Evaluating Caregiver Risk: The Dementia Caregiver Interview Guide

Objectives: Family and other informal caregivers of individuals with dementia can be at increased risk for a significant decline in wellbeing or their ability to continue to provide care. There is extensive literature on the multifactorial elements contributing to risk, but frontline practitioners may be uncertain how to apply their knowledge of risk to an assessment of individual caregivers during clinical encounters. We developed a new one-page guided interview tool (the Dementia Caregiver Interview Guide, or DCIG) to guide practitioners to: (1) systematically assess known factors associated with high caregiver risk in a clinical interview format and (2) concisely document their judgement regarding risk of decompensation arising from caregiver stress. This semi-structured interview format collects detailed information while promoting a collaborative communication process. This study evaluated the validity of risk-assessment using the DCIG. Methods: A convenience sample of 50 caregivers was recruited during routine intake at the Reitman Centre at Sinai Health in Toronto, Canada. Risk was assessed using both the DCIG and the Caregiver Risk Screen (CRS). Total scores on the two tools were compared to establish concurrent and discriminant validity for the DCIG. Results: The DCIG correlated positively with the CRS (Spearman’s rho = 0.737; p < 0.001) and identified caregivers at risk at a moderate level of agreement with the CRS (Cohen’s Kappa = 0.559). Conclusions: The DCIG allows clinicians to efficiently identify caregivers’ level of risk for functional and emotional decline or decompensation in a client-centered, naturalistic manner.

Technology Use among Family Caregivers of People with Dementia

This study explored family caregivers' use of technology to care for people with dementia living at home. Three questions were pursued: (1) what are the important, unmet needs of family caregivers, (2) how do they use technologies to assist in care tasks, and (3) what do health care providers know about caregivers' needs and technology use? Two comprehensive surveys were developed to answer these questions: one for family caregivers (n = 33), and one for health care providers (n = 60). Descriptive and quantitative analyses showed that caregivers' important, unmet needs were in the domains of information, formal services, and emotional support. Caregivers make limited use of technology but believe in its potential usefulness. Health care providers agree that technology is useful in dementia care; however, they underestimate caregivers' willingness to adopt technologies to communicate with providers. Findings prove caregiver willingness to use technology to support their care role and provide guidance regarding the caregiver needs that these technologies should address.

Caregiver Needs Assessment in Primary Care: Views of Clinicians, Staff, Patients, and Caregivers

OBJECTIVES

To understand current practices, challenges, and opportunities for a systematic assessment of family caregivers' needs and risks in primary care.

DESIGN

Qualitative study consisting of in-depth semi-structured interviews.

SETTING

Four primary care practices located in urban and rural settings.

PARTICIPANTS

Primary care clinicians, staff, and administrators (N = 30), as well as older adult patients and family caregivers (N = 40), recruited using purposive and maximum variation sampling.

MEASUREMENTS

Current experiences, challenges, and opportunities for integrating standardized caregiver assessment into primary care delivery. Interviews were audio-recorded and transcribed; transcripts were analyzed using the constant comparative method of data analysis.

RESULTS

Participating clinicians had been in practice for an average of 12.8 years (range = 1-36 y). Patients had a mean age of 84.0 years (standard deviation [SD] = 9.7); caregivers had a mean age of 67.0 years (SD = 9.3). There was wide variability in current practices for identifying caregivers' needs and risks, encompassing direct and indirect approaches, when such issues are considered. Participants posited that integrating standardized caregiver assessment into primary care delivery could help improve patient care, enhance clinician-caregiver communication, and validate caregivers' efforts. Barriers to assessment included insufficient time and reimbursement, liability concerns, lack of awareness of community resources, and concerns about patient autonomy. To facilitate future uptake of caregiver assessment, participants recommended brief self-administered assessment tools and post-screen discussions with practice staff.

CONCLUSION

Identification of caregivers' needs and risks in primary care is highly variable. Integration of standardized caregiver assessment into practice requires coordinated changes to policy, revision of practice workflows, and an interdisciplinary approach to the development of appropriate assessment tools. J Am Geriatr Soc 68:1262-1270, 2020.

Understanding the needs of caregivers of persons with dementia: a scoping review

BACKGROUND

The number of people living with dementia (PWD) is increasing worldwide, corresponding with an increasing number of caregivers for PWD. This study aims to identify and describe the literature surrounding the needs of caregivers of PWD and the solutions identified to meet these needs.

