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van Gorkom RNFG, Meulenbroek AL, de Vries J, Frost DM, van der Laan L. A fluctuating intensity of care: A qualitative study on the experiences of informal caregivers of patients with critical limb-threatening ischemia. PLoS One 2024; 19:e0298959. [PMID: 38739667 PMCID: PMC11090309 DOI: 10.1371/journal.pone.0298959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/01/2024] [Indexed: 05/16/2024] Open
Abstract
Informal caregivers play a significant role in providing care for older, often vulnerable, patients, and supporting them as they live with chronic diseases. Due to the rising prevalence of older vascular patients and their use of healthcare, the role of their informal caregivers will become more important. However, little is known about the experiences of informal caregivers of patients with critical limb-threatening ischemia and the impact of informal care on different aspects of these caregivers' lives. In addition, literature does not describe the burden this role brings with it, or lack thereof. Therefore a qualitative study using a phenomenological approach, specifically interpretive phenomenological analysis, was used to gain insight into the experiences of the primary informal caregivers of patients with chronic limb-threatening ischemia. Data were collected via semi-structured interviews and focus groups discussions. Fifteen primary informal caregivers of patients with critical limb-threatening ischemia under the care of the vascular surgeon at a tertiary teaching hospital in the Netherlands were included. Data analysis yielded three themes: the perceived identity of this group of caregivers; the varying intensity of informal care; and the collaboration between informal carers, their care recipients and the professional care provider within the vascular surgery department. In contrast to carers of other chronic diseases, the shifting intensity of care that informal caregivers of critical limb-threatening ischemia patients experience seems to prevent long-term overload. Adapting to that fluctuating situation requires flexibility from healthcare providers within the vascular surgery department. In addition, professionals need to involve informal caregivers in the patient's decision-making process and recognize their role in that process.
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Affiliation(s)
| | | | - Jolanda de Vries
- Admiraal de Ruyter Hospital, Goes, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Donna M. Frost
- School of People & Health Studies, Fontys University of Applied Sciences, Tilburg, The Netherlands
| | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Cardiovascular Science, University Hospitals Leuven, Leuven, Belgium
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Elliott J, Francetic I, Meacock R, Sutton M. Do Informal Care Recipients Internalise Carer Burden? Examining the Impact of Informal Care Receipt on Health Behaviours. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:209-225. [PMID: 38198104 PMCID: PMC10864417 DOI: 10.1007/s40258-023-00843-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Providing informal care has a negative effect on the caregiver's health and well-being, but little is known about how individuals respond to receiving informal care. Care recipients may improve their health behaviours to minimise the onerousness of caregiving and the stress faced by their carer from seeing a loved one in ill-health. OBJECTIVE We aimed to examine whether informal care recipients internalise the potential for carer spillovers through changes in health behaviours. METHODS We used data from 3250 older adults with care needs who took part in the UK Household Longitudinal Study between 2017 and 2019. We examined the response to informal care receipt in terms of the probability of engaging in four health behaviours: healthy diet, physical activity, smoking and alcohol consumption. We estimated average treatment effects using regression adjustment with inverse probability treatment weights, comparing individuals that received informal care to those receiving either formal or no care. RESULTS We found that informal care receipt increased the probability of refraining from negative health behaviours (smoking and alcohol consumption) but reduced the probability of engaging in positive health behaviours (eating fruits and/or vegetables and physical activity). CONCLUSIONS The asymmetric effects detected suggest that the underlying mechanisms are different, and care recipients may be engaging in risk and effort compensation between negative and positive health behaviours. Failure to account for the behavioural responses from informal care recipients may lead to under-estimation or over-estimation of the extent of caregiving burden and the effectiveness of interventions impacting informal carers.
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Affiliation(s)
- Jack Elliott
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Services, The University of Manchester, Williamson building, 176 Oxford Road, Manchester, M13 9QQ, UK.
| | - Igor Francetic
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Services, The University of Manchester, Williamson building, 176 Oxford Road, Manchester, M13 9QQ, UK
| | - Rachel Meacock
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Services, The University of Manchester, Williamson building, 176 Oxford Road, Manchester, M13 9QQ, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Services, The University of Manchester, Williamson building, 176 Oxford Road, Manchester, M13 9QQ, UK
- Melbourne Institute, Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia
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Marques MJ. The quality of family relationships in dementia: Mixed methods to unravel mixed feelings. DEMENTIA 2024; 23:210-233. [PMID: 38100191 PMCID: PMC10807244 DOI: 10.1177/14713012231220759] [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: 12/21/2023]
Abstract
Objective: Close relationships influence health and quality of life outcomes for people with dementia and their families. Yet, we know little on the role of different relationship domains with quantitative methods having proved to have limitations in this research field. We aimed to study these relationship domains over time, contrasting the views of people with dementia and their family carers, making use of both quantitative and qualitative approaches.Methods: A convergent mixed methods design was adopted, analysing longitudinal data (four time points over three years) from 66 dyads of Portuguese community-dwelling people with dementia and their primary carers, from the EU-Actifcare project sample. Quantitative assessments used sociodemographic and clinical variables, and Positive Affect Index scores, with descriptive and inferential analyses. Qualitative data, collected through individual and joint semi-structured interviews, were explored using thematic analysis.Results: Both quantitative and qualitative findings demonstrated that some domains of relationship quality are affected in different ways, with changes occurring at different stages. Some (e.g., 'communication') may even improve after initial decline. 'Closeness' was consistently altered over time, from carers' perspectives, and played an important protective role regarding institutionalisation. Overall, changes in the relationship quality were perceived differently by people with dementia and their carers, and these divergent perspectives often led to tension. Qualitative data revealed that 'mixed feelings' (ambivalence) involve complex experiences, arguably more difficult to manage than negative feelings alone. Furthermore, perceived informal support, particularly from the extended family, and receiving formal services' assistance, seemed to facilitate positive (re)appraisals of the relationship.Conclusions: A deeper understanding of relationship quality and its domains as dementia progresses may help tailoring interventions to tackle modifiable aspects of relationships, meeting the needs and cherishing the resources of dyads and families. Timely assessments could identify relationships at risk and need for support, including for alternative caring arrangements.
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Affiliation(s)
- Maria J. Marques
- Maria J. Marques, CHRC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 130, Lisbon 1169-056, Portugal.
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Zhylkybekova A, Grjibovski AM, Glushkova N, Koshmaganbetova GK. Exploring the burden and support needs of informal caregivers for the older adults in Kazakhstan: a mixed-methods study protocol. Front Public Health 2024; 11:1248104. [PMID: 38249404 PMCID: PMC10796845 DOI: 10.3389/fpubh.2023.1248104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background The growing population of older adults, often affected by chronic illnesses, disabilities, or frailty has led to a substantial increase in the need for informal caregivers. Objective This paper is a protocol for a study that aims to investigate the effects of caregiving on informal caregivers of older adults in Kazakhstan with special emphasis on the cultural context. Methods The protocol outlines a mixed-methods study that will be conducted in four cities in Kazakhstan. A total of 400 informal caregivers of older adults with two or more limitations in Activities of Daily Living (ADL) will be recruited to participate in a survey, aiming to evaluate care-related burdens and quality of life and health-related quality of life. The Institute for Medical Technology Assessment (iMTA) Valuation of Informal Care Questionnaire (iVICQ) was selected to be the main research instrument. Additionally, a subset of participants who express their willingness to participate will be selected from the pool of survey respondents to engage in semi-structured interviews, allowing for a deeper understanding of their experiences and providing insights into their social and medical support needs. Conclusion This study will be the first investigation of the impact of caregiving on informal caregivers of older adults in Central Asia. The results will contribute to the literature by providing insights into older adults care within the specific national and cultural context of Kazakhstan with potential generalization to other Central Asian republics of the former USSR.
