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Varilek BM, Mollman S. Healthcare professionals' perspectives of barriers to cancer care delivery for American Indian, rural, and frontier populations. PEC INNOVATION 2024; 4:100247. [PMID: 38225930 PMCID: PMC10788248 DOI: 10.1016/j.pecinn.2023.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 01/17/2024]
Abstract
Objective This descriptive qualitative study sought to understand the barriers affecting cancer care delivery from the perspective of healthcare professionals (HCPs) serving American Indian (AI), rural, and frontier populations. Methods One-on-one, semi-structured interviews with multidisciplinary HCPs (N = 18) who provide cancer care to AI, rural, and frontier populations were conducted between January and April 2022. Interviews were conducted via Zoom. Data were analyzed following thematic content analysis methodologies. Results Thematic content analysis revealed three major themes: (a) Access, (b) Time, and (c) Isolation. The themes represent the HCP perspectives of the needs and barriers of persons with cancer to whom they provide cancer care. Furthermore, these themes also reflect the barriers HCPs experience while providing cancer care to AI, rural and frontier populations. Conclusions This study provides preliminary evidence for the need and strong multidisciplinary support for an early palliative care intervention in rural and frontier South Dakota (SD). This intervention could support the needs of persons with advanced cancer as well as the HCPs delivering cancer care in rural settings. Innovation This study is the initial step to develop the first culturally responsive, nurse-led, early palliative care intervention for AI, rural, and frontier persons with advanced cancer in SD.
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Affiliation(s)
- Brandon M. Varilek
- South Dakota State University, College of Nursing, 2300 North Career Ave, Suite 260, Sioux Falls, SD 57107, USA
| | - Sarah Mollman
- South Dakota State University, College of Nursing – Office of Nursing Research, 1011 11 St, Rapid City, SD 57701, USA
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2
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Miyawaki CE, McClellan A, Russell D, Bouldin ED. Comparing Unmet Service Needs Between Rural and Urban Family Caregivers of People Living With Alzheimer's Disease and Related Dementias: A Multisite Study. THE GERONTOLOGIST 2024; 64:gnae083. [PMID: 38946163 PMCID: PMC11308181 DOI: 10.1093/geront/gnae083] [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: 01/28/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The scarcity of resources and available caregiving services in rural areas in the United States has been well documented. However, less research has compared unmet service needs between caregivers of people with Alzheimer's disease and related dementias (ADRD) in rural versus urban areas. RESEARCH DESIGN AND METHODS Using semistructured interviews guided by theories of health service use and dependent care, we interviewed 20 family caregivers residing in rural areas of Western North Carolina and 18 caregivers within the urban setting of Houston, Texas, and compared their unmet service needs and contextual factors that facilitate their service use. RESULTS Thematic analyses revealed similar unmet service needs among rural and urban caregivers; however, the ways they approached and solved their challenges differed. Caregivers in rural areas wished for more information and caregiver support whereas urban caregivers looked for information they needed until they found the answers. Rural caregivers expressed guilt about using services because they felt they were limited and zero-sum whereas urban caregivers shared available resources so that other caregivers could use them as well. Unmet service needs for urban caregivers included more racially and ethnically specific services for people with ADRD in their ethnic-specific languages and foods while rural caregivers' cultural needs were not racially and ethnically specific but for more place-specific services. DISCUSSION AND IMPLICATIONS Recommendations for rural caregivers included utilizing online and virtual opportunities and expanding their reach across the United States. For urban caregivers, increasing culturally tailored service options would likely increase access and use.
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Affiliation(s)
| | - Angela McClellan
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, North Carolina, USA
| | - Erin D Bouldin
- Health Services Research & Development, Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
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3
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Kaufman BG, Huang RW, Holland DE, Vanderboom CE, Ingram C, Wild EM, Dose AM, Stiles C, Gustavson AM, Mandrekar J, Van Houtven CH, Griffin JM. Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial. J Am Geriatr Soc 2024; 72:2523-2531. [PMID: 38698643 PMCID: PMC11323163 DOI: 10.1111/jgs.18934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Rural family caregivers (FCGs) in the United States often experience high economic costs. This randomized controlled trial compared a transitional palliative care intervention (TPC) to support FCGs of seriously ill care recipients (CRs) to an attention control condition. We evaluated the TPC's effect on healthcare use and out-of-pocket spending for both FCGs and CRs. METHODS TPC FCGs received teaching, guidance, and counseling via video calls for 8 weeks following CR discharge from the hospital. After discharge, a research assistant called all FCGs once a month for up to 6 months or CR death to collect self-reported healthcare utilization (e.g., outpatient, emergency department, and hospital), out-of-pocket healthcare spending (e.g., deductibles and coinsurance), and health-related travel costs (e.g., transportation, lodging, food) for FCGs and CRs. Incidence rate ratios (IRRs) were estimated using negative binomial regressions. RESULTS The study included 282 FCG-CR dyads across three U.S. states. Follow-up over the 6-month period was shortened by high CR mortality rates across both arms (29%), but was similar across arms. TPC reduced nights in the hospital for CR (IRR = 0.75; 95% confidence interval [CI] = 0.56-0. 99). Total out-of-pocket spending was not significantly different for TPC versus control. Across both groups, mean out-of-pocket spending for dyads was $1401.85, with healthcare payments contributing $1048.58 and transportation expenses contributing $136.79. TPC dyads reported lower lodging costs (IRR = 0.71; 95% CI = 0.56-0.89). CONCLUSIONS This study contributes to evidence that palliative care interventions reduce the number of nights in the hospital for seriously ill patients. Yet, overall rural FCGs and seriously ill CRs experience substantial out-of-pocket economic costs in the 6 months following hospitalization. Transitional care intervention design should consider impacts on patient and caregiver spending. CLINICALTRIALS gov # is NCT03339271.
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Affiliation(s)
- Brystana G. Kaufman
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
| | - Ro W. Huang
- Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
| | - Diane E. Holland
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Catherine E. Vanderboom
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Cory Ingram
- Department of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Ellen M. Wild
- Department of Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ann Marie Dose
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Carole Stiles
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Allison M. Gustavson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Rochester, Minnesota, USA
| | - Jay Mandrekar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Courtney H. Van Houtven
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
| | - Joan M. Griffin
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
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4
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Biney A, Sarfo JO, Poku CA, Deegbe DA, Atibila F, Ti-Enkawol Nachinab G, Anaba E, Dzansi G, Attafuah PYA. Challenges and coping strategies when caring for terminally ill persons with cancer: perspectives of family caregivers. BMC Palliat Care 2024; 23:175. [PMID: 39020352 PMCID: PMC11253565 DOI: 10.1186/s12904-024-01518-z] [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: 09/21/2023] [Accepted: 07/12/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Terminal illness is an irreversible illness that, without life-sustaining procedures, usually results in death or permanent disability from which recovery is unlikely. When involved, family caregivers are believed to improve health outcomes, such as reduced hospitalization, and establishing a patient's initial access to professional treatment services. However, caring for a patient with a terminal illness is viewed as one of the most difficult aspects of providing care. This study aimed to identify the challenges, and coping strategies developed by family caregivers to cope with the care of the terminally ill person. METHODS An exploratory descriptive qualitative approach was used. Twenty (20) family caregivers voluntarily participated in the study from the Korle-Bu Teaching Hospital. Semi-structured interviews were conducted with the participants. The transcribed interviews were then analysed using thematic analysis. RESULTS From the analysis, three main themes emerged: challenges, coping strategies, and social support. These themes encompassed sixteen subthemes including financial burden, bad health conditions, faith and prayer, and support from health professionals. From the study, both male and female family caregivers narrated that providing care for sick relatives undergoing terminal disease is characterized as a daily duty demanding one's time and fraught with emotional strain. In addition, even though it was a difficult job, family members who provided care for ailing relatives never gave up, citing responsibility, the importance of family, and religious beliefs as the primary motivations for doing so. CONCLUSION The difficulties and demands of family caregiving roles for terminally ill relatives are complex and multifactorial. The findings call for multidisciplinary professional attention for family caregivers and policies that will support their lives holistically.
