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Heymann J, Raub A, Waisath W, Earle A, Stek P, Sprague A. Paid Leave to Meet the Health Needs of Aging Family Members in 193 Countries. J Aging Soc Policy 2024; 36:508-531. [PMID: 36007142 DOI: 10.1080/08959420.2022.2110804] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/04/2022] [Indexed: 10/15/2022]
Abstract
Women and workers over 50 disproportionately provide care for aging family members worldwide, including the 101 million who are care-dependent. Paid leave for adult health needs, which temporarily replaces employment income for workers providing care, can critically support both caregivers' economic outcomes and care recipients' wellbeing. We created quantitatively comparable data on paid leave policies that can be used to meet adult family members' health needs in all United Nations member states. Globally, 112 countries fail to provide any paid leave that can be used to meet the serious health needs of an aging parent, spouse, or adult child. These gaps have profound consequences for older workers providing care as well as care access by aging, ill, and disabled adults.
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Affiliation(s)
- Jody Heymann
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Amy Raub
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Willetta Waisath
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Alison Earle
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Pamela Stek
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Aleta Sprague
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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Domeisen Benedetti F, Hechinger M, Fringer A. Self-Assessment Instruments for Supporting Family Caregivers: An Integrative Review. Healthcare (Basel) 2024; 12:1016. [PMID: 38786426 PMCID: PMC11120749 DOI: 10.3390/healthcare12101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Family caregivers take on a variety of tasks when caring for relatives in need of care. Depending on the situation and the intensity of care, they may experience multidimensional burdens, such as physical, psychological, social, or financial stress. The aim of the present study was to identify and appraise self-assessment instruments (SAIs) that capture the dimensions of family caregivers' burdens and that support family caregivers in easily identifying their caregiving role, activities, burden, and needs. We performed an integrative review with a broad-based strategy. A literature search was conducted on PubMed, Google Scholar, Google, and mobile app stores in March 2020. After screening the records based on the eligibility criteria, we appraised the tools we found for their usefulness for family care and nursing practice. From a total of 2654 hits, 45 suitable SAIs from 274 records were identified and analyzed in this way. Finally, nine SAIs were identified and analyzed in detail based on further criteria such as their psychometric properties, advantages, and disadvantages. They are presented in multi-page vignettes with additional information for healthcare professionals. These SAIs have proven useful in assessing the dimensions of caregiver burden and can be recommended for application in family care and nursing practice.
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Affiliation(s)
- Franzisca Domeisen Benedetti
- School of Health Professions, Institute of Nursing, ZHAW—Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401 Winterthur, Switzerland (A.F.)
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Bueno MV. A Duty to Care: Male Perspectives on the Caregiver Role for Persons With Alzheimer's or Dementia. JOURNAL OF FAMILY NURSING 2024:10748407231222291. [PMID: 38205720 DOI: 10.1177/10748407231222291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The population of family caregivers (FCGs) of persons with Alzheimer's disease and related dementias (ADRD) is growing, as is the proportion of males taking on this traditionally female role. Caregiving research has centered around women due to historic roles, resulting in a knowledge gap regarding male caregiving experiences. The purpose of this qualitative descriptive study was to explore the experiences of male FCGs of people with ADRD. Eleven male caregivers were recruited and interviewed by telephone or Zoom/videoconferencing. Data were analyzed using thematic analysis. Four major themes emerged highlighting males' struggles with the unfamiliar caregiving role and changing identity; their acknowledgment of personal growth and discovery through caregiving; their challenges in finding the "right" kind of support; and their perceived reshaping of masculinity through the caregiving role. Male caregivers expressed unique experiences as FCGs. Findings indicate the need for researchers and clinicians to develop tailored support to address their needs.
