The Relationship Between Mutuality, Filial Piety, and Depression in Family Caregivers in China

Mutuality between nurses and patients with chronic illnesses: A cross-sectional descriptive study

BACKGROUND AND AIM

Mutuality is a process in which the patient participates and is involved in decision-making and care interventions. The aim of this study was to measure mutuality in the relationship between nurses and chronic illness patients.

METHODS

This study had a cross-sectional design; the sample included 249 patients and 249 nurses. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale.

RESULTS

Patients had higher scores in almost all items (p < 0.001). Patients demonstrate high reciprocity towards nurses and the ability to express and share their emotions. Patients consider nurses their point of reference and share with them their health goals. Nurses show more difficulty in being mutual with the patient, especially in the aspects related to the sharing of emotions, objectives, and planning. The egalitarian relationship score was low in both patients and nurses.

CONCLUSION

These findings are important to consider at clinical, educational, organisational, and policy levels. Nurse education and organisation must push towards respect for the wishes of patients, the possibility of expressing their choices, and their involvement in the care plan.

PRACTICE IMPLICATIONS

In clinical practice, it is necessary to put the patients more at the centre, involving them in the identification of objectives and in making decisions.

Randomized controlled trials on promoting self-care behaviors among informal caregivers of older patients: a systematic review and meta-analysis

BACKGROUND

Informal caregivers of older patients often neglect their self-care, despite the mental and physical health effects of caregiving. Randomized controlled trials (RCTs) on self-care interventions for informal caregivers are lacking, making it difficult to determine effective strategies. This systematic review explored the definition and categories of self-care RCTs for informal caregivers and a meta-analysis was conducted to determine the effectiveness of these interventions.

METHODS

Seven databases (Scopus, Web of Science, MEDLINE, PubMed, ProQuest, CINAHL, and Embase) were searched for articles in English reporting on self-care intervention outcomes for informal caregivers of patients aged 60 years or older. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. Subgroup, sensitivity, and publication bias analyses were conducted.

RESULTS

Eighteen studies were included in the systematic review, of which fifteen studies were included in the meta-analysis. RCTs lacked a clear definition of self-care, mainly focused on promoting physical and mental health and individual capacity, and neglected disease prevention. The interventions focused on self-management for health and individual agency, with less attention on health literacy, decision-making capacity, self-monitoring for health status, and linkage to the health system. Meta-analysis results showed that RCTs had a small effect on reducing anxiety (SMD = -0.142, 95% CI [-0.302, 0.017], p = .081) but a significant effect on reducing depression (SMD = -0.214, 95% CI [-0.353, -0.076], p = .002). Country and type of caregiver significantly contributed to the effect of reducing caregivers' depression in subgroup analysis.

CONCLUSIONS

Studies on caregiver-centered self-care interventions are limited, resulting in a lack of a clear definition and comprehensive intervention. RCTs indicated a small effect on informal caregivers' mental health, and interventions should consider both mental and physical health. More evidence is needed on the effectiveness of self-care interventions for informal caregivers' anxiety and physical health.

Prediction of survival of persons with advanced dementia using the advanced dementia prognostic tool: A 2-year prospective study

BACKGROUND

In this prospective study, we evaluated the usefulness of the advanced dementia prognostic tool (ADEPT) for estimating the 2-year survival of persons with advanced dementia (AD) in China.

METHODS

The study predicted the 2-year mortality of 115 persons with AD using the ADEPT score.

RESULTS

In total, 115 persons with AD were included in the study. Of these persons, 48 died. The mean ADEPT score was 13.0. The AUROC for the prediction of the 2-year mortality rate using the ADEPT score was 0.62. The optimal threshold of the ADEPT score was 11.2, which had an AUROC of 0.63, specificity of 41.8, and sensitivity of 83.3.

CONCLUSIONS

The ADEPT score based on a threshold of 11.2 may serve as a prognostic tool to determine the 2-year survival rate of persons with AD in Chongqing, China. However, further studies are needed to explore the nature of this relationship.