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Affiliation(s)
| | - Jacob Owusu Sarfo
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Collins Atta Poku
- School of Nursing and Midwifery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Atsu Deegbe
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Fidelis Atibila
- School of Life and Medical sciences Centre for postgraduate medicine and Public Health, University of Hertfordshire UK, College Lane Campus, Hertfordshire, UK
| | - Gilbert Ti-Enkawol Nachinab
- Department of General Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Emmanuel Anaba
- School of Public Health, University of Ghana, Accra, Ghana
| | - Gladys Dzansi
- Ghana College of Nurses and Midwives, Accra, Ghana
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Priscilla Yeye Adumoah Attafuah
- Ghana College of Nurses and Midwives, Accra, Ghana.
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana.
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Griffin JM, Kaufman BG, Bangerter L, Holland DE, Vanderboom CE, Ingram C, Wild E, Dose AM, Stiles C, Thompson V. Improving Transitions in Care for Patients and Family Caregivers Living in Rural and Underserved Areas: The Caregiver Advise, Record, Enable (CARE) Act. J Aging Soc Policy 2024; 36:581-588. [PMID: 35156557 PMCID: PMC9374844 DOI: 10.1080/08959420.2022.2029272] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
In this Perspective, we contend bold action is needed to improve transitions from hospitals to home for aging patients and their family caregivers living in rural and underserved areas. The Caregiver Advise, Record, Enable (CARE) Act, passed in over 40 US states, is intended to provide family caregivers of hospitalized patients with the knowledge and skills needed for safe and efficient transitions. It has broken important ground for family caregivers who assist with transitions in patient care. It may fall short, however, in addressing the unique needs of family caregivers living in rural and underserved areas. We contend that to realize the intended safety, cost, and care quality benefits of the CARE Act, especially for those living in rural and underserved areas, states need to expand the Act's scope. We provide three recommendations: 1) modify hospital information systems to support the care provided by family caregivers; 2) require assessments of family caregivers that reflect the challenges of family caregiving in rural and underserved areas; and 3) identify local resources to improve discharge planning. We describe the rationale for each recommendation and the potential ways that an expanded CARE Act could reduce the risks associated with transitions in care for aging patients.
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Affiliation(s)
- Joan M. Griffin
- Division of Health Care Delivery Research (HCDR) and Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905
| | | | | | - Diane E. Holland
- Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Catherine E. Vanderboom
- Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | | | | | - Ann Marie Dose
- Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
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Bender AA, Pier E, Moore M, Jungerman J, Davis A, Perkins MM. Barriers to Community Service Use Among Persons With Dementia and Their Care Partners: A Focus on Consumers of a Novel Statewide Dementia Care Program. J Appl Gerontol 2024; 43:612-622. [PMID: 38171532 DOI: 10.1177/07334648231223295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Although the importance of access to, and utilization of, home and community-based services (HCBS) is a well-documented aspect of informal care and the ability to age in place among people living with dementia, these resources are underutilized, especially in the initial stages of the disease. In 2017, the Georgia Memory Net was established as a novel private-public partnership to extend dementia screening, diagnosis, care planning, and direct HCBS connections for people with memory concerns throughout the State of Georgia. We aimed to identify barriers and facilitators to HCBS utilization following a dementia diagnosis and subsequent referral for services. Data were collected through in-depth interviews with 7 Georgia Memory Net patients and 19 care partners (unconnected dyads) and analyzed using thematic analysis. We found that even with a direct handoff, many people do not use HCBS and face barriers to accessing services. We offer several recommendations based on these findings.
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Affiliation(s)
| | - Ellyn Pier
- Spaulding Rehabilitation Hospital, Boston, MA, USA
| | | | | | | | - Molly M Perkins
- Emory University, Atlanta, GA, USA
- Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center, Atlanta, GA, USA
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Michaels JA, Meeker MA. Orchestrating Care: A Grounded Theory Study of Family Caregiving for Older Adults in Rural Areas. QUALITATIVE HEALTH RESEARCH 2024:10497323241236308. [PMID: 38594823 DOI: 10.1177/10497323241236308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Family caregivers provide the majority of long-term care and support of older adults as they age or approach the end of life. Studies often refer to family caregivers as invisible because the American healthcare system, public policy, and society do not support or recognize their work. Family caregivers who provide care to older adults who live in rural areas face unique challenges due to the rural environment. The purpose of this study was to inductively develop a theoretical framework that explains the process of family caregiving to older adults who live at home in rural areas and require daily assistance while exploring their experiences regarding access, utilization, challenges, and effectiveness of patient healthcare services and caregiver resources in rural areas. The grounded theory method of Strauss and Corbin was used for sampling, data collection, and data analysis. Fifteen family caregivers who oversaw and/or provided care on a daily basis to an older adult living in two rural counties of New York State participated in the study. Data were collected through two semi-structured interviews with each participant, yielding 30 interviews. Findings revealed that family caregivers engaged in the process of orchestrating care by growing into caregiving, integrating technology, and utilizing networks when providing and managing caregiving. Understanding caregiving from the perspective of family caregivers engaged in the process can inform healthcare practice, healthcare education, and public policy and can support better outcomes for both older adults and their family caregivers.
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Affiliation(s)
- Jacqueline A Michaels
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
- School of Nursing and Allied Health, SUNY Empire State University, Saratoga Springs, NY, USA
| | - Mary Ann Meeker
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Griesemer I, Palmer JA, MacLaren RZ, Harvey KLL, Li M, Garikipati A, Linsky AM, Mohr DC, Gurewich D. Rural Veterans' Experiences with Social Risk Factors: Impacts, Challenges, and Care System Recommendations. J Gen Intern Med 2024; 39:782-789. [PMID: 38010459 PMCID: PMC11043235 DOI: 10.1007/s11606-023-08530-8] [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: 04/20/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Social risk factors, such as food insecurity and financial needs, are associated with increased risk of cardiovascular diseases, health conditions that are highly prevalent in rural populations. A better understanding of rural Veterans' experiences with social risk factors can inform expansion of Veterans Health Administration (VHA) efforts to address social needs. OBJECTIVE To examine social risk and need from rural Veterans' lived experiences and develop recommendations for VHA to address social needs. DESIGN We conducted semi-structured interviews with participants purposively sampled for racial diversity. The interview guide was informed by Andersen's Behavioral Model of Health Services Use and the Outcomes from Addressing Social Determinants of Health in Systems framework. PARTICIPANTS Rural Veterans with or at risk of cardiovascular disease who participated in a parent survey and agreed to be recontacted. APPROACH Interviews were recorded and transcribed. We analyzed transcripts using directed qualitative content analysis to identify themes. KEY RESULTS Interviews (n = 29) took place from March to June 2022. We identified four themes: (1) Social needs can impact access to healthcare, (2) Structural factors can make it difficult to get help for social needs, (3) Some Veterans are reluctant to seek help, and (4) Veterans recommended enhancing resource dissemination and navigation support. CONCLUSIONS VHA interventions should include active dissemination of information on social needs resources and navigation support to help Veterans access resources. Community-based organizations (e.g., Veteran Service Organizations) could be key partners in the design and implementation of future social need interventions.
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Affiliation(s)
- Ida Griesemer
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
| | - Jennifer A Palmer
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Risette Z MacLaren
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Kimberly L L Harvey
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Mingfei Li
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Mathematical Sciences, Bentley University, Waltham, MA, USA
| | | | - Amy M Linsky
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - David C Mohr
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Deborah Gurewich
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Gansa WH, Kleijwegt H, Aldridge M, Ankuda C. Individual Socioeconomic Factors Have a Greater Impact on End-of-Life Care Outcomes Than Regional Factors. J Palliat Med 2024; 27:160-167. [PMID: 37699248 PMCID: PMC11265611 DOI: 10.1089/jpm.2023.0163] [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] [Accepted: 07/25/2023] [Indexed: 09/14/2023] Open
Abstract
Background: End-of-life (EoL) care provided to Americans in urban and rural settings is distinct in terms of both available and delivered services. However, much less is known about which geographic, demographic, and health indicators are associated with disparities in EoL care and how individual versus regional characteristics influence quality of care (QoC). Objective: This study aimed to assess how regionality, rurality, and individual socioeconomic factors are associated with QoC in the last month of life (LML). Design: Nationally representative cross-sectional study using the proxy-completed LML questionnaire as part of the National Health and Aging Trends Study (NHATS). The data were linked at the zip code level to geographic and economic indicators. Settings/Subjects: A total of 2778 NHATS enrollees who died from 2012 to 2020. Measurements: Measurements included population density, socioeconomic indicators, health factors, and health outcomes. The primary independent variable was proxy-reported QoC during the LML (excellent vs. not excellent). Results: In our sample, 52.1% (n = 1447) reported not excellent care and 47.9% (n = 1331) reported excellent care. These populations varied in their demographic and socioeconomic characteristics. After accounting for survey weighting and design, decedents in the top (odds ratio [OR]: 1.58; 95% confidence interval [CI]: 1.08-2.32) income quartile had significantly greater odds of receiving excellent care than decedents in the bottom quartile. Decedents in zip codes with top quartile health outcome metrics had significantly greater odds of receiving excellent care (OR: 1.64; 95% CI: 1.17-2.29) than decedents in zip codes with bottom quartile health outcomes. County rurality index and county health factors were not correlated with QoC in the LML. Conclusions: High QoC at the EoL may be more associated with individual socioeconomic factors than regional indicators, including degrees of rurality. Clinicians should strive to recognize the interplay of individual characteristics and regional indicators to provide more personalized care.