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Dau H, Gottschlich A, Metz L, Pineda N, Pineda A, Alvarez CS, Bevliacqua K, Mendoza-Montano C, Ogilvie G, Rivera-Andrade A, Gharzouzi E, Meza R. The role of daughters in relation to their mother's cervical cancer diagnosis and treatment in Guatemala: a descriptive study. BMC Womens Health 2023; 23:142. [PMID: 36991461 PMCID: PMC10053719 DOI: 10.1186/s12905-023-02305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE There is currently no information on how caregivers for women diagnosed with cervical cancer in Guatemala, particularly daughters, are affected by their supportive role. This study's objective was to describe the support role of caregivers in the country, with a focus on daughters with a mother diagnosed with cervical cancer. METHODS This analysis utilizes data from a cross-sectional study which aimed to understand pathways to cervical cancer care. Women seeking cervical cancer treatment at the Instituto de Cancerologia (INCAN) in Guatemala City, Guatemala and their companions were surveyed. Descriptive statistics were calculated. RESULTS One hundred forty-five women seeking treatment and 71 companions participated in the study. Patient's daughters were most frequently reported as the person who provided the most support (51%) and as the most reported to have encouraged the patient to seek care. Furthermore, daughters were noted as the person most reported to fulfill the major household and livelihood roles of the patient while they were seeking or receiving treatment (38.0%). Most daughters reported that they were missing housework (77%), childcare (63%), and income-earning activities (60%) to attend the appointment with their mothers. CONCLUSION Our study suggests that in Guatemala cervical cancer patient's daughters have a significant support role in their mother's cancer diagnosis. Furthermore, we found that while caring for their mothers, daughters in Guatemala are often unable to participate in their primary labor activities. This highlights the additional burden that cervical cancer has on women in Latin America.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Anna Gottschlich
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada.
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Lynn Metz
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Natalia Pineda
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | - Andres Pineda
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | | | - Kristin Bevliacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Mendoza-Montano
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | - Gina Ogilvie
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Alvaro Rivera-Andrade
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | | | - Rafael Meza
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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5
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Perrin PB. Setting a research agenda for caregiving after neurotrauma and neurological disability. NeuroRehabilitation 2023; 52:1-7. [PMID: 36617763 DOI: 10.3233/nre-228027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Research on caregiving after neurotrauma and neurological disability critically extends the focus beyond individuals with neurological conditions to family, friends, and significant others who also are greatly impacted. This article introduces a thematic issue of NeuroRehabilitation on the topic with 10 articles that coalesce around the three approaches of (a) literature reviews, (b) empirical studies, and (c) caregiver intervention studies. This introductory article introduces each of these articles and synthesizes them to chart important future directions for research on caregiving after neurotrauma and neurological disability including: (a) a focus on evidence-based common factors caregiver interventions, (b) dissemination and implementation science approaches to imbedding caregiver interventions into health care systems, and (c) cultural considerations in the context of caregiving. This thematic issue helps rehabilitation clinicians incorporate more of a systems perspective to improve the functioning not only of individuals with neurological conditions but also their caregivers.
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Affiliation(s)
- Paul B Perrin
- School of Data Science, University of Virginia, Charlottesville, VA, USA.,Department of Psychology, University of Virginia, Charlottesville, VA, USA.,Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
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Bueno MV, Chase JAD. Gender Differences in Adverse Psychosocial Outcomes among Family Caregivers: A Systematic Review. West J Nurs Res 2023; 45:78-92. [PMID: 35614567 DOI: 10.1177/01939459221099672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This systematic review explores gender differences in adverse psychosocial and role-related outcomes of family caregivers of older adults with chronic illnesses. Data sources for the systematic review included CINAHL, PubMed, PsycINFO, and Google Scholar. Eligible primary research focused on examining gender-based differences in psychological and emotional outcomes (e.g., burden, depression, stress) among family caregivers of an older adult with chronic illness. In total, 16 studies were included in the review with most studies using a cross-sectional design and conducted outside of the United States. Studies reported on gender differences in health outcomes such as burden, stress, and anxiety. Women caregivers had overall higher negative outcomes, but men may have more intense difficulty during the initial caregiver transition phase. Resources to address caregiver health should consider the caregiver's gender. As the older adult population grows, more caregiver research is needed and future studies to include more male caregivers.