Actor-partner effects of wellbeing, hope and self-esteem on depression in stroke survivor-caregiver dyads: A randomized controlled trial

BACKGROUND

Stroke is a disabling, long-term condition that challenges the mental and physical health of stroke-survivors concurrently with their primary family-caregivers (dyad). However, there has been a lack of emphasis on this dyadic need. Thus, this study aims to investigate the impacts of two interventions on hope, self-esteem and hedonic wellbeing on depression among the stroke-survivor-caregiver dyad.

METHODS

This randomized-controlled-trial applied the actor-partner interdependence model to 100 randomly-selected dyads (N = 200) of stroke-survivors, mean (SD) age was 73.63(7.22) and family-caregivers, mean (SD) age was 62.49(14.44) years, recruited from Hong Kong hospitals and rehabilitation centres. The intervention was eight-weekly two-hour narrative therapy group sessions (n = 54 dyads), compared with the current model of psychoeducational group to each dyad as needed. Outcomes were collected via questionnaires and interviews, at four time-points: baseline (T₁), during-intervention (T₂) (1-month), immediately post-intervention (T₃) (2-months) and follow-up (T₄) (6-months).

RESULTS

The results demonstrated that there are actor effects on stroke-survivors (β = -0.353, p < 0.05) and caregivers (β = -0.383, p < 0.05), where higher levels of hedonic wellbeing were associated with fewer depressive symptoms. Partner effects were observed as caregivers' depressive symptoms were possessing a significant negative relationship with stroke survivors' wellbeing (β = -0.387, p < 0.05). Those stroke survivors in the intervention group had a significantly higher level of self-esteem associated with lower levels of depression (β = -0.314, p < 0.05).

CONCLUSIONS

Improving hope, self-esteem and wellbeing through narrative therapy significantly mediates depressive symptoms, strengthening the dyadic support of stroke survivors and family caregivers.

The experiences of East Asian dementia caregivers in filial culture: a systematic review and meta-analysis

Background

With the aging population in East Asia, the prevalence of dementia and the need for patient care is increasing. Family caregivers of people with dementia are at risk of physical and mental health problems. Filial piety culture regulates relationships within East Asian families and effects the well-being and behavior of dementia family caregivers (CGs).

Objective

To systematically assess the experience of East Asian dementia caregivers in filial culture. Methods: Electronic databases, including MEDLINE, APA PsycINFO, CINAHL (via EBSCOhost), Web of Science, and Cochrane Library, were searched for relevant studies up to July 2021. Only original articles were included.

Results

Thirteen eligible studies were included, of which eight were qualitative and five were quantitative. Meta-analysis showed a negative association (r = -0.18, 95%CI [-0.28, -0.08]) between filial culture and caregiver burden. The quantitative studies identified four themes related to dementia caregivers' experiences: (1) Recognition and understanding of filial piety as part of cultural identity, (2) Role transitions- from child to CG, (3) Filial piety's constraints on CGs; (4) CGs' self-compassion through changing cultural norms of filial practice.

Conclusion

Filial culture influences the whole process behind caregiving for East Asian dementia caregivers. At the same time, cultural transition has also brought about new connotations and practices to filial culture.

Relationship between mutuality and depression in patients with chronic heart failure and caregivers in China: An actor-partner interdependence model analysis

Background

Patients with chronic heart failure and their family caregivers may experience adverse emotional problems, such as depression. Mutuality, which refers to the relationship between caregivers and those they care for, is an important factor affecting depression in the dyads. The purpose of this study was to investigate the relationship between mutuality and depression in patients with CHF and their caregivers in China.

Methods

In this cross-sectional study, we used the Mutuality Scale and the Self-Rating Depression Scale to measure mutuality and depression of patients and caregivers. We used SPSS version 26.0 and AMOS version 21.0 to analyze the data. An APIM was established to analyze the actor-partner effects of patient-caregiver mutuality and depression.

Results

A total of 250 dyads of patients and caregivers were included in the study. There were statistically significant differences in mutuality and depression between CHF patients and caregivers. The 4 dimensions of patients' mutuality all have the actor effect on depression. There were 3 partner effects of caregivers' "pleasurable activities", "shared values", and "reciprocity" on depression. Regarding caregiver depression, we only found an actor effect of caregivers' "shared values" on depression.