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Affiliation(s)
- William H. Gansa
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Kleijwegt
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Aldridge
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claire Ankuda
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Yoshikawa A, Bouldin ED, López-Anuarbe M, Kindratt TB, Sylvers DL, Webster NJ. Use of Caregiving Support Services Among Diverse Dementia Caregivers by Geographic Context. THE GERONTOLOGIST 2024; 64:gnad067. [PMID: 37318017 PMCID: PMC10825843 DOI: 10.1093/geront/gnad067] [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: 12/28/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about how race/ethnicity and geographic context relate to support service use among dementia caregivers. Our objectives were to investigate (a) whether the use of at least one formal caregiving service-support groups, respite care, and training-differed by race/ethnicity and across metro and nonmetro areas; and (b) whether predisposing, enabling, and need characteristics influenced support service use by race/ethnicity. RESEARCH DESIGN AND METHODS Data were analyzed from a sample of primary caregivers of care recipients aged 65 years or older with probable dementia (n = 482) in the 2017 National Health and Aging Trends Study and National Study of Caregiving. We calculated weighted prevalence estimates and then used the Hosmer-Lemeshow goodness of fit statistic to find the best-fitting logistic regression models. RESULTS Among minority dementia caregivers, support service use was higher in metro than nonmetro areas (35% and 15%); the trend was reversed for non-Hispanic White caregivers (47% nonmetro and 29% metro). The best-fitting regression models included predisposing, enabling, and need factors for both minority and non-Hispanic White caregivers. Younger age and more disagreement within the family were consistently associated with more service use in both groups. Among minority caregivers, better caregiver and care recipient health were associated with using support services. Among non-Hispanic White caregivers, nonmetro geographic context and caregiving interfering with valued activities were associated with using support services. DISCUSSION AND IMPLICATIONS Geographic context differently affected support service use and the influence of predisposing, enabling, and need factors varied by race/ethnicity.
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Affiliation(s)
- Aya Yoshikawa
- School of Health Promotion and Kinesiology, Texas Woman’s University, Denton, Texas, USA
| | - Erin D Bouldin
- Health Services Research and Development, Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Tiffany B Kindratt
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
| | - Dominique L Sylvers
- Population Studies Center, Institute for Social Research, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Noah J Webster
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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11
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Kaufman BG, Holland DE, Vanderboom CE, Ingram C, Wild EM, Dose AM, Stiles C, Gustavson AM, Chun A, Langan EM, Baer-Benson HA, Mandrekar J, Griffin JM. Implementation Costs of Technology-Enhanced Transitional Palliative Care for Rural Caregivers. Am J Hosp Palliat Care 2024; 41:38-44. [PMID: 36798053 PMCID: PMC10427729 DOI: 10.1177/10499091231156145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES Compared to urban family caregivers (FCG), rural FCG experience greater burdens accessing coordinated care for their loved ones during and after hospitalization. The impact of technology-enhanced transitional palliative care (TPC) on caregiver outcomes is currently being evaluated in a randomized control trial. This study evaluates resource use and health system costs of this FCG-focused TPC intervention and potential Medicare reimbursement mechanisms. METHODS Rural caregivers of hospitalized patients were randomized into an 8-week intervention consisting of video visits conducted by a registered nurse certified in palliative care, supplemented with phone calls and texts (n = 215), or attentional control. Labor costs were estimated for a registered nurse and compared to scenario analyses using a nurse practitioner or social worker wages. Medicare reimbursement scenarios included Transitional Care Management (TCM) and Chronic Care Management (CCM) CPT codes. RESULTS In the base case, TPC cost was $395 per FCG facilitated by a registered nurse, compared to $337 and $585 if facilitated by a social worker or nurse practitioner, respectively. Mean Medicare reimbursement in the TCM-only scenario was $322 and $260 for high or moderate complexity patients, respectively. Reimbursement in the CCM only scenario was $348 and $274 for complex and non-complex patients, respectively. Reimbursement in the TCM+CCM scenario was $496 and $397, for high/complex and moderate/non-complex patients, respectively. CONCLUSION TPC is a feasible, low cost and sustainable strategy to enhance FCG support in rural areas. Potential reimbursement mechanisms are available to offset the costs to the health system for providing transitional palliative care to caregivers of patients recently hospitalized.
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Affiliation(s)
- Brystana G Kaufman
- Population Health Sciences, Duke University School of Medicine, Durham NC, USA
- Margolis Center for Health Policy, Duke University, Durham NC, USA
- Durham VA HSR&D
| | - Diane E Holland
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Catherine E Vanderboom
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Cory Ingram
- Department of Community Internal Medicine Geriatrics, Palliative Care Mayo Clinic, Rochester, MN, USA
| | - Ellen M Wild
- Department of Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ann Marie Dose
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Carole Stiles
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Allison M Gustavson
- Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Alice Chun
- Margolis Center for Health Policy, Duke University, Durham NC, USA
| | - Erica M Langan
- Margolis Center for Health Policy, Duke University, Durham NC, USA
| | - Henry A Baer-Benson
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Jay Mandrekar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
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Monahan Z, Shores D, Mack A, Bray N, Ford A, Hartwell M. Prevalence of depression among caregivers based on the condition and relationship of care recipient. J Affect Disord 2023; 340:442-447. [PMID: 37582463 DOI: 10.1016/j.jad.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Caregiver distress is the strain experienced by individuals providing care for people with chronic conditions which limit their self-sufficiency for tasks of daily living. Over 1 in 5 Americans are caregivers-a number expected to increase with an aging population. METHODS We performed a cross-sectional analysis using the 2021 Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC) to determine rates of depressive disorders among caregivers and associations between demographic and relational aspects of the care recipient. RESULTS The included sample size for analysis was 32,676, representing 17,274,935 US caregivers. We found that caregivers who were female, American Indian/Alaskan Native, race-not-listed, earning less than $15,000 a year, or did not complete high school, had higher rates of depression diagnosis. The rates of depression were higher among caregivers if the recipient had a mental or chronic respiratory condition, or if the recipient was their live-in partner. Rates of depression were lower for caregivers of their mother-in-law or spouse. LIMITATIONS Results were based on self-reported survey data, which are susceptible to social desirability bias. Diagnoses of depression may also be over or under reported across several demographic variables, which may confound results. CONCLUSION Our findings add to previous research showing that specific groups of caregivers are at higher risk for caregiver stress. Future qualitative research may elucidate underlying causes of depression among caregivers. Analysis into the risk factors for depression among caregivers is vital in providing effective therapeutic options for the caregiver.
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Affiliation(s)
- Zach Monahan
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America; Oklahoma State University Center for Health Sciences, Department of Healthcare Administration, Master of Science in Global Health Program, Tulsa, OK, United States of America.
| | - Dyani Shores
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Alyson Mack
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Natasha Bray
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Alicia Ford
- Oklahoma State University Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Tulsa, OK, United States of America
| | - Micah Hartwell
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America; Oklahoma State University Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Tulsa, OK, United States of America
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Shuffler J, Lee K, Fields N, Graaf G, Cassidy J. Challenges Experienced by Rural Informal Caregivers of Older Adults in the United States: A Scoping Review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2023; 20:520-535. [PMID: 37330681 DOI: 10.1080/26408066.2023.2183102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE The purpose of this scoping review was to document the state of the literature regarding the challenges experienced by rural informal caregivers of older adults in the United States. METHOD We reviewed peer-reviewed academic articles published through December 1, 2021, based on Arksey and O'Malley's framework. RESULTS The initial search resulted in 1,255 articles, of which 12 studies were included for the final review. Thematic content analysis was utilized to identify emerging themes of challenges experienced by rural informal caregivers of older adults. The identified challenges include a lack of knowledge regarding resources, financial difficulties, health-related challenges, and barriers related to geographic distance. DISCUSSION AND CONCLUSION The implications of these challenges are used to shape recommendations for social work, service planning, and policy changes that can improve caregiving experiences for rural families.
