Covid-19 and the quality of life of people with dementia and their carers-The TFD-C19 study

Introduction

COVID-19 has placed unprecedented pressure on dementia health and social care systems worldwide. This has resulted in reduced services and support for people with dementia and their family carers. There are gaps in the evidence on the impact of the pandemic on Quality of Life (QoL). We carried out a study on the impact of the pandemic on the QoL of a group of people with dementia and their family carers who were part of a larger existing cohort study.

Methods

We quantitatively measured QoL, on two occasions during the two national lockdowns in 2020 and compared these data with those obtained when they entered the study (before the pandemic). Measures used included: DEMQOL-Proxy, Clinical Dementia Rating Scale and C-DEMQOL. To understand how QoL changed over time, a repeated measures ANOVA was run for each dependent variable with the following variables entered as co-variates: duration in study, baseline dementia severity, gender of the family carer, gender of the person with dementia, family carer relationship, dementia type, living status, age of the person with dementia, and age of the family carer.

Results

248 participants took part in the study. QoL scores did not significantly decline between either time period for the person with dementia or their family carer. There was variation in subgroups; with co-resident status, carer relationship, gender of the person with dementia, age of the person with dementia, and baseline cognitive status influencing QoL outcomes in family carers.

Discussion

It is striking that people with dementia and their carers did not report a decline in QoL during the pandemic or in the months following restrictions suggesting the possibility of resilience. Variation in subgroups suggests that specific groups of family carers were more vulnerable to lower QoL; indicating the need for more tailored, nuanced support during this period.

An analysis of carer burden among family carers of people with and without dementia in Ireland

OBJECTIVE

Despite the policy relevance of carer burden, limited research focuses on family carers' experience of carer burden among different disease groups. This study aimed to examine differences in carer burden among family carers of people with and without dementia.

DESIGN

Secondary data analysis was conducted on a national cross-sectional dataset. Multivariable ordered logistic regression was used to analyze four levels of carer burden (low, mild, moderate, high). The main independent variable was dementia diagnosis, and controls included variables relating to the care recipient, family carer, and context of care.

SETTING

The original survey was funded by Irish Health Service Executive and undertaken by the National Centre for the Protection of Older People in Ireland.

PARTICIPANTS

The original dataset consisted of 2,311 family carers of older people in Ireland. Approximately, one-fifth of this sample had a diagnosis of dementia.

MEASUREMENTS

Carer burden was measured using the standardized 22-item Zarit Burden Interview. Care-recipient dependency was measured using the Activities for Daily Living Scale. Sociodemographic details and information about the context of caring were collected using self-report scales.

RESULTS

In our model, dementia diagnosis and dependency level were significantly associated with carer burden. Family carer and context of care variables including gender, marital status, education, residence, co-residence, and perceived support showed significant relationships with carer burden. Our results highlighted significant differences in carer burden distribution; in particular, family carers of people with dementia were less likely to report low or mild carer burden (-6.95 ppts and -3.64 ppts, respectively) and more likely to report moderate or high carer burden (8.46 ppts and 2.13 ppts, respectively).

CONCLUSION

Our findings suggest that family carers of people with dementia may experience additional challenges associated with caring. Therefore, family carers of people with dementia may require tailored social supports to maintain good health and well-being.

Geographical proximity and depressive symptoms among adult child caregivers: social support as a moderator

OBJECTIVES

This study examined whether geographical proximity is a predictor of depressive symptoms, and whether family and friend support can moderate the relationship between geographical proximity and depressive symptoms.

METHOD

A survey of 557 adult child primary caregivers was conducted in Shanghai, China in 2013. Geographical proximity was measured as a categorical variable: coresidence, short distance (less than 30 minutes' travel time), and long distance (more than 30 minutes' travel time). Family and friend support were assessed using the Multidimensional Scale of Perceived Social Support. Depressive symptoms were evaluated using the Center on Epidemiologic Studies Depression Scale. Multiple regression analyses and interaction terms were used to test the moderating roles of family and friend support.