METHOD

A literature search was performed in: PsycInfo, Medline, CINAHL, SCIELO and LILACS, January 2007-January 2018. Two independent reviewers evaluated 1,661 abstracts, and full-text screening was subsequently performed for 55 articles. The scoping review consisted of 31 studies, which were evaluated according to sociodemographic characteristics, methodological approach, and caregiver's experiences, realities, and needs. To help extract and organize reported caregiver needs, we used the C.A.R.E. Tool as a guiding framework.

RESULTS

Thirty-one studies were identified. The most common needs were related to personal health (58% emotional health; 32% physical health) and receiving help from others (55%). Solutions from the articles reviewed primarily concerned information gaps (55%) and the education/learning needs of caregivers (52%).

CONCLUSION

This review identified the needs of caregivers of PWD. Caregivers' personal health emerged as a key area of need, while provision of information was identified as a key area of support. Future studies should explore the changes that occur in needs over the caregiving trajectory and consider comparing caregivers' needs across different countries.

The assessment experience of spousal dementia care-givers: ‘It's made me realise that I am a person also’

This article is based on a study that used a validated care-giver assessment instrument known as ‘The C.A.R.E. (Caregivers’ Aspirations, Realities, and Expectations) Tool’ to understand its usefulness in working with older adults caring for a spouse with cognitive impairment. It draws on data collected as part of a larger, quasi-experimental pre- and post-test study examining the impact of a care-giver assessment on older spousal care-givers of a partner with cognitive impairment. One hundred community-living individuals (average age of 74) participated in the study. Participants met with a third-year nursing student who administered The C.A.R.E. Tool. Within three to seven days following this, a research team member conducted a semi-structured interview by telephone. This interview provided participants with the opportunity to comment on their experience and the usefulness of The C.A.R.E. Tool. Transcriptions of the interviews were analysed using a thematic analysis. Results indicate that the assessment experience was evaluated positively by most participants. Two broad themes emerged: assessment encourages care-givers to take stock of their situation, and it provides a relationship with a caring professional. In particular, the assessment experience gave these care-givers to have the opportunity to reflect, while expressing emotions and developing awareness, and provided them with an appreciated relationship with a caring professional who helped to validate and normalise their situation. For care-givers, the results suggest that assessment may serve as a catalyst for taking action in their care-giving situation or turning to services for help. For practitioners, assessment may increase awareness of the experience of spousal care-givers, potentially leading to interventions to support them. This study found that the attitudes and knowledge of practitioners play a role in care-givers’ experience of the assessment as positive. However, the goal of assessment must be clarified, as outcomes of other tools will differ depending on the aims.

Utilizing evidence-based assessment instruments to detect well-being and distress in English- and Spanish-speaking caregivers of individuals affected by dementia

Objective

The purpose of this study was to examine the most effective and available English and Spanish language caregiver assessments for providers and caregivers.

Methods

Assessments were included if they screened for caregiving-related concerns, including stress, depression, and caregiving burden and could be administered directly to caregivers in person or online.

Results

Eighteen assessments are designed to assess caregiver burden, distress, depression, and grief. Six did not have psychometric data to support efficacy but are widely used in clinical and research settings. Six were validated in Spanish, and one other is available in Spanish but not validated.

Conclusion

As many as 80% of care recipients are cared for in the home by family members who act as informal caregivers. Caregivers of persons with dementia may experience depression symptoms, high caregiver burden, and feelings of being constrained. Due to the lack of psychometric evidence available, the validity of some assessments is questionable.

Agency and Communion in People with Alzheimer’s Disease, as Described by Themselves and their Spousal Carers

Agency (individuality) and communion (togetherness) are vital to a positive sense of self. People with Alzheimer’s disease are at risk of experiencing diminished agency and decreased communion. Their family members’, especially their partner’s, view on their agency and communion is also likely to influence their sense of agency, communion, and self. In the present study, individual interviews with 10 people with Alzheimer’s disease and their spousal carers were qualitatively analysed to describe how in each couple the two spouses viewed the agency and communion of the person with Alzheimer’s disease from an individual perspective. The findings show that the carers generally described the agency of the person with Alzheimer’s disease as slightly weaker compared with the persons with Alzheimer’s disease themselves. The carers also appeared to have poor knowledge of what supported and threatened the sense of communion of the person with Alzheimer’s disease.