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Affiliation(s)
- Aliya Zhylkybekova
- Department of Evidence-Based Medicine and Scientific Management, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Andrej M. Grjibovski
- Central Scientific Research Laboratory, Northern State Medical University, Arkhangelsk, Russia
- Department of Epidemiology and Modern Vaccination Technologies, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Biology, Ecology and Biotechnology, Northern (Arctic) Federal University, Arkhangelsk, Russia
| | - Natalya Glushkova
- Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Gulbakit K. Koshmaganbetova
- Department of Evidence-Based Medicine and Scientific Management, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
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Peng X, Nakatani H, Chen H, Inoue Y, Song F, Yoshihara M, Lei R. Developing a scale for examining the perspective of university students on parental care. Front Psychol 2023; 14:1256110. [PMID: 38023053 PMCID: PMC10657846 DOI: 10.3389/fpsyg.2023.1256110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction With the declining birth rate and increasingly aging population in Japan, an increased care burden may be placed on the family and the younger generation will address challenging circumstances when they can care for their parents. This study aimed to develop a scale for examining the perspectives of Japanese university students on parental care and determines its reliability and validity. Methods A web-based survey on a total of 408 Japanese students was adopted. This study performed exploratory and confirmatory factor analyses to obtain the underlying factors of the scale. Reliability was verified using Cronbach's α coefficient and Spearman-Brown's split-half reliability α coefficient. Validity was verified through sample, criterion-related, and convergent and discriminant validity. Results In total, the study identified a three-factor 11 item-scale. Cronbach's α for the scale was 0.901, and the Cronbach's α and split-half reliability α coefficients of each factor were greater than 0.7. Three factors explained 64.6% of the total variance. The model indicators were χ2/df = 2.241, comparative fit index (CFI) = 0.951, incremental fit index (IFI) = 0.951, TLI = 0.942, root mean square error of approximation (RMSEA) = 0.078 (p < 0.001). Thus, the study confirmed that the convergent and discriminant validity is acceptable. Correlations were noted for criterion-related validity (r = 0.675, p < 0.001). Discussion The results show that the scale for examining the perspective of Japanese university students on parental care was confirmed with good reliability and validity.
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Affiliation(s)
- Xuxin Peng
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hisae Nakatani
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Huifang Chen
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuriko Inoue
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fang Song
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mikako Yoshihara
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ruxin Lei
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Mouchaers I, Metzelthin S, van Haastregt J, Vlaeyen E, Goderis G, Verbeek H. Exploring the Support and Involvement of Family Caregivers for Reablement Programs: A Qualitative Study. J Multidiscip Healthc 2023; 16:2993-3005. [PMID: 37849961 PMCID: PMC10577240 DOI: 10.2147/jmdh.s424147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Background Reablement is a person-centered, holistic approach promoting older adults' participation through social, leisure, and physical activities. Family caregivers are seldom involved in reablement services despite their wish to be an active member of the care team and expressing a need for more support and recognition. The voice of family caregivers is often forgotten when evaluating services such as reablement. Little is known how family caregivers can be involved and supported more effectively in reablement services, therefore the aim of our research is to investigate the perceived support and involvement of family caregivers. Methods As part of the TRANS-SENIOR project, we studied perceived support and involvement of family caregivers during and after geriatric rehabilitation, a setting in which principles of reablement, like goal setting and training of daily activities, are applied. In total, fourteen semi-structured interviews were conducted with family caregivers of people admitted to a geriatric rehabilitation facility. Thematic analysis was used. Results Results reflected four themes: (1) support for family caregivers, (2) involvement in care, (3) trusting care professionals, and (4) asking for and accepting support. Family caregivers' experiences with support from care professionals were mainly ambivalent. While caregivers expressing a lack of support and information whilst also indicating that they do not expect to be supported by care professionals. Regarding involvement, caregivers wanted to be involved; ie express their opinion and be involved in decision-making. However, more involvement could also lead to a higher burden. Conclusion There is a discrepancy between the perceived support and involvement of family caregivers, their expressed needs, and their expectations of care professionals. A personalized approach is needed to create room for the family caregiver to be an active participant in the care process while also providing the right amount of support, when preferred by the caregiver.
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Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
| | - Jolanda van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
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Shin JY, Pohlig R, Habermann B. Impacts of Perceived Choice on Physical Strain, Emotional Stress and Health among Caregivers. West J Nurs Res 2023; 45:826-832. [PMID: 37431090 DOI: 10.1177/01939459231186900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND Having no choice in becoming a caregiver has been associated with higher levels of emotional stress and physical strain. This secondary analysis examined associations between caregivers' perceived choice and health outcomes. METHODS This study utilized data from caregivers who answered a question about whether they felt they had a choice to take on caring for a care recipient in the Caregiving in the U.S. in 2020 survey. Variables of caregivers' and recipients' characteristics, caregiving activities, and health outcomes were extracted. Data were analyzed using descriptive statistics, t-tests, Chi-squared tests, and regression models. RESULTS More than half of the 1,642 caregivers (54.4%) perceived no choice in becoming a caregiver. Having no choice was associated with higher levels of physical strain and emotional stress, and greater negative impact on caregiver's health. Other predictive variables of higher physical strain included being a primary caregiver, recipients having more comorbidities, and a higher level of care intensity. Higher education level, household income, number of recipient's conditions, level of care intensity, and being a primary caregiver were associated with higher levels of emotional stress. Taking care of a spouse and non-relative compared to taking care of a grandparent or parent was associated with lower emotional stress. Recipients with more comorbidities and higher care intensity were associated with worse caregiver health. CONCLUSIONS There is a need to screen and identify caregivers who have no choice in caregiving and assist them in providing care for their recipient to prevent them from being invisible patients.
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Affiliation(s)
- Ju Young Shin
- Associate Professor, School of Nursing, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Ryan Pohlig
- Director of the Biostatistics Core, Assistant Professor of Epidemiology, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Barbara Habermann
- Dean and Professor of Nursing, School of Nursing, Pacific Lutheran University, Tacoma, WA, USA
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Osborne T, Lowe TA, Meijering L. Care and rhythmanalysis: Using metastability to understand the routines of dementia care. Soc Sci Med 2023; 331:116099. [PMID: 37478663 DOI: 10.1016/j.socscimed.2023.116099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
An increasing number of people living with dementia worldwide receive informal care from their family members. A key element of dementia care is maintaining a daily routine and familiarity, making caring an extremely rhythmic practice. To explore the rhythmic nature of informal care, we apply and advance Lefebvre's unfinished rhythmanalysis by developing an original typology of eurhythmia as a metastable equilibrium. Metastability, although appearing macroscopically stable, is a vulnerable state where a slight disturbance can result in deviation to another state (i.e., stable or unstable). Drawing upon interviews with informal caregivers, we discuss the rhythms and (dis)harmonies of caring practice, including the substantial rhythms of caring practice, the relational balance of rhythms between the caregiver and care recipient, and the various rhythmic disruptions that occur. We demonstrate how metastability provides an understanding of the ever-changing rhythms of every day and allows us to move beyond the immediacy of arrhythmic breaks and explore the subtle changes that occur in (poly)rhythms. Thus, eurhythmia as a metastable equilibrium allows us to explore the gradual and subtle development of, and changes to, dementia care and other routine practices in health geography.