Conclusion

The relationship between patients and caregivers should be evaluated in the clinical setting, and it is very important to develop intervention measures to improve the adverse emotional problems affecting both patients and their caregivers.

Role of the Social Support and Health Status in Living Arrangement Preference of the Elderly in China—A Cross-Sectional Study

Background

Living arrangement of the elderly is one of the most important components that affect their quality of life in later years. The aging, with the phenomenon of low fertility rate and family structure transformation, has caused changes in the living arrangements of the elderly. This research aimed to find the elderly's living arrangement preferences and influencing factors.

Methods

The data were obtained from The Chinese Longitudinal Healthy Longevity Survey (CLHLS) in the 2018, and the sample was comprised of 9,638 individuals aged ≥ 60 years. Independent variables were divided into social support, health status and so-economic status. Chi-square test and binary logistic regression were used to analyze the relationship between the above variates and living arrangement preferences.

Results

Currently, in terms of living arrangement preferences, nearly half (45.6%) of the respondents choose not to live with their children. The binary model results showed that elderly who were married (OR = 0.166, 95% CI: 0.147–0.187), experienced more than 6 years of education (OR = 0.600, 95% CI: 0.517–0.695), ability of daily living (ADL) impaired (OR = 0.810, 95% CI: 0.720–0.912), suffering from multiple chronic diseases (OR = 0.803, 95% CI: 0.720–0.912), and obtained community services (OR = 0.884, 95% CI: 0.803–0.972) incline to not live with their children. The elderly who living in rural areas (OR = 1.244, 95% CI: 1.129–1.371), with an income of more than 500,000 yuan per year (OR = 1.557, 95% CI: 1.380–1.757), having children visiting regularly (OR = 1.405, 95% CI: 1.161–1.707) and receiving children's financial support (OR = 1.194, 95% CI: 1.080–1.319) are more likely to choose to live with their children.

Conclusions

This study found that the living arrangement preferences of the elderly were affected by social support and health status, and living with children is no longer the only option for the elderly these days. The elderly care services provided by communities or professional care institutions may become the mainstream of taking care of the elderly citizens in the aging society. Improving the types and forms of community nursing services to increase the accessibility of these services; setting up elderly care institutions reasonably and equipping adequate professional nursing staff should be considered as priority measures.

"I thought that I had to be alive to repay my parents": Filial piety as a risk and protective factor for suicidal behavior in a qualitative study of Chinese women

Filial piety involves the Confucian view that children always have a duty to be obedient and to provide care for their parents. Filial piety has been described as both a risk and a protective factor in depression and suicide. This qualitative study aimed to explore the role of filial piety in the suicidal behavior of Chinese women. Qualitative interviews were conducted with Chinese women with a history of suicidal behavior living in the Beijing area (n = 29). Filial piety data were extracted and analyzed in accordance with constructivist grounded theory. The women described five specific family and filial piety factors and how they influenced their ability to fulfill family role obligations, which was described as a nexus connecting these factors to depression, suicidal behavior, and recovery. The five factors were: 1) rigidity of parental filial expectations, 2) perception of family relationships as positive/supportive or negative/harsh, 3) whether filial piety is of high or low personal value in the woman's life, 4) any experiences of rebellion leading to punitive consequences, and 5) how much filial piety she receives from her children. These factors could inform suicide risk assessments in this population. They can be harnessed as part of recovery and protect against future suicidal behavior.

The relationship between filial piety and caregiver burden among adult children: A systematic review and meta-analysis

INTRODUCTION

Filial piety is an important cultural value in aging societies. However, mixed findings were identified regarding its influence on caregiver burden. The purpose of this meta-analysis was to clarify the relationships between filial concepts and caregiver burden.

METHOD

Twelve databases on filial piety, filial obligation, and caregiver burden among adult children prior to January, 2020 were systematically cross-culturally reviewed.

RESULTS

Twelve studies were finalized for analysis. Fixed effect models indicated that stronger filial piety was significantly correlated (r = -.23) or associated with (β = -.27) less caregiver burden. However, no significant relationship between filial obligation and caregiver burden was revealed by random effect models.