The effects of informal carers' characteristics on their information needs: The information needs state approach

BACKGROUND

There has been little research that provides a comprehensive account of the nature and aspects of information needs of informal carers. The authors have previously developed and validated a framework that accounts for major underlying states of information need. This paper aims to apply this framework to explore whether there are common demographic and socioeconomic characteristics that affect the information needs states of carers. A questionnaire about the information needs states was completed by 198 carers above 18 years old. We use statistical methods to look for similarities and differences in respondents' information needs states, in terms of the demographic and socioeconomic variables. At least one information needs state varies among carers, in terms of seven demographic and socioeconomic variables: the age of the patient(s) that they are caring for; the condition(s) of the patient(s) that they are caring for; the number of patients that they are caring for; their length of time as a carer; their gender; the country that they live in; and the population of the area that they live in. The findings demonstrate the utility of the information needs state framework. We outline some practical implications of the framework.

Observing women caregivers' everyday experiences: new ways of understanding and intervening

This article discusses the practice implications of videographic research examining the everyday lived experiences of 5 women family caregivers of older adults with chronic illness. The women's nonverbal expressions and gestures revealed how caregiving is accomplished and lived on a daily basis, in particular through emotion and body management, abnegation, and performance. The findings from this microethnographic study suggest that observing women caregivers' everyday experiences can open new avenues for holistic intervention with this population. Observing nonverbal cues can offer a way for practitioners to better understand women caregivers' realities, to question their practice, and to adapt their interventions accordingly.

Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: a qualitative study

BACKGROUND

Current end-of-life care policy and guidance recognises the important contribution of family carers, recommending that their needs should be assessed to support them in their caring role. How regular carer assessment is to be achieved is unclear, particularly because there is no evidence-based tool for directly assessing carers' support needs that is suitable for use in end-of-life home care practice.

AIMS

To obtain carers' perspectives of key aspects of support needed during provision of end-of-life care at home and to develop a carer support needs assessment tool suitable for use in everyday practice.

DESIGN

Qualitative using focus groups and telephone interviews. Thematic analysis uses a framework approach.

SETTING/PARTICIPANTS

75 adult bereaved carers who were family members/friends of patients referred to five Hospice at Home services in the UK.

RESULTS

Carers' needs fell into two distinct groupings of key support areas or 'domains': support to enable them to provide care for their relative and more direct personal support for themselves. Many aspects of supportive input were common across domains, for example, anticipatory information, explanations or being included in the care process. Therefore, the tool was designed as a screening measure, to identify support needs requiring further detailed assessment.

CONCLUSIONS

The Carer Support Needs Assessment Tool (CSNAT) is an evidence-based direct measure of carers' support needs in 14 domains. It is short but comprehensive in approach and thus suitable for both end-of-life care research and practice. Further work has been undertaken to test its psychometric properties.

Relational experiences of family caregivers providing home-based end-of-life care

The multiple relationships involved in home-based end-of-life care have received little systematic analysis. As part of a focused ethnographic study examining client-caregiver-provider relational care experiences within the sociocultural context of home-based end-of-life care, this article describes the provision of end-of-life care to older adults with advanced cancer from the perspective of family caregivers. Data were collected through in-depth interviews (n = 16) with 4 family caregivers and participant observations in each of the 4 households over a 6- to 8-month period. Family caregiving in home-based end-of-life care was portrayed in this study as 3 dialectical relational care experiences: (1) prioritizing care recipient needs-ignoring own needs, (2) feeling connected-feeling isolated, and (3) juggling to manage-struggling to survive. Study findings suggest that the sociocultural context of end-of-life care is not conducive to quality care and provide several insights for future directions in nursing practice, policy, and research.

Caregivers' retirement congruency: a case for caregiver support

Using the concept of retirement congruency (RC), which takes into account greater variation in retirement decisions (low, moderate, or high RC) than a dichotomous conceptualization (forced versus chosen), multinomial logistic regression was conducted on a sample of caregivers from the 2002 Canadian General Social Survey who were retired from employment (n=700). Different variables increased the risk of having low and moderate RC, when both were compared to high RC. Factors predicting low RC (versus moderate RC), were similar but not identical to those predicting low RC (versus high RC). Retiring for health reasons and job problems were significant in all three comparisons. Retiring to give care only increased the probability of having moderate RC, compared to high RC, indicating that many employed caregivers who voluntarily retired because ofcaregiving responsibilities still expressed a desire to have remained in the labor force. Results raise questions about which policy domain-income security or labor-is most appropriate within this context.

Dementia home care resources: how are we managing?

With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future.