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Affiliation(s)
- Tess Osborne
- School of Geography, Geology and the Environment, University of Leicester, UK; Population Research Centre, Faculty of Spatial Sciences, University of Groningen, the Netherlands.
| | - Thomas A Lowe
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, the Netherlands
| | - Louise Meijering
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, the Netherlands
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de Jong L, Schmidt T, Carstens AK, Damm K. The impact of different care dependencies on people's willingness to provide informal care: a discrete choice experiment in Germany. HEALTH ECONOMICS REVIEW 2023; 13:35. [PMID: 37269446 DOI: 10.1186/s13561-023-00448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Informal care provided by family members, friends, or neighbors is a major pillar in the German long-term care system. As the number of care-dependent older adults grow, ensuring their future care still relies on the willingness of family members, friends, or neighbors to assume the role of an informal caregiver. This study aimed to investigate the impact on people's willingness to provide informal care to a close relative with predominately cognitive compared to physical impairments. METHODS An online survey was distributed to the general population in Germany, which resulted in 260 participants. A discrete choice experiment was created to elicit and quantify people's preferences. A conditional logit model was used to investigate preferences and marginal willingness-to-accept values were estimated for one hour of informal caregiving. RESULTS Increased care time per day (hours) and expected duration of caregiving were negatively valued by the participants and reduced willingness to care. Descriptions of the two care dependencies had a significant impact on participants' decisions. Having to provide care to a close relative with cognitive impairments was slightly preferred over caring for a relative with physical impairments. CONCLUSIONS Our study results show the impact of different factors on the willingness to provide informal care to a close relative. How far the preference weights as well as the high willingness-to-accept values for an hour of caregiving can be explained by the sociodemographic structure of our cohort needs to be investigated by further research. Participants slightly preferred caring for a close relative with cognitive impairments, which might be explained by fear or discomfort with providing personal care to a relative with physical impairments or feelings of sympathy and pity towards people with dementia. Future qualitative research designs can help understand these motivations.
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Affiliation(s)
- Lea de Jong
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany.
| | - Torben Schmidt
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Ann-Katrin Carstens
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
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de Jong L, Schmidt T, Stahmeyer JT, Eberhard S, Zeidler J, Damm K. Informelle Pflege und Berufstätigkeit: Einflussfaktoren auf die Bereitschaft. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2023:S1865-9217(23)00008-9. [PMID: 37019756 DOI: 10.1016/j.zefq.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION The proportion of people in need of care will continue to rise in Germany. In 2019, the majority of people in need of care was cared for at home. Reconciling caregiving and work poses a heavy burden for many caregivers. Therefore, a monetary compensation for care is being discussed politically in order to facilitate the reconciliation of work and care. The aim of this study was to investigate whether and under which circumstances a sample of the German population is willing to care for a close relative. A particular focus was placed on the willingness to reduce working hours, the importance of the expected period of caregiving, and monetary compensation. METHODS A primary data collection was conducted in two modes using a questionnaire. A self-completion postal survey was sent out via the AOK Lower Saxony and complemented with an online survey. Data was analysed descriptively and using logistic regression. RESULTS 543 participants were included. 90% of the sample surveyed was willing to provide care for a close relative, with the majority stating that their willingness depended on various factors: both the health status and the person of the family member needing care had the greatest influence. 34% of the employed respondents were not willing to reduce their working hours, mostly for financial reasons. DISCUSSION AND CONCLUSION Many older adults want to stay in their homes for as long as possible. Thus, the willingness to provide and take over the role of informal caregiver is and will remain a central pillar of the German care system. Negotiating between informal caregiving and professional activities often creates a substantial burden. For people from lower income households monetary compensation might enhance their willingness to provide informal care. However, in order to increase the willingness to engage in informal care of people from different backgrounds and life stages, flexible approaches are needed that go beyond monetary compensation.
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Urwin S, Lau Y, Grande G, Sutton M. Informal caregiving, time use and experienced wellbeing. HEALTH ECONOMICS 2023; 32:356-374. [PMID: 36303421 PMCID: PMC10092671 DOI: 10.1002/hec.4624] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/20/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Informal carers report lower evaluative wellbeing than non-carers. In contrast to this literature and our own analysis of evaluative wellbeing, we find carers have a small but higher level of experienced wellbeing than non-carers do. To investigate why, we use decomposition analysis which separates explanatory factors into how time is used and how those uses of time are experienced. We analyze activities and associated experienced wellbeing measured in ten-minute intervals over two days by 4817 adults from the 2014/15 UK Time Use Survey. We use entropy balancing to compare carers with a re-weighted counterfactual non-carer group and then apply Oaxaca-Blinder decomposition. The experienced wellbeing gap of 0.066 is the net result of several substantial competing effects of time use. Carers experienced wellbeing would be higher by 0.188 if they had the same patterns and returns to time use as non-carers which is driven by sleep, time stress and alternative characteristics of time use. However, leisure and non-market activities serve to dampen this increase in experienced wellbeing. Initiatives to improve and assess carer wellbeing should pay close attention to how carers spend their time.
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Affiliation(s)
- Sean Urwin
- Health OrganisationPolicy and Economics GroupSchool of Health SciencesUniversity of ManchesterManchesterUK
| | - Yiu‐Shing Lau
- Health OrganisationPolicy and Economics GroupSchool of Health SciencesUniversity of ManchesterManchesterUK
| | - Gunn Grande
- Division of NursingMidwifery and Social WorkManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
| | - Matt Sutton
- Health OrganisationPolicy and Economics GroupSchool of Health SciencesUniversity of ManchesterManchesterUK
- Melbourne Institute; Applied Economic and Social ResearchUniversity of MelbourneMelbourneAustralia
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Charenkova J. " Parenting my parents": Perspectives of adult children on assuming and remaining in the caregiver's role. Front Public Health 2023; 11:1059006. [PMID: 36875393 PMCID: PMC9982148 DOI: 10.3389/fpubh.2023.1059006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Background Family caregivers are essential when responding to the long-term care needs of aging societies. The complex and multifaceted caregiver's role encompasses a unique set of challenges and strains, however, it can be a rewarding experience with many benefits and positive outcomes. Moreover, there is a link between the caregiver's wellbeing, quality of care, and the quality of life of the care recipient. Thus, the current study aimed to explore why adult children are assuming and remaining in the caregiver's role despite its challenges. Methods Research data was collected through the use of qualitative semi-structured interviews from September 2021 to July 2022. In total 16 Lithuanian and Italian caregivers were recruited through convenience/snowball sampling. The study utilized the constructivist grounded theory for data analysis and self-determination theory for data interpretation. Results Adult children's caregiving experiences revealed three themes related to the motivation to assume and continue with family care: (1) believing in the inherent value of family care; (2) making sense of the changing nature of caregiving; and (3) "making the best of it". Key motivational drivers of these decisions were associated with the satisfaction of the three basic psychological needs - autonomy, competence, and relatedness. Results show that finding meaning and making sense of the caregiving role when responding to a parent's increased care needs may result in positive caregiving experiences and outcomes even at rather low levels of the care recipient's autonomy. Conclusion Caregivers were able to experience family care as a meaningful and rewarding experience while acknowledging its challenges and limitations. Implications for family caregiving decisions and experiences, social policy, and future research are discussed in more depth in the paper.