CONCLUSION

Stronger filial piety may lessen caregiver burden. Therefore, filial piety should be assessed and supported in adult child caregivers, particularly in Eastern cultures. However, the concept of filial piety and its tools should be updated transculturally. PROSPERO Registration Number: CRD42020161969.

Family Caregiver-Receiver Mutuality: A Concept Analysis

There are more than 43 million family caregivers in the United States. In studies of family caregivers and receivers, evidence suggests that family caregiver-receiver mutuality is linked to health. Lack of a clear definition of family caregiver-receiver mutuality is an obstacle that prevents scientific progress and effective operationalization of the concept. To address this issue, the authors applied Walker and Avant's method for concept analysis and clarified the concept of family caregiver-receiver mutuality. A standardized definition of caregiver-receiver mutuality is presented along with antecedents, consequences, defining attributes, empirical referents, and case illustrations.

Dyadic effects of family-functioning and resilience on quality of life in advanced lung cancer patients and caregivers: An actor-partner interdependence mediation model

PURPOSE

Lung cancer as a stressful event profoundly impacts the entire family, especially patients and their family caregivers. This study uses a dyadic analysis approach to explore the dyadic effects of family functioning on the quality of life (QoL), and whether resilience acts as a mediator in advanced lung cancer patient-caregiver dyads.

METHODS

This was a cross-sectional study, and 287 dyads of advanced lung cancer patients and their caregivers were enrolled. Family-functioning, resilience, and QoL were assessed by the General Functioning subscale of the Family Assessment Device (FAD), the 10-item Connor-Davidson Resilience Scale, and the Short Form-8 (SF-8) Health Survey, respectively. Data were analyzed using the actor-partner interdependence mediation model.

RESULTS

This study found that, for patients and caregivers, resilience mediates the actor effects of family-functioning on QoL. That is, family-functioning was positively related to their resilience, which improved QoL. Another important finding is that caregivers' family-functioning had significant indirect effects on patients' QoL through their resilience.

CONCLUSIONS

Positive family functioning perceived by patients and caregivers can improve their QoL by developing their own resilience. Furthermore, family-functioning perceived by caregivers can also improve patients' QoL through their resilience. Medical staff should identify vulnerable patients and caregivers with poorer family-functioning and resilience, and make focused intervention to improve the QoL of both lung cancer patients and their family caregivers.

Mutuality in Motor Neuron Disease: A Mixed-Method Study

ABSTRACT

BACKGROUND: Mutuality, a positive relationship between caregiver and care receiver that affects patient's health and caregiver's burden, stress, and well-being, has never been investigated in motor neuron disease. METHOD: We conducted a mixed-method study with convergent parallel design. Quantitative data were collected with the Mutuality Scale, and qualitative data were collected using deep interviews. The sample was composed of 30 people with motor neuron diseases and 24 family caregivers. RESULTS: Deductive, qualitative content analysis of the interviews confirmed the presence of mutuality and its 4 dimensions. The average score of patients' Mutuality Scale was 3.07 (SD, 0.79; range, 1.3-4), and that of the caregivers was 3.16 (SD, 0.53; range, 2.2-3.9). The dimensions "love" and "shared values" had the highest scores, whereas the dimension "shared pleasurable activities" had the lowest score. Patients' and caregivers' answers correlated. CONCLUSION: Mutuality concept and its 4 dimensions had content validity in motor neuron disease people. Nurses should consider the level of mutuality and adopt strategies to increase and preserve it.

An international systematic review of dementia caregiving interventions for Chinese families

OBJECTIVES

Older Asians and Chinese are among the least studied populations in the dementia caregiving literature. This review seeks to critically synthesize the literature on intervention characteristics, components and tailoring strategies for dementia family caregivers in Chinese communities globally.

METHODS

Five electronic databases (PsychINFO, PubMed, CINAHL, ScienceDirect and Google Scholar) were searched for articles published between 1980 and July 2018. The protocol of this review was registered with PROSPERO (CRD42019132800).