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Affiliation(s)
- Jon Shuffler
- School of Social Work, The University of Texas, Arlington,Texas, USA
| | - Kathy Lee
- School of Social Work, The University of Texas, Arlington,Texas, USA
| | - Noelle Fields
- School of Social Work, The University of Texas, Arlington,Texas, USA
| | - Genevieve Graaf
- School of Social Work, The University of Texas, Arlington,Texas, USA
| | - Jessica Cassidy
- School of Social Work, The University of Texas, Arlington,Texas, USA
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14
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Tan KR, Waters AR, Chen Q, Hendricks BA, Coombs LA, Kent EE. Inequities Among Cancer Caregivers with Diverse Identities: A Review of the Literature and Future Directions. Curr Oncol Rep 2023; 25:803-812. [PMID: 37043117 PMCID: PMC10091341 DOI: 10.1007/s11912-023-01415-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE OF REVIEW The number of older adults with cancer relying on support from caregivers continues to increase. Health disparities in older adults with cancer often extend to their caregivers. This review aims to assess the state of cancer caregiving research in historically underrepresented diverse populations and provide recommendations for future research and policy. RECENT FINDINGS Research on caregivers of older adults with cancer from diverse backgrounds has primarily been descriptive. Health disparities for historically underrepresented caregivers (LGBTQ + , BIPOC, rural, young adults, youth) exist across several dimensions (e.g., financial, mental, and physical health, and access to caregiver support). Few published studies have closely examined the unique experiences of these caregivers nor provided culturally appropriate tailored interventions. Health equity research within caregiving populations is in its infancy. Priorities for future work should focus on identifying modifiable targets for intervention, changing systems-level processes in acknowledging and supporting caregivers, and creating policies that reduce financial inequities of caregiving.
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Affiliation(s)
- Kelly R Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 East Weaver Street, CB 7293, 2nd Floor, Suite 220, Chapel Hill, NC, USA.
| | - Austin R Waters
- Gillings School of Global Public Health, Department of Health Policy and Management, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qi Chen
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Bailey A Hendricks
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lorinda A Coombs
- School of Nursing, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin E Kent
- Gillings School of Global Public Health, Department of Health Policy and Management, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Qian Y, Asad S, Park EM, Mills JA, Kent EE. Rural resilience during COVID-19: the lived experience of North Carolinian rural-dwelling cancer caregivers. Support Care Cancer 2023; 31:396. [PMID: 37318622 PMCID: PMC11071545 DOI: 10.1007/s00520-023-07840-1] [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: 11/11/2022] [Accepted: 05/24/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To illuminate the lived experience of resilience in rural-dwelling North Carolinian cancer caregivers at the intersection of cancer and the COVID-19 pandemic. METHODS In spring, 2020, we recruited self-identified primary caregivers (CGs) for a relative/friend with cancer living in a rural area. We conducted cross-sectional semi-structured interviews and then thematically analyzed transcripts to identify and categorize instances of stressors and benefit-finding. RESULTS Of the 24 participants, 29% were < 50 years old, 42% identified as non-Hispanic Black, 75% were women, and 58% were spousal CGs. Most care recipients (CRs) had stage IV cancer (n = 20) and cancer types varied. Participants played a variety of roles in caregiving and experienced stressors related to caregiving demands (e.g., conflicts with other responsibilities), rurality (e.g., transportation), and the COVID-19 pandemic (e.g., new visitor policy at hospital). Despite stressful experiences, participants also identified many positive aspects of their caregiving. Five domains of benefit-finding were identified: appreciation (e.g., gratitude toward their ability to care for CRs), CG-CR dyad relationship dynamics (e.g., increased closeness), interpersonal relationship dynamics (e.g., perceived peer support), faith (e.g., ability to cope through praying), and personal growth (e.g., new skills learned from caregiving). CONCLUSION Rural-dwelling cancer caregivers from mixed sociodemographic backgrounds identified a diverse range of benefits from caregiving, despite experiencing multiple stressors, including emergent stressors from the COVID-19 pandemic. Healthcare delivery serving rural communities may consider expanding transportation assistance and boosting benefit-finding to ameliorate stress in cancer caregivers.
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Affiliation(s)
- Yiqing Qian
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah Asad
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102-B McGavran-Greenberg Hall, CB # 7411, Chapel Hill, NC, 27599-7411, USA
| | - Eliza M Park
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jiona A Mills
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102-B McGavran-Greenberg Hall, CB # 7411, Chapel Hill, NC, 27599-7411, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Kindratt TB, Sylvers DL, Yoshikawa A, López-Anuarbe M, Webster NJ, Bouldin ED. Dementia Caregiving Experiences and Health Across Geographic Contexts by Race and Ethnicity. J Gerontol B Psychol Sci Soc Sci 2023; 78:S48-S58. [PMID: 36913373 PMCID: PMC10010466 DOI: 10.1093/geronb/gbac182] [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: 02/04/2022] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES Few studies have examined how the intersectionality of geographic context and race/ethnicity influences dementia caregiving. Our objectives were to determine whether caregiver experiences and health (a) differed across metro and nonmetro areas and (b) differed by caregiver race/ethnicity and geography. METHODS We used data from the 2017 National Health and Aging Trends Study and National Study of Caregiving. The sample included caregivers (n = 808) of care recipients ages 65 and older with "probable" dementia (n = 482). The geographic context was defined as the care recipient's residence in metro or nonmetro counties. Outcomes included caregiving experiences (care situation, burden, and gains) and health (self-rated anxiety, depression symptoms, and chronic health conditions). RESULTS Bivariate analyses indicated that nonmetro dementia caregivers were less racially/ethnically diverse (82.7% White, non-Hispanic) and more were spouses/partners (20.2%) than their metro counterparts (66.6% White, non-Hispanic; 13.3% spouses/partners). Among racial/ethnic minority dementia caregivers, nonmetro context was associated with more chronic conditions (p < .01), providing less care (p < .01), and not coresiding with care recipients (p < .001). Multivariate analyses demonstrated that nonmetro minority dementia caregivers had 3.11 times higher odds (95% confidence interval [CI] = 1.11-9.00) of reporting anxiety in comparison to metro minority dementia caregivers. DISCUSSION Geographic context shapes dementia caregiving experiences and caregiver health differently across racial/ethnic groups. Findings are consistent with previous studies that have shown that feelings of uncertainty, helplessness, guilt, and distress are more prevalent among people providing caregiving from a distance. Despite higher rates of dementia and dementia-related mortality in nonmetro areas, findings suggest both positive and negative aspects of caregiving among White and racial/ethnic minority caregivers.
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Affiliation(s)
- Tiffany B Kindratt
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
| | - Dominique L Sylvers
- Population Studies Center, Institute for Social Research and School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Aya Yoshikawa
- School of Health Promotion and Kinesiology, College of Health Sciences, Texas Woman’s University, Denton, Texas, USA
| | | | - Noah J Webster
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin D Bouldin
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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Brennan MB, Tan TW, Schechter MC, Fayfman M. Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations. Semin Vasc Surg 2023; 36:19-32. [PMID: 36958894 PMCID: PMC10039286 DOI: 10.1053/j.semvascsurg.2023.01.002] [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: 11/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Recently, the United States experienced its first resurgence of major amputations in more than 20 years. Compounding this rise is a longstanding history of disparities. Patients identifying as non-Hispanic Black are twice as likely to lose a limb as those identifying as non-Hispanic White. Those identifying as Latino face a 30% increase. Rural patients are also more likely to undergo major amputations, and the rural-urban disparity is widening. We used the National Institute on Minority Health and Health Disparities framework to better understand these disparities and identify common factors contributing to them. Common factors were abundant and included increased prevalence of diabetes, possible lower rates of foot self-care, transportation barriers to medical appointments, living in disadvantaged neighborhoods, and lack of insurance. Solutions within and outside the health care realm are needed. Health care-specific interventions that embed preventative and ambulatory care services within communities may be particularly high yield.
