Change in Social Engagement among Incident Caregivers and Controls: Findings from the Caregiving Transitions Study

Informal Caregiver Social Network Types and Mental Health: The Mediating Role of Psychological Resilience

Little is known about whether and why social networks protect mental health among informal caregivers. This study examined the association between informal caregiver social network types and depressive symptoms and the mediatory mechanism of psychological resilience. Latent class analysis, applied to cross-sectional data on 278 Singaporean caregivers, identified four social network types: restricted (42%), friend (16%), family (21%), and diverse (21%). Path analysis showed that the diverse social network type, compared to the restricted social network type, was associated with a lower level of depressive symptoms, and psychological resilience fully mediated this association. Interventions should help caregivers to maintain social networks with their family and friends.

2024 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.

Social Activity Restriction and Psychological Health Among Caregivers of Older Adults With and Without Dementia

OBJECTIVES

We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups.

METHODS

Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers' age, gender, race, education, relationship to care recipient, and self-rated health.

RESULTS

Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting friends and family was associated with higher distress and lower well-being in non-dementia caregivers. Any activity restriction had stronger association with distress for caregivers of older adults with versus without dementia.

DISCUSSION

Findings highlight the need for tailored interventions based on caregivers' perceptions of meaningful social activities and dementia-friendly communities to promote social participation.

Changes in Network Size, Quality, and Composition among Informal Caregivers in Different Welfare Clusters: Longitudinal Analyses Based on a Pan-European Survey (SHARE)

INTRODUCTION

This study analyzed the association between transitions into informal caregiving, inside and outside their own household, and changes in network size, quality, and composition among older adults (≥50 years) in four different welfare systems in Europe.

METHODS

Data from waves 4, 6, and 8 of the Survey of Health, Ageing and Retirement in Europe was used and included up to 110,823 participants (aged ≥50 years) from 12 countries. Participants were asked about informal caregiving inside and outside the household and their network size, quality (emotional closeness, contact frequency), and composition (family, friends, men, women). Adjusted linear and Poisson fixed effects regression analyses were conducted.

RESULTS

Participants transitioning into any caregiving (inside or outside the household) had a larger network. More women and family members were found among all those transitioning into caregiving, but only outside caregiving was associated with more men and friends in the network. Transitioning into caregiving outside was associated with reduced network closeness and contact. Changes among caregivers outside were similar in all welfare states but were more pronounced among caregivers inside the household of Eastern Europe.

CONCLUSION

Different patterns of changes in network size, quality, and composition were found among adults transitioning into caregiving inside and outside the household. All parameters changed among caregivers outside the household. However, the welfare system played a key role in the network changes among inside household caregivers. Thus, the micro as well as the macro context of caregiving is important for the support network of informal caregivers.

Associations of Midlife Dietary Patterns with Incident Dementia and Brain Structure: Findings from the UK Biobank Study

BACKGROUND

At present, the results on the associations between dietary patterns and the risk of dementia are inconsistent, and studies on the associations between dietary patterns and brain structures are limited.

OBJECTIVE

We aimed to investigate the associations of midlife dietary patterns with incident dementia and brain structures.

METHODS

Based on the UK Biobank Study, we investigated the 1) prospective associations of four healthy dietary pattern indices (healthy plant-based diet index [hPDI], Mediterranean diet score [MDS], Recommended food score [RFS], and Mediterranean-Dietary Approaches to Stop Hypertension Intervention [DASH] Intervention for Neurodegenerative Delay Diet [MIND]) with incident dementia (identified using linked hospital data; N = 114,684; mean age, 56.8 years; 55.5% females) using Cox proportional-hazards regressions and the 2) cross-sectional associations of these dietary pattern indices with brain structures (estimated using magnetic resonance imaging; N = 18,214; mean age, 55.9 years; 53.1% females) using linear regressions. A series of covariates were adjusted, and several sensitivity analyses were conducted.

RESULTS

A total of 481 (0.42%) participants developed dementia during the average 9.4-year follow-up. Although the associations were not statistically significant, all dietary patterns exerted protective effects against incident dementia (all hazard ratios < 1). Furthermore, higher dietary pattern indices were significantly associated with larger regional brain volumes, including volumes of gray matter in the parietal and temporal cortices and volumes of the hippocampus and thalamus. The main results were confirmed via sensitivity analyses.

CONCLUSIONS

Greater adherence to hPDI, MDS, RFS, and MIND was individually associated with larger brain volumes in specific regions. This study shows a comprehensive picture of the consistent associations of midlife dietary patterns with the risk of dementia and brain health, underscoring the potential benefits of a healthy diet in the prevention of dementia.

2023 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.

Loneliness in the presence of others: A mixed-method study of social networks of caregivers of patients with severe mental disorders

BACKGROUND

One in four families has at least one member with a mental disorder and families are the main caregivers in most patients in low and middle-income countries. Caregivers experience disruption in their routine lives, increased responsibilities, increased need for support, and changes in their network. The role of personal support networks in the health and burden of the caregivers is complex and depends on the context, cultural and socioeconomical variables. In this study, we aimed to investigate the personal support network of caregivers of patients with severe mental illness in Iran.