RESULTS

Adult child caregivers who live more than 30 minutes away from care recipients experienced higher depressive symptoms than coresiding caregivers (β = .114, p < .01). Family support (β = -.408, p < .05) and friend support (β = -.235, p < .05) were protective factors that lessened depressive symptoms for long-distance adult child caregivers.

CONCLUSION

This study adds spatial dimension to caregiving literature and extends stress process theory. These findings have important implications for service planning and social support for adult child caregivers.

Family close but friends closer: exploring social support and resilience in older spousal dementia carers

OBJECTIVES

Spousal dementia carers have unique support needs; they are likely to disengage from their existing social networks as they need to devote more time to caring as the disease progresses. Previously we showed that support resources can facilitate resilience in carers, but the relationship is complex and varies by relationship type. The current paper aims to explore social support as a key component of resilience to identify the availability, function and perceived functional aspects of support provided to older spousal dementia carers.

METHOD

We conducted 23 in-depth qualitative interviews with spousal carers from two carer support groups and a care home in North West England.

RESULTS

Family and friends served a wide range of functions but were equally available to resilient and non-resilient participants. Family support was perceived as unhelpful if it created feelings of over-dependence. Participants were less likely to resist involvement of grandchildren due to their relatively narrow and low-level support functions. Friend support was perceived as most helpful when it derived from those in similar circumstances. Neighbours played a functionally unique role of crisis management. These perceptions may moderate the effect of support on resilience.

CONCLUSION

Family and friend support is not always sufficient to facilitate resilience. Support functions facilitate resilience only if they are perceived to match need. Implications of these findings are discussed.

Alzheimer’s Caregiver Differences in Experience of Loss, Grief Reactions and Depressive Symptoms Across Stage of Disease

The self-reported losses, grief reactions, and depressive symptoms experienced by caregivers in the early, middle, and late stages of dementia were assessed using open-ended descriptive questions and scaled measures including the Meuser-Marwit Caregiver Grief Inventory (MM-CGI; Marwit & Meuser, 2002). Ninety-nine caregivers associated with an urban Alzheimer’s Association chapter were surveyed by post. While there were moderate levels of grief and depression reported across the entire sample, those caring for individuals in the late stage of dementia reported significantly more symptoms of grief and depression than those in the early or middle stages. Responses to open-ended questions regarding losses and grief also differed across the groups in the three disease stages. The late-stage group’s comments most resembled bereavement, in keeping with the higher grief and depression scores among members of this group. Findings suggest there are different emotional tasks faced by caregivers as the dementia progresses, and it is important to acknowledge the particular losses and facilitate grieving at each stage.

What Quality Paid Home Care Means to Family Caregivers

The authors investigate the meanings of paid home care for family caregivers to frail older adults, comparing and contrasting what good and poor quality home care means to their caregiving efforts. Semistructured interviews were conducted with caregivers and were analyzed qualitatively, using McCracken’s (1988) five-step method for analysis of long interviews. Data from two studies were combined because of similarities in sample characteristics and interview questions and because data from the second study included both positive and negative experiences with home care providers. The authors find that caregivers perceived that good-quality paid home care facilitated enhanced quality of life for care recipients and improved perceptions of their performances as caregivers. When paid home care was of poor quality, caregivers felt more stress and increased their monitoring of providers. Caregiver circumstances, as well as care recipient needs, should be considered in making decisions about who receives formal home care services.

Factor Analysis of the 12-Item Zarit Burden Interview in Caregivers of Persons Diagnosed With Dementia

The Zarit Burden Interview (ZBI) is commonly used to measure dementia caregiver burden, but its factor structure is unclear. A two-factor structure for the 12-item ZBI, “personal strain” and “role strain,” has been shown, but recent data suggest that an additional factor of “guilt” is embedded in the “role strain” items. The 12-item ZBI administered to 194 informal rural and urban caregivers of persons diagnosed with dementia was analyzed using exploratory factor analysis. A two-factor structure, with item loadings consistent with previously conceptualized constructs of “personal strain” and “role strain,” was found. Moreover, this factor structure was invariant to caregiver subgroups. When the predictive value of these factors was explored, only “personal strain” was important in predicting caregiver psychological distress, measured with the Brief Symptom Inventory. However, “role strain,” which included the hypothesized “guilt” items, did not appear to be an important predictor of caregiver distress.