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Affiliation(s)
- Michael V Bueno
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Jo-Ana D Chase
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
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Ruiz-Lozano RE, de la Rosa-Pacheco S, Hernández-Camarena JC, Garza-Garza LA, Davila-Cavazos O, Dominguez-Varela IA, Quiroga-Garza ME, Rodriguez-Garcia A. Burden and depression among informal caregivers of visually impaired patients in Mexico. Disabil Health J 2022; 15:101284. [PMID: 35337783 DOI: 10.1016/j.dhjo.2022.101284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The needs of informal caregivers who provide care to family relatives with visual impairment are often neglected, resulting in burden and depression. OBJECTIVE To determine the degree of burden and the prevalence of major depression experienced by caregivers, defined as non-paid family relatives, of legally blind individuals in a Mexican population. METHODS Observational, single-center, cross-sectional study in adults providing care to their family relatives with visual impairment (visual acuity ≤ 20/200 in the best eye for at least 3 months). According to visual impairment degree, care provided included activities of daily living (ADL) and instrumental ADL. Burden of care was evaluated with the Zarit burden interview (ZBI)-22 and the prevalence of major depression was determined by the patient health questionnaire (PHQ)-9. RESULTS 115 patients and 115 caregivers were included. Male caregivers had significantly higher ZBI-22 (28.7 ± 15.5 vs. 19.2 ± 12.6, p = 0.001) and PHQ-9 (10.0 ± 5.5 vs. 5.3 ± 5.1, p < 0.001) scores than females. Likewise, parent caregivers of adult children and the hours of daily care were significantly associated with higher burden and depression scores. A significant linear correlation between ZBI-22 and PHQ-9 scores in caregivers was also found (r = 0.649, p < 0.001). CONCLUSIONS Male caregivers, parent caregivers of adult children, and caregivers providing greater hours of care were at higher risk of burden and depression. Upon diagnosis of visual impairment, adults providing care to visually impaired family relatives should be screened for burden and depression and referred to a mental health specialist when necessary. Tailored interventions targeting the caregivers' needs are required to reduce burden and depression.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Sylvia de la Rosa-Pacheco
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Av. I. Morones Prieto No. 3000 Pte. Col. Sertoma, Monterrey, NL, CP, 64710, Mexico.
| | - Julio C Hernández-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Lucas A Garza-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Osvaldo Davila-Cavazos
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Irving A Dominguez-Varela
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Manuel E Quiroga-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
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Rajachandrakumar R, Finlayson M. Multiple sclerosis caregiving: A systematic scoping review to map current state of knowledge. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e874-e897. [PMID: 34935217 DOI: 10.1111/hsc.13687] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/07/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
Unpaid caregivers, typically family and friends, provide significant amounts of support to people with multiple sclerosis (MS). Understanding their experiences, needs and challenges is necessary to ensure that caregivers receive the support that they require to continue in their role. Our aim was to map the current state of knowledge about unpaid caregivers of people with MS and identify gaps in knowledge to guide future research and practice. We used scoping review methodology with three major health-related databases (MEDLINE, CINAHL, APA Psychinfo), searching in September 2019, April and October 2020 and October 2021. We selected peer-reviewed scientific articles reporting on primary studies of unpaid caregivers of people with MS, regardless of topic or research design. We extracted information on study aim, participant characteristics, measures used and key findings to generate major themes and identify knowledge gaps. We identified 108 published studies between 1992 and 2021 that met our criteria. Studies of spousal caregivers were most common. Studies focused primarily on measurement of caregiver burden or other negative consequences of caregiving. Thirteen studies addressed positive consequences of caregiving. Sixteen studies reported actual tasks performed by caregivers and seven reported outcomes of caregiver support interventions. Attention to diversity issues that may influence caregiving experiences and outcomes was rare. Overall, knowledge of MS caregiving is limited, particularly with respect to tasks performed by caregivers that may contribute to negative outcomes, diversity issues and effective approaches to remediate caregiver burden. Without this knowledge, finding ways to better support MS caregivers will be difficult.
