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Singh Solorzano C, Rowlands H, Ronaldson A, Kidd T, Steptoe A, Leigh E, Jahangiri M, Poole L. Caregiver burden in informal spousal caregivers predicts psychological and physical health in patients following coronary artery bypass graft surgery: a longitudinal clinical cohort study. J Behav Med 2024:10.1007/s10865-024-00512-3. [PMID: 39183251 DOI: 10.1007/s10865-024-00512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024]
Abstract
Previous research has shown that informal caregiver burden can have deleterious effects on patient recovery; however, this relationship has yet to be investigated in patients undergoing coronary artery bypass graft (CABG) surgery. This study aimed to examine the impact of the change of caregiver burden from pre- to post-surgery on patients' mental and physical health after CABG surgery. Ninety patient-caregiver dyads were assessed one month before the surgery, two months and one year after the surgery. Caregivers completed the Oberst Burden Scale to measure caregiver burden. Patients completed the Beck Depression Inventory to measure depressive symptoms, a subscale of the Hospital Anxiety and Depression Scale to measure anxiety symptoms, the Short Form-12 health assessment to measure health-related quality of life, and the Coronary Revascularisation Outcomes Questionnaire to measure surgery symptoms. Hierarchical linear regression analyses were conducted to explore the association between change in caregiver burden and post-surgery patient outcomes. A greater increase in caregiver burden from pre- to two-months post-surgery significantly predicted higher patients' depressive symptoms (β = 0.179, p = 0.010), anxiety symptoms (β = 0.114, p = 0.017), reported post-surgery symptoms (β = 0.335, p = 0.008) and reduced physical health-related quality of life (β = -0.358, p = 0.003), after controlling for a wide range of covariates. These findings were not replicated at a one-year follow-up. These results provide insights into the impact of caregiver burden on patient distress following CABG surgery, supporting the idea of psychological support interventions for caregivers to increase patients' short-term recovery outcomes.
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Affiliation(s)
- Claudio Singh Solorzano
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, 25125, Italy.
| | - Hannah Rowlands
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Amy Ronaldson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Tara Kidd
- School of Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Elizabeth Leigh
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, London, SW17 0QT, UK
| | - Lydia Poole
- Department of Psychological Interventions, School of Psychology, University of Surrey, Stag Hill Campus, Guildford, GU2 7XH, Surrey, UK
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Zhang C, Zhao Y, Li X, Guo Y, Peng R, Wan X, Zhou Q, Yang J, Wu S, Feng H. The effect of self-rated health on depressive symptoms in Chinese older adults: The mediating role of social participation and spouse health. Geriatr Nurs 2024; 59:411-417. [PMID: 39141948 DOI: 10.1016/j.gerinurse.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/05/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
This study investigates the relationship between self-rated health, social participation, spouse health, and depressive symptoms in older adults. It also analyzed the moderating effects of gender, drinking, visual function, diet, quality of life, and economic level on the model. We analyzed data from 5119 participants aged 60 and above, from the CLHLS. We used a partial least squares structural equation model to explore the correlation between self-rated health, spouse health, social participation, and depressive symptoms. Self-rated health was significantly correlated with spouse health, social participation, and depressive symptoms (P < 0.001). Social participation (β=-0.034) and spouse health (β=-0.029) were mediators of self-rated health to depressive symptoms. In addition, gender, drinking, visual function, diet, quality of life, and economic level were mediated factors. This study provides evidence that self-rated health has direct or indirect associations with depressive symptoms in older people, with social participation and spouse health playing a crucial mediating role.
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Affiliation(s)
- Chi Zhang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yinan Zhao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoyang Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yongzhen Guo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ruotong Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiao Wan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qin Zhou
- Geriatric Department, Hunan Province Directly Affiliated TCM Hospital, Zhuzhou, China
| | - Juan Yang
- School of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Siliang Wu
- Geriatric Department, Hunan Province Directly Affiliated TCM Hospital, Zhuzhou, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, China; Xiangya-Oceanwide Health Research Institute, Central South University, Changsha, China; Hunan Engineering Research Center for Intelligent Medical Care, Central South University, Changsha, China.