Effects of a problem-solving intervention (COPE) on quality of life for patients with advanced cancer on clinical trials and their caregivers: simultaneous care educational intervention (SCEI): linking palliation and clinical trials

CONTEXT

Patients on investigational clinical trials and their caregivers experience poor quality of life (QOL), which declines as the disease progresses.

OBJECTIVE

To examine the effect of a standardized cognitive-behavioral problem-solving educational intervention on the QOL of patients enrolled on investigational clinical trials and their caregivers.

DESIGN

Prospective, multi-institution, randomized trial. QOL was measured repeatedly over 6 months.

PARTICIPANTS

Patients were simultaneously enrolled onto phase 1, 2, or 3 Institutional Review Board (IRB)-approved cancer clinical trials.

INTERVENTION

Intervention arm dyads participated in three conjoint educational sessions during the first month, learning the COPE problem solving model. Nonintervention arm dyads received usual care.

OUTCOME MEASURES

Global QOL was measured by the City of Hope Quality of Life Instruments for Patients or Caregivers; problem solving skills were measured by the Social Problem Solving Inventory-Revised.

RESULTS

The results are reported using the CONSORT statement. The analytic data set included 476 dyads including 1596 patient data points and 1576 care giver data points. Patient QOL showed no significant difference in the rate of change between the intervention and usual care arms (p = 0.70). Caregiver QOL scores in the intervention arm declined, but at less than half the rate in the control arm (p = 0.02).

CONCLUSIONS

The COPE intervention enabled the average caregiver to come much closer to stable QOL over the 6-month follow-up. Future studies should enroll subjects much earlier in the cancer illness trajectory, a common patient/caregiver theme. The maximum effect was seen in caregivers who completed the 6-month follow-up, suggesting that the impact may increase over time.

Canadian Alzheimer's disease caregiver survey: baby-boomer caregivers and burden of care

OBJECTIVE

Alzheimer's disease (AD) burdens not only the person, but also the person's caregiver(s). This burden has been linked to negative health effects for caregivers. To that end, a survey of Canadian caregivers of persons with AD/other dementias was conducted to investigate the social, physical, psychological and financial impact of AD and/or dementia-related conditions on caregivers' quality of life.

METHODS

A web-based survey, the Canadian Alzheimer's Disease Caregiver survey, was made available through the Canadian Alzheimer's Society website and 50plus.com, an internet portal for baby boomers (BB) (people aged 50 years or older), as well as through HarrisDecima Research's e-Vox panel. A total of 398 individuals completed the survey between 15 September and 5 November 2006.

RESULTS

Of the 398 total respondents, 221 were identified as baby boomers who provided care to an individual with AD/dementia. Respondents identified several areas of burden of care. These included negative effects on emotional health (such as increased depression, more stress and greater fatigue), financial costs and a need to change a working situation (e.g. by retiring early, reducing work hours or refusing a promotion).

CONCLUSION

Caregivers of persons with AD/related dementia face important social, physical, psychological and financial pressures. These negatively affect the quality of life of caregivers with a significant increased burden being placed on live-in caregivers versus caregivers who do not co-reside with their care recipients. Interventions that address these pressures will not only improve the health and well-being of caregivers, but likely also the care of persons with AD/dementia.

