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Mossad NA, Hamza SA, Wahba HMF, Youssif HY, Tolba MF. The Health Outcomes of a Telegeriatrics Follow-Up Model on Dementia Patients and Their Caregivers in Cairo. Telemed J E Health 2024; 30:e1757-e1768. [PMID: 38457647 DOI: 10.1089/tmj.2023.0668] [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: 03/10/2024] Open
Abstract
Background/Purpose: Older patients living with dementia and their caregivers are ideal beneficiaries of telemedicine, cost-effectiveness, caregiver satisfaction, and physician acceptance. The aim is to study the effect of a telemedicine dementia enabled program on the health outcome of dementia patients and their caregivers, as regard the patient outcome, caregiver stress, and caregiver satisfaction. Methods: Ninety-seven (n = 97) elderly subjects were recruited from the outpatient clinics and inpatient ward of Geriatrics Hospital, Ain Shams University Hospitals. Seventy subjects completed 6 months of follow-up using a telegeriatrics model. Patient outcomes (delirium, behavioral and psychological symptoms of dementia [BPSD], and need for home consultations, emergency room [ER] visits, clinic visits, and hospital admissions) were assessed and followed. Caregiver stress was evaluated and monitored using the abridged Arabic version of the Zarit Burden Interview ZBI-A. Caregiver satisfaction was assessed using dedicated satisfaction questionnaire designed by Ain Shams Virtual Hospital. Results: elirium episodes, BPSD episodes, and the need for home consultations, clinic visits, ER visits, and hospital admissions. This was statistically significant after the second, fourth, and sixth months of follow-up (p-value <0.001). In addition, the telegeriatrics follow-up model had a positive effect on both caregiver stress and caregiver satisfaction. Conclusions: The telegeriatrics follow-up model is a useful tool in the improvement of health outcomes of dementia patients, reduction of caregiver stress, and achievement of caregiver satisfaction.
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Affiliation(s)
- Nora Ali Mossad
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Geriatric Palliative Care Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Sarah Ahmed Hamza
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Heba Youssif Youssif
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammad Fahmy Tolba
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Geriatric Palliative Care Unit, Ain Shams University Hospitals, Cairo, Egypt
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Onseng P, Jiraporncharoen W, Moonkayaow S, Veerasirikul P, Wiwatkunupakarn N, Angkurawaranon C, Pinyopornpanish K. Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study. JMIR Aging 2024; 7:e48132. [PMID: 38324373 PMCID: PMC10882467 DOI: 10.2196/48132] [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: 04/13/2023] [Revised: 09/26/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. OBJECTIVE This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. METHODS This qualitative study used semistructured interviews to explore caregivers' perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework. RESULTS The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75%), with an average age of 86.2 years. Of these patients, 40% (n=8) of patients were bedridden, and 60% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use. CONCLUSIONS Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare.
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Affiliation(s)
- Pansiree Onseng
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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Sang E, Hirschman KB, Bowles KH. Feasibility, usability, and acceptability of psychoeducational videoconferencing interventions for informal caregivers: A systematic review of randomized controlled trials. Res Nurs Health 2024; 47:60-81. [PMID: 38069607 PMCID: PMC10841701 DOI: 10.1002/nur.22358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 01/19/2024]
Abstract
Psychoeducational videoconferencing interventions bypass traditional in-person barriers to attendance and are effective in improving caregiving skills, self-care, and wellness among informal caregivers. Information on their feasibility, usability, and acceptability from the caregivers' perspective is needed to inform future designs and developments. This systematic review follows PRISMA 2020 guidelines to integrate this information. Five databases were systematically searched for relevant randomized control trials published between January 2012 and December 2022. Reference lists were cross-checked for additional studies. Relevant studies were appraised and had their data extracted. This review contains 14 randomized controlled trials. Retention rates ranged from 55.56% to 100%, and major reasons for withdrawing include deteriorating patient health, lack of interest, and technical difficulties (feasibility). Caregivers found the videoconference technology usable, although participants in one intervention experienced poor connectivity and persistent technical issues (usability). Most caregivers were satisfied with videoconferencing interventions, found their content applicable to their situation, and appreciated their structure (acceptability). Those in videoconferencing group interventions were satisfied with small caregiver group sizes (acceptability). Adding respite care to interventions and incorporating short and regular videoconferencing sessions may improve feasibility. Ensuring small group sizes in videoconferencing group interventions and using participatory design may enhance acceptability. Advocacy is needed for employees identifying as informal caregivers to receive employer support and for quality connectivity within underserved areas. This may improve the feasibility and usability of interventions, allowing caregivers to receive the support they need. In future studies, power analyses and recruiting more caregivers may better assess feasibility.