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Affiliation(s)
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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9
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Juengst SB, Perrin PB, Klyce DW, O’Neil-Pirozzi TM, Herrera S, Wright B, Lengenfelder J, Lercher K, Callender L, Arango-Lasprilla JC. Caregiver Characteristics of Adults with Acute Traumatic Brain Injury in the United States and Latin America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5717. [PMID: 35565112 PMCID: PMC9102876 DOI: 10.3390/ijerph19095717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022]
Abstract
Objectives: To compare characteristics of caregivers of adults with acute traumatic brain injury (TBI) in the U.S. and Latin America (Mexico and Colombia). Design: Secondary data analysis of two cohorts. Cohort 1: English-speaking caregivers of adults with TBI in the U.S. (n = 80). Cohort 2: Spanish-speaking caregivers of adults with TBI in Mexico or Colombia (n = 109). Results: Similarities between the U.S. and Latin American caregiver groups, respectively, were: predominantly women (81.3%, 81.7%, respectively); spouses/domestic partners (45%, 31.2%); and motor vehicle accident (41.5%, 48.6%) followed by fall etiologies (40%, 21.1%). Differences between U.S. and Latin American caregivers were: age (49.5 years, 41.5 years, p < 0.001); employment status ((Χ52 = 59.63, p < 0.001), full-time employment (63.7%, 25.7%), homemaker (2.5%, 31.2%), and retired (17.5%, 1.8%)); violence-related etiology (2.5%, 15.6%); and severity of depressive symptoms (M = 7.9, SD = 5.8; M = 5.8, SD = 5.7; p = 0.014). Conclusions: TBI caregivers in the U.S. were older and employed full-time or retired more often than those in Latin America. Violence-related etiology was nearly five times more common in Latin America, raising concerns for potential implications of post-traumatic stress and family adjustment after injury. Although both groups likely could use mental health support, this was particularly true of the U.S. cohort, maybe due to differential demographics, mechanisms of injury, or family and community support.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX 77030, USA
- Department of Physical Medicine & Rehabilitation, UT Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA;
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
| | - Daniel W. Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
- Virginia Commonwealth University Health System, Richmond, VA 23284, USA
- Sheltering Arms Institute, Richmond, VA 23233, USA
| | - Therese M. O’Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA;
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA 02115, USA
| | - Susan Herrera
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
| | - Brittany Wright
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
| | - Jean Lengenfelder
- Department of Physical Medicine & Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ 07101, USA;
- Kessler Foundation, East Hanover, NJ 07936, USA
| | - Kirk Lercher
- Department of Physical Medicine & Rehabilitation, JFK Johnson Rehabilitation Institute, Hackensack Meridian Health, Edison, NJ 08820, USA;
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX 75246, USA;
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country, 48940 Leioa, Spain
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Özen Ş, Karataş T, Polat Ü. Perceived social support, mental health, and marital satisfaction in multiple sclerosis patients. Perspect Psychiatr Care 2021; 57:1862-1875. [PMID: 33728706 DOI: 10.1111/ppc.12760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study aimed to examine the patients' perceived social support, mental health, and marital satisfaction. DESIGN AND METHODS Data were collected via Patient Information Form, Barthel Index of Activities of Daily Living, Marital Life Scale, Multidimensional Scale of Perceived Social Support, and General Health Questionnaire for 72 patients. FINDINGS Multiple sclerosis (MS) patients had a moderate level of marital satisfaction. The perceived social support showed positive correlation with marital satisfaction and negative correlation with mental health disorders in MS. PRACTICE IMPLICATIONS These results will facilitate the perception of mental problems, marital satisfaction, and social support in MS patients by the nurses.