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García PS, Souto Serrano M, Alcedo Rodríguez MÁ, Peña Suárez E, Pedrosa I, Diaz ALA. Ageing with Parkinson's: Identification of Personal Needs in the Northern Spanish Context. Healthcare (Basel) 2024; 12:498. [PMID: 38391873 PMCID: PMC10888230 DOI: 10.3390/healthcare12040498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/02/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
As individuals diagnosed with Parkinson's disease enter older age, the myriad challenges and complications associated with this condition tend to escalate. Hence, there is a critical necessity to comprehensively discern the perceived needs of these individuals, along with their proposed remedies and essential support requisites. Additionally, understanding the perspectives of their families becomes imperative to formulate tailored interventions aimed at enhancing their overall development, progression, and quality of life. The study's main objective is to assess the perceived needs of individuals with PD and their family members, propose necessary solutions, and suggest future perspectives. The study encompassed a cohort of 268 participants, comprising 179 individuals diagnosed with Parkinson's disease and 89 of their relatives. A meticulously designed structured interview instrument consisting of 93 items was employed to assess various domains encompassing perceived needs, institutional support mechanisms, essential solutions, and future anticipations. Results: Statistically significant differences were found in health resources, social services resources, obstacles, solutions, and future outlook, with higher mean values from the relatives. Conclusions: The results highlight the most concerning needs in this context. Specifically, those needs related to health resources, social services resources, and future outlook present the greatest differences between the two subsamples, with the family members perceiving more needs. This alignment extended to both the categorization of unmet needs and the requisite solutions envisioned to address them. Suggested improvements include a sociosanitary strategy, stakeholder involvement, and prioritizing flexible home assistance to support older individuals with PD and their families.
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Affiliation(s)
| | | | | | - Elsa Peña Suárez
- Department of Education of the Government of the Principality of Asturias, 33007 Oviedo, Spain
| | - Ignacio Pedrosa
- Information and Communication Technology Center, 33203 Gijón, Spain
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Glasier W, Arbeau K, Launeanu M, Kwee J. The social process of involuntary separation and the search for connection. Health Psychol Open 2024; 11:20551029231224368. [PMID: 38420186 PMCID: PMC10898822 DOI: 10.1177/20551029231224368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Placing a loved one in care does not relieve informal caregivers' physical and emotional stresses. This study identified the unique psycho-social-spiritual processes of involuntary separation among spouses following long-term care admission. Participants were 17 spouse-caregivers (12 women and 5 men) with a mean age of 84 years who had been involuntarily separated for an average of 20 months. The basic psycho-social-spiritual process of spouse-caregiver involuntary separation was connecting in disconnection, which had three distinct stages: (1) Initial coping, (2) Adjusting to the new situation, and (3) Moving forward. Movement through the three stages was influenced by individuals' capacity and willingness to reach out for connection and by the abilities of others to extend accurate empathy and practical help. The implications of this study highlight spouse-caregivers' needs for connection and support not only during the crisis of separation, but in the months and years that follow.
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Yang L, Wei W, Wu Y, Zhu S, Zeng X, Wang R, Zhang M, Lin X, Zhou C. The experiences of caring for disabled older adults in long-term: A qualitative study from the perspective of spousal caregivers. Chronic Illn 2023; 19:848-861. [PMID: 36594348 DOI: 10.1177/17423953221148972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To explore the care experiences of spouses as long-term and primary caregivers for disabled older adults in China. METHODS A descriptive phenomenological method was used in this study, as well as purposive and convenient sampling. Semi-structured interviews were conducted with 15 spousal caregivers in Guangdong, China, from March to December 2021. Interview audio-recordings were transcribed verbatim and data were analyzed using Colaizzi's phenomenological analysis method. RESULTS We identified four themes from the data: spousal care motivation; sacrifices in caregiving; obstacles in caregiving; spousal caregivers' positive experiences. CONCLUSIONS Spouses took responsibility for providing care for their disabled partners regardless of their willingness. They had positive experiences while providing care, but negative experiences were dominant, especially for spouses of severely disabled older adults. Spouses are always perfect in caregiving roles, although they may also need medical assistance. To prevent a decline in spousal caregivers' quality of life and relieve their care burdens, health care providers should support them as soon as possible or offer formal care for disabled older adults. It is necessary to intervene considering disabled older adults and their spousal caregivers as a unit to empower their confidence in coping with life together.