RESULTS

Twenty-nine unique interventions across 39 papers met inclusion criteria. Results from descriptive and thematic syntheses revealed that most interventions were psychoeducational, CBT-based, multicomponent, structured, and less than a year in duration. Disease education, management of behavioral and psychological symptoms of dementia, stress coping techniques, and referral to community resources were frequently included in interventions. Community-, culture- and language-focused strategies were used to tailor interventions. The most common tailoring strategies were: (a) using community networks and media for outreach and recruitment; (b) making translations and language adaptations to the intervention materials; and (c) focusing on trust and therapeutic alliance. Most interventions produced desired outcomes, particularly reducing caregiver burden and increasing self-efficacy.

CONCLUSIONS

To our knowledge, this is the first review to date that systematically synthesized the characteristics and tailoring of dementia caregiving interventions for Chinese families globally. Current findings suggest that most interventions are effective, although many only superficially address Chinese culture. Future research should incorporate Chinese values and cross-cultural challenges into caregiving interventions for deep-level adaptations that could potentially be more effective to engage and support Chinese caregivers.

The Association Between Mutuality, Anxiety, and Depression in Heart Failure Patient-Caregiver Dyads: An Actor-Partner Interdependence Model Analysis

BACKGROUND

Heart failure (HF) patient-caregiver dyads experience severe psychological problems, such as anxiety and depression. A variable that has been found to be associated with anxiety and depression in patients and caregivers in severe chronic conditions is mutuality. However, this association has not been explored in HF patient-caregiver dyads to date.

OBJECTIVE

The aim of this study was to evaluate the associations among mutuality, anxiety, and depression in HF patient-caregiver dyads.

METHODS

This was a cross-sectional study. Mutuality, anxiety, and depression in HF patient-caregiver dyads were assessed using the Mutuality Scale (MS) total and 4 dimension scores and the Hospital Anxiety and Depression Scale, respectively. Data were analyzed using the actor-partner interdependence model to examine how mutuality of patients and caregivers was associated with both the patients' own (actor effect) and their partners' anxiety and depression (partner effect).

RESULTS

A sample of 366 dyads of patients with HF (mean age, 72 years; 56% male) and caregivers (mean age, 54 years; 73.3% female) was enrolled. Regarding patient anxiety, we observed only an actor effect between the MS dimension scores of "love and affection" and "reciprocity" and anxiety in patients (B = -1.108, P = .004 and B = -0.826, P = .029, respectively). No actor and partner effects were observed concerning caregiver anxiety. Regarding depression, we observed that only the MS dimension of "love and affection" in patients had both an actor (patient: B = -0.717, P = .032) and a partner (caregiver: B = 0.710, P = .040) effect on depression.

CONCLUSIONS

The assessment of MS in HF patient-caregiver dyads is important to formulate interventions aimed at improving anxiety and depression in patients and caregivers.

Psychiatric morbidity and its correlates among primary family caregivers of individuals diagnosed with schizophrenia in Taiwan

BACKGROUND

Caregiving for patients with schizophrenia is often challenging and may increase the risk of psychiatric morbidity among primary family caregivers. However, the associated factors of psychiatric morbidity among caregivers have not been fully investigated.

AIMS

This study aimed to screen psychiatric morbidity and its correlates among primary family caregivers of persons with schizophrenia receiving inpatient psychiatric rehabilitation services.

METHODS

A cross-sectional, correlational design was used. A total of 184 Taiwanese primary family caregivers in inpatient psychiatric rehabilitation units participated in the study. Descriptive statistics, Chi-square tests, independent t-tests, and a stepwise binary logistic regression analysis were performed to examine the association among primary family caregivers' psychiatric morbidity and primary family caregivers' sociodemographic characteristics and mutuality and patients' sociodemographic and clinical characteristics.

RESULTS

The prevalence of psychiatric morbidity among primary family caregivers was 48.4%. Unemployment, lower mutuality, additional dependents in need of care, and caring for patients with more psychiatric hospitalizations were the most significant factors for psychiatric morbidity among primary family caregivers.

CONCLUSION

Mental healthcare professionals should recognize patients and their primary family caregivers as a unit of care. Primary family caregivers must receive increased assistance, including supportive resources and therapeutic interventions, to reduce psychiatric morbidity.