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Affiliation(s)
- Şükrü Özen
- Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
| | - Tuğba Karataş
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Ülkü Polat
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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11
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Pugh M, Perrin PB, Arango-Lasprilla JC. Predicting caregiver burden over the first 4 months after acute traumatic brain injury in Latin America: a multi-country study. Brain Inj 2021; 35:769-777. [PMID: 33822684 PMCID: PMC8217148 DOI: 10.1080/02699052.2021.1907861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Background: Traumatic brain injury (TBI) rates and outcomes are worse in Latin American countries relative to high-income countries. This study examined whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation in individuals with an acute TBI in Latin America predict longitudinal trajectories of caregiver burden during the first 4 months post-discharge.Method: A sample of 109 caregivers of individuals with a new TBI from Colombia and Mexico completed the observer European Brain Injury Questionnaire before hospital discharge and the Zarit Burden Inventory at the same time and again at 2 and 4 months after discharge. A hierarchical linear model (HLM) was used to assess whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation at hospital discharge predicted longitudinal trajectories of caregiver burden.Results: Results suggested that burden trajectories decreased over time and men reported higher burden than women. Additionally, results showed that poor patient social and emotional self-regulation predicted higher burden trajectories.Conclusions: Men and caregivers providing care for those experiencing poor social and emotional self-regulation may be at risk for burden. Culturally sensitive interventions focusing on social functioning of individuals with TBI and gender-informed caregiver interventions aimed at burden should be implemented in Latin America.
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Affiliation(s)
- Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonweath University, Richmond, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, Cruces University Hospital Barakaldo, Barakaldo, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Bilbao, Spain
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12
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Lester EG, Silverman IH, Gates MV, Lin A, Vranceanu AM. Associations Between Gender, Resiliency Factors, and Anxiety in Neuro-ICU Caregivers: a Prospective Study. Int J Behav Med 2020; 27:677-686. [PMID: 32488793 DOI: 10.1007/s12529-020-09907-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Informal caregivers of patients admitted to the neuroscience intensive care unit (Neuro-ICU) are at risk for developing chronic anxiety. Resiliency factors may reduce risk, yet their differential effects for female and male caregivers have not been studied in this population. We aim to examine interactions between gender and baseline resiliency factors and anxiety at baseline, 3 months, and 6 months. METHOD Prospectively studied caregivers (N = 96) of patients admitted to the Neuro-ICU completed baseline sociodemographics and resiliency measures (coping, mindfulness, self-efficacy, intimate care, and caregiver preparedness), and anxiety severity at baseline (hospitalization), 3 months, and 6 months. RESULTS Baseline anxiety predicted future anxiety (3 and 6 months). Caregivers who reported high (versus low) baseline coping, mindfulness, self-efficacy, and preparedness for caregiving reported lower baseline anxiety (ps ≤ 0.012). An interaction between caregiver gender and baseline mindfulness was seen at 3 months (p = 0.021), with high mindfulness males reporting lower anxiety than high mindfulness females, and low mindfulness males reporting higher anxiety than low mindfulness females. CONCLUSION Results emphasize the protective role of resilience in the trajectory of anxiety among informal caregivers. Findings emphasize the need to rapidly deploy skills-based treatment to Neuro-ICU caregivers to prevent future development and maintenance of anxiety, specifically emphasizing mindfulness in male caregivers.
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Affiliation(s)
- Ethan G Lester
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA.,Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ilyssa H Silverman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA
| | - Melissa V Gates
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA
| | - Ann Lin
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA. .,Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Xi X, Lu Q, Lu M, Xu A, Hu H, Ung COL. Evaluation of the association between presenteeism and perceived availability of social support among hospital doctors in Zhejiang, China. BMC Health Serv Res 2020; 20:609. [PMID: 32616033 PMCID: PMC7331165 DOI: 10.1186/s12913-020-05438-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background This study investigated the association between presenteeism and the perceived availability of social support among hospital doctors in China. Methods A questionnaire was administered by doctors randomly selected from 13 hospital in Hangzhou China using stratified sampling. Logit model was used for data analysis. Results The overall response rate was 88.16%. Among hospital doctors, for each unit increase of the perceived availability of social support, the prevalence of presenteeism was decreased by 8.3% (OR = 0.91, P = 0.000). In particular, if the doctors perceived availability of appraisal support, belonging support and tangible support as sufficient, the act of presenteeism was reduced by 20.2% (OR = 0.806, P = 0.000) 20.4% (OR = 0.803, P = 0.000) and 21.0% (OR = 0.799, P = 0.000) respectively with statistical differences. Conclusion In China, appraisal support, belonging support and tangible support, compared to other social support, had a stronger negative correlation with presenteeism among hospital doctors. The benefits of social support in alleviating doctors’ presenteeism warrant further investigation.