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Affiliation(s)
- Lingli Yang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Wei Wei
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Shunfang Zhu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaoli Zeng
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Run Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Mi Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaolu Lin
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
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Wang F, Irani E, Tian MC, Yi Lau MM. The Mediating Effect of Caregiving Relationship Quality on the Association Between Caregiving Stressors and Mental Health Problems Among Older Spousal Caregivers. Int J Aging Hum Dev 2023; 97:435-455. [PMID: 36518012 DOI: 10.1177/00914150221143959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Providing care to a spouse can be especially challenging for older adults given their compounding stressors resulting from aging and caregiving. This cross-sectional study examines the relationships between caregiving stressors and caregiver mental health problems and the potential mediator (i.e., caregiving relationship quality) of these associations. A total of 431 Americans (≥65 years) were selected from the National Study of Caregiving. Path analysis shows that care assistance was positively associated with caregiver mental health problems, and this association was mediated by negative relationship quality (Indirect effect = .14, p = .016). Moreover, role overload was positively associated with caregiver mental health problems, which was mediated by negative relationship quality (indirect effect = .13, p = .002). Findings suggest that caregiving stressors can adversely affect mental health by exacerbating negative relationship quality. Interventions that limit negative exchanges and increase compassionate communications between older spousal caregivers and their care-receiving partners are needed.
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Affiliation(s)
- Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Mandy Man Yi Lau
- Department of Social Work, Chinese University of Hong Kong, Hong Kong, SAR, China
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Durak M, Karakose S, Yow WQ. Editorial: Late-life psychopathology. Front Psychol 2023; 14:1204202. [PMID: 37303896 PMCID: PMC10249054 DOI: 10.3389/fpsyg.2023.1204202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Mithat Durak
- Department of Psychology, Bolu Abant Izzet Baysal University, Bolu, Türkiye
| | - Selin Karakose
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - W. Quin Yow
- Humanities, Arts and Social Sciences, Singapore University of Technology and Design, Singapore, Singapore
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Abstract
OBJECTIVES We analyzed whether marital status and experiences of marital loss or gain were associated with self-perceptions of aging (SPA), a major psychosocial mechanism of healthy aging. METHOD We used data from 7028 participants of the Health and Retirement Study. Participants reported their marital status and their positive and negative SPA on two occasions 4 years apart. We ran general linear models to analyze differences in SPA between men and women who remained married, became divorced or widowed, or remarried following divorce or widowhood. RESULTS Participants who experienced marital loss had lower positive SPA than participants who remained marred. Participants who experienced marital gain had lower negative SPA than participants who remained married. None of the associations differed between men and women. DISCUSSION Results suggest that it may not be marital status itself, but rather the transition into or out of marriage, that impacts how people appraise their own aging.
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Affiliation(s)
- Shelbie G. Turner
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Dakota D. Witzel
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Robert S. Stawski
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Karen Hooker
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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Falcão DVDS, Paulson D. Quality of relationship between adult children caregivers and parents with dementia. INTERPERSONA: AN INTERNATIONAL JOURNAL ON PERSONAL RELATIONSHIPS 2022. [DOI: 10.5964/ijpr.5481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The main effects for associations between psychosocial stressors and caregiver outcomes are well established, but little is known about the mechanisms of these relationships. Aims of this study were to examine the hypotheses that satisfaction with family relationships (SF) is a mechanism by which quality of relationship (QR) between adult children caregiver and parents with Alzheimer’s disease (AD) influences depression, life satisfaction (LF), and self-rated health (SRH) among these caregivers. The participants were 716 Brazilian adult children who cared for their parents with AD and related disorders. Regression-based path analysis was performed; a PROCESS, bias-corrected and accelerated bootstrapping method was used to test confidence intervals. The relationships between QR and both depression (B = .3263, p < .001) and SRH (B = .3263, p < .001), were fully mediated by SF. The relationship between QR and LF was partially mediated by SF. The primary finding is that SF is one mechanism by which QR relates to depressive symptomatology, self-rated health, and life satisfaction.