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Affiliation(s)
- Jūratė Charenkova
- Faculty of Philosophy, Institute of Sociology and Social Work, Vilnius University, Vilnius, Lithuania
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Simard-Duplain G. Heterogeneity in informal care intensity and its impact on employment. JOURNAL OF HEALTH ECONOMICS 2022; 86:102647. [PMID: 36252319 DOI: 10.1016/j.jhealeco.2022.102647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/17/2022] [Accepted: 06/13/2022] [Indexed: 06/16/2023]
Abstract
Working-age individuals are under growing pressure to contribute unpaid time to the care of elderly family members and friends. Existing work has generally found informal care to negatively impact labor market outcomes, an effect that varies considerably by caregiving intensity, as defined by average hours of care or co-residence with the care receiver. I construct a new measure of caregiving intensity based on the length of caregiving spells. To do so, I use the Longitudinal and International Study of Adults, which provides data on the monthly caregiving status of respondents over a six-year period. I investigate how this dimension of caregiving intensity intersects with better-known measures, and show that results relying on the latter conceal substantial heterogeneity in the impact of caregiving on employment. These differences are particularly important to understand disparities in the impact of caregiving on female and male employment.
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Affiliation(s)
- Gaëlle Simard-Duplain
- Department of Economics, Carleton University, 1125 Colonel By Drive, Ottawa, ON Canada K1S 5B6.
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14
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Brimblecombe N, Cartagena Farias J. Inequalities in unpaid carer's health, employment status and social isolation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6564-e6576. [PMID: 36371632 PMCID: PMC10099700 DOI: 10.1111/hsc.14104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/22/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Providing higher-intensity unpaid care (higher care hours or care within the household) is associated with negative impacts on people's paid employment, mental health and well-being. The evidence of effects on physical health is mixed and carer's social and financial outcomes have been under-researched. The biggest evidence gap, however, is on how outcomes vary by factors other than type or level of care provision, in particular socio-demographic factors. Our study used two waves of data (2017/19 and 2018/2020) from the United Kingdom Household Longitudinal Study for people aged 16 and older. We investigated the effects of providing care for 10 or more hours a week or within the household in interaction with people's socio-demographic characteristics. Outcomes included mental and physical health, social isolation, employment status and earnings. We found that caring responsibilities interacted with gender, ethnicity, socio-economic status (as measured by highest educational qualification), or age to affect carers differentially in a number of areas of their lives leading to, and exacerbating, key disadvantages and inequalities.
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Affiliation(s)
- Nicola Brimblecombe
- Care Policy and Evaluation Centre (CPEC)London School of Economics and Political Science (LSE)LondonUK
| | - Javiera Cartagena Farias
- Care Policy and Evaluation Centre (CPEC)London School of Economics and Political Science (LSE)LondonUK
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15
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Zarzycki M, Seddon D, Morrison V. Informal caregiver motivations, values, challenges and gains: A photovoice and interpretative phenomenological analysis of interrelationships. J Health Psychol 2022; 28:568-582. [PMID: 36300898 PMCID: PMC10119898 DOI: 10.1177/13591053221124647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The adoption of a caregiving role in the context of illness and disability is often taken for granted. This study explores caregivers’ motivations to provide care and how these relate to values, and to the challenges and gains of caregiving. Eight semi-structured interviews were conducted with caregivers and photographs were taken by caregivers to exemplify their caregiving experiences. This photo-elicitation method complemented the use of Interpretative Phenomenological Analysis when applied to verbatim transcripts. Superordinate themes included: caregiver’s life story; significance of family; caregiving obligations; caring relationship; challenges and gains associated with caregiver motivations. Intrinsic and extrinsic motivations were less distinct in caregivers’ lived experiences than previously suggested, and were influenced by family values and specific challenges and gains of caregiving. The coexistence of different motivations and the nature of single complex motivations is discussed. The importance of caregiver assessment and support planning, and regular breaks from caregiving are highlighted.
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16
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Intersections between the culture of Xiao (孝) and caring for older relatives in China: perspectives of United Kingdom-based Chinese students on future care for their parents. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Emphasis placed on Xiao (孝; filial piety) in Chinese culture highlights parents' investment in their children with the expectation of being cared for when older. An increasing number of Chinese students come to the United Kingdom (UK) to study, with the majority returning home and likely to become future care-givers for their parents. Little attention has been paid to the implications of transnational mobility of Chinese students on the reciprocal aspects of future care responsibility. With the uniquely changing family structure due to consequences of the One-Child Policy, we conducted proactive research on the opportunities and challenges that Chinese transnational students anticipate they may face in future care-giving for elderly parents. Hence, this study's aim was to make a novel contribution to knowledge through exploration of the perspectives of Chinese students in England on intergenerational ties and filial obligations. Adopting a social constructivist philosophical position, we conducted three focus groups with 19 UK-based Chinese students, using a semi-structured topic guide with informed consent. Interviews were translated, transcribed and analysed using reflective thematic analysis, capturing semantic and latent meanings, and employed a descriptive and interpretative approach. Six themes were discovered, revealing a ‘culture of duty’ where familial obligation and societal expectations were prominent. Prospective care-givers anticipated a future dilemma between balancing work commitments and providing care as mandated by Xiao. Furthermore, it appeared that lack of preparedness might further exacerbate barriers faced when accessing support. We surmised that the changing demographics and absence of formal support could compound stressors over time, especially if cognitive dissonance arises as realities of life do not fit with societal expectations. Our findings imply that policy makers, practitioners and the government will need to adequately support prospective family care-givers who are returnees in caring for older generations.
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17
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Pacheco Barzallo D, Hernandez R, Brach M, Gemperli A. The economic value of long-term family caregiving. The situation of caregivers of persons with spinal cord injury in Switzerland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2297-e2307. [PMID: 34854509 PMCID: PMC9543297 DOI: 10.1111/hsc.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 10/15/2021] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
Health systems rely on the unpaid work of family caregivers. Nevertheless, demographic changes suggest a shortage of caregivers in the near future, which can constrain the long-term care policy in many countries. In order to find ways to support family caregivers, a primary effort would be to estimate how much their work is worth. This paper estimates the economic value of long-term family caregivers and how these costs would be shared by the health system, the social insurances and the cared-for person in the absence of informal caregivers. We use data of 717 family caregivers of persons with spinal cord injury (SCI) in Switzerland. We implemented the proxy-good method and estimated the market value of their work if performed by professional caregivers. Our results show that family caregivers in the sample spent an average of 27 hr per week caring for a relative for almost 12 years. This work, if undertaken by professional home care, has a market value of CHF 62,732 (EUR 56,455) per year. In the absence of family caregivers, these costs should be financed by the health insurances (47%), by the cared-for person (24%) and by the social insurances (29%). It is in the best interest of the cared-for person and of the healthcare and social systems to keep a sustained supply of family caregivers. One option is finding ways to recognise and compensate them for their work and make it less cumbersome.
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Affiliation(s)
- Diana Pacheco Barzallo
- Department of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
- Swiss Paraplegic ResearchRehabilitation, Services & Care UnitNottwilSwitzerland
- Center for Rehabilitation in Global Health SystemsWHO Collaborating CenterLucerneSwitzerland
| | - Rina Hernandez
- Department of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
| | - Mirjam Brach
- Department of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
- Swiss Paraplegic ResearchRehabilitation, Services & Care UnitNottwilSwitzerland
| | - Armin Gemperli
- Department of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
- Swiss Paraplegic ResearchRehabilitation, Services & Care UnitNottwilSwitzerland
- Center for Primary and Community CareLucerneSwitzerland
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18
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Thinking about caring for older relatives in the future: a qualitative exploration. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x21002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The number of dependent older people in England, as elsewhere, is projected to rise substantially, while the number of unpaid carers is not projected to rise by an equivalent amount. Barriers to people caring for older relatives have been theorised, however, there is a lack of understanding of attitudes to providing care in the future among people who are not currently carers. This paper presents qualitative analysis of interviews with 20 people in middle age about their willingness to care for older relatives in the future. Interviewees were asked their general views about who should provide care, then to consider future scenarios in which a close relative developed care needs. Willingness to care was influenced by beliefs about reciprocity, love and identity, beliefs about who was likely to provide the best quality and most appropriate care, and beliefs about how difficult caring would be. Older relatives’ care preferences were a key consideration. While some interviewees felt the best care would always be provided by family, others considered that professional skills were needed. Interviewees saw important roles for easily accessible information and advice, sharing care, including respite care, and financial support, in making it easier to provide care. The COVID-19 pandemic and lockdown had highlighted relevant issues for interviewees, which are discussed.