Caregiving: Predicting At-Risk Status

Malgré l'accent mis, lors de la recherche en gérontologie, sur les obligations en matière de prestation de soins, des études ont démontré que peu de dispensateurs de soins sont soumis à un trop lourd fardeau. Le présent article compare les prévisions des obligations particulières aux rôles et deux mesures de la qualité de vie chez les dispensateurs de soins soumis à des exigences importantes en matière de soins de santé afin d’évaluer les effets du rôle de chacun. l'étude a porté sur 92 dispensateurs communautaires de soins dans l'île de Vancouver, en Colombie-Britannique. Les prédicteurs comprenaient des facteurs primaires de stress, des ressources personnelles, et des facteurs socio-démographiques. Les exigences en matière de prestation de soins ont été la corrélation la plus significative des obligations particulières aux rôles, et elles avaient une importance indirecte en raison des obligations liées au bien-être général. La résilience avait un rapport important avec les trois résultats. Au cours de l'année de l'étude, les dispensateurs de soins se sont améliorés dans les trois résultats, mais ils n’ont pas réussi à prévoir ce changement. Les résultats suggèrent que les dispensateurs de soins peuvent être à la fois accablés et faire simultanément l'expérience d’un bien-être appréciable ou élevé, ce qui exige de ne pas généraliser à partir d’études limitées uniquement aux obligations des dispensateurs de soins lorsqu’il s’agit de présenter des recommandations sur l'ensemble de la vie de chacune de ces personnes.

Personality, Cognitive Adaptation, and Marital Satisfaction as Predictors of Well-Being among Older Married Adults

The current study examines constructs that contribute to the well-being of an international sample of older married adults. A convenience sample of 208 participants was recruited through an Internet site as well as more traditional means such as newspaper advertisements and contact with community groups. The resulting structural equation model provides further support for the revised theory of cognitive adaptation. Within this model, the direct and indirect contributions of personality, marital satisfaction, and cognitive adaptation are examined in relation to well-being. Contrary to previous findings, personality appears to have an indirect effect upon both marital satisfaction and well-being. Cognitive adaptation, in contrast, has both a direct and indirect effect upon the well-being of older adults. Limitations of use of the Internet as a vehicle for data collection are considered as well as directions for future study.

Unmet supportive care needs and interest in services among patients with a brain tumour and their carers

OBJECTIVES

To assess the supportive care needs and interest in related services among brain tumour patients and their carers and to compare the level of unmet needs to other cancer populations.

METHODS

A cross-sectional survey was posted to 363 households who were subscribed to the Queensland Cancer Fund Brain Tumour Support Service in 2005. Overall, 75 patients and 70 carers (response rate 29.8%) returned completed questionnaires. Measures were the Supportive Care Needs Survey (SCNS-34) and a brain tumour specific subscale for patients and carers, as well as the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Patients most frequently reported requiring support to overcome fatigue, uncertainty about the future and not being able to do the things they used to do. Carers wanted help dealing with fears about the patients mental or physical deterioration, with the impact caring had on their own life, and with reducing stress in the patient's life. Among patients, 30% reported anxious mood and 17% depressed mood on the HADS, while corresponding numbers for carers were 40% and 10%, respectively. Patients and/or carers with higher than average supportive care needs expressed greater interest in support services, such as those to improve physical activity, using community services more effectively and to manage stress. Greater emotional distress predicted higher supportive care needs (e.g. odds ratio depressed patients=2.11; (95% confidence interval 1.10-4.03), while no association was detected between patients' or carers' demographic characteristics, or patients' self-reported medical status and higher than average supportive care needs.

CONCLUSION

The level of unmet supportive care needs observed among patients with a brain tumour and their carers is similar to that observed among cancer populations with metastatic disease.

PRACTICE IMPLICATIONS

Interventions for this group should integrate lifestyle, coping support, and neuropsychological rehabilitation.

Episodic Crises in the Provision of Care to Elderly Relatives

An extensive body of research explores caring for older relatives. However, relatively little is known about crisis episodes in the provision of care to older adults. The purpose of this research is to explore the nature of crises in employed caregivers' lives by examining the type, frequency, and impact associated with crises. Data come from the Canadian Aging Research Network's (CARNET) survey of 5,496 employed Canadians. The analyses focus on open- and close-ended data collected from 250 respondents (108 men and 142 women) with caregiving responsibilities. Nearly half the participants (47%) reported a crisis in the previous 6 months. Crises are predictable and unpredictable events in the lives of the caregiver and the older person receiving care. They are primarily health related but could also be social, emotional, financial, and idiosyncratic to a family. Findings from this research contribute to a more comprehensive understanding of the trajectories in caregiving.