A Pilot Study on the Efficacy of Stress Relief Programs for Family Caregivers of Older People with Dementia

The aim of this study was to evaluate the effects of stress-relief programs on positive aspects of caregiving and depression among caregivers of older people with dementia. A quasi-experimental design was employed. Participants in the experimental group received a 8-week period and 120 minutes each session cognitive-behavioral therapy. Participants in the control group received standard health education. Stress relief programs may alleviate depression and increase positive aspects of caregiving among family caregivers of older people with dementia. These findings will help health professionals to implement stress-relief strategies for family caregivers of older people with dementia, or to use those strategies to increase positive aspects of caregiving, or to alleviate depression in caregivers.

Moderator Role of Mutuality on the Association Between Depression and Quality of Life in Stroke Survivor-Caregiver Dyads

BACKGROUND

Authors of previous research have not yet analyzed the role of potential moderators in the relationship between depressive symptoms and quality of life (QOL).

AIMS

The aim of this study was to examine the moderating effect of mutuality between depressive symptoms and QOL in stroke survivor and caregiver dyads.

METHODS

This study used a longitudinal design with 222 stroke survivor-caregiver dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed for 12 months. We examined survivor and caregiver QOL dimensions (physical, psychological, social, and environmental), depression, and mutuality at baseline and every 3 months. Hierarchical linear modeling was used to test 4 longitudinal dyadic moderation models (1 for each QOL domain).

RESULTS

Survivors (50% male) and caregivers (65% female) were 70.8 (SD, 11.9) and 52.5 (SD, 13.1) years old, respectively. We observed no significant moderating effects of mutuality for survivors across the 4 dimensions of QOL over time. However, higher survivor mutuality was significantly associated with higher survivor psychological and social QOL at baseline. Regarding caregivers, caregiver mutuality significantly moderated the association between caregiver depressive symptoms and caregiver physical (B = 0.63, P < .05), psychological (B = 0.63, P < .01), and social (B = 0.95, P < .001) QOL at baseline, but not in environmental QOL. Higher caregiver mutuality was significantly associated with less improvement in caregiver physical QOL over time.

CONCLUSIONS

Mutuality is a positive variable on the association between depression and QOL for both members of the dyad at discharge but may lead to declines in physical health for caregivers over time. Further work is needed to understand the role of mutuality on long-term outcomes and associations with increased care strain.

Source of Social Support and Caregiving Self-Efficacy on Caregiver Burden and Patient's Quality of Life: A Path Analysis on Patients with Palliative Care Needs and Their Caregivers

Few studies have explored the inter-relationships of sources of social support and caregiving self-efficacy with caregiver burden and patient’s quality of life among patients with palliative care needs and their caregivers. This study tested the associations of two sources of social support (family and friends) and the mediating role of caregiving self-efficacy on caregiver burden and patient’s quality of life. A convenience sample of 225 patient–caregiver dyads recruited between September 2016 and May 2017 from three hospitals in Hong Kong was included in the current analysis. Results showed that the final model provided a satisfactory fit (SRMR = 0.070, R-RMSEA = 0.055 and R-CFI = 0.926) with the data, as good as the hypothesized model did (p = 0.326). Significant associations were detected. Family support had a significant negative indirect effect on caregiver burden and a significant positive indirect effect on patient’s quality of life through caregiving self-efficacy, whereas friend support had a significant positive direct effect on caregiver burden but a minimal effect, if any, on patient’s quality of life. These findings emphasized (1) the importance of caregiving self-efficacy in improving caregiver burden and patient’s quality of life and that (2) sources of social support may be an important dimension moderating the associations of caregiving self-efficacy with caregiver burden and patient’s quality of life.

Social Support and the Incidence of Cognitive Impairment Among Older Adults in China: Findings From the Chinese Longitudinal Healthy Longevity Survey Study

OBJECTIVE

Social support shows a protective effect against cognitive impairment in older adults. However, the longitudinal relationship between the distinct sources of social support and the incidence of cognitive impairment remains unclear. This study aims to investigate the association between different sources of social support and the incidence of cognitive impairment among older adults in China.