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Affiliation(s)
- Meghan B Brennan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53583.
| | - Tze-Woei Tan
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Marcos C Schechter
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
| | - Maya Fayfman
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
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McCarthy MJ, Garcia YE, Remiker M, Hustead MLR, Bacon R, Williamson HJ, Dunn DJ, Baldwin JA. Diverse rural caregivers for individuals with Alzheimer's disease or related dementias: analysis of health factors at the individual, interpersonal, and community level. Aging Ment Health 2023; 27:94-100. [PMID: 35098811 PMCID: PMC9339023 DOI: 10.1080/13607863.2022.2026880] [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] [Indexed: 02/04/2023]
Abstract
Objectives: Approximately 6.2 million Americans aged 65 or older have Alzheimer's disease or related dementias (ADRD). Unpaid family members and friends provide the bulk of caregiving for these individuals. Caregiving in rural areas adds unique challenges, particularly for ethnically/racially diverse caregivers. This study provides a profile of diverse, rural ADRD caregivers with an emphasis on multi-level factors that influence physical and mental health.Methods: A cross-sectional survey was conducted with 156 diverse rural ADRD caregivers.Results: 65% of participants identified as White/Non-Hispanic (WNH; n = 101) and 35% identified as ethnically/racially diverse (ERD; n = 55). The majority of participants reported economic deprivation. More ERD caregivers were uninsured and had at least one chronic health condition. Higher proportions of ERD caregivers smoked cigarettes, consumed alcohol regularly, and had not seen or talked to a doctor in the previous year. There were no ethnic/racial group differences in stress, anxiety, depressive symptoms, subjective health, or sleep quality.Conclusion: Rural caregivers, regardless of ethnicity/race, may benefit from extra supports in order to maintain optimal health. Further research is needed to disentangle the complex relationship between culture, caregiving, and health.
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Affiliation(s)
| | - Y. Evie Garcia
- Department of Educational Psychology, Northern Arizona University, Flagstaff, AZ
| | - Mark Remiker
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
| | | | - Rachel Bacon
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
| | | | - Dorothy J. Dunn
- School of Nursing, Northern Arizona University, Flagstaff, AZ
| | - Julie A. Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
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Abstract
BACKGROUND Multiple system atrophy (MSA) is a rare Parkinson-plus syndrome with rapid progression and a high symptom burden. The experience of caregivers of people with MSA has not been closely examined. We therefore sought to document the impact of MSA on caregivers using a mixed methods approach. METHODS Patients and caregivers were recruited from a movement disorders program in Edmonton, Canada. Participants completed the following survey instruments based on their own or their loved one's symptoms: 36-Item Short-Form Health Survey (SF-36), Multiple System Atrophy health-related Quality of Life scale (MSA-QoL), and Hospital Anxiety and Depression Scale (HADS). Caregivers also completed the Zarit Burden Interview and HADS based on their own experience. Qualitative data were obtained through semi-structured interviews. RESULTS Nine people with MSA (PwMSA) (age range: 48-78 years) and 11 caregivers (49-76 years) participated. All completed surveys; 7 PwMSA and 10 caregivers were interviewed. Eight PwMSA had the parkinsonian type of MSA (MSA-P) and one a mixed type. Caregivers had on average mild-moderate caregiver burden and mild anxiety. Caregiver burden and anxiety were correlated. Qualitative subthemes under the caregiving theme included keeping the patient safe, caregivers' own health, and communication symptoms cause frustration. The rapid progression of illness was bewildering to caregivers and increased their workload. Public home care services were invaluable to caregivers' maintaining their loved ones at home. Caregivers were inventive in finding sources of hope and quality of life for their loved ones. CONCLUSION Publicly funded home care was essential for caregivers of PwMSA in this study. Caregiver support is needed to provide this unrecognized workforce with information and resources to face this challenging condition.
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20
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Kent EE, Lee S, Asad S, Dobbins EE, Aimone EV, Park EM. "If I wasn't in a rural area, I would definitely have more support": social needs identified by rural cancer caregivers and hospital staff. J Psychosoc Oncol 2022; 41:393-410. [PMID: 36214743 PMCID: PMC10083183 DOI: 10.1080/07347332.2022.2129547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The social needs of rural families facing cancer warrant investigation to inform psychosocial care planning and policy development. METHODS Using purposive sampling, we interviewed 24 rural caregivers and 17 hospital staff from an academic cancer center in the U.S. South. Social needs were defined as the support needed to effectively provide informal caregiving across economic, physical, interpersonal, and service domains. We used the framework method to code and synthesize findings. FINDINGS Caregiver economic and physical needs were interconnected and most pressing, including common examples of distance to care and transportation barriers. Caregivers desired additional support from the health system, insurance providers, and community resources. Staff identified similar need patterns and gaps in health system capacity. CONCLUSIONS Rural cancer caregivers experience multiple unmet social needs. Supportive interventions for this population will benefit from flexible implementation and multilevel, multisector approaches. In particular, interventions that address financial hardship and limited internet access are needed.
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Affiliation(s)
- Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sejin Lee
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah Asad
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin E Dobbins
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth V Aimone
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eliza M Park
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Quinlan C, McKibbin C, Cuffney C, Brownson R, Brownson C, Clark J, Osvold L. Barriers to Aging in Place for Rural, Institutionalized Older Adults: A Qualitative Exploration. Clin Gerontol 2022; 45:1167-1179. [PMID: 32981469 DOI: 10.1080/07317115.2020.1820651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Although the majority of older adults wish to "age in place" in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings. METHODS A series of individual and group interviews was conducted in SNFs across seven rural communities. A grounded, thematic analysis was used to interpret interview findings, and coding was informed by the socio-ecological model (SEM). RESULTS Participants were 32 adults with a mean age of 72 years (SD = 5.7 years) and an average SNF residence of 3.9 years. Two themes emerged as primary barriers to successful aging in place: (1) Caregiver-related support issues and (2) Present focus, or lack of advanced care-planning. CONCLUSIONS Findings suggest the importance of specifically supporting caregivers, to ease burden and allow for increased agency for rural older adults. A lack of access to caregiver supports and other services limits the ability of community-dwelling rural older adults to age in place or plan for the future. CLINICAL IMPLICATIONS Existing networks of rural community resources and innovative solutions should be leveraged to improve access to services for older adults and their informal caregivers.
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Affiliation(s)
- Claire Quinlan
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | | | - Cari Cuffney
- Wyoming Department of Family Services, Cheyenne, Wyoming, USA
| | - Ross Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carol Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeff Clark
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | - Lisa Osvold
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
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22
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Sterling MR, Cené CW, Ringel JB, Avgar AC, Kent EE. Rural-urban differences in family and paid caregiving utilization in the United States: Findings from the Cornell National Social Survey. J Rural Health 2022; 38:689-695. [PMID: 35355330 PMCID: PMC9492623 DOI: 10.1111/jrh.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE While rates of family caregiving and paid caregiving are increasing, how often they occur together ("shared care") and whether utilization varies geographically are unknown. We examined differences in family and paid caregiving utilization by rurality and region in the United States. METHODS The 2020 Cornell National Social Survey is an annual cross-sectional telephone-based survey of a random sample of 1,000 US adults. Participants were asked if they have been a family caregiver, including if they provided care alongside a paid caregiver. Rural-Urban Commuting Area Codes and Census areas classified rurality and region. The association between residence and the prevalence of caregiving was determined with multivariable Poisson regression. FINDINGS Among 857 participants with geographic and caregiving data, 11.8% (n = 101) were rural dwellers and 34.2% were family caregivers. Rural residence (vs urban) was associated with a higher prevalence of family caregiving (PR: 1.59 [1.22, 2.06]), and Western residence (vs Northeast) was associated with a lower prevalence of family caregiving (PR: 0.63 [0.46, 0.87], P = .01). Forty percent of family caregivers shared care with a paid caregiver. There was no significant difference in shared care by rural residence in unadjusted (31.8% rural vs 43.1% urban, P = .22) or adjusted models (PR: 0.85 [0.51, 1.41], P = .53). CONCLUSIONS Although family caregiving was more prevalent in rural areas and certain regions, shared care did not differ by rurality or region. Studies are needed to understand why rural residents do more family caregiving without additional support from paid caregivers, and what the implications are for caregivers and care recipients.