METHODS

By using a mixed-methods design, we focused on the structure and composition of caregiver networks, as well as self-perceived caregiver support.

RESULTS

We found that the support network of caregivers was mostly composed of immediate family members whom themselves were selectively chosen as a result of the multidimensional process of interaction between stigma, availability, and the perceived needs of caregivers. The participants mentioned economic and instrumental supports more frequently than emotional support, probably reflecting their unmet basic needs. Advocacy for providing formal systemic supports to caregivers, as well as interventions that expand caregivers personal support network is recommended.

CONCLUSIONS

Most participants of the study were relatively isolated and had a small network of support, mostly composed of immediate family members. Stigma was a serious source of family distress for caregivers and a limiting factor in social relationships.

Positive aspects of caregiving in incident and long-term caregivers: Role of social engagement and distress

OBJECTIVES

Positive caregiver adaptation over time may be associated with reports of positive aspects of caregiving (PAC). We examined differences in PAC by caregiving duration and social engagement, controlling for measures of distress.

METHODS

Participants included 283 African American or White caregivers from the Caregiving Transitions Study with a wide range of caregiving durations. PAC are defined as positive appraisals that caregivers report about their role, such as feeling appreciated or confident. We fit multivariable linear models with the total PAC score as the outcome to assess its association with years of caregiving and social engagement (social network, monthly social contact). Models were adjusted for age, sex, race, marital status, relationship to care recipient, care recipient's dementia status, perceived stress and caregiving strain.

RESULTS

Caregivers with higher social engagement reported significantly higher PAC. A non-significant trend was found in most analytic models for caregivers with longer duration of care to report higher PAC. African American caregivers reported higher PAC compared to White caregivers. Dementia caregivers reported lower PAC than non-dementia caregivers in models adjusting for demographics and social network size, but the association was attenuated with the addition of caregiving strain.

DISCUSSION

Higher social engagement and longer duration of care tend to be associated with higher PAC after adjusting for demographics and measures of distress. Future studies should aim to leverage longitudinal data to understand whether caregivers shift appraisal to positive aspects of their role and explore implementation of caregiving interventions targeting PAC in order to improve the caregiving experience.

Automatically Identifying Twitter Users for Interventions to Support Dementia Family Caregivers: Annotated Data Set and Benchmark Classification Models (Preprint)

Background

More than 6 million people in the United States have Alzheimer disease and related dementias, receiving help from more than 11 million family or other informal caregivers. A range of traditional interventions has been developed to support family caregivers; however, most of them have not been implemented in practice and remain largely inaccessible. While recent studies have shown that family caregivers of people with dementia use Twitter to discuss their experiences, methods have not been developed to enable the use of Twitter for interventions.

Objective

The objective of this study is to develop an annotated data set and benchmark classification models for automatically identifying a cohort of Twitter users who have a family member with dementia.

Methods

Between May 4 and May 20, 2021, we collected 10,733 tweets, posted by 8846 users, that mention a dementia-related keyword, a linguistic marker that potentially indicates a diagnosis, and a select familial relationship. Three annotators annotated 1 random tweet per user to distinguish those that indicate having a family member with dementia from those that do not. Interannotator agreement was 0.82 (Fleiss kappa). We used the annotated tweets to train and evaluate support vector machine and deep neural network classifiers. To assess the scalability of our approach, we then deployed automatic classification on unlabeled tweets that were continuously collected between May 4, 2021, and March 9, 2022.

Results

A deep neural network classifier based on a BERT (bidirectional encoder representations from transformers) model pretrained on tweets achieved the highest F₁-score of 0.962 (precision=0.946 and recall=0.979) for the class of tweets indicating that the user has a family member with dementia. The classifier detected 128,838 tweets that indicate having a family member with dementia, posted by 74,290 users between May 4, 2021, and March 9, 2022—that is, approximately 7500 users per month.

Conclusions

Our annotated data set can be used to automatically identify Twitter users who have a family member with dementia, enabling the use of Twitter on a large scale to not only explore family caregivers’ experiences but also directly target interventions at these users.

2022 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.

Rural-Urban Differences in Caregiver Burden Due to the COVID-19 Pandemic among a National Sample of Informal Caregivers

The objective of this exploratory study was to explore potential associations between changes to caregiver burden (CB) due to the COVID-19 pandemic and rural-urban status using a nationally representative sample of 761 informal caregivers. Tertiles of two measures of rural-urban status were used: Rural-Urban Commuting Areas (RUCAs) and population density. Bivariate and multivariable binary and ordinal logistic regression were used to asses study objectives. Using RUCAs, rural informal caregivers were more than twice as likely as urban informal caregivers to report a substantial increase in CB due to COVID-19 (OR 2.27, 95% CI [1.28-4.02]). Similar results were observed for population density tertiles (OR 2.20, 95% CI [1.22-3.96]). Having a COVID-19 diagnosis was also significantly associated with increased CB. Understanding and addressing the root causes of rural-urban disparities in CB among informal caregivers is critical to improving caregiver health and maintaining this critical component of the healthcare system.