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19
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Zarzycki M, Seddon D, Bei E, Morrison V. Why do they care? A qualitative systematic review and meta-synthesis of personal and relational motivations for providing informal care. Health Psychol Rev 2022; 17:344-376. [PMID: 35383541 DOI: 10.1080/17437199.2022.2058581] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Informal caregiving is crucial to the sustainability of health and social care systems globally. With ageing populations and a rising prevalence of acute and chronic health conditions, the need for informal care is growing, making it important to understand what motivates individuals to care and to continue caring. This paper reports findings of a systematic review which examined determinants of motivations and willingness to provide informal care. A systematic search was conducted using six electronic databases and a wide range of additional sources. 105 qualitative studies published before August 2019 were included with 103 of them reporting on personal and relational motivations, and the contextual factors underpinning these. Grounded theory-based, thematic synthesis was applied to synthesise the literature. This meta-synthesis reports on findings from across the world spanning three decades, with data from over 2500 caregivers across a range of health conditions. This paper presents the relational, personal and contextual themes. It highlights the significance of reciprocity, affection, family values and caregiving obligations. Personal characteristics, finding meaning, illness perceptions, situational and temporal aspects of caregiving are also identified as important in shaping motivations and willingness to care and to continue caring. Implications for theory, research, policy and practice are discussed.
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Affiliation(s)
- Mikołaj Zarzycki
- School of Human & Behavioural Sciences, College of Human Sciences, Bangor University, Bangor, UK
| | - Diane Seddon
- School of Medical & Health Sciences, Bangor University, Bangor, UK
| | - Eva Bei
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Val Morrison
- School of Human & Behavioural Sciences, College of Human Sciences, Bangor University, Bangor, UK
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20
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Zarzycki M, Morrison V, Bei E, Seddon D. Cultural and societal motivations for being informal caregivers: a qualitative systematic review and meta-synthesis. Health Psychol Rev 2022; 17:247-276. [PMID: 35081864 DOI: 10.1080/17437199.2022.2032259] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Informal caregiving constitutes the mainstay of a society's care supply. Motivations for caring and continuing to provide care are crucial to understanding the nature of caregiver experiences and their relationship with the person/people they support. This systematic review of qualitative evidence examines determinants of motivations and willingness to provide informal care. 105 qualitative studies published before August 2019 and fitting the inclusion criteria were identified, 84 of them pertaining to cultural and societal motivations for caregiving. Grounded theory-based, thematic synthesis was conducted. Cultural and societal factors strongly underpinned motivations and willingness for informal caregiving. The main cultural motives for caregiving were cultural values and beliefs encompassing the ethnocultural context of the caregiving role, culture-specific norms, cultural and spiritual beliefs, illness beliefs and socialisation. Societal norms and perceived expectations, such as gendered roles, norms and expectations of caregiving, and perceptions of health and social care services further shaped caregiver motivations and willingness to provide care. These meta-synthesis findings contribute towards novel understandings about the cultural and societal aspects shaping informal care provision. These findings bear important implications for theory, research, policy and practice; all of which contributing to the issue of the sustainability of informal care from a 'macro' perspective.
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Affiliation(s)
- Mikołaj Zarzycki
- School of Human & Behavioural Sciences, College of Human Sciences, Bangor University, Bangor LL57 2DG, Wales, United Kingdom; Telephone
| | - Val Morrison
- School of Human & Behavioural Sciences, College of Human Sciences, Bangor University, Bangor LL57 2DG, Wales, United Kingdom;
| | - Eva Bei
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, 5290002, Israel;
| | - Diane Seddon
- School of Health Sciences, Bangor University, Bangor LL57 2DG, Wales, United Kingdom;
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21
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Di Gessa G, Glaser K, Zaninotto P. Is grandparental childcare socio-economically patterned? Evidence from the English longitudinal study of ageing. Eur J Ageing 2022; 19:763-774. [PMID: 36052190 PMCID: PMC9424417 DOI: 10.1007/s10433-021-00675-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/24/2022] Open
Abstract
AbstractGrandparents play a vital role in providing childcare to families. Qualitative research and evidence from parents raise concerns that it is grandparents who are socio-economically disadvantaged who provide grandchild care more regularly, perform more intensive tasks, and care out of financial necessity. However, no European studies have investigated these issues at population level. This study is based on grandparents aged 50+ who looked after grandchildren. Data are from wave 8 of the nationally representative English Longitudinal Study of Ageing (2016/2017). We exploit newly collected information on frequency of grandchild care, activities, and reasons for care. Using multinomial regressions, we first examined the extent to which grandparents’ socio-economic characteristics (wealth and education) are associated with frequency of grandchild care. Second, using logistic regressions, we investigated whether wealth and education are associated with activities and reasons for grandchild care. Overall, grandparents from disadvantaged socio-economic backgrounds were more likely to provide more regular childcare. Similarly, grandparents in the lowest wealth quartile were more involved in hands-on activities (cooking, taking/collecting grandchildren to/from school), whereas highly educated grandparents were more likely to help grandchildren with homework. Finally, better-off grandparents were more likely to look after grandchildren to help parents and provide emotional support and less likely to report difficulty in refusing to provide care. Our findings show that grandparental childcare varies by socio-economic status with more intensive childcare activities falling disproportionately on those with fewer resources, and this may act to exacerbate existing socio-economic inequalities in later life.
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Affiliation(s)
- Giorgio Di Gessa
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Karen Glaser
- Department of Global Health and Social Medicine, King’s College London, London, UK
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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22
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Ribeiro L, Ho BQ, Senoo D. How Does a Family Caregiver's Sense of Role Loss Impact the Caregiving Experience? Healthcare (Basel) 2021; 9:healthcare9101337. [PMID: 34683017 PMCID: PMC8544366 DOI: 10.3390/healthcare9101337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022] Open
Abstract
Family caregivers reportedly have a powerful sense of role loss, which is felt when one senses a change in role or responsibility, relationship distancing, or a changed asymmetry. Little is known about the impact it has on the caregiving experience, so the purpose of this study was to clarify this in three distinct settings: when an individual’s primary role changed to the caregiver role after the start of caregiving; when their primary role was other than the caregiver role after this start; and when their primary role was the caregiver role before caregiving started. Sixty-six individuals responded to an online survey, and a framework method was employed to organize the collected data and uncover themes for analysis. Our findings shed light on the sense of caregiver role loss and pointed to the possibility of generating it when family caregivers rotate through held roles and the use of it as a tool to maintain or regain a sense of personal choice in life and self-priority. Our study is probably the first to analyze this phenomenon in different caregiving settings based on an individual’s primary role and role transitions and brings to light a new perspective of the phenomenon by understanding how it arises, its nuances, and its impact on the caregiver’s experience.