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Affiliation(s)
| | - Crystal W. Cené
- University of North Caroline at Chapel Hill, Chapel Hill, NC
| | | | | | - Erin E. Kent
- University of North Caroline at Chapel Hill, Chapel Hill, NC
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De Anda-Duran I, Woltz SG, Bell CN, Bazzano LA. Hypertension and cognitive function: a review of life-course factors and disparities. Curr Opin Cardiol 2022; 37:326-333. [PMID: 35731677 PMCID: PMC9354652 DOI: 10.1097/hco.0000000000000975] [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] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Dementia is a life-course condition with modifiable risk factors many from cardiovascular (CV) origin, and disproportionally affects some race/ethnic groups and underserved communities in the USA. Hypertension (HTN) is the most common preventable and treatable condition that increases the risk for dementia and exacerbates dementia pathology. Epidemiological studies beginning in midlife provide strong evidence for this association. This study provides an overview of the differences in the associations across the lifespan, and the role of social determinants of health (SDoH). RECENT FINDINGS Clinical trials support HTN management in midlife as an avenue to lower the risk for late-life cognitive decline. However, the association between HTN and cognition differs over the life course. SDoH including higher education modify the association between HTN and cognition which may differ by race and ethnicity. The role of blood pressure (BP) variability, interactions among CV risk factors, and cognitive assessment modalities may provide information to better understand the relationship between HTN and cognition. SUMMARY Adopting a life-course approach that considers SDoH, may help develop tailored interventions to manage HTN and prevent dementia syndromes. Where clinical trials to assess BP management from childhood to late-life are not feasible, observational studies remain the best available evidence.
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Affiliation(s)
- Ileana De Anda-Duran
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Sara G. Woltz
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Caryn N. Bell
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Lydia A. Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- Tulane University School of Medicine, New Orleans, LA
- Ochsner Clinic Foundation, New Orleans, LA
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Kim D, Peterson N, Lee JE. Caregiving Outcomes of Sub/Urban and Rural Caregivers: The Powerful Tools for Caregivers Program. Clin Gerontol 2022:1-12. [PMID: 35767851 DOI: 10.1080/07317115.2022.2090878] [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: 11/03/2022]
Abstract
OBJECTIVES The research aimed to investigate the effectiveness of the Powerful Tools for Caregivers (PTC) program for rural caregivers. METHODS A total of 160 caregivers participated in the program. Exploratory factor analysis was performed to identify latent caregiving outcomes. Paired samples t-tests were conducted to investigate changes in caregiving outcomes before and after the program. To examine geographical differences in the caregiving outcomes, independent samples t-tests were performed. Qualitative responses of the participants were also analyzed. RESULTS Self-care and positive coping strategies were identified as latent caregiving outcomes. When comparing these two outcome scores before and after the program, the scores significantly improved. The changes in the caregiving outcomes of rural caregivers were greater than those of sub/urban caregivers. Although rural and sub/urban caregivers qualitatively reported similar themes, there were geographical differences in the percentages of caregivers reporting each theme. CONCLUSIONS The PTC program was effective in improving self-care and positive coping strategies, but the effect of the program was more pronounced in rural areas. Our findings suggest that interventions focusing on self-care and positive coping strategies may beneficially impact rural caregivers. CLINICAL IMPLICATIONS The PTC program appears promising to improve self-care strategies and enhance self-efficacy of rural caregivers.
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Affiliation(s)
- Dahee Kim
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
| | - Natasha Peterson
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
| | - Jeong Eun Lee
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
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Cordova-Marks FM, Valencia C, Badger TA, Segrin C, Sikorskii A. Depression among Underserved Rural and Urban Caregivers of Latinas with Breast Cancer. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2022; 33:450-464. [PMID: 37082709 PMCID: PMC10112537 DOI: 10.1080/10911359.2022.2062516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Among Latino/as, informal caregiving duties are often deemed a family responsibility. Understanding psychological outcomes tied to caregivers of Latina breast cancer survivors is important to identify the impacts of cancer. Secondary analysis of baseline data collected in a randomized clinical trial (RCT) from 230 Latina breast cancer survivor-caregiver dyads. Characteristics of caregivers residing in rural/underserved and urban areas were compared using t- or chi-square tests. General linear models were used to analyze depressive symptoms in relation to residence, survivor-caregiver relationship, acculturation, obligation, reciprocity, and comorbidities. Urban residence was significantly associated with higher levels of depression controlling for survivor-caregiver relationship acculturation, obligation, reciprocity, and comorbidities. Mother caregivers had significantly higher levels of depression than other caregivers. Depression among Latino/a caregiver's providing care to an adult child is an important consideration as Latino/as are less likely to seek out/have access to mental health services than other groups.
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Affiliation(s)
- Felina M Cordova-Marks
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85719
| | - Celina Valencia
- Family and Community Medicine, University of Arizona, Tucson
| | - Terry A Badger
- Professor and Chair, Community and Systems Health Science Division, Professor, Department of Psychiatry, University of Arizona College of Nursing
| | - Chris Segrin
- Department Head Steve and Nancy Lynn Professor of Communication, Department of Communication, University of Arizona, Tucson, AZ
| | - Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University
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Atkinson E, Savla J, Roberto KA, Blieszner R, McCann BR, Knight AL. Dual Caregivers of Persons living with Dementia: The Added Stress of COVID-19 Pandemic. Gerontol Geriatr Med 2022; 8:23337214221081364. [PMID: 35321191 PMCID: PMC8935589 DOI: 10.1177/23337214221081364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/17/2021] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
Serving in dual caregiving roles presents challenges and has consequences for caregivers’ physical and mental health. Forty-six dual caregivers in rural southwest Virginia participated in one semi-structured telephone interview pre-pandemic. Of these caregivers, nine dual caregivers of multiple older adults (MOA) and six caregivers of multiple generations (MG) participated in two telephone interviews during the COVID-19 pandemic. Pre-pandemic health, stress, and support data were used to compare dual caregivers of MOA and MG; differences were minimal. Responses to interviews conducted during the pandemic highlighted the effects of social restrictions on MOA and MG caregivers, revealing five themes (1) Increased isolation, (2) Increased need for vigilance, (3) Negative impact on mental health, (4) Tendency to “do it all,” and (5) Increased informal help. MOA and MG caregivers differed on managing care responsibilities and ensuring the health of care recipients. In general, dual caregivers experienced decreased mental health, increased social isolation, and increased caregiving responsibilities. Antecedents of the pandemic experiences differentiated MOA and MG caregiver. Findings suggest that programs and services should target dual caregivers’ unique needs.
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Li C, Shi C. Adverse Events and Risk Management in Residential Aged Care Facilities: A Cross-Sectional Study in Hunan, China. Risk Manag Healthc Policy 2022; 15:529-542. [PMID: 35378829 PMCID: PMC8976485 DOI: 10.2147/rmhp.s351821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Adverse events threaten residents’ safety. Risk management is important to provide proper care and maintain quality in residential aged care facilities (RACFs). However, there is little data on adverse events, risk management, and risk early warning in RACFs in the Chinese mainland. This study aimed to fill this gap by investigating the prevalence of the aforementioned aspects and related factors in China. Participants and Methods Using a cross-sectional design, a field survey of 272 RACFs in Hunan Province was conducted from January 25 to June 1, 2020. Data were collected using four main tools on prevalence of nursing adverse events, risk management, risk early warning, and general information. Descriptive statistics were described by frequency (percentage) and median (interquartile range). Mann–Whitney U-test and Kruskal–Wallis H-test, and Spearman coefficient were used for statistical analysis. Results RACFs experienced an average of five (15) adverse events in 2019, with falls and pressure ulcers being the most common. The total average score of risk management in RACFs was 4.72 (0.98) out of 5, with the environment and personnel management dimensions scoring the highest with 4.75 (1) and the service management dimension scoring the lowest with 4.60 (1). Only 72.79% had trained their staff on ethical and legal knowledge and 84.56% had utilized pre-hospital first aid. Further, 30% to 40% were unprepared for contingency plans of suicide, electric shock, gas poisoning, and drowning. There were significant risk management differences among the following variables: facilities’ locations, accreditation with the Practice Certificate of Social Welfare Facilities, bed-size, nursing hours per resident day, requirement for nursing staff with certificates, and payment for nursing staff (p < 0.05). Conclusion RACFs are facing safety challenges with a high prevalence of nursing adverse events. These facilities need to improve risk early warning and management to ensure residents’ safety.