METHOD

We used longitudinal data (2005-2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2005-2014, mean follow-up years 5.32 ± 2.64). In total, 5897 participants (aged 81.7 ± 9.7 years, range 65-112 years, 49.0% male) were enrolled. Cognitive impairment was measured by the Mini-Mental State Examination (MMSE). Social support included support from family and friends (marital status; contacts with family and friends; children's visits; siblings' visits, sick care; money received from and money given to children) and the availability of support from social community (social service and social security). We calculated subdistribution hazard ratios (SHR) of cognitive impairment by establishing Cox regression models, adjusting for residence, gender, age, education, participation in physical exercise, activities of daily living, smoking, drinking, negative psychological well-being, baseline cognitive function, occupation, leisure activities, and diseases.

RESULTS

During a 9-year follow-up, 1047 participants developed cognitive impairment. Participants who were married had a 16.0% lower risk of developing cognitive impairment compared to the widowed older adults after controlling for all covariates, but the protective effect of being married was no longer significant (p = 0.067) when additional adjustment was made for all types of social support. Children's visits were significantly associated with the risk of cognitive impairment after controlling for all types of social support and covariate variables (SHR = 0.808, 95% confidence interval, 0.669-0.975, p = 0.026).

CONCLUSION

Children's visits were consistently associated with a lower incidence of cognitive impairment in Chinese older adults.

The Role of Mutuality and Coping in a Nurse-Led Cognitive Behavioral Intervention on Depressive Symptoms Among Dementia Caregivers

The current study explored whether mutuality and coping predicted and/or mediated the effect of a nurse-led cognitive behavioral intervention (NLCBI) on depressive symptoms of caregivers of persons with dementia. The intervention group (n = 56) received five monthly in-home nurse-led cognitive behavioral sessions and consultation calls after each session. The control group (n = 56) received five monthly short general conversations with the nurse interventionist. Questionnaires on study variables and demographics were collected at baseline, end of intervention, and 2-month follow up. Improved mutuality (β = -0.75, p = 0.049) and active coping (β = -2.06, p = 0.0001) and decreased passive coping (β = 1.43, p = 0.001) were found to predict the reduction of depressive symptoms among caregivers in the NLCBI. However, none of these variables mediated the interventional effect. Regular mental health nursing interventions are suggested to focus on enhancing mutuality and active coping and decreasing passive coping to maintain caregivers' mental health.

TARGETS

Caregivers of persons with dementia.

INTERVENTION DESCRIPTION

Nurse-led cognitive behavioral sessions and subsequent consultation calls.

MECHANISMS OF ACTION

Impacted caregivers' reappraisals, thus improving their active coping skills and mutuality and decreasing their passive coping, which directly reduced their depressive symptoms.

OUTCOMES

Mutuality, active coping, and passive coping played a predicting, but not mediating, role in the effect of the NLCBI. [Res Gerontol Nurs. 2019; 12(1):44-55.].

Caregiver burden and bereavement among family caregivers who lost terminally ill cancer patients

OBJECTIVE

Family caregivers (FCs) in China provide hospice care to terminally ill cancer patients; however, few studies have been conducted in China on caregiver burden and bereavement experiences as a process that continues over time. The purpose of this study was to identify the main elements of caring and bereavement experiences for FCs caring for patients diagnosed with terminal cancer.

METHOD

Twenty in-depth qualitative semistructured interviews were conducted with FCs providing care in a hospice unit in Shenzhen, Southern China. Interview transcripts were analyzed via thematic content analysis.

RESULT

A framework based on the following eight principal themes was developed through content analysis of our FC interviews: symptoms of the illness, the truth-telling process, attitudes toward death, the "color" of death, social and professional support, the moment of death, and grief and loss.

SIGNIFICANCE OF RESULTS

The analysis showed that caregiving may positively or negatively influence the bereavement process.

Financial transfers from adult children and depressive symptoms among mid-aged and elderly residents in China - evidence from the China health and retirement longitudinal study

BACKGROUND

Although the awareness of mental health problems in late life is rising, the association between financial transfers to the older generations from children and mental health at older ages in China has received little attention. This study examines the association between financial transfers from children and depressive symptoms among the mid-aged and elderly residents (from 45 years of age and older) in China.

