. The study is funded by the United States National Institute on Aging (R01AG067546); funding was initiated as on February, 2021. DISCUSSION Tele-STELLA fills a gap in current videoconference-based psychoeducational interventions in that it offers real-time interaction with nurses and peers. The intervention was designed with feedback by pilot participants. This study will assess Tele-STELLA in its current, novel format; thus, preparing it for a larger, future randomized controlled trial. IMPACT Tele-STELLA addresses symptoms that occur in the later stages of dementia, providing families with tools to facilitate effective behavioural management. Because Tele-STELLA is implemented via videoconferencing, it targets Care Partners who face barriers to support, such as cost and transportation. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (#NCT04627662).
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Affiliation(s)
- Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA.,School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Deborah Messecar
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Glenise McKenzie
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Allison Gibson
- School of Social Work, University of Kentucky, Lexington, KY, USA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Allison Bianchi
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Robin Tarter
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA.,School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Ruth Tadesse
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Charles Boardman
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Ona Golonka
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Sarah Gothard
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Hiroko H Dodge
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
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Treml J, Schmidt V, Nagl M, Kersting A. Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review. Soc Sci Med 2021; 284:114240. [PMID: 34303292 DOI: 10.1016/j.socscimed.2021.114240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer is one of the most common causes of death. The period of time between receiving a terminal diagnosis of cancer and the death of a loved one has been operationalized as pre-loss grief and, more recently, as preparedness for death. Originally, grief before loss was thought to have positive effects on the bereavement outcome, but some studies have revealed contradictory findings. This systematic review investigates definitions and measurement tools of pre-loss grief and preparedness for death, as well as the associations of both constructs with caregiver characteristics, pre-loss psychological aspects and post-loss adjustment among caregivers of people living with terminal cancer. METHODS PubMed/Medline, PsycINFO and Web of Science were searched for studies published up until October 2020. Quantitative empirical studies from peer reviewed journals were included if a measurement tool for pre-loss grief or preparedness for death was used and if they focused on adult caregivers of adult people with cancer in an end-of-life trajectory and were excluded when they were not written in English or were descriptive/qualitative studies. Quality assessment of all studies was performed. RESULTS Most studies used convenience samples and had a mean number of 725 participants. Overall, 16,326 participants in 35 articles were included and narratively synthesized. High levels of pre-loss grief, as well as low levels of perceived preparedness for death, were associated with poor post-loss adjustment (e.g., prolonged grief, depressive symptoms, etc.). CONCLUSIONS Caregivers with high levels of pre-loss grief and low levels of preparedness for the death of their loved one would benefit from targeted support for post-loss adjustment. Results are limited by an inconsistent operationalization of both constructs.
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Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Michaela Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
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Tookey SA, Greaves CV, Rohrer JD, Stott J. Specific support needs and experiences of carers of people with frontotemporal dementia: A systematic review. DEMENTIA 2021; 20:3032-3054. [PMID: 34111957 DOI: 10.1177/14713012211022982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Frontotemporal dementia (FTD) is one of the most common types of dementia in persons younger than 65 years of age. Diagnosis is often delayed due to slow, gradual decline and misinterpretation of 'non-typical' dementia symptoms. Informal carers of people with FTD experience greater levels of overall burden than carers of people with other forms of dementia. The aim of this systematic review was to describe the subjective experience of being an informal carer of a person with FTD and to identify the specific needs, coping strategies and helpful support resources of this carer population. METHODS Four electronic databases were used to search for published literature presenting experiences of carers of people with FTD between January 2003 and July 2019. Search strategy followed PRISMA guidelines. Findings were analysed using framework analysis, employing five stages of analysis to develop a coding index and thematic framework that included key aspects of the carer experience, which were grouped into themes and presented in a narrative format. RESULTS 1213 articles were identified in total. Twelve studies were included in the final synthesis of the review. Six themes were identified: 'Challenging road to and receipt of diagnosis', 'relationship change and loss', 'challenging experiences in caring', 'positive experiences and resilience', 'coping' and 'support needs'. DISCUSSION Findings highlight an increased need for carers of people with FTD to receive support during the pre-diagnostic stage, including support to manage symptoms. Further research should explore relationship changes and loss amongst carers to inform approaches for carer support. In conclusion, the lack of knowledge and unique needs of carers highlight the importance of public awareness campaigns and healthcare professional education to support carers with FTD symptom impact.
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Affiliation(s)
- Sara A Tookey
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Caroline V Greaves
- Dementia Research Centre, UCL, Queen Square Institute of Neurology, 4919UCL, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL, Queen Square Institute of Neurology, 4919UCL, London, UK
| | - Joshua Stott
- Department of Clinical, Educational and Health Psychology, University College London, London, UK; ADAPT Lab, UCL, London, UK
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Yehene E, Manevich A, Rubin SS. Caregivers' Grief in Acquired Non-death Interpersonal Loss (NoDIL): A Process Based Model With Implications for Theory, Research, and Intervention. Front Psychol 2021; 12:676536. [PMID: 33995234 PMCID: PMC8119762 DOI: 10.3389/fpsyg.2021.676536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/07/2021] [Indexed: 12/31/2022] Open
Abstract
The number of family members caring and caregiving for a loved one undergoing physical and mental changes continues to increase dramatically. For many, this ongoing experience not only involves the “burden of caregiving” but also the “burden of grief” as their loved-one’s newfound medical condition can result in the loss of the person they previously knew. Dramatic cognitive, behavioral, and personality changes, often leave caregivers bereft of the significant relationship they shared with the affected person prior to the illness or injury. This results in what we term conditions of acquired “non-death interpersonal loss” (NoDIL). Current approaches to these losses use an amalgam of models drawn from both death and non-death loss. Despite their utility, these frameworks have not adequately addressed the unique processes occurring in the interpersonal sphere where the grieving caregiver needs to reach some modus vivendi regarding the triad of “who the person was,” “who they are now,” and “who they will yet become.” In this paper we propose a process-based model which addresses cognitive-emotional-behavioral challenges caregivers meet in the face of their new reality. These require a revision of the interpersonal schemas and the relationships that takes into account the ongoing interactions with the affected family member. The model and its utility to identify adaptive and maladaptive responses to NoDIL is elaborated upon with clinical material obtained from caregivers of people diagnosed with major neuro-cognitive disorder and pediatric traumatic brain injury. The article concludes with implications for theory, research and clinical intervention.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Alexander Manevich
- The School of Psychological Sciences and the International Laboratory for the Study of Loss, Bereavement and Human Resilience, University of Haifa, Haifa, Israel
| | - Simon Shimshon Rubin
- The School of Psychological Sciences and the International Laboratory for the Study of Loss, Bereavement and Human Resilience, University of Haifa, Haifa, Israel.,Department of Psychology, Max Stern Academic College of Emek Yezreel, Jezreel Valley, Israel
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Huntley JD, Fleming SM, Mograbi DC, Bor D, Naci L, Owen AM, Howard R. Understanding Alzheimer's disease as a disorder of consciousness. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12203. [PMID: 34877398 PMCID: PMC8630359 DOI: 10.1002/trc2.12203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/28/2021] [Accepted: 07/28/2021] [Indexed: 11/07/2022]
Abstract
People with Alzheimer's disease (AD) demonstrate a range of alterations in consciousness. Changes in awareness of cognitive deficit, self-awareness, and introspection are seen early in AD, and dysfunction of awareness and arousal progresses with increasing disease severity. However, heterogeneity of deficits between individuals and a lack of empirical studies in people with severe dementia highlight the importance of identifying and applying biomarkers of awareness in AD. Impairments of awareness in AD are associated with neuropathology in regions that overlap with proposed neural correlates of consciousness. Recent developments in consciousness science provide theoretical frameworks and experimental approaches to help further understand the conscious experience of people with AD. Recognition of AD as a disorder of consciousness is overdue, and important to both understand the lived experience of people with AD and to improve care.
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Affiliation(s)
- Jonathan D. Huntley
- Division of PsychiatryUniversity College LondonLondonUK
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
| | - Stephen M. Fleming
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
- Department of Experimental PsychologyUniversity College LondonLondonUK
- Max Planck‐UCL Centre for Computational Psychiatry and Ageing ResearchUniversity College LondonLondonUK
| | - Daniel C. Mograbi
- Department of PsychologyPontifical Catholic University of Rio de JaneiroRio de JaneiroBrazil
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Daniel Bor
- Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Lorina Naci
- School of PsychologyGlobal Brain Health InstituteTrinity College DublinDublinIreland
| | - Adrian M. Owen
- Brain and Mind InstituteDepartment of Physiology and Pharmacology and Department of PsychologyUniversity of Western OntarioLondonOntarioCanada
| | - Robert Howard
- Division of PsychiatryUniversity College LondonLondonUK
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Sandford DG. Preparatory and Anticipatory Grief, Anxiety and Depression in Life-Limiting Lung Disease. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hovland CA, Mallett CA. Positive Aspects of Family Caregiving for Older Adults at End-of-Life: A Qualitative Examination. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2021; 17:64-82. [PMID: 33682635 DOI: 10.1080/15524256.2021.1888845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family caregivers of older adults with dementia have significant challenges across many domains. While this role has been found to be burdensome on the caregiver, increasingly, though, there are also significant positive aspects reported by caregivers (known as the positive aspects of caregiving-PAC). This participatory qualitative study of 30 United States caregivers of family members age 65 and older who died with a dementia-related diagnoses used in-depth qualitative interviews and directed content analysis to understand the data. The study addressed a gap in the research literature and asked about caregiver's positive experiences during their family members' last weeks of life and investigated what this meant for the caregiver. Three primary themes were identified: (1) The Importance and Impact of Family Traditions/Celebrations, (2) Use of Humor in Living and the Difficult Experiences at End-of-Life, and (3) "The Gift of Caregiving." These findings are explored and reviewed in light of other research looking at the positive aspects of caregiving for caregivers taking care of persons living with dementia, finding concurrence and some uniqueness across the results. Implications of the findings for families and social work professionals are reviewed.
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Affiliation(s)
- Cynthia A Hovland
- School of Social Work, Cleveland State University, Cleveland, Ohio, USA
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Requena MDC, Suárez-Álvarez S. [Pre-death grief in caregivers of Alzheimer patients. A validation of a guide]. Rev Esp Geriatr Gerontol 2020; 55:216-224. [PMID: 32249007 DOI: 10.1016/j.regg.2020.02.001] [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: 09/01/2019] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The pre-death grief in family caregivers (FC) of people with Alzheimer's disease has not been sufficiently treated in studies on this group. Thus, the design and validation of informative printed materials is relevant due to its important implications for the well-being of these FCs and their training in the proper performance of their role. The objective was to design and validate a booklet aimed at informing FCs about this topic, as well as the procedure for its dissemination and use. MATERIALS AND METHODS After a review of the literature, a booklet and a questionnaire were designed to determine the acceptability and dissemination procedure and use of the booklet by 73 professionals working with FCs. With the suggestions made, modifications were made to both the content and format of the booklet. RESULTS The questionnaire used presented adequate content validity and reliability in its different sections (α=0.793 and α=0.888). The level of acceptability of the booklet was high by professionals (83.85% of total score). Its dissemination was especially valued in the initial stages of the disease, and its use in therapeutic and supportive group contexts, with professional advice. CONCLUSIONS The study made it possible to verify the relevance and acceptability of a booklet as a training resource for FCs about pre-death grief, making it a useful tool for professionals that work in this area of great relevance.
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Abstract
OBJECTIVES Family caregivers of people with dementia can experience loss and grief before death. We hypothesized that modifiable factors indicating preparation for end of life are associated with lower pre-death grief in caregivers. DESIGN Cross-sectional. SETTING Caregivers of people with dementia living at home or in a care home. PARTICIPANTS In total, 150 caregivers, 77% female, mean age 63.0 (SD = 12.1). Participants cared for people with mild (25%), moderate (43%), or severe dementia (32%). MEASUREMENTS Primary outcome: Marwit-Meuser Caregiver Grief Inventory Short Form (MMCGI-SF). We included five factors reflecting preparation for end of life: (1) knowledge of dementia, (2) social support, (3) feeling supported by healthcare providers, (4) formalized end of life documents, and (5) end-of-life discussions with the person with dementia. We used multiple regression to assess associations between pre-death grief and preparation for end of life while controlling for confounders. We repeated this analysis with MMCGI-SF subscales ("personal sacrifice burden"; "heartfelt sadness"; "worry and felt isolation"). RESULTS Only one hypothesized factor (reduced social support) was strongly associated with higher grief intensity along with the confounders of female gender, spouse, or adult child relationship type and reduced relationship closeness. In exploratory analyses of MMCGI-SF subscales, one additional hypothesized factor was statistically significant; higher dementia knowledge was associated with lower "heartfelt sadness." CONCLUSION We found limited support for our hypothesis. Future research may benefit from exploring strategies for enhancing caregivers' social support and networks as well as the effectiveness of educational interventions about the progression of dementia (ClinicalTrials.gov ID: NCT03332979).
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Meichsner F, O'Connor M, Skritskaya N, Shear MK. Grief Before and After Bereavement in the Elderly: An Approach to Care. Am J Geriatr Psychiatry 2020; 28:560-569. [PMID: 32037292 DOI: 10.1016/j.jagp.2019.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 02/01/2023]
Abstract
Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly; it can also precede the death. Knowledge about four distinct forms of grief can aid clinicians with the conceptualization of grief, and the assessment and care of grievers. First, predeath grief is experienced by many caregivers of terminally ill patients. Second, acute grief arises immediately after the death of a loved one; and third, this normally evolves to a permanent state of integrated grief after a process of adaptation. Finally, failure of adaptation results in Prolonged Grief Disorder (PGD) which has been recently included in ICD-11. The hallmark feature of PGD is intense longing for the deceased or persistent preoccupation with the deceased that lasts longer than 6 months after the death. Validated instruments are available to assist practitioners with assessment of predeath grief and screening for PGD, thereby enabling identification of patients in need of additional support. Increased risks of morbidity and mortality following bereavement are important health issues for clinicians to be aware of. All grievers can benefit from support focused on understanding their grief, managing emotional pain, thinking about the future, strengthening their relationships, telling the story of the death, learning to live with reminders of the deceased, and connecting with memories. A short-term evidence-based intervention for PGD is based upon these seven themes and is efficacious in the elderly. Caregivers of the terminally ill benefit from psychological support that validates and normalizes their grief experiences and helps them recognize and accept their losses.
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Affiliation(s)
- Franziska Meichsner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt (FM), Frankfurt, Germany.
| | - Monique O'Connor
- Perth Clinic Medical Suites (MO), West Perth, Western Australia, Australia
| | - Natalia Skritskaya
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
| | - M Katherine Shear
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
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Chan I, Yap P, Wee SL, Liew TM. The three dimensions of caregiver grief in dementia caregiving: Validity and utility of the subscales of the Marwit-Meuser Caregiver Grief Inventory. Int J Geriatr Psychiatry 2020; 35:213-222. [PMID: 31736107 PMCID: PMC7004032 DOI: 10.1002/gps.5238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/07/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The experience of grief in family caregivers as they provide care for persons with dementia is often overlooked. The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) is one among the few scales that capture such experiences. In a recent study, MM-CGI was found to contain three subscales identifying dimensions of loss in caregivers-Personal-Sacrifice Burden (PSB), Heartfelt Sadness, Longing, and Worry (HSLW), and Felt Isolation (FI). We aimed to evaluate the validity and utility of these dimensions in a multiethnic Asian population. METHODS Family caregivers (n = 394) completed MM-CGI and scales assessing caregiver burden, depression, and gains. Internal consistency reliability was examined using Cronbach α; test-retest reliability using intraclass correlation coefficient; and construct validity using Pearson correlation coefficient. The utility of the MM-CGI dimensions was evaluated by comparing caregivers with high subscale scores across dementia stages and caregiving relationship. RESULTS The three dimensions of MM-CGI exhibited adequate internal consistency, test-retest reliability, construct validity, and known-group validity. PSB correlated most strongly with caregiver burden (r = 0.78); HSLW with caregiver depression (r = 0.75); and FI with caregiver burden and caregiver depression (r = 0.60, respectively). Caregivers with high total grief scores tended to experience most difficulty with HSLW (90.8%), followed by PSB (75.4%) and FI (46.2%). The three dimensions also increased across the dementia stages, with FI higher in mild dementia, PSB higher in moderate dementia, and HSLW higher in severe dementia. Spousal caregivers experienced most difficulty in HSLW, whereas children caregivers experienced similar levels of difficulty across the dimensions. CONCLUSIONS The three dimensions of MM-CGI captured distinct aspects of caregiver grief in a multiethnic Asian population and would enable more individualized assessments and interventions for caregiver grief.
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Affiliation(s)
- Ivana Chan
- Geriatric Education and Research InstituteSingapore
| | - Philip Yap
- Geriatric Education and Research InstituteSingapore,Department of Geriatric Medicine, Khoo Teck Puat HospitalSingapore
| | - Shiou Liang Wee
- Geriatric Education and Research InstituteSingapore,Health and Social Sciences ClusterSingapore Institute of TechnologySingapore
| | - Tau Ming Liew
- Department of Geriatric PsychiatryInstitute of Mental HealthSingapore,Psychotherapy ServiceInstitute of Mental HealthSingapore,Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
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Liew TM, Yap P. A Brief, 6-Item Scale for Caregiver Grief in Dementia Caregiving. THE GERONTOLOGIST 2020; 60:e1-e10. [PMID: 30544229 DOI: 10.1093/geront/gny161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of the person. Although such experience of caregiver grief is measurable, available scales (such as the Marwit-Meuser Caregiver Grief Inventory, MM-CGI) are lengthy and have overlaps with other caregiving constructs. We developed a briefer scale that captures the essence of caregiver grief-with comparable psychometric properties and total score to MM-CGI, as well as less overlap with other caregiving constructs. DESIGN AND METHODS Family caregivers of community-dwelling PWD (N = 394) completed questionnaires containing MM-CGI and other caregiving scales. Initially, we split the study samples into two -the derivation sample (n = 179) was used to develop a brief scale that best predicts MM-CGI (using the best-subset approach with tenfold cross-validation), whereas the validation sample (n = 215) verified its actual performance in predicting MM-CGI. Thereafter, we evaluated the derived scale in its reliability and validity, and mapped its scores to MM-CGI using the equipercentile equating method. RESULTS We derived a 6-item scale, which explained 84.1% of the variability in MM-CGI and had area under the receiver operating characteristic curve of .96 in discriminating high caregiver grief (95% CI: .94-.99). It had single dimension in confirmatory factor analysis (comparative fit index = .98; Tucker-Lewis index = .97) and maintained good psychometric properties similar to those of MM-CGI, while showing lower correlation with caregiver burden and depression. It also had scores that could be mapped to MM-CGI with reasonable precision. IMPLICATIONS We developed the first brief scale with less than 10 items that can conveniently and accurately measure caregiver grief, which opens the way for grief-related interventions in clinical care. Notably, this 6-item scale was developed using rigorous methods and demonstrated consistent evidence of capturing the essence of caregiver grief.
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Affiliation(s)
- Tau Ming Liew
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore.,Psychotherapy Service, Institute of Mental Health, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore.,Geriatric Education and Research Institute, Singapore
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Rubin SS, Manevich A, Doron II. The Two-Track Model of Dementia Grief (TTM-DG): The theoretical and clinical significance of the continuing bond in sickness and in death. DEATH STUDIES 2019; 45:755-771. [PMID: 31713463 DOI: 10.1080/07481187.2019.1688014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Grief and mourning for family members caring for a dementia patient begin with the initial changes in the person's cognitive abilities, and intensify with the worsening of his or her condition. The aim of this article is to propose a Two-Track Model of Dementia Grief (TTM-DG). This model enlarges the theoretical, research and clinical lenses for dementia, and explores how the illness process as well as the bereavement responses after death stimulate the reworking of grief and mourning over the beloved family member. Based on the insights derived from the Two-Track Model of Loss and Bereavement and the Continuing Bonds paradigm, we propose that the clinical and research examination of dementia grief begin in life and continue after the death. The TTM - DG's Track I focuses on bio-psycho-social functioning and Track II focuses on the internalized psychological representation of the patient, the ongoing relational bond and the illness and death story. A case study illustrates how this combined perspective provides a comprehensive picture of the experience of grief for persons afflicted with dementia over the course of the disease trajectory. Future clinical and empirical research has an important role to play in the further development of this model.
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Affiliation(s)
- Simon Shimshon Rubin
- International Center for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Psychology, Max Stern Yezreel Valley College, Israel
| | - Alexander Manevich
- International Center for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Israel Issi Doron
- Department of Gerontology and the Center for Research and Study of Ageing, University of Haifa, Haifa, Israel
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Gibson K, Peacock S, Bayly M. Qualitative exploration of emotional and social changes from diagnosis to bereavement for spousal caregivers of persons with dementia. BMJ Open 2019; 9:e031423. [PMID: 31551389 PMCID: PMC6773340 DOI: 10.1136/bmjopen-2019-031423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To understand how bereaved spousal caregivers of persons with dementia perceive and respond to changes over the course of their spouse's disease, from diagnosis into bereavement. DESIGN Qualitative interview study with convenience sampling and thematic analysis approach. PARTICIPANTS Participants included eight women and two men (n=10) who had been spousal caregivers for a person with dementia prior to his/her death. Participants were older adults who self-reported good health and were bereaved longer than a year. SETTING Data collected in a small Canadian prairie city between fall 2014 and winter 2015. FINDINGS Two overarching themes were developed as important components of participants' caregiving journey: emotional reactions to change and variation in social connectedness throughout the caregiving and bereavement journey. Four key sub-themes developed through the analysis of emotional reactions to events: memorable grief overshadows persistent grief, a progressive feeling of hopelessness and overwhelmed, relief is common but hidden and gratitude is a milestone in a constructive bereavement. Three key variations of social connectedness throughout the caregiving and bereavement journey were developed: the importance of social inclusion throughout a caregiving and bereavement journey, the repeated loss of companionship and withdrawing from social interactions is contingent on needs. CONCLUSIONS The findings suggest that emotional changes throughout caregiving and bereavement are not linear. The need for support from family, friends and new social supports is influential in enabling the caregiver to move forward during caregiving and bereavement.
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Affiliation(s)
- Kirstian Gibson
- College of Arts and Science (Psychology), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Melanie Bayly
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Lindauer A, McKenzie G, LaFazia D, McNeill L, Mincks K, Spoden N, Myers M, Mattek N, Teri LL. Using Technology to Facilitate Fidelity Assessments: The Tele-STAR Caregiver Intervention. J Med Internet Res 2019; 21:e13599. [PMID: 31127721 PMCID: PMC6555120 DOI: 10.2196/13599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background Families living with Alzheimer disease and related dementias have more access to support thanks to the development of effective telehealth-based programs. However, as technological science grows, so does the risk that these technology-based interventions will diverge from foundational protocols, diluting their efficacy. Strategies that ensure programs are delivered as intended, with fidelity to guiding protocols, are needed across the intervention spectrum—from development to wide-scale implementation. Few papers address fidelity in their technology-based work. Here, we present our translated telehealth intervention, Tele-STAR, with our fidelity findings. Objective This study aimed to assess the preliminary efficacy of Tele-STAR on reducing family caregiver burden and depression. Across the implementation phases, we assessed the fidelity of a caregiver education intervention, STAR-C, as it was translated into a telehealth option (Tele-STAR). Methods A total of 13 family caregivers consented to participate in an 8-week, videoconference-based intervention (Tele-STAR). Tele-STAR efficacy in reducing the affective burden of caregiving was assessed using pre- and postintervention paired t tests. Content experts assessed program fidelity by reviewing and rating Tele-STAR materials for adherence to the original STAR-C protocol. These experts assessed treatment fidelity by viewing videos of the intervention and rating adherence on a checklist. Results Tele-STAR reduced caregiver burden and retained good program and treatment fidelity to STAR-C. Conclusions We found Tele-STAR reduced caregiver burden and had good fidelity to the original protocol. Assessing fidelity is a complex process that requires incorporation of these procedures early in the research process. The technology used in this study facilitated the accrual of informative data about the fidelity of our translated intervention, Tele-STAR.
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Affiliation(s)
- Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Glenise McKenzie
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - David LaFazia
- School of Social Work, University of Washington, Seattle, WA, United States.,Northwest Research Group on Aging, School of Nursing, University of Washington, Seattle, WA, United States
| | - Loriann McNeill
- Family Caregiver Support Program, Multnomah County, Oregon, Portland, OR, United States
| | - Kate Mincks
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Natasha Spoden
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Marcella Myers
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Nora Mattek
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Linda L Teri
- Northwest Research Group on Aging, School of Nursing, University of Washington, Seattle, WA, United States.,Northwest Roybal Center, School of Nursing, University of Washington, Seattle, WA, United States
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Parsons GS. Help seeking increases stress among caregivers of partners with young-onset dementia. Evid Based Nurs 2019; 23:28. [PMID: 31092543 DOI: 10.1136/ebnurs-2018-103037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 11/04/2022]
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50
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Jain FA, Connolly CG, Moore LC, Leuchter AF, Abrams M, Ben-Yelles RW, Chang SE, Ramirez Gomez LA, Huey N, Lavretsky H, Iacoboni M. Grief, Mindfulness and Neural Predictors of Improvement in Family Dementia Caregivers. Front Hum Neurosci 2019; 13:155. [PMID: 31156412 PMCID: PMC6530345 DOI: 10.3389/fnhum.2019.00155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/24/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Family dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement. Methods: Twenty three family dementia caregivers were assessed at baseline for grief, mindfulness and depression, of which 17 underwent functional magnetic resonance imaging (fMRI). During fMRI, caregivers were shown faces of either their dementia-stricken relative or that of a stranger, paired with grief-related or neutral words. In nine subjects, post fMRI scans were also obtained after 4 weeks of either guided imagery or relaxation. Robust regression was used to predict changes in symptoms with longitudinal brain activation (BA) changes as the dependent variable. Results: Grief and depression symptoms were correlated (r = 0.50, p = 0.01), and both were negatively correlated with mindfulness (r = -0.70, p = 0.0002; r = -0.52, p = 0.01). Relative to viewing strangers, caregivers showed pictures of their loved ones (picture factor) exhibited increased activation in the dorsal anterior cingulate gyrus and precuneus. Improvement in grief but not mindfulness or depression was predicted by increased relative BA in the precuneus and anterior cingulate (different subregions from baseline). Viewing grief-related vs. neutral words elicited activity in the medial prefrontal cortex and precuneus. Conclusions: Caregiver grief, depression and mindfulness are interrelated but have at least partially nonoverlapping neural mechanisms. Picture and word stimuli related to caregiver grief evoked brain activity in regions previously identified with bereavement grief. These activation foci might be useful as biomarkers of treatment response.
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Affiliation(s)
- Felipe A. Jain
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Colm G. Connolly
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Leonardo C. Moore
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Institute for Simulation and Training, University of Central Florida, Orlando, FL, United States
| | - Andrew F. Leuchter
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle Abrams
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ramzi W. Ben-Yelles
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sarah E. Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Liliana A. Ramirez Gomez
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Nora Huey
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marco Iacoboni
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Ahmanson-Lovelace Brain Mapping Center, Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
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