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Affiliation(s)
- Chunyan Li
- School of Nursing, Hunan University of Chinese Medicine, Changsha, People’s Republic of China
| | - Chunhong Shi
- School of Nursing, Xiangnan University, Chenzhou, People’s Republic of China
- Correspondence: Chunhong Shi, Tel +86 15907354840, Fax +86 735 2325007, Email
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Besser LM, Galvin JE. Rural Versus Non-Rural Residence and Psychosocial Outcomes Among Caregivers of Patients with Dementia and Related Disorders. J Alzheimers Dis 2022; 85:993-999. [PMID: 34897088 PMCID: PMC8821350 DOI: 10.3233/jad-215162] [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: 01/03/2023]
Abstract
We used data on 718 dementia caregivers and multivariable linear regression to test associations between residential locale and psychosocial outcomes (grief, wellbeing, burden, quality of life [QOL], self-efficacy/mastery, and social networks). Rural residence (versus urban or suburban) was not associated with the psychosocial outcomes. However, for rural caregivers, greater self-efficacy/mastery was associated with lower grief (versus urban/suburban) and burden (versus suburban), and greater social network quality was associated with lower burden (versus suburban) and higher QOL (versus urban). Interventions targeting self-efficacy/mastery and social networks may be particularly effective at improving rural caregivers' mental health and QOL.
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Affiliation(s)
- Lilah M. Besser
- Institute for Human Health and Disease Intervention (I-HEALTH), Department of Urban and Regional Planning, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136
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Smith JL, Chung ML, Miller JL, Biddle M, Schuman DL, Rayens MK, Lennie TA, Smalls B, Hammash M, Mudd-Martin G, Moser DK. Profile of informal rural Appalachian caregivers of patients with chronic illnesses. J Rural Health 2022; 38:240-250. [PMID: 33644897 PMCID: PMC8397797 DOI: 10.1111/jrh.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Caring for a family member with chronic illness increases cardiovascular disease (CVD) risk by 82%, and rurality imparts additional CVD disparities. The purpose of this study was to describe a profile of rural caregivers of patients with chronic illnesses to determine the prevalence of CVD risk factors, and psychosocial and socioeconomic burden, as well as to compare these variables across gender. METHODS Baseline data from a trial of CVD risk reduction in rural caregivers of patients with chronic illnesses were used. We measured depression and anxiety with the PHQ-9 and Brief Symptom Inventory; social, economic, and environmental factors using the MOS-Social Support and Economic and Environmental surveys; body mass index (BMI); blood pressure (BP); and lipid profile. RESULTS Of 181 caregivers (age 53±14 years, 80% female), 69% were married; 88% were caring for a family member, including 46% caring for a spouse and 18% for a parent. A total of 51% were anxious, 25% depressed, and 25% reported lack of social support. Most (51%) caregivers had one or more types of CVD; and 49% were smokers. By examination, 76% had elevated BP; 35% had total cholesterol >200; 50% low-density lipoprotein >100; 56% triglycerides >150; and 79% high-density lipoprotein <60. Based on BMI, 91.5% were overweight or obese. Gender comparisons revealed that women reported higher levels of depressive symptoms than men. CONCLUSIONS Rural caregivers, regardless of gender, are at increased risk of CVD and struggle with factors that make caregiving burdensome and contribute to their own poor cardiac health.
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Affiliation(s)
| | - Misook L. Chung
- College of Nursing, University of Kentucky, Lexington, Kentucky
- College of Nursing, Yonsei University, Seoul, Korea
| | | | - Martha Biddle
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Donna L. Schuman
- College of Social Work, University of Kentucky, Lexington, Kentucky
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Terry A. Lennie
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Brittany Smalls
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Muna Hammash
- School of Nursing, University of Louisville, Louisville, Kentucky
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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Savla J, Roberto KA, Blieszner R, Knight AL. Family Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service Use. Innov Aging 2021; 6:igab055. [PMID: 35146130 PMCID: PMC8824523 DOI: 10.1093/geroni/igab055] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the United States. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, underresourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. Research Design and Methods The study was grounded in the Andersen Behavioral Model, supplemented with culturally relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver’s rural community identity and attitude toward services were moderators. Results Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. Discussion and Implications Although the extent of needs and the caregiver’s economic situation were essential influences on formal service utilization, the main drivers were the caregiver’s identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.
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Affiliation(s)
- Jyoti Savla
- Virginia Tech Center for Gerontology, Blacksburg, Virginia, USA
| | - Karen A Roberto
- Virginia Tech Center for Gerontology, Blacksburg, Virginia, USA
| | | | - Aubrey L Knight
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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31
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Cohen SA, Ahmed N, Brown MJ, Meucci MR, Greaney ML. Rural-urban differences in informal caregiving and health-related quality of life. J Rural Health 2021; 38:442-456. [PMID: 33956360 DOI: 10.1111/jrh.12581] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Rural-urban health disparities are pervasive among older adults. Rural US locations have a disproportionately high population of older adults, have reduced access to services, and are therefore more reliant on family and friends for care. However, little is known about rural-urban disparities among the 40+ million informal caregivers nationwide. There is a critical need to understand how rural-urban disparities impact caregiving experiences and health-related quality of life (HRQoL). The objectives of this study were to assess rural-urban differences in informal caregiving status, caregiving intensity (caregiving hours/week and types of care provided), and caregiver HRQoL. METHODS Data were abstracted from the 2018 Behavioral Risk Factor Surveillance System. The primary measure of rural-urban status was "metropolitan status." Associations between rural-urban status and caregiving and rural-urban differences in caregiving intensity and HRQoL were examined using generalized linear models, controlling for confounding and accounting for complex sampling. RESULTS Rural respondents were more likely to be caregivers than urban respondents (OR = 1.17, 95% CI: 1.02-1.34). After adjustment for confounders, rural caregivers were more likely than urban caregivers to provide 20 or more hours of caregiving per week (OR 1.38, 95% CI: 1.07-1.77), although the findings for health and HRQoL were somewhat mixed. CONCLUSION Results indicate that rural older adults offer more care than urban counterparts, which may have implications for caregiver health, well-being, and quality of life. These results can inform policies designed to improve caregiver health, and facilitate the translation and adaptation of existing policies, programs, and interventions to address rural caregivers' needs.
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Affiliation(s)
- Steven A Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Neelam Ahmed
- Department of Biological Sciences, College of Environmental and Life Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Marissa R Meucci
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Mary L Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
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Alhasan DM, Hirsch JA, Jackson CL, Miller MC, Cai B, Lohman MC. Neighborhood Characteristics and the Mental Health of Caregivers Cohabiting with Care Recipients Diagnosed with Alzheimer's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:913. [PMID: 33494425 PMCID: PMC7908545 DOI: 10.3390/ijerph18030913] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
While studies have documented the influence of caregiver and care recipient factors on caregiver health, it is important to address the potential impact of neighborhood contexts. This study estimated the cross-sectional associations between neighborhood characteristics and mental health among caregivers cohabiting with Alzheimer's disease care recipients that were experiencing severe or non-severe neuropsychiatric symptoms (NPSs) (e.g., aggression/anxiety). We obtained data collected in 2010 on caregivers and care recipients (n = 212) from a subset of South Carolina's Alzheimer's Disease Registry. Neighborhood measures (within 1 mile of the residence) came from the American Community Survey and the Rural-Urban Commuting Area Code. We categorized the neighborhood median household income into tertiles, namely, "low" (<$31,000), "medium" ($31,000-40,758), and "high" (>$40,758), and rurality as "large urban," "small urban," and "rural." We used negative binomial regression to estimate the prevalence ratios (PRs) and 95% confidence intervals (CIs) for caregiver mental health using neighborhood characteristics. The mean age was 58 ± 10.3 years, 85% were women, and 55% were non-Hispanic Black. Among the caregivers cohabiting with a recipient experiencing severe NPS, higher distress was experienced by caregivers living in low- (PR = 1.61 (95% CI = 1.26-2.04)) and medium- (PR = 1.45 (95% CI = 1.17-1.78)) vs. high-income neighborhoods after an adjustment. These results suggest that neighborhood characteristics may amplify other social stressors experienced by caregivers.
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Affiliation(s)
- Dana M. Alhasan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institute of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA;
| | - Jana A. Hirsch
- Urban Health Collaborative, Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institute of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA;
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20814, USA
| | - Maggi C. Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.C.M.); (B.C.); (M.C.L.)