METHODS

We used the data from the China Health and Retirement Longitudinal Study (CHARLS, 2013) (n = 10,935) This included data on financial transfers from all non-co-resident children to their parents, and the individual scores on depressive symptoms as measured by the 10-item Center for Epidemiologic Studies-Depression Scale (CESD-10). A two-level - individual and community levels - mixed linear model was deployed to explore their association.

RESULTS

Financial transfers from children to parents was the major component of inter-generational financial transfers in Chinese families. A higher financial support from non-co-resident children was signivicantly and positively related to fewer depressive symptoms (coef. = - 0.195,P-value< 0.001) among both the mid-aged and elderly parents.

CONCLUSIONS

Financial transfers from non-co-resident children are associated with depressive symptoms among mid-aged and elderly residents in the China situation. Taxation and other policy measures should encourage and facilitate these type of financial transfers and prevent a decrease of support from children to parents.

The Relationship Between Mutuality and Health-Related Quality of Life in Adult Child Caregivers in China

The strain inherent in caregiving relationships between adult children and aging parents is a prominent issue in contemporary China due to a combination of demographic and socioeconomic changes. The purpose of this study was to explore how mutuality, a positive quality of caregiving relationships, contributes to the physical health and mental health (health-related quality of life [HRQoL]) of adult child caregivers [ACCs] of parent stroke survivors. A cross-sectional correlational study was conducted on a nonproportional quota sample of 126 ACCs, using questionnaires of demographics, the 15-item Mutuality Scale, and the Second Version of the Standard 12-Item Health Survey (SF-12v2). Higher mutuality was found to be correlated with better caregiver physical health and mental health. However, after adjusting for the covariates, mutuality significantly explained 4.6% of the variance of caregiver physical health (β = .22, ΔR² = .046, p < .01) but it did not significantly explain the variance of caregiver mental health. Although multiple factors correlate with Chinese family caregivers' HRQoL, this was the first study exploring the impact of caregiver-care receiver dyadic relationships on caregiver HRQoL in mainland China by using a mutuality scale with SF-12v2. Despite the fact that the Chinese tradition of filial piety can facilitate mutuality, socioeconomic changes and legislation that require adult children to care for aging parents appear to create high stress among family caregivers. Higher levels of mutuality contribute to better physical health in Chinese family caregivers. Therefore, culturally appropriate family nursing strategies and social policies in China could enhance caregiver mutuality and potentially promote their HRQoL, in particular physical health.

Chinese family caregivers of stroke survivors: Determinants of caregiving burden within the first six months

AIMS AND OBJECTIVES

To describe the family caregivers' caregiving experience for stroke survivors and to identify the determinants of caregiving burden over 6 months.

BACKGROUND

Sociocultural factors influence the caregiving experience in China. However, little is known about the dynamic changes occurring in Chinese caregivers' burden and its determinants.

DESIGN

This is a prospective longitudinal study.

METHODS

A total of 328 participants (164 stroke survivors and 164 family caregivers) from the neurological units of three hospitals in Shiyan were examined during a 6-month period at 1-2 days before discharge (T1) and 3 weeks (T2), 3 months (T3) and 6 months (T4) postdischarge using the Short Portable Mental Status Questionnaire, Multidimensional Scale of Perceived Social Support, Caregiver Strain Index and the Center for Epidemiological Studies-Depression.

RESULTS

Of the 209 dyads recruited, 164 completed all data collection phases, with 69% of the female caregivers aged 56.04 (SD = 4.0; range = 22-80) years. Caregivers reported higher mean burden at T1 (7.35 ± 2.9) but slightly decreased over time at T4 (6.34 ± 3.4), had borderline mean depressive symptoms only in T1 (9.71 ± 3.2) and T2 (9.02 ± 3.8) and had moderate mean social support throughout the 6-month period. Determinants of caregiving burden were stroke survivors' physical dependence, caregivers' age, caring hours per day, depressive symptoms and social support, which explained 46.8%-55.0% of the total variance (p < .05).

CONCLUSION

Caregivers' burden remains a serious problem in the first 6 months. It is an increasing hazard, especially for those at an advanced age who have depressive symptoms and care for severely dependent stroke survivors requiring more caring hours.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to be aware of and understand caregivers' cultural values and beliefs about family obligations when considering an intervention to support them in their role at home.