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Affiliation(s)
- Xiaoyu Xi
- The Research Center of National Drug Policy& Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Qianni Lu
- The Research Center of National Drug Policy& Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Mengqing Lu
- The Research Center of National Drug Policy& Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Ailin Xu
- The Research Center of National Drug Policy& Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China.
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Abstract
Purpose of Review In spite of recent advances in treatment, many people with multiple sclerosis (MS) require ongoing care and support. Informal caregivers can experience burden as a result of their role, with possible implications for quality of life (QOL). We review recent research examining MS caregiver experience to (1) understand current risk factors for caregiver burden and (2) identify possible strategies for increasing carer well-being. Recent Findings MS caregiver experience is highly variable and can be predicted by a variety of care recipient, caregiver and contextual factors. Burden is not the only characteristic associated with care, with positive consequences also reported. Emerging research suggests a number of ways in which carers can be better supported. Summary Identifying and meeting the needs of MS caregivers offers the best way of delivering tailored support. Future research should focus on the development of psychosocial supports, while acknowledging the needs of those caring for different MS patient populations.
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Affiliation(s)
- Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland.
| | - Phil Maguire
- Department of Computer Science, Maynooth University, Maynooth, Co. Kildare, Ireland
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15
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Covid-19 and Women’s Triple Burden: Vignettes from Sri Lanka, Malaysia, Vietnam and Australia. SOCIAL SCIENCES 2020. [DOI: 10.3390/socsci9050087] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During disease outbreaks, women endure additional burdens associated with paid and unpaid work, often without consideration or the alleviation of other life responsibilities. This paper draws on the concept of the triple burden in theorizing the gender divisions in productive and reproductive work and community activities in the context of disaster. Events that include famine, war, natural disaster or disease outbreak are all well documented as increasing women’s vulnerability to a worsening of gendered burdens. In the case of the Covid-19 coronavirus pandemic, this is no different. Focussing on Sri Lanka, Malaysia, Vietnam and Australia, the four vignettes in this paper serve to highlight the intersections between Covid-19 and gendered burdens, particularly in frontline work, unpaid care work and community activities. While pre-disaster gender burdens are well established as strong, our analysis during the early months of the pandemic indicates that women’s burdens are escalating. We estimate that women will endure a worsening of their burdens until the pandemic is well under control, and for a long time after. Public policy and health efforts have not sufficiently acknowledged the issues concerned with the associations between gender and disease outbreaks.
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16
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Henry RS, Lageman SK, Perrin PB. The relationship between Parkinson's disease symptoms and caregiver quality of life. Rehabil Psychol 2020; 65:137-144. [PMID: 32068420 DOI: 10.1037/rep0000313] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Caregivers for individuals with Parkinson's disease (PD) can experience high burden, which underlies the importance of examining the needs of caregivers to be able to support them in the caregiving role. The current study aims to assess the relationships among PD symptoms and four measures of caregiver quality of life (QOL; i.e., personal and social activities, anxiety and depression, self-care, and strain). METHOD Data from 181 caregiver/care recipient dyads (N = 362) were collected at a multidisciplinary PD clinic in a public, academic medical center in the southeastern United States at the time of the care recipient's first neuropsychological evaluation. RESULTS All PD symptoms were positively correlated with each other, as were all forms of caregiver QOL, and all PD symptoms were associated with each measure of caregiver QOL. A series of regressions suggested that demographics and PD symptoms predicted all four types of caregiver QOL, explaining 33% of the variance in caregiver personal and social activities, 24% in anxiety and depression, 28% in self-care, and 36% in strain. Female caregivers and those who provided care to male care recipients generally had worse QOL. Greater PD-related symptoms including difficulties with mobility, decreased emotional well-being, and greater nonmotor functioning impairment were unique predictors of reduced caregiver QOL. CONCLUSIONS PD symptoms are robustly related to caregiver QOL, with mobility and nonmotor symptoms as the primary drivers of this relationship. Interventions for PD caregivers should include strategies for managing mobility and nonmotor symptoms, as well as their QOL effects on caregivers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University
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17
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Smith ER, Perrin PB, Tyler CM, Lageman SK, Villaseñor T. Parkinson's Symptoms and Caregiver Burden and Mental Health: A Cross-Cultural Mediational Model. Behav Neurol 2019; 2019:1396572. [PMID: 31871491 PMCID: PMC6913294 DOI: 10.1155/2019/1396572] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/15/2019] [Accepted: 11/06/2019] [Indexed: 12/26/2022] Open
Abstract
Informal caregivers are critical in the care of individuals with Parkinson's disease (PD) and spend substantial time providing care, which may be associated with negative caregiver outcomes such as burden and mental health issues. Although research in the United States and Europe has generally supported these relations, there is very limited research on PD caregiving in Latin America. The current study examined the following connections in a sample of PD caregivers from the United States (N = 105) and Mexico (N = 148): (a) PD-related impairments (motor and nonmotor symptoms) and caregiver burden, (b) caregiver burden and caregiver mental health, and (c) PD-related impairments and mental health through caregiver burden. Study results uncovered significant relations among PD-related impairments, caregiver burden, and caregiver mental health. Further, caregiver burden fully mediated the relation between PD-related impairments and caregiver mental health at both study sites. Findings highlight a number of important intervention targets for caregivers and families, including caregiver burden and mental health.