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Feeling low and unhappy together? An actor-partner-interdependence model uncovering the linkage between different operationalizations of relationship quality and depression in different-sex couples. PLoS One 2022; 17:e0274756. [DOI: 10.1371/journal.pone.0274756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Some studies suggest a bi-directional association between low relationship quality and depression. However, the social impact of depression and the potential preventative effects of healthy relationships are not yet sufficiently understood, as studies have shown heterogenous results for effects in both directions. Therefore, the main aim of this study was to differentiate the actor and partner effects of this association more comprehensively using two measures to capture characteristics of relationship quality–firstly regarding general aspects of social system quality and secondly considering specific aspects of the romantic relationship. 110 different-sex couples were included, being separated in partners with highly pronounced depressive symptoms in women (Cw/DW) versus partners with low depressive symptoms (LDCs). We investigated effects cross-sectionally using multi-group analyses to predict relationship (couple specific questionnaire: PFB) versus system quality (general system quality questionnaire: EVOS) in a step-by-step approach, modelling actor and partner effects with variation within and across both groups and then comparing the results to models with equal actor and partner effects. Depression was measured with the PHQ-9. With regard to the relationship between depressive symptoms and system quality, the model that constrained actor and partner effects to be equal across both groups was preferred and showed negative significant actor effects across gender and groups. Concerning the association between depressive symptoms and relationship quality, the model constraining actor and partner effects to be equal within groups had the best fit to the data and revealed a negative partner effect in LDCs.
Conclusions
Controlling for the moderating variable of clinically relevant depressive symptoms, we found evidence for actor and partner effects, which differed between the two relationship measures. This underlines the importance to reflect how relationship quality is operationalized. The negative partner effect on relationship quality in LDCs emphasizes that even in a non-clinical context, depressive symptoms negatively impact the perceived relationship quality of both women and men. This suggests that addressing the relationship is important in non-clinical preventive contexts and calls for integrating the partner into counselling or trainings.
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Pickering J, Crooks VA, Snyder J, Milner T. Relational, community-based and practical: Support systems used by Canadian spousal caregivers living seasonally in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2311-2319. [PMID: 35285564 DOI: 10.1111/hsc.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/09/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
Every year tens of thousands of older Canadians travel to the southern United States (US) to live there seasonally during the winter months to enjoy a warmer climate-a practice known as international retirement migration. Several factors facilitate participation in this transnational mobility, including having the financial resources needed to live abroad. For those managing chronic or acute health conditions, traveling with a caregiver (typically a spouse) is another important facilitator. In this qualitative analysis, we explore the transnational systems of support that Canadian international retirement migrant spousal caregivers draw upon to enable them to provide care while in the US. We report on the findings of ten semi-structured dyad interviews (n = 20 participants) conducted with Canadian international retirement migrants living seasonally in Yuma, Arizona. The dyads consisted of spouses, one of whom had defined care needs and the other of whom provided informal care. Through thematic analysis of these interviews, we identified three types of transnational support systems that spousal caregivers draw on: relational, community-based and practical. While aspects of these support systems have been documented in other informal care-giving studies, this analysis demonstrates their copresence in the transnational care-giving context associated with international retirement migration. Overall, this analysis highlights the benefits of close social relations enjoyed by international retirement migrants providing informal care to mitigate the lack of access to their established support networks at home.
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Affiliation(s)
- John Pickering
- Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Jeremy Snyder
- Simon Fraser University, Burnaby, British Columbia, Canada
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Robinson ES, Cyarto E, Ogrin R, Green M, Lowthian JA. Quality of life of older Australians receiving home nursing services for complex care needs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6091-e6101. [PMID: 36200317 DOI: 10.1111/hsc.14046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/04/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.
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Affiliation(s)
| | - Elizabeth Cyarto
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Rajna Ogrin
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Department of Business Strategy and Innovation, Griffith University, Nathan, Queensland, Australia
| | - Maja Green
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- School of Public Health & Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
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Kim SJ, Park K, Kim K. Post-intensive care syndrome and health-related quality of life in long-term survivors of intensive care unit. Aust Crit Care 2022:S1036-7314(22)00088-1. [PMID: 35843808 DOI: 10.1016/j.aucc.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE The objective of this study was to provide preliminary data for improving the health-related quality of life of long-term intensive care unit survivors by identifying the relationship between health-related quality of life and post-intensive care syndrome. METHODS Using a descriptive correlation research design, data from patients who visited the outpatient department for continuous treatment after discharge from the intensive care unit were analysed. Post-intensive care syndrome was measured by physical, cognitive, and mental problems. Data were collected from 1st August to 31st December, 2019, and 121 intensive care unit survivors participated in the study. RESULTS Health-related quality of life showed a negative correlation with physical, mental, and cognitive problems. The factors associated with health-related quality of life were physical and mental problems, education level, sedatives and neuromuscular relaxants, and marital status. CONCLUSIONS To improve the health-related quality of life of intensive care unit survivors, post-intensive care syndrome prevention is important, and a systematic strategy is required through a long-term longitudinal trace study. In addition, intensive care unit nurses and other healthcare professionals need to provide early interventions to reduce post-intensive care syndrome.
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Affiliation(s)
- Seung-Jun Kim
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, South Korea
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14
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Swinkels JC, van Tilburg TG, Broese van Groenou M. Why do spouses provide personal care? A study among care-receiving Dutch community-dwelling older adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e953-e961. [PMID: 34245192 PMCID: PMC9291597 DOI: 10.1111/hsc.13497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/31/2021] [Accepted: 06/05/2021] [Indexed: 06/13/2023]
Abstract
This study investigates under what conditions older spouses receive personal care from their spouse. Whether spousal care is provided is determined by individual and societal factors related to informal and formal care provision. Individual factors concern the need for care (the care recipient's health status), the spouse's ability to provide care (the spouse's health status) and the quality of the marital bond. Societal factors reflect changing policies on long-term care (indicated by the year in which care started) and gender role socialisation (gender). From the Longitudinal Aging Study Amsterdam, which completed eight observations between 1996 and 2016, we selected 221 independently living married respondents, aged 59-93, who received personal care for the first time and had at least one previous measurement without care use. The results show that if an older adult received personal care, the likelihood of receiving that care from the spouse decreased over the years: from 80% in 1996 to 50% in 2016. A husband or wife was less likely to receive spousal care when the spouse was unable to provide care or the quality of the relationship was low. No gender differences were found in either the prevalence of spousal care use or in the factors associated with that use. Thus, individual factors and the societal context seem to determine whether one receives personal care from their spouse. The decline in the likelihood of personal care provision from a spouse over the years may indicate a crumbling of family solidarity, an unmeasured and growing inability of the older spouse to provide care or an increasing complexity of care needs that requires the use of formal care. As care-giving can be a chronic stressor and most spouses provide care without assistance from others, attention from policy makers is needed to sustain the well-being of older couples.
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Affiliation(s)
- Joukje C. Swinkels
- Department of SociologyFaculty of Social SciencesVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Theo G. van Tilburg
- Department of SociologyFaculty of Social SciencesVrije Universiteit AmsterdamAmsterdamthe Netherlands
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Mack L, Zonsius MC, Newman M, Emery-Tiburcio EE. Recognizing and Acting on Mentation Concerns. Am J Nurs 2022; 122:50-55. [PMID: 35447655 DOI: 10.1097/01.naj.0000830764.74949.fd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article is the fourth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Laurin Mack
- Laurin Mack is an assistant professor and Erin E. Emery-Tiburcio is an associate professor in the Department of Psychiatry and Behavioral Sciences at Rush University Medical Center in Chicago, where Mary C. Zonsius is an associate professor in the College of Nursing and Michelle Newman is a program manager in the Department of Social Work and Community Health. Contact author: Erin E. Emery-Tiburcio, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Bernstein Sideman A, Wells JL, Merrilees J, Shdo SM, Yee CI, Possin KL, Levenson RW. Pronoun Use among Caregivers of People Living with Dementia: Associations with Dementia Severity Using Text Analysis of a Natural Language Sample. Dement Geriatr Cogn Dis Extra 2022; 12:60-68. [PMID: 35702160 PMCID: PMC9149456 DOI: 10.1159/000522122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Family caregivers of persons living with dementia (PLWDs) have extensive social, physical, emotional, and financial responsibilities. However, less is known about the relationship and interpersonal connection between caregivers and PLWDs. We examined caregiver pronoun use, as an index of the connection between the caregiver and PLWD and its associations with the caregiver's and PLWD's health and well-being. Methods Caregivers of PLWDs (N = 320) were asked to describe a recent time they felt connected to the PLWD in their care. Responses were transcribed and coded to quantify pronoun use by category (we-pronouns, I-pronouns, and they-pronouns). Caregivers also reported on their depression, burden, and the PLWD's dementia severity and marital satisfaction. Sixty-eight caregivers repeated the same survey 24 months after the initial survey. Results Caregivers used less we-pronouns when the PLWD's dementia was more severe, at both timepoints. Spousal caregivers used more we-pronouns and less I- and they-pronouns than nonspousal caregivers. There was an interaction between spousal relationship and dementia severity, such that spousal caregivers exhibited a stronger negative association between dementia severity and we-pronoun use. There were no associations between pronoun category and caregiver burden or depression. Discussion Caregivers may feel increasingly disconnected from the PLWD as their dementia becomes more severe, as reflected by less we-pronoun usage. This study highlights the opportunity to explore relationship connection through text analysis.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Department of Humanities & Social Sciences, University of California, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, California, USA
| | - Jenna L. Wells
- Department of Psychology, University of California, Berkeley, California, USA
| | - Jennifer Merrilees
- Department of Neurology, University of California, San Francisco, California, USA
| | - Suzanne M. Shdo
- Department of Psychology, University of California, Berkeley, California, USA
| | - Claire I. Yee
- Department of Psychology, University of California, Berkeley, California, USA
| | - Katherine L. Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, California, USA
| | - Robert W. Levenson
- Department of Psychology, University of California, Berkeley, California, USA
- *Robert W. Levenson,
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Johansson MF, McKee KJ, Dahlberg L, Summer Meranius M, Williams CL, Marmstål Hammar L. Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1788. [PMID: 35162811 PMCID: PMC8835239 DOI: 10.3390/ijerph19031788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer-care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.
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Affiliation(s)
- Marcus F. Johansson
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
| | - Kevin J. McKee
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
| | - Lena Dahlberg
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
- Aging Research Center, Karolinska Institutet & Stockholm University, Tomtebodavägen 18A, 171 65 Solna, Sweden
| | | | - Christine L. Williams
- Christine E Lynn College of Nursing, Florida Atlantic University Boca Raton, FL 334 31, USA;
| | - Lena Marmstål Hammar
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
- School of Health, Care and Social Welfare, Mälardalen University, 721 23 Västerås, Sweden;
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden
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Gehr TJ, Freiberger E, Sieber CC, Engel SA. A typology of caregiving spouses of geriatric patients without dementia: caring, worried, desperate. BMC Geriatr 2021; 21:483. [PMID: 34488636 PMCID: PMC8419985 DOI: 10.1186/s12877-021-02425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background An increasing number of older people in Germany receive care at home from family members, particularly from spouses. Family care has been associated not only with subjective burden but also with negative effects on caregivers’ health. A heterogeneous group, caregivers are confronted with individual situational demands and use different available coping strategies. To date, little is known about the relationship between burden and coping by spousal caregivers, particularly in the context of geriatric patients without dementia. Objectives The aim of this study is to explore the burden and coping strategies of caregiving spouses of geriatric patients without dementia and with a hospitalization within the last year. To help explore this population, a typology is presented that has been based on reported perceptions of home care burden and individual coping strategies. Furthermore, a case study is presented for each type of spousal caregiver. Methods The study used a concurrent mixed method design with a sample of nine spousal caregivers (mean age: 78.9 years). Four women and five men were recruited in an acute hospital setting during the TIGER study. Quantitative data were collected using a self-questionnaire and qualitative data were gathered through nine problem-centered interviews with spousal caregivers. The latter were subsequently analyzed utilizing the structured content analysis method. The data were then summarized to nine individual cases. Finally, the results were clustered using the empirically grounded construction of types and typologies. Each type of spousal caregiver is presented by a case study. Results Three types of caregiving spouses were identified: “The Caring Partner”, “The Worried Manager” and “The Desperate Overburdened”. These types differ primarily in the level of subjective burden and caregiving stress, the coping strategies, the motivation for caregiving, and expressed emotions. Conclusions The development of this new typology of caregiving spouses could help health care professionals better understand caregiving arrangements and thus provide more targeted advice. Trial registration The TIGER study was registered with clinicaltrials.gov: NCT03513159. Registered on April 17, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02425-1.
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Affiliation(s)
- Thomas Johann Gehr
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany. .,Hospital of the Order of St. John of God Regensburg, Regensburg, Germany.
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany.,Department of Internal Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Sabine Alexandra Engel
- Department of Social Services, Catholic University of Applied Sciences of North Rhine-Westphalia, Campus Paderborn, Paderborn, Germany.,Private Institute for Gerontological Intervention and EduKation at Dementia GmbH, Buckenhof, Germany
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Thomeer MB, Pollitt A, Umberson D. Support in Response to a Spouse's Distress: Comparing Women and Men in Same-sex and Different-sex Marriages. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2021; 38:1513-1534. [PMID: 34776578 PMCID: PMC8590207 DOI: 10.1177/0265407521998453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Support for a spouse with psychological distress can be expressed in many different ways. Previous research indicates that support expression is shaped by gender, but we do not know much about how support within marriage is provided in response to a spouse's distress outside of a different-sex couple context. In this study, we analyze dyadic data from 378 midlife married couples (35-65 years; N = 756 individuals) within the U.S. to examine how men and women in same- and different-sex relationships provide support when they perceive that their spouse is experiencing distress. We find women in different-sex couples are less likely to report taking care of their distressed spouse's tasks or giving their distressed spouse more personal time and space compared to women in same-sex couples and men. We also find that men in different-sex couples are less likely to report encouraging their spouse to talk compared to men in same-sex couples and women. Being personally stressed by a spouse's distress is positively associated with providing support to that spouse, whereas feeling that a spouse's distress is stressful for the marriage is negatively associated with providing support. This study advances understanding of gendered provisions of support in response to psychological distress in marriage, moving beyond a framing of women as fundamentally more supportive than men to a consideration of how these dynamics may be different or similar in same- and different-sex marital contexts.
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Affiliation(s)
- Mieke Beth Thomeer
- Department of Sociology, The University of Alabama at Birmingham, Heritage Hall 460, 1401 University Blvd., Birmingham, AL 35233
| | - Amanda Pollitt
- Department of Health Sciences, Northern Arizona University
| | - Debra Umberson
- Department of Sociology, University of Texas at Austin
- Population Research Center, University of Texas at Austin
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Happich F, König H, Hajek A. Spousal care and its effect on partnership characteristics – a longitudinal analysis of spousal caregiving and care receipt in Germany. Scand J Caring Sci 2021; 36:109-119. [DOI: 10.1111/scs.12968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/22/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Fiona Happich
- Department of Health Economics and Health Services Research University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Hans‐Helmut König
- Department of Health Economics and Health Services Research University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - André Hajek
- Department of Health Economics and Health Services Research University Medical Center Hamburg‐Eppendorf Hamburg Germany
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Abstract
Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies to support caregivers. Caregiving as chronic stress exposure is the conceptual driver for much of this research. We review and synthesize the literature on the impact of caregiving and intervention strategies for supporting caregivers. The impact of caregiving is highly variable, driven largely by the intensity of care provided and the suffering of the care recipient. The intervention literature is littered with many failures and some successes. Successful interventions address both the pragmatics of care and the emotional toll of caregiving. We conclude with both research and policy recommendations that address a national agenda for caregiving.
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Affiliation(s)
- Richard Schulz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA; .,University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Scott R Beach
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Sara J Czaja
- Center on Aging and Behavioral Research, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Lynn M Martire
- College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Joan K Monin
- School of Public Health, Yale University, New Haven, Connecticut 06520, USA
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Factors Associated with Marital Satisfaction and Quality of Life in Family Caregivers of Patients with Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162825. [PMID: 31398793 PMCID: PMC6719212 DOI: 10.3390/ijerph16162825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 01/04/2023]
Abstract
(1) Background: The aim of this research was to analyze factors associated with quality of life (QoL) and marital satisfaction in married family caregivers of patients with mental disorders. (2) Methods: A cross-sectional study was conducted in all community mental health services in Goiania municipality, Brazil, in 2016–2017. Married family caregivers of patients with severe and persistent mental disorders were recruited and their QoL and marital satisfaction was assessed by using the World Health Organization Quality of Life Instrument Abbreviated version (WHOQOL-BREF) and Marital Satisfaction Scale. Multiple linear regressions were performed to identify factors associated with QoL and marital satisfaction. (3) Results: For 163 family caregivers, the psychological and environmental QoL domains presented the best and the worst scores, respectively. Factors independently associated with better QoL for caregivers were male caregiver, the younger age of a caregiver, >8 years of schooling, ≥5 years as a caregiver who performed physical activities, caregiver without chronic disease, and no patient’s crisis in the last 30 days. Factors independently associated with marital satisfaction of the caregiver were male caregiver, caregiver with >8 years of schooling, caregiver who received support by relatives to care for the patient, caregiver who performed physical activities, no patient’s crisis in the last 30 days, and patient hospitalization in the last six months; (4) Conclusions: The main predictor for marital satisfaction was support by relatives, and for QoL it was no patient’s crisis in the last 30 days.
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Litchman ML, Wawrzynski SE, Allen NA, Tracy EL, Kelly CS, Helgeson VS, Berg CA. Yours, Mine, and Ours: A Qualitative Analysis of the Impact of Type 1 Diabetes Management in Older Adult Married Couples. Diabetes Spectr 2019; 32:239-248. [PMID: 31462880 PMCID: PMC6695253 DOI: 10.2337/ds18-0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study was to understand perceptions of diabetes management responsibilities and the impact of diabetes on day-to-day activities in older adulthood for individuals with type 1 diabetes and their spouses. DESIGN AND METHODS This qualitative content analysis used a constant-compare approach to analyze individual interviews conducted with older adults and their spouses. People with type 1 diabetes (PWD) and their spouses were interviewed regarding how they coped or dealt with diabetes, what activities they carried out or avoided because of diabetes, and how they appraised diabetes as an individual or shared problem. RESULTS Participants (n = 52) included 26 older adults with diabetes (mean age 69 years, SD 2.56 years; 38.5% female) and their spouses (mean age 68 years, SD 5.11 years; 61.5% female). Half of the PWD (50%) and the majority of spouses (76.9%) appraised diabetes as a shared issue. Five themes emerged from the interview data: 1) Perceptions pf PWD of spouse involvement in diabetes care, 2) PWD underestimated the impact of diabetes on their spouse's daily lives, 3) gendered nature of spouses supporting diabetes management, 4) evolution of diabetes and the relationship across developmental time, and 5) differences in diabetes management among couples. CONCLUSION Older adults with type