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Affiliation(s)
- Elaine Sang
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen B. Hirschman
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn H. Bowles
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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In de Braekt A, Coolen CM, Maaskant JM, de Man-van Ginkel JM, Eskes AM, Jongerden IP. Views of family members on using video calls during the hospital admission of a patient: A qualitative study. J Adv Nurs 2024. [PMID: 38243625 DOI: 10.1111/jan.16060] [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: 04/17/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Utilization of video calls on hospital wards to facilitate involvement of and communication with family members is still limited. A deeper understanding of the needs and expectations of family members regarding video calls on hospital wards is necessary, to identify potential barriers and facilitate video calls in practice. AIM The aim of this study was to explore the views, expectations and needs of a patient's family members regarding the use of video calls between family members, patients and healthcare professionals, during the patient's hospital admission. METHODS A qualitative study was carried out. Semi-structured interviews with family members of patients admitted to two hospitals were conducted between February and May 2022. Family members of patients admitted to the surgical, internal medicine and gynaecological wards were recruited. RESULTS Twelve family members of patients participated. Family members stated that they perceive video calls as a supplemental option and prefer live visits during hospital admission. They expected video calls to initiate additional moments of contact with healthcare professionals, e.g. to join in medical rounds. When deploying video calls, family members mentioned that adequate instruction and technical support by nurses should be available. CONCLUSION Family members considered video calls valuable when visiting is not possible or to participate in medical rounds or other contacts with healthcare professionals outside of visiting hours. IMPLICATIONS Family members need to be supported in options and use of video calls on hospital wards. Additional knowledge about actual participation in care through video calls is needed as well as the effect on patient, family and healthcare professional outcomes. IMPACT Using video calls on hospital wards can provide family members with flexible alternatives for contact and promote family involvement. REPORTING METHOD COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION Family members of patients admitted to hospital have contributed by sharing their perspectives in interviews. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Family members perceive additional value from the use of video calls on hospital wards. For family, use of video calls needs to be facilitated with clear instruction materials and support. TRIAL AND PROTOCOL REGISTRATION Amsterdam UMC Medical Ethics Review Committee (ref number W21_508 # 21.560).
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Affiliation(s)
- Anna In de Braekt
- Nursing Science, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Celeste M Coolen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jolanda M Maaskant
- Department of Pediatrics, University Medical Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Janneke M de Man-van Ginkel
- Nursing Science, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Nursing Science, Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Eskes
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Digital Health, Amsterdam, The Netherlands
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Irene P Jongerden
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health research institute, Quality and Organization of Care, Amsterdam, The Netherlands
- Expertise Center for Palliative Care, Amsterdam, The Netherlands
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Ko HYK, Tripathi NK, Mozumder C, Muengtaweepongsa S, Pal I. Real-Time Remote Patient Monitoring and Alarming System for Noncommunicable Lifestyle Diseases. Int J Telemed Appl 2023; 2023:9965226. [PMID: 38020047 PMCID: PMC10681793 DOI: 10.1155/2023/9965226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Telemedicine and remote patient monitoring (RPM) systems have been gaining interest and received adaptation in healthcare sectors since the COVID-19 pandemic due to their efficiency and capability to deliver timely healthcare services while containing COVID-19 transmission. These systems were developed using the latest technology in wireless sensors, medical devices, cloud computing, mobile computing, telecommunications, and machine learning technologies. In this article, a real-time remote patient monitoring system is proposed with an accessible, compact, accurate, and low-cost design. The implemented system is designed to an end-to-end communication interface between medical practitioners and patients. The objective of this study is to provide remote healthcare services to patients who need ongoing care or those who have been discharged from the hospital without affecting their daily routines. The developed monitoring system was then evaluated on 1177 records from MIMIC-III clinical dataset (aged between 19 and 99 years). The performance analysis of the proposed system achieved 88.7% accuracy in generating alerts with logistic regression classification algorithm. This result reflects positively on the quality and robustness of the proposed study. Since the processing time of the proposed system is less than 2 minutes, it can be stated that the system has a high computational speed and is convenient to use in real-time monitoring. Furthermore, the proposed system will fulfil to cover the lower doctor-to-patient ratio by monitoring patients from remote locations and aged people who reside in their residences.