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Affiliation(s)
- Erin R. Smith
- Department of Psychology, Virginia Commonwealth University, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, USA
| | - Carmen M. Tyler
- Department of Psychology, Virginia Commonwealth University, USA
| | - Sarah K. Lageman
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, USA
| | - Teresita Villaseñor
- Hospital Civil Fray Antonio Alcalde, Mexico
- Department of Neurosciences, University of Guadalajara, Mexico
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18
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Caregiver strain among life partners of persons with mild disability due to relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2019; 31:5-11. [DOI: 10.1016/j.msard.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/18/2019] [Accepted: 03/05/2019] [Indexed: 11/20/2022]
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19
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Rodríguez-Madrid MN, Del Río-Lozano M, Fernandez-Peña R, Jiménez-Pernett J, García-Mochón L, Lupiañez-Castillo A, García-Calvente MDM. Gender Differences in Social Support Received by Informal Caregivers: A Personal Network Analysis Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010091. [PMID: 30602656 PMCID: PMC6339235 DOI: 10.3390/ijerph16010091] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 11/27/2022]
Abstract
Social support is an important predictor of the health of a population. Few studies have analyzed the influence of caregivers’ personal networks from a gender perspective. The aim of this study was to analyze the composition, structure, and function of informal caregiver support networks and to examine gender differences. It also aimed to explore the association between different network characteristics and self-perceived health among caregivers. We performed a social network analysis study using a convenience sample of 25 female and 25 male caregivers. A descriptive analysis of the caregivers and bivariate analyses for associations with self-perceived health were performed. The structural metrics analyzed were density; degree centrality mean; betweenness centrality mean; and number of cliques, components, and isolates. The variability observed in the structure of the networks was not explained by gender. Some significant differences between men and women were observed for network composition and function. Women received help mainly from women with a similar profile to them. Men’s networks were broader and more diverse and they had more help from outside family circles, although these outcomes were not statistically significant. Our results indicate the need to develop strategies that do not reinforce traditional gender roles, but rather encourage a greater sharing of responsibility among all parties.
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Affiliation(s)
- María Nieves Rodríguez-Madrid
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), 18012 Granada, Spain.
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
| | - María Del Río-Lozano
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
- Biomedical Research Centre (ibs.GRANADA), 18080 Granada, Spain.
| | - Rosario Fernandez-Peña
- Department of Nursing, SALBIS Research Group, Nursing Research Group IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - Jaime Jiménez-Pernett
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
- Public Health Research Institute (IRSPUM), University of Montreal, Montreal, QC H3N 1X7, Canada.
| | - Leticia García-Mochón
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
- Biomedical Research Centre (ibs.GRANADA), 18080 Granada, Spain.
- CIBER en Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain.
| | - Amparo Lupiañez-Castillo
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
| | - María Del Mar García-Calvente
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
- Biomedical Research Centre (ibs.GRANADA), 18080 Granada, Spain.