Perspectives from the frontlines: palliative care providers' expectations of Canada's compassionate care benefit programme

Recognising their valuable role as key informants, this study examines the perspectives of front-line palliative care providers (FLPCP) regarding a social benefit programme in Canada designed to support family caregivers at end-of-life, namely the Compassionate Care Benefit (CCB). The CCB's purpose is to provide income assistance and job security to family caregivers who take temporary leave from employment to care for a dying family member. Contributing to an evaluative study that aims to provide policy-relevant recommendations about the CCB, this analysis draws on semi-structured interviews undertaken in 2007/2008 with FLPCPs (n = 50) from across Canada. Although participants were not explicitly asked during interviews about their expectations of the CCB, thematic content analysis revealed 'expectations' as a key finding. Through participants' discussions of their knowledge of and familiarity with the CCB, specific expectations were identified and grouped into four categories: (1) temporal; (2) financial; (3) informational; and (4) administrative. Findings demonstrate that participants expect the CCB to provide: (1) an adequate length of leave time from work, which is reflective of the uncertain nature of caregiving at end-of-life; (2) adequate financial support; (3) information on the programme to be disseminated to FLPCPs so that they may share it with others; and (4) a simple, clear, and quick application process. FLPCPs hold unique expertise, and ultimately the power to shape uptake of the CCB. As such, their expectations of the CCB contribute valuable knowledge from which relevant policy recommendations can be made to better meet the needs of family caregivers and FLPCPs alike.

Needs, barriers and facilitators experienced by spouses of people with aphasia

PURPOSE

Little is known about how spouses cope with their needs as a result of their partner's aphasia. This study described spouses' needs and identified the barriers and facilitators to satisfying them.

METHODS

Four associations of people with aphasia were approached. Eleven spouses were interviewed in small groups. They described the results of their inquiries and efforts to satisfy their needs because their partner had aphasia (mean time since onset 6 years 8 months) as a result of stroke or surgery. Discussions were transcribed and coded. Excerpts were grouped into categories.

RESULTS

Spouses mainly needed support and respite, and perceived their partner to need help for communication and well-being. Personal factors like the availability of close others to provide help were facilitating. However, participants encountered barriers, mainly organisational, i.e. the help needed did not exist. Some needs persisted over time.

CONCLUSIONS

Results confirm the long-term needs of spouses in adjusting to the aphasia of their partner, as well as the limited services available to them. Many of the needs reflected spouses' concerns about their partner, while others were a consequence of their caregiving role as well as the unavailability of support. Spouses of people with aphasia should have access to support during and after rehabilitation.

Evaluation of an assessment battery for estimating dementia caregiver needs for health and social care services

OBJECTIVES

The aim of this study was to examine a battery of questionnaires for assessing the personal resources and vulnerabilities of family caregivers of persons with dementia (Alzheimer or other).

METHODS

A cross-sectional survey design was used to obtain dementia caregiver responses to questionnaires that targeted caregiver stress response, physical/mental health status, self-efficacy, personality, and social support.

RESULTS

A personality factor (neuroticism) explained over 20% of the variance in caregiver mental health status and depression. With caregiver distress as the dependent variable, personality and self-efficacy accounted for 15% to 17% of the explained variance.

CONCLUSIONS

The results suggest that measures of personality factors, self-efficacy, mental health status, and distress response could be used for assessing caregiver vulnerabilities and health service needs. This individualized approach could ensure allocation of multicomponent intervention programs that have been shown to be more effective in sustaining caregiver role functions.

What Will the Family Composition of Older Persons Be Like Tomorrow? A Comparison of Canada and France

L’ensemble des sociétés occidentales connaissent actuellement une croissance considérable des personnes âgées de 75 ans et plus. De nombreux changements familiaux affectant ces sociétés, il est pertinent de se demander qui prendra en charge les aînés de demain en cas de besoin d’assistance. Cet article compare les projections démographiques du réseau familial des personnes âgées de 75 ans et plus jusqu’en 2030 au Canada et en France. Au cours des 25 années prochaines, le vivier des aidants familiaux potentiels, constitué des conjoint(e)s et des enfants, s’élargira en raison des effets du Baby Boom (dont l’ampleur a été particulièrement forte au Canada) et de la proportion croissante de femmes qui ont un conjoint. Les populations les plus tributaires de l’aide formelle – sans soutien potentiel provenant d’un enfant ou d’un conjoint – augmenteront à un rythme beaucoup plus soutenu au Canada (123 pour cent) qu’en France (34 pour cent), mais moins rapidement toutefois que l’ensemble des personnes âgées. Les politiques publiques de ces deux pays devront être adaptées afin de soutenir adéquatement des effectifs croissants de personnes âgées confrontés à la dépendance de leurs conjoints. Au Canada, ces politiques devront, de plus, faire face à une hausse, plus forte qu’en France, du nombre d’aînés qui dépendront des services d’aide formelles.