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.C.M.); (B.C.); (M.C.L.)
| | - Matthew C. Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.C.M.); (B.C.); (M.C.L.)
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Ludwig A, Monico LB, Lertch E, Schwartz RP, Fishman M, Mitchell SG. Until there's nothing left: Caregiver resource provision to youth with opioid use disorders. Subst Abuse 2021; 42:990-997. [PMID: 33759732 PMCID: PMC9813860 DOI: 10.1080/08897077.2021.1901178] [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: 01/11/2023]
Abstract
Background and Aims: Despite the considerable literature associating certain characteristics of caregivers and family structures with risks of adolescent/young adult (youth) substance use, there has been little study of the role of caregivers in opioid use disorder (OUD) treatment outcomes. This qualitative study sought to understand and contextualize the factors that influenced the resources caregivers provided their youth after residential treatment. Methods: In order to improve understandings of the role caregivers play both during and after residential OUD treatment, 31 caregivers of youth who were in a residential substance use disorder treatment center were interviewed at baseline, three-months, and six-months following their youth's discharge. Results: This analysis focused on the provision of caregiver resources and identified three key influences - OUD understandings and expectations, relationships with youth, and the emotional toll on caregivers. This has important implications as residential treatment success rates are relatively low among this population. Conclusions: These findings suggest that engagement of caregivers and families in outpatient care following residential treatment could offer an important opportunity for interventions that promote youth recovery.
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Affiliation(s)
- Ariel Ludwig
- Friends Research Institute, Inc, Baltimore, Maryland, USA
| | | | | | | | - Marc Fishman
- Mountain Manor Treatment Center, Baltimore, Maryland, USA
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Berrocoso S, Amayra I, Lázaro E, Martínez O, López-Paz JF, García M, Pérez M, Al-Rashaida M, Rodríguez AA, Luna PM, Pérez-Núñez P, Blanco R, Nevado J. Coping with Wolf-Hirschhorn syndrome: quality of life and psychosocial features of family carers. Orphanet J Rare Dis 2020; 15:293. [PMID: 33076957 PMCID: PMC7574588 DOI: 10.1186/s13023-020-01476-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/21/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Wolf-Hirschhorn Syndrome (WHS) is a rare, congenital disease characterized by a distinctive facial phenotype, seizures, intellectual disability and developmental delay, and pre and postnatal growth requiring lifelong care. The psychosocial status of the family caregivers of children diagnosed with WHS is unknown. This study aims to characterize the sociodemographic and psychosocial profile of WHS caregivers and analyze how these variables impact their quality of life (QoL) and well-being. RESULTS The sociodemographic and clinical profile of 22 Spanish caregivers of children with WHS and the characteristics of those affected have been described. Significant relationships were found between sociodemographic and psychosocial characteristics among caregivers. The impact on the parents' QoL and negative relationship with the symptomatology were assessed. The use of engagement strategies such as problem focused coping was associated with improved psychological QoL and social support. CONCLUSIONS WHS caregivers share similarities in their profile and needs with caregivers of children with other rare diseases. Pychosocial support groups involving parents caring for children with the same disease could improve caregivers' well-being and QoL by strengthening their social support network and using positive coping styles.
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Affiliation(s)
- Sarah Berrocoso
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Imanol Amayra
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Esther Lázaro
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Oscar Martínez
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Juan Francisco López-Paz
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Maitane García
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Manuel Pérez
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Mohammad Al-Rashaida
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Alicia Aurora Rodríguez
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Paula Maria Luna
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Paula Pérez-Núñez
- Facultad de Psicología y Educación, Neuro-e-Motion, Investigación sobre aspectos Neuropsicológicos y Psicosociales de las Enfermedades Raras, Universidad de Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Raquel Blanco
- Hospital Universitario Central de Asturias, Neurología Pediátrica, Oviedo, Spain
| | - Julián Nevado
- INGEMM Hospital Universitario La Paz Madrid, Instituto de Genética Médica y Molecular; CIBERER, Madrid, Spain
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Swinkels JC, Broese van Groenou MI, de Boer A, Tilburg TGV. Male and Female Partner-Caregivers' Burden: Does It Get Worse Over Time? THE GERONTOLOGIST 2020; 59:1103-1111. [PMID: 30321338 DOI: 10.1093/geront/gny132] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The general view is that partner-caregiver burden increases over time but findings are inconsistent. Moreover, the pathways underlying caregiver burden may differ between men and women. This study examines to what degree and why partner-caregiver burden changes over time. It adopts Pearlin's Caregiver Stress Process Model, as it is expected that higher primary and secondary stressors will increase burden and larger amounts of resources will lower burden. Yet, the impact of stressors and resources may change over time. The wear-and-tear model predicts an increase of burden due to a stronger impact of stressors and lower impact of resources over time. Alternatively, the adaptation model predicts a decrease of burden due to a lower impact of stressors and higher impact of resources over time. RESEARCH DESIGN AND METHODS We used 2 observations with a 1-year interval of 279 male and 443 female partner-caregivers, derived from the Netherlands Older Persons and Informal Caregivers Survey Minimum Data Set. We applied multilevel regression analysis, stratified by gender. RESULTS Adjusted for all predictors, caregiver burden increased over time for both men and women. For female caregivers, the impact of poor spousal health on burden increased and the impact of fulfillment decreased over time. Among male caregivers, the impact of predictors did not change over time. DISCUSSION AND IMPLICATIONS The increase of burden over time supports the wear-and-tear model, in particular for women. This study highlights the need for gender-specific interventions that are focused on enabling older partners to be better prepared for long-term partner-care.
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Affiliation(s)
- Joukje C Swinkels
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam
| | | | - Alice de Boer
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam.,The Netherlands Institute for Social Research, The Hague, The Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam
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Gorawara-Bhat R, Graupner J, Molony J, Thompson K. Informal Caregiving in a Medically Underserved Community: Challenges, Construction of Meaning, and the Caregiver-Recipient Dyad. SAGE Open Nurs 2019; 5:2377960819844670. [PMID: 33415239 PMCID: PMC7774370 DOI: 10.1177/2377960819844670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/13/2019] [Accepted: 03/23/2019] [Indexed: 11/15/2022] Open
Abstract
Little is known about informal caregivers' challenges in medically underserved communities. This qualitative study explores their perceptions/experiences of caregiving in a medically underserved community in Midwest United States. Two focus groups (n = 12) were conducted and themes were extracted and analyzed. Theme 1 included perceived barriers/unmet needs; most prevalent of which were lack of informational resources and support groups. A second unsolicited and unanticipated theme highlighted how caregivers constructed meaning through reappraising challenges to create enriching experiences for themselves, reinforcing their evolving dyadic relationship with care-recipient. Challenging and enriching aspects of caregiving coexisted and were rooted in caregiver-care-recipient dyad. Caregivers used meaning-making as a coping strategy for challenges. Prior research corroborates caregivers' challenges and meaning-making; this study contributes by delineating how both become interrelated. Policy makers can (a) alleviate challenges by increasing informational resources and support groups and (b) provide training to optimize caregivers' meaning-making, thus enhancing their positive experiences.
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Affiliation(s)
| | | | - Jason Molony
- Department of Medicine, The
University of Chicago, IL, USA
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Henning-Smith C, Lahr M, Casey M. A National Examination of Caregiver Use of and Preferences for Support Services: Does Rurality Matter? J Aging Health 2018; 31:1652-1670. [PMID: 29978742 DOI: 10.1177/0898264318786569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The objective of this study was to assess rural-urban differences in caregiver use of and preferences for support services. Method: Using the 2015 Caregiving in the U.S. survey data (n = 1,389), we analyzed rural-urban differences by caregiver residence in use of and preferences for support services. We analyzed bivariate differences in service use and preferences, as well as in sociodemographic and caregiving relationship characteristics. We also assessed the correlates of service use using stratified ordered logistic regression models. Results: Approximately one third of all caregivers had used no supportive services, with few differences in service use and preference by location. For caregivers in both locations, having more financial strain was associated with greater use of services. Discussion: This article identifies broad needs for caregiver support across all geographic locations. Targeted efforts should be made to ensure access to supportive services accounting for unique barriers by geography.
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Affiliation(s)
| | - Megan Lahr
- 1 University of Minnesota, Minneapolis, USA
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