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20
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Pucciarelli G, Ausili D, Galbussera AA, Rebora P, Savini S, Simeone S, Alvaro R, Vellone E. Quality of life, anxiety, depression and burden among stroke caregivers: A longitudinal, observational multicentre study. J Adv Nurs 2018; 74:1875-1887. [PMID: 29700840 DOI: 10.1111/jan.13695] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Abstract
AIM To longitudinally describe stroke caregivers' quality of life, anxiety, depression and burden and to identify predictors of stroke caregivers' quality of life, anxiety, depression and burden. BACKGROUND Caregivers have a key role in stroke survivor care and the first year of caregiving is the most challenging. To give tailored interventions, it is important to capture changes and identify predictors of caregiver quality of life, anxiety, depression and burden during the first year. DESIGN A 12-month longitudinal study. Data were collected between June 2013-May 2016. METHODS Changes in stroke caregiver quality of life, anxiety and depression and burden and their predictors were identified using linear mixed-effects models. RESULTS The caregivers (N = 244) were 53 years old and mostly female. Caregiver quality of life did not change significantly over the 12 months, anxiety and depression decreased up to 9 months and caregiver burden decreased from baseline to 3 months, then increased up to 9 months. Higher caregiver quality of life was predicted by caregiver younger age, higher education, living with a stroke survivor, survivor older age and higher physical functioning; higher anxiety and depression were predicted by older caregiver age and younger survivor age; higher burden was predicted by caregiver male gender, the caregiver not living with survivor and survivor lower physical functioning. CONCLUSION The first 9 months of caregiving are particularly problematic for caregivers. The trajectories of the above variables and their predictors may be useful for policy makers, clinicians, investigators and educators to give better care to stroke caregivers and their survivors.
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Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessia Antonella Galbussera
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paola Rebora
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Silvio Simeone
- Department of Cardiology, Policlinico Federico II, Naples, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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21
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Health-related quality of life in Spanish informal caregivers: gender differences and support received. Qual Life Res 2017; 26:3227-3238. [DOI: 10.1007/s11136-017-1678-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
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22
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Rushton PW, Labbé D, Demers L, Miller WC, Mortenson WB, Kirby RL. Understanding the Burden Experienced by Caregivers of Older Adults Who Use a Powered Wheelchair: A Cross-Sectional Study. Gerontol Geriatr Med 2017; 3:2333721417703736. [PMID: 28491917 PMCID: PMC5406150 DOI: 10.1177/2333721417703736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 11/16/2022] Open
Abstract
Objective: In this study, we aimed to describe the burden of family caregivers providing powered wheelchair-related and overall assistance and test the hypotheses that caregiver burden correlates with participation, wheelchair skills capacity, anxiety, depression, and social support. Methods: Cross-sectional study. Participants included 35 family caregivers of powered wheelchair users. Caregivers were assessed using the Power Mobility Caregiver Assistive Technology Outcome Measure, Late Life Disability Instrument, Wheelchair Skills Test Questionnaire for caregivers, Hospital Anxiety and Depression Scale, and Interpersonal Support Evaluation List-12. Results: The most burdensome powered wheelchair assistance items were providing verbal hints/directions, needing to be nearby, anxiety, and fear that user may be harmed. The most burdensome overall assistance item was feeling limited in recreational/leisure activities. Caregiver burden was significantly correlated with participation limitations, anxiety, depression, and social support. Discussion: Caregivers experience burden for wheelchair-related and overall help, especially psychological burden. Such results have implications for the type of resources required to support family caregivers.
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Affiliation(s)
- Paula W. Rushton
- Université de Montréal, Québec, Canada
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | | | - Louise Demers
- Université de Montréal, Québec, Canada
- Centre de recherche de l’institut universitaire de gériatrie de Montréal, Québec, Canada
| | - William C. Miller
- The University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
- Rehabilitation Research Program and GF Strong Rehabilitation Research Lab, Vancouver, British Columbia, Canada
| | - William B. Mortenson
- The University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
- Rehabilitation Research Program and GF Strong Rehabilitation Research Lab, Vancouver, British Columbia, Canada
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