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Affiliation(s)
- Htet Yamin Ko Ko
- Department of Information and Communication Technologies, School of Engineering and Technology, Asian Institute of Technology, Pathum Thani 12120, Thailand
| | - Nitin Kumar Tripathi
- Department of Information and Communication Technologies, School of Engineering and Technology, Asian Institute of Technology, Pathum Thani 12120, Thailand
| | - Chitrini Mozumder
- Department of Information and Communication Technologies, School of Engineering and Technology, Asian Institute of Technology, Pathum Thani 12120, Thailand
| | - Sombat Muengtaweepongsa
- Center of Excellence in Stroke, Faculty of Medicine, Thammasat University, Pathum Thani 10121, Thailand
| | - Indrajit Pal
- School of Environment, Resources and Development, Asian Institute of Technology, Pathum Thani 12120, Thailand
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Hu H, Ambadar Z, Quinby E, Choi YK, Setiawan IMA, Saptono A, Parmanto B, Dicianno BE. The iMHere 2.0 System for Family Caregivers of Older Adults: A Focus Group. Int J Telerehabil 2023; 15:e6557. [PMID: 38046547 PMCID: PMC10687951 DOI: 10.5195/ijt.2023.6557] [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: 12/05/2023] Open
Abstract
Background Family caregivers with continuous caregiving responsibilities are at increased risk for adverse physical and mental health outcomes. In response to the challenges of caregiving, a mobile health system (iMHere 2.0) was developed to support caregivers. The study's objective was to gather feedback from family caregivers of older adults on the current features of iMHere 2.0 and to formulate design criteria for future iterations of the system. Methods An exploratory qualitative study with thematic analyses of focus group feedback. Findings A total of 10 caregivers of older adults participated in a focus group. Five themes emerged: (1) Monitoring health data, (2) Setting up customized reminders, (3) Supporting care coordination, (4) Balancing security and multiple user access, and (5) Disseminating iMHere 2.0 into the community, along with some potential barriers to implementation. Conclusions Design criteria were developed to provide a framework for iterative design and development of the iMHere system to support caregivers of older adults.
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Affiliation(s)
- Haomin Hu
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zara Ambadar
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eleanor Quinby
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yong K. Choi
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - I Made Agus Setiawan
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Computer Science, Udayana University, Badung, Bali, Indonesia
| | - Andi Saptono
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bambang Parmanto
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brad E. Dicianno
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Boyt N, Ho AK, Morris-Bankole H, Sin J. Internet-facilitated interventions for informal caregivers of patients with neurodegenerative disorders: Systematic review and meta-analysis. Digit Health 2022; 8:20552076221129069. [PMID: 36276187 PMCID: PMC9585576 DOI: 10.1177/20552076221129069] [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: 12/13/2021] [Accepted: 09/11/2022] [Indexed: 11/15/2022] Open
Abstract
Objective This systematic review explored the effectiveness of internet-delivered interventions in improving psychological outcomes of informal caregivers for neurodegenerative-disorder (ND) patients. Methods We searched seven databases for English-language papers published from 1999 to May 2021. Study-eligibility required that interventions used a minimum 50% internet-facilitation, targeting unpaid, adult informal caregivers of community-based ND-patients. We included randomised controlled trials (RCTs) and pre-post evaluative studies reporting outcomes for at least one-time point post-intervention. Independent quality checks on abstract and full-text screening were completed. Data extraction encompassed interventions' features, approaches, theoretical bases and delivery-modes. The Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS) framework assessed risk of bias. Alongside narrative synthesis, we calculated meta-analyses on post-intervention using outcome measures from at least two RCTs to assess effectiveness. Results Searches yielded 51 eligible studies with 3180 participants. In 48 studies, caregivers supported a dementia-diagnosed individual. Intervention-durations encompassed four weeks to 12 months, with usage-frequency either prescribed or participant-determined. The most frequently-used approach was education, followed by social support. We calculated meta-analyses using data from 16 RCTs. Internet-delivered interventions were superior in improving mastery (g = 1.17 [95% CI; 0.1 to 2.24], p = 0.03) and reducing anxiety (g = -1.29 [95% CI; -1.56 to -1.01], p < 0.01), compared to all controls. Findings were equivocal for caregivers' quality of life, burden and other outcomes. High heterogeneity reflected the multifarious combinations of approaches and delivery-modes, precluding assessment of the most efficacious intervention features. Analyses using burden and self-efficacy outcomes' follow-up data were also non-significant compared to all comparator-types. Although 32 studies met the ICROMS threshold scores, we rated most studies' evidence quality as 'very-low'. Conclusions This review demonstrated some evidence for the efficacy of internet-delivered interventions targeting informal ND-caregivers. However, more rigorous studies, with longer follow-ups across outcomes and involving NDs other than dementia, are imperative to enhance the knowledge-base.
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Affiliation(s)
- Neil Boyt
- School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, RG6 6AL, England,Neil Boyt, School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, RG6 6AL, England, UK.
| | - Aileen K Ho
- School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, RG6 6AL, England
| | - Hannah Morris-Bankole
- School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, RG6 6AL, England
| | - Jacqueline Sin
- School of Health Sciences, University of London, Myddelton Street Building, Myddelton Street, London, EC1R 1UW, England
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Huang SS. Depression among caregivers of patients with dementia: Associative factors and management approaches. World J Psychiatry 2022; 12:59-76. [PMID: 35111579 PMCID: PMC8783169 DOI: 10.5498/wjp.v12.i1.59] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
As elderly people increasingly come to represent a higher proportion of the world’s population, various forms of dementia are becoming a significant chronic disease burden. The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant, central role in dementia care. Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers. Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient. This review article explores depression in dementia caregivers and summarizes proposed mechanisms, associated factors, management and research findings, and proposes future research directions.
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Affiliation(s)
- Si-Sheng Huang
- Division of Geriatric Psychiatry, Department of Psychiatry, Changhua Christian Hospital, Changhua 500, Taiwan
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