Recurrent depressive symptomatology and physical health: a 10-year study of informal caregivers of persons with dementia

OBJECTIVE

To examine the degree to which recurrent depressive symptomatology predicts the decline in the health status of a randomly derived national sample of caregivers of persons with dementia.

METHOD

Individuals with dementia and their caregivers were recruited from each Canadian province as part of a national epidemiologic study of dementia prevalence and the health and welfare of care providers. Both patients and caregivers were assessed at 3 points over a 10-year period. Cohabiting family members who shared the same residence as care recipients were selected for the current study (n = 96 pairs). We computed a repeated measures analysis of variance to compare the health of caregivers who were consistently asymptomatic for depression, of those symptomatic at 1 of 3 points of measurement, and of those symptomatic at 2 of 3 points.

RESULTS

As hypothesized, caregivers presenting with elevated depressive symptomatology at multiple points of measurement reported poorer and worsening physical health over time.

CONCLUSIONS

The results of this study support the assertion that depressive symptomatology significantly predicts the decline in health status of caregivers of persons with dementia. Concerted effort to treat depression in this population is warranted to forestall this trajectory of decline and premature patient institutionalization.

Measurement and analysis of behavioural disturbance among community-dwelling and institutionalized persons with dementia

Census data suggest that persons over 84 years of age represent the fastest growing segment of populations in most western nations. As advancing age remains the single strongest risk factor for dementia, prevalence rates are expected to increase substantially in coming years. This awareness underscores the need to more fully understand the clinical presentation of Alzheimer disease and other neurodegenerative disorders. The present study examines responses to the 28-item Dementia Behaviour Disturbance Scale (DBD; Baumgarten, Becker, & Gauthier, 1990) among a national sample of persons with dementia (PWD) in Canada. A 3-factor solution appears to best reflect DBD responses for both institutionalized and community-dwelling PWD. This finding is notable given that the former was significantly more impaired and presented with significantly greater levels of behavioural disturbance. Support for the factorial validity of these constructs is provided relative to caregiver burden and depressive symptomatology. Of note, only 14 of 28 DBD items were retained in our analyses; on this basis, we propose the use of an abridged version of the scale. These findings can be generalized with greater confidence given the random and representative nature of the PWD and caregiver samples.

Caregiver physical and mental health predicts reactions to caregiving

Self-reported health and reactions to providing care to older adults with cognitive or physical impairments were examined. Health status was examined on a single occasion in 177 persons (aged 63-94 years) referred to programs within a comprehensive set of geriatric care services and the 133 family members involved in their care (ages 31-96 years). The five-scale Caregiver Reaction Assessment (CRA) was administered to the family members. Reliability analyses revealed that the CRA had good internal consistency. Being older was related to experiencing greater health problems in the caregiver role. Greater health problems from providing care were reported by caregivers in worse physical health and also when the care recipient had more physical pain. Caregivers who reported fewer health problems attributed to caregiving reported better mental health and less depressive symptomatology. Caregivers with health problems may be at increased risk of suffering from stress from caregiving.

More than the epidemiology of Alzheimer's disease: contributions of the Canadian Study of Health and Aging

OBJECTIVE

To highlight contributions to knowledge made by the Canadian Study of Health and Aging (CSHA).

METHOD

The CSHA began in 1991, with follow-ups in 1996 and 2001. It was national in scope, with 18 study centres and a coordinating centre. It included 10 263 participants; of these, 9008 were in the community, and 1255 were in institutions. In each phase, community participants were screened for cognitive impairment, and where appropriate, cognitive status was determined by a detailed clinical examination. Data on possible risk factors for dementia were collected at baseline. Data on caring for people with dementia were collected in each phase.