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23
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de Jong L, Stahmeyer JT, Eberhard S, Zeidler J, Damm K. Willingness and preparedness to provide care: interviews with individuals of different ages and with different caregiving experiences. BMC Geriatr 2021; 21:207. [PMID: 33765937 PMCID: PMC7992803 DOI: 10.1186/s12877-021-02149-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background At present, the provision of informal care to older relatives is an essential pillar of the long-term care system in Germany. However, the impact of demographic and social changes on informal caregiving remains unclear. Methods Thirty-three semi-structured interviews were conducted with care consultants, informal caregivers and people without any caregiving experience to explore if people are willing to provide older adult care and how prepared these are with regard to the possibility of becoming care dependent themselves. Results In total, three main categories (willingness to provide care, willingness to receive care and information as preparation) with several sub-categories were identified during the content analysis. While almost all interviewees were willing to provide care for close family members, most were hesitant to receive informal care. Other factors such as the available housing space, flexible working hours and the proximity of relatives were essential indicators of a person’s preparedness to provide informal care. It is, however, unclear if care preferences change over time and generations. Six out of 12 informal caregivers and nine out of 14 care consultants also reported an information gap. Because they do not possess adequate information, informal caregivers do not seek help until it is too late and they experience high physical and mental strain. Despite the increased efforts of care consultants in recent years, trying to inform caregivers earlier was seen as almost impossible. Conclusions The very negative perception of caregiving as a burden was a reoccurring theme throughout all interviews and influenced people’s willingness to receive care as well as seeking timely information. Despite recent political efforts to strengthen home-based care in Germany, it remains unclear whether political efforts will be effective in changing individuals’ perceptions of informal caregiving and their willingness to be better prepared for the highly likely scenario of having to care for a close relative or becoming care dependent at a later stage in life. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02149-2.
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Affiliation(s)
- Lea de Jong
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Str.7, 30159, Hannover, Germany.
| | | | - Sveja Eberhard
- Health Services Research Unit, AOK Niedersachsen, Hannover, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Str.7, 30159, Hannover, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Str.7, 30159, Hannover, Germany
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Teahan Á, Carney P, Cahill S, O'Shea E. Establishing priorities for psychosocial supports and services among family carers of people with dementia in Ireland. DEMENTIA 2021; 20:2109-2132. [PMID: 33423536 DOI: 10.1177/1471301220984907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Many family carers, particularly those caring for people with dementia, report significant personal and social challenges associated with caring. The aim of this article is to identify the range of challenges experienced by family carers of people with dementia and to ascertain their preferences for various supports and services that address those challenges. METHOD Three modified nominal group technique (NGT) focus groups were conducted with family carers of people with dementia. The NGT groups were conducted with 17 participants in two stages, focusing separately on personal and social domains. Family carers identified challenges and individually ranked preferences for both existing and new services and supports. Data analysis consisted of qualitative content analysis and summative scoring of individual rankings. FINDINGS Family carers identified the following personal-level challenges: needing a break, social isolation and relationship changes. Family carers' combined preferences for personal-level supports and services to overcome these challenges were day care, family care support groups, short-term respite, long-break respite and social activities. Social challenges referenced by family carers included finances, rights and entitlements and stigma and awareness. Preferences for supports and services to address these social challenges were non-means-tested carer's allowance, legal recognition, carer's support grant, monthly wage and community awareness programmes. CONCLUSION Participants ranked day care and non-means-tested carer's allowance as their top priorities under personal and social headings. Increased government investment in these two areas would not only help to maintain family carers' contributions to community-based care in dementia but would also facilitate social inclusion, social connectedness and economic sustainability.
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Affiliation(s)
- Áine Teahan
- Centre for Economic and Social Research on Dementia (CESRD), 8799NUI Galway, Galway, Ireland
| | - Patricia Carney
- Department of Public Health Midlands, 8004Health Service Executive, Tullamore, Ireland
| | - Suzanne Cahill
- Centre for Economic and Social Research on Dementia (CESRD), 8799NUI Galway, Galway, Ireland
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia (CESRD), 8799NUI Galway, Galway, Ireland
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25
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The subjective index of benefits in volunteering (SIBiV): an instrument to manage satisfaction and permanence in non-profit organizations. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-020-01224-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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26
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Brenna E. Should I care for my mum or for my kid? Sandwich generation and depression burden in Italy. Health Policy 2020; 125:415-423. [PMID: 33358032 DOI: 10.1016/j.healthpol.2020.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 11/17/2022]
Abstract
SETTING AND OBJECTIVE In Italy, over the last decades, elderly care has been mostly provided by family members, especially adult offspring, and in particular daughters. This paper investigates the relationship between informal caregiving and mental distress among Italians aged 35-59, with a focus on gender effect and parenthood responsibilities. DATA The dataset is the European Health Interview Survey (EHIS), second wave, year 2015. As far as it is known, the Italian EHIS has not been used for studies on ageing and caregiving. METHODS Using selected subsamples, a Propensity Score Matching between caregivers and non-caregivers aged 35-59 is implemented, with the aim of measuring the difference in level of depression, if any, between the two groups. RESULTS Findings show that women providing their frail relatives with informal care are less likely to suffer from mental distress compared to non-carers. However, results change radically if they have children aged less than 15 at home, and a higher probability of being depressed is detected for women overwhelmed by the double responsibility of assisting both dependent relatives and their own children. Results are not significant for men.
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Affiliation(s)
- Elenka Brenna
- Department of Economics and Management, Università degli Studi di Pavia, Via San Felice, 5 - 27100, Pavia, Italy(1).
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27
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James C, Walshe C, Froggatt K. Protocol for a systematic review on the experience of informal caregivers for people with a moderate to advanced dementia within a domestic home setting. Syst Rev 2020; 9:270. [PMID: 33243281 PMCID: PMC7694266 DOI: 10.1186/s13643-020-01525-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The knowledge about the experience of informal caregivers who provide care to people with moderate to advanced dementia in a domestic home setting is limited. A consequence of long hours of caregiving in addition to dealing with normal challenges of daily living is their experience of a poor quality of life. Some of their experiences may be described in terms of a feeling of powerlessness to make changes during care provision. This feeling may also suggest an experience of moral distress. The aim of this systematic review is to synthesise qualitative evidence relating to these experiences. METHODS This review adopts a narrative synthesis approach. A search will be conducted for studies written in the English language in the bibliographic databases MEDLINE Complete, CINAHL, EMBASE, PsycINFO, Web of Science and Academic Search Complete covering periods from 1984 to present. Included studies will be qualitative or mixed-methods designs. The search terms will be related to dementia and caregivers, and the process will be focused on dementia at the moderate to the advanced stages within the domestic home setting. Reference lists of included papers will also be searched for additional relevant citations. Search terms and strategies will be checked by two independent reviewers. The identification of abstracts and full texts of studies will be done by the author, while the quality and the risk of bias will also be checked by the two independent reviewers. DISCUSSION Psychological distress is cited as an experience reported within informal caregiving. For the caregiver, it is associated with a negative impact on general health. To date, no synthesis exists on the specific experience of informal caregiving for people with moderate to advanced dementia within the domestic home setting. This review considers that variation of accounts contributes to how the informal caregivers' general experience is explored in future research. This may enable gaps in current knowledge to be highlighted within the wider context of caregiving in the domestic home setting. SYSTEMATIC REVIEW REGISTRATION This review is registered with PROSPERO ( CRD42020183649 ).
