"Been there, done that:" A grounded theory of future caregiver preparedness in former caregivers of parents living with dementia

Caregiving Challenges From Persistent Pain Among Family Caregivers to People With Dementia

BACKGROUND AND OBJECTIVES

Many family caregivers to people with dementia experience persistent physical pain. Though caregivers' pain is associated with poor caregiving outcomes, there is little research on how pain challenges caregiving to yield poor outcomes. This study developed a typology of caregiving challenges from pain among family caregivers to people with dementia.

RESEARCH DESIGN AND METHODS

We conducted semistructured, in-depth interviews with 25 family caregivers living with persistent pain and caring for people with dementia. We inductively analyzed data via a thematic analysis approach, wherein we identified and categorized caregiving challenges stemming from caregivers' pain. We then analyzed how challenges were related to one another and their consequences for caregiving outcomes.

RESULTS

Analysis revealed 3 interrelated categories of caregiving challenges from living with pain: (a) physical (e.g., difficulty lifting care recipient), (b) psychological/emotional (e.g., worry about future care if their pain condition worsens), and (c) familial/relational (e.g., resentment toward family without pain for not helping with care). Caregivers reported that these challenges compounded one another in ways that made both caregiving and pain management more difficult. Moreover, challenges led to caregivers delaying or skipping care tasks. The nature of challenges and their connection to caregiving outcomes were dependent on various supporting factors, such as whether caregivers reported benefits from their own pain (e.g., greater empathy).

DISCUSSION AND IMPLICATIONS

The resulting typology informs a conceptual model to guide future translational research on caregivers' pain, including illuminating promising intervention targets of pain self-management programs for family caregivers to people with dementia.

Preparedness for caregiving among informal caregivers of people with dementia: A scoping review

INTRODUCTION

Dementia is a global health concern, and informal caregivers often provide care for those affected. Caregiver preparedness is crucial for optimizing quality of life. However, knowledge about the determinants of caregiver preparedness is limited.

PURPOSE

The aim of this scoping review was to identify the factors associated with preparedness for caregiving among informal caregivers of people with dementia.

METHODOLOGY

The review adhered to the methods from the Joanna Briggs Institute. Studies exploring the preparedness of informal caregivers of people with dementia were included in this review. Data were extracted from studies found in five major databases: PubMed, PsycINFO, Scopus, CINAHL, and Embase.

RESULTS

The final review included twenty-three studies. Self-efficacy and confidence, resilience and self-conduct, knowledge, education and training, mutuality, mental health, less caregiving conflict, and mindfulness were associated with caregiver preparedness.

CONCLUSION

This review identified a significant research gap in preparedness among caregivers of people with dementia. More research is essential to understand the factors associated with caregivers' preparedness. Recognizing these elements can inform tailored interventions, assisting informal caregivers in their caregiving transition and journey.

Longitudinal changes in coping strategies across midlife and older adulthood: findings from the midlife in the United States study

OBJECTIVES

Most studies examining age differences in coping across adulthood come from cross-sectional studies and focus on the broader categories of problem- and emotion-focused coping. We aimed to establish a factor structure for coping items used in a national, longitudinal study of aging (MIDUS) and examine age patterns in coping strategies over 10 years.

METHOD

We performed exploratory and confirmatory factor analysis, and factorial invariance testing. Next we conducted a series of multilevel models for each coping factor with participants from waves II and III of the MIDUS study (N = 2,661, Mage = 55, 58% women, 84% White).

RESULTS

We found a four-factor solution: instrumental action; denial/disengagement; positive reappraisal; focus and venting of emotions. Invariance was established across time and age. At baseline, age was positively associated with the use of three strategies, though younger adults used more focus and venting of emotions. There was an overall decrease over 10 years in use of all strategies, which was moderated by age. Positive reappraisal declined more steeply among midlife participants, whereas the remaining strategies declined more for older participants.

CONCLUSION

Results highlight the multi-dimensionality of MIDUS coping items and underscores the import of age in understanding changes in coping across midlife and older adulthood.

Care Partner Confidence and Experiences in Legal Planning for People Living With Dementia: A Mixed-Methods Study

BACKGROUND AND OBJECTIVES

Care partners of persons living with dementia perform complex legal planning tasks. The purpose of this study was to survey care partners in the United States to understand their confidence and experience in performing legal planning tasks.

RESEARCH DESIGN AND METHODS

This study used a parallel mixed-methods research design. We administered a web-based survey to 318 adults who self-identified as care partners of persons living with dementia. The survey contained Likert scale questions and open-ended questions about legal planning tasks. Multivariate linear regression was used to analyze quantitative data and inductive thematic analysis was used to analyze qualitative data.

RESULTS

Care partners were, on average, 53 years of age and 78% female. The three topics in which participants were least confident were: protecting oneself legally as a care partner; options when legal documents are not in place and a family member is not legally competent; and circumstances when legal documents should be updated or renewed. We observed significant differences in legal planning confidence between newer and more experienced care partners (p < .001); lower- and higher-income care partners (p = .01); and adult child versus spousal care partners (p < .001). Thematic analysis revealed that legal planning challenges include initiating a conversation with the person living with dementia, understanding and using legal materials, and accessing materials that accommodate individual differences.

DISCUSSION AND IMPLICATIONS

It is vital to develop legal planning interventions that are tailored to specific subgroups of care partners, and to maximize the clarity, comprehensiveness, and accessibility of available legal planning education.

"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

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.

Comparative Analysis of Quality of Life of Family Caregivers of Patients With Heart Failure and Cancer Who Receive Palliative Care

BACKGROUND

Quality of life (QoL) is the criterion-standard outcome in palliative care for patients with various illnesses and their family caregivers. There is a need to determine the factors affecting caregivers' QoL in each population and the differences between groups to design differentiated intervention strategies.

PURPOSE

The aims of this study were to compare the role adoption, social support, and QoL of family caregivers of patients with heart failure and cancer in palliative care and to examine the determinants of QoL.

METHODS

A comparative study was conducted with the family caregivers of patients with cancer (n = 81) and heart failure (n = 80) in palliative care. Quality of life in life-limiting situations, role adoption, and social support questionnaires were also administered. A χ2 test, Student t test, and Mann-Whitney U test were used for between-group comparisons. Multiple linear regression was used to examine the effects of the correlated variables on caregivers' QoL.

RESULTS

Caregivers of patients with heart failure had better QoL (P = .006) and lower tangible social support (P = .007) than caregivers of patients with heart failure. No differences were found in caregiver role adoption between the groups. Linear regression indicated that for caregivers of patients with cancer, social support, role adoption, caregiver age, and patient functional status affect caregiver QoL. For caregivers of patients with heart failure, role adoption and patient functional status are predictors of QoL.

CONCLUSIONS

Overall, healthcare professionals should focus on improving social support and caregiver role adoption and provide greater attention to the QoL of caregivers of patients with cancer.