RESULTS

The prevalence of dementia was established at 8% of those aged 65 years and over; incidence (new cases each year) was about 2%. Cognitive impairment not dementia (CIND) was more than twice as common as dementia. Factors affecting the risk of institutionalization, mortality, and the health of caregivers were examined. The costs of dementia were conservatively estimated at dollar 3.9 billion in 1991. Risk factors for Alzheimer's disease (AD) and vascular dementia are presented; it is noteworthy that physical activity appeared to protect against all forms of cognitive decline, particularly for women. Clinical contributions include the development of norms for several neuropsychological tests. Other topics include the health of those with CIND, predicting dementia, medication use, frailty and healthy aging, and urinary incontinence.

CONCLUSION

The CSHA has contributed substantially to knowledge of the epidemiology of dementia, including AD, and to many other topics relevant to seniors' health.

Depressive symptoms and physical health of caregivers of persons with cognitive impairment: analysis of reciprocal effects over time

Research indicates that caregivers of persons with cognitive impairment are at elevated risk for clinical depression. The current study examines the association between physical illness and depressive symptoms among caregivers over a 5-year interval.

METHODS

Participants were recruited as part of a longitudinal study of dementia prevalence in Canada (N = 382). Persons with cognitive loss and their primary caregivers were randomly identified from each Canadian province.

RESULTS

Subsequent to control for sociodemographic variables, patient illness characteristics and initial depressive symptomatology, baseline health of caregivers contributed significantly to the prediction of depressive symptoms five years later. In contrast, depressive symptomatology was not a significant predictor of physical health over this same interval (again controlling for sociodemographic variables, patient illness characteristics, and caregivers' health at baseline).

DISCUSSION

These analyses provided partial support for reciprocal effects between physical illness and depression. Findings are discussed in terms of the applicability of a model of reciprocal effects to older adults.

Psychometric properties of an abridged version of The Zarit Burden Interview within a representative Canadian caregiver sample

PURPOSE

Given the exponential increase in dementia prevalence anticipated in the coming years, measurement of caregiver burden has become common in gerontological research and clinical practice. The Zarit Burden Interview (BI) has emerged as the most widely utilized burden measure. The current study examines the psychometric properties of responses to an abridged, 12-item version of this scale.

DESIGN AND METHODS

Data were derived from a national epidemiological study of dementia incidence and patterns of care (N = 1,095). Informal caregivers of surviving institutionalized and community-dwelling index subjects were interviewed 5 years subsequent to initial recruitment (n = 770).

RESULTS

Results of both the exploratory and confirmatory factor analyses support a two-factor structure of responses to this abridged scale. Subsequent to control for demographic variables, dementia illness features, and baseline depressive symptoms at baseline, responses to this brief BI provide a significant increase to prediction of depressive symptoms at Time 2 (R(2) =.24, p <.01) with no additional variance provided by the 10 remaining items from the complete BI (deltaR(2) = 0, ns).

IMPLICATIONS

The results of this study are discussed relative to theory and the operational definition of caregiver burden. Findings can be generalized with greater confidence given the representative and national composition of caregivers recruited for this study.

Development and validation of a couples measure of biased responding: the Marital Aggrandizement Scale

More than 30 years ago, Edmonds (1967) recognized the need for a couples measure of biased responding. Like other categories of self-report instruments, marital measures are believed to be highly susceptible to distortion. In this study, we describe the development of the Marital Aggrandizement Scale (MAS). For this study, item analyses were performed on a subset of responses (n = 200). A priori inclusion criteria were applied from which a set of 18 items was selected. Three phases of validation research establish the reliability and validity of responses to the MAS among an international sample of older married adults (n = 410). The concurrent and discriminant validity of responses to this scale is demonstrated vis-à-vis separate measures of biased responding, marital satisfaction, and psychological well-being. Internal consistency was calculated as alpha = .84. Test-retest reliability was calculated as r(200) = .80 over an average interval of 15 months. The challenge remains to identify factors associated with the etiology and maintenance of this construct. Subsequent research is required to identify correlates and antecedents of marital aggrandizement across populations over time.