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Affiliation(s)
- Charles James
- Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YG UK
| | - Catherine Walshe
- Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YG UK
| | - Katherine Froggatt
- Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YG UK
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McCaffrey N, Bucholc J, Rand S, Hoefman R, Ugalde A, Muldowney A, Mihalopoulos C, Engel L. Head-to-Head Comparison of the Psychometric Properties of 3 Carer-Related Preference-Based Instruments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1477-1488. [PMID: 33127019 DOI: 10.1016/j.jval.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To compare the psychometric properties of the Adult Social Care Outcomes Toolkit for carers (ASCOT-Carer), the Carer Experience Scale (CES), and the Care-related Quality of Life (CarerQol) to inform the choice of instrument in future studies. METHODS Data were derived from a 2018 online survey of informal carers in Australia. Reliability was assessed via internal consistency (Cronbach alpha, α) and test-retest reliability (intraclass correlation coefficient, ICC) for respondents who self-reported no change in their quality of life as a carer over 2 weeks. Convergent validity was evaluated via predetermined hypotheses about associations (Spearman's rank correlation) with existing, validated measures. Discriminative validity was assessed based on the ability of the carer-related scores to distinguish between different informal care situations (Mann-Whitney U, Kruskal-Wallis one-way analysis of variance). RESULTS Data from 500 carers were analyzed. The ASCOT-Carer demonstrated a higher degree of internal consistency, possibly due to a unidimensional structure, and test-retest reliability than the CarerQol and CES (α = 0.87, 0.65, 0.59; ICC, 0.87, 0.67, 0.81, respectively). All 3 instruments exhibited convergent validity and detected statistically significant associations between carer-related scores and different informal care situations, except for the CarerQol-7D and sole carer status. CONCLUSIONS The ASCOT-Carer, CarerQol, and CES performed reasonably well psychometrically; the ASCOT-Carer exhibited the best psychometric properties overall in this sample of Australian informal carers. Findings should be used in conjunction with consideration of research goals, carer population, targeted carer-related constructs, and prevailing perspectives on the economic evaluation to inform choice of instrument in future studies.
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Affiliation(s)
- Nikki McCaffrey
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia.
| | - Jessica Bucholc
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), Cornwallis Building, University of Kent, Canterbury, UK
| | - Renske Hoefman
- The Netherlands Institute for Social Research (SCP), The Hague, The Netherlands
| | - Anna Ugalde
- Deakin University, School of Nursing and Midwifery, Quality and Patient Safety, Institute for Health Transformation, Burwood, Victoria, Australia
| | | | - Cathrine Mihalopoulos
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Lidia Engel
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia
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Pertl MM, Sooknarine-Rajpatty A, Brennan S, Robertson IH, Lawlor BA. Caregiver Choice and Caregiver Outcomes: A Longitudinal Study of Irish Spousal Dementia Caregivers. Front Psychol 2019; 10:1801. [PMID: 31456713 PMCID: PMC6700469 DOI: 10.3389/fpsyg.2019.01801] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/19/2019] [Indexed: 11/17/2022] Open
Abstract
Background The perception of choice in becoming a caregiver may impact on caregiver psychological and physical health. We determined the proportion of spousal dementia caregivers who felt they had a choice, and examined whether lack of choice in taking up the caregiving role and the perceived degree of choice in caregiving predicted caregiver health and wellbeing and care-recipient placement in long-term care at 1-year follow-up. Methods We performed secondary analyses of data from DeStress, a longitudinal study of 251 spousal dementia caregivers in Ireland. We used multivariate logistic and linear regression analyses to examine whether lack of choice (a dichotomous item) and/or the perceived degree of choice (a 9-point scale) at baseline predicted caregiver health (number of chronic health conditions; self-reported health) and wellbeing (e.g., burden, anxiety, depression, stress, and positive aspects of caregiving) and care status (continued care at home or placement in long-term care) at follow-up. Results The vast majority of caregivers (82%) reported that they had no choice in taking up the caregiving role. Nevertheless, nearly three-quarters (74%) responded above the midpoint on the rating scale (Mean = 6.82, SD = 3.22; Median = 9; Mode = 9), indicating they provided care voluntarily. Caregivers who reported a greater degree of choice were more likely to still be providing care at home at follow-up and to identify benefits from providing care. Neither choice nor degree of choice predicted any other caregiver outcomes. Conclusion For the vast majority of spousal dementia caregivers, taking up the caregiving role is not perceived as a choice; yet, most report performing this role voluntarily. Thus, facilitating greater choice may not necessarily diminish the key contribution family caregivers make to the care system. Although we found no evidence that caregiver choice predicted more positive caregiver health and wellbeing, the perception of choice is important in and of itself, and may benefit caregivers by facilitating the identification of positive aspects of care and be a factor in delaying care-recipient placement in long-term care. Future research should be especially mindful of how caregiver choice is assessed and how this may affect the resulting prevalence of choice.
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Affiliation(s)
- Maria M Pertl
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Sabina Brennan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Ian H Robertson
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Brain A Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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Dombestein H, Norheim A, Lunde Husebø AM. Understanding informal caregivers' motivation from the perspective of self-determination theory: an integrative review. Scand J Caring Sci 2019; 34:267-279. [PMID: 31313852 DOI: 10.1111/scs.12735] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND A long-term illness is stressful both for the person with the diagnosis and for his or her informal caregivers. Many people willingly assume the caregiving role, so it is important to understand why they stay in this role and how their motivation affects their health. Self-determination theory (SDT) is a theory of human motivation that has been successfully applied in human research domains. To our knowledge, there is no literature review on the application of SDT in a caregiver context. A systematic review of the literature could improve the understanding of motivation in caregiver work and contribute to the utility of SDT. AIM To describe and explore empirical studies of caregivers' motivation from the perspective of self-determination theory. METHODS An integrative literature review according to Whittemore and Knafl was conducted with systematic repetitive searches in the MEDLINE, Scopus, PsychInfo, PsycNET, Chinal, Cochrane Library and EMBASE databases. The searches were performed from May through December 2018. The PRISMA diagram was used for study selection, and papers were assessed for quality based on the Mixed Methods Appraisal Tool. Data analysis consisted of a four-stage narrative analysis method. RESULT Of 159 articles, 10 were eligible for inclusion. All studies considered satisfaction of the three basic psychological needs for competence, autonomy and relatedness as essential in predicting the quality of caregivers' motivation and thereby their well-being. In this review, autonomous motivation was the most important determinant of caregivers' well-being. CONCLUSIONS Findings showed that SDT can be applied to identify, categorise, explain, predict, promote and support motivation among caregivers. This lends interesting support for SDT and promotes further study and application of the theory as a psychological approach to caregivers' health and health promotion.
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Affiliation(s)
- Heidi Dombestein
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Anne Norheim
- Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Family Caregivers’ Satisfaction With Specialized End-of-Life Care Provided at Home. J Hosp Palliat Nurs 2019; 21:412-421. [DOI: 10.1097/njh.0000000000000583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jarling A, Rydström I, Ernsth-Bravell M, Nyström M, Dalheim-Englund AC. A responsibility that never rests - the life situation of a family caregiver to an older person. Scand J Caring Sci 2019; 34:44-51. [PMID: 31058334 DOI: 10.1111/scs.12703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND When the ageing population increases, the burden and responsibility of close family members will likely increase. Those closely related who assume a great responsibility can be significantly affected in health, well-being and daily life. AIM This study aims to describe the life situation when family caregivers are imposed responsibility for an older person with complex care needs in their own home. METHODS In this Swedish qualitative study, ten family caregivers were strategically selected in order to achieve variations in the life situation. A reflective lifeworld research design based on phenomenological philosophy was used throughout the data collection with the lifeworld interviews and the analytic process. FINDINGS In terms of extensive responsibility, the life situation is complex and involves emotions that are difficult to manage. In essence, a paradoxical life situation is described which is experienced as both voluntarily and nonchosen at the same time. The responsibility never rests. The essential meaning is further illustrated with three constituents: loss of freedom, contradictory feelings and affected relationships. CONCLUSION A life situation with extensive responsibility for an older family member interferes with the whole life situation with an impact on health and relationships with other people. The findings are crucial for professional caregivers in order to capture the nature of family support in a way that enables a meaningful life for both the family caregiver and the older person being cared for. Knowledge of this will give professional caregivers an increased awareness of the life situation of family caregivers and provide a better understanding of the support they are longing for, and, in some countries, such as Sweden, also are entitled to by law.
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Affiliation(s)
- Aleksandra Jarling
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ingela Rydström
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | | | - Maria Nyström
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Pedersen B, Uhrenfeldt L, Jacobsen HR, Jørgensen L. The role of responsibility in oncological emergency telephone calls. Nurs Ethics 2019; 26:2071-2084. [PMID: 30961433 DOI: 10.1177/0969733019839214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory. RESEARCH OBJECTIVE The aim was to explore the meaning of responsibility as it appeared in patients' or caregivers' experiences of calling an oncological emergency telephone. DESIGN, PARTICIPANTS AND CONTEXT Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the oncological emergency telephone at a Danish university hospital was performed. ETHICAL CONSIDERATIONS The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act. FINDINGS Two main themes emerged: (1) to act responsibly as a patient or caregiver was to 'be watchful and alert', 'report symptoms the right way' and 'do crosschecking' and (2) to deal with the burden of responsibility was to 'feel safe when dealing with the burden of responsibility' and 'be relieved from the burden of responsibility'. DISCUSSION Too much responsibility and a potential imbalance between healthcare professionals' expectations and callers' knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care. CONCLUSION The meaning of responsibility appeared in the participants' capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis.
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Jacobs JC, Van Houtven CH, Tanielian T, Ramchand R. Economic Spillover Effects of Intensive Unpaid Caregiving. PHARMACOECONOMICS 2019; 37:553-562. [PMID: 30864064 DOI: 10.1007/s40273-019-00784-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Growing evidence has documented economic spillover effects experienced by intensive caregivers across the lifecycle. These spillover effects are rarely incorporated in economic analyses of health interventions. When these costs are captured, it is shown that commonly applied methods for valuing caregiver time may be underestimating the true opportunity costs of informal care. We explore how intensive caregiving is associated with economic outcomes for caregivers aged 18 years and older. METHODS We used the cross-sectional 2013 RAND Survey of Military and Veteran Caregivers, a survey of 3876 caregivers and non-caregivers aged 18 years and older to conduct multivariable analyses and calculate average marginal effects, focusing on the association between intensive caregiving (i.e., providing ≥ 20 h of weekly care) and six economic outcomes: schooling, labor force participation, taking unpaid time off of work, cutting back work hours, quitting a job, and early retirement. RESULTS Intensive caregivers are 13 percentage points (95% confidence interval [CI] 8-18) less likely to be employed than non-caregivers. Intensive caregivers are 3 percentage points (95% CI 0.5-5) more likely to cut back schooling, 6 percentage points (95% CI 2-10) more likely to take unpaid time off of work, 4 percentage points (95% CI 0.1-9) more likely to cut back work hours, 12 percentage points (95% CI 8-15) more likely to quit a job, and 5 percentage points (95% CI 2-7) more likely to retire early due to caregiving responsibilities relative to non-intensive caregivers. CONCLUSIONS Despite the difficulty of quantifying the true opportunity costs of informal care, policy makers and researchers need to understand these costs. The higher the opportunity costs of unpaid care provision, the less likely it is that caregivers will provide this care and the less economically attractive this 'free' source of care is from a societal perspective.
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Affiliation(s)
- Josephine C Jacobs
- Health Economics Resource Center, Palo Alto Veterans Health Administration, 795 Willow Rd, Menlo Park, CA, 94043, USA.
| | - Courtney H Van Houtven
- Department of General Internal Medicine, Center for Health Services Research in Primary Care, Durham Veterans Health Administration Medical Center, Duke University, 508 Fulton St, Durham, NC, 27707-3897, USA
| | - Terri Tanielian
- RAND Corporation, 1200 South Hayes St, Arlington, VA, 22202-5050, USA
| | - Rajeev Ramchand
- RAND Corporation, 1200 South Hayes St, Arlington, VA, 22202-5050, USA
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Rand S, Malley J, Forder J. Are reasons for care-giving related to carers' care-related quality of life and strain? Evidence from a survey of carers in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:151-160. [PMID: 30063106 PMCID: PMC6334528 DOI: 10.1111/hsc.12634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/14/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
In England, choice and control is promoted for service users in relation to social care services. Increased choice and control has also been promoted for unpaid carers, although this is still relatively underdeveloped. There is limited recognition of carers' choice in terms of the decision of whether to provide care. Alongside the promotion of choice and control, there has also been a focus on quality of life as an outcome of social care for care-recipients and their carers. Although it is known that carer choice (in terms of the decision of whether or not to provide care) is related to increased burden and poorer psychological health, there is limited evidence of the relationship between reasons for caring and care-related quality of life (CRQoL) and subjective strain in England. In this study, 387 carers were surveyed across 22 English local authorities between June 2013 and March 2014. Multiple regression analysis explored the relationship between carer-reported reasons for caring and CRQoL and strain, whilst controlling for individual characteristics (e.g. age). Reasons for caring were important predictors of CRQoL and strain. Where people were carers because social services suggested it or the care-recipient would not want help from anyone else, this was related to lower CRQoL. By contrast, where carers took on care-giving because they had time to care, this was significantly associated with better CRQoL. Carers reported greater strain where they provided care because it was expected of them. These findings are relevant to policy and practice because they indicate that, while social care systems rely on carers, the limiting of carers' choice of whether to provide care is related to worse outcomes. Increased awareness of this relationship would be beneficial in developing policy and practice that improves the QoL of care-recipients and also their carers.
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Affiliation(s)
- Stacey Rand
- Personal Social Services Research Unit (PSSRU)University of KentCanterburyUK
| | - Juliette Malley
- Personal Social Services Research Unit (PSSRU)London School of Economics and Political ScienceLondonUK
| | - Julien Forder
- Personal Social Services Research Unit (PSSRU)University of KentCanterburyUK
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Al-Janabi H, Carmichael F, Oyebode J. Informal care: choice or constraint? Scand J Caring Sci 2017; 32:157-167. [PMID: 28401583 PMCID: PMC5873411 DOI: 10.1111/scs.12441] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/11/2017] [Indexed: 12/13/2022]
Abstract
Background ‘Choice’ is increasingly pursued as a goal of social policy. However, the degree to which choice is exercised when entering an informal caring role is open to debate. Aim In this study, we examined the degree of choice and constraint in entering a caring role, and the relationship between choice and carers’ well‐being. Methods Data were derived from 1100 responses to a postal survey conducted in a British city. Statistical tests of association and multivariable regression modelling were applied to study the factors associated with choice in entering a caring role and the association that choice in entering a caring role had with carers’ well‐being. Results We found that informal care was generally perceived to be a free choice, albeit in most cases, a choice was also constrained by duty, financial or social resources. Having a sense of free choice in entering care was strongly and positively associated with the carer's well‐being. Conclusion The study findings are consistent with a view that enabling individuals to have more choice in their caring roles may be beneficial.
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Affiliation(s)
- Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Jan Oyebode
- Faculty of Health Studies, University of Bradford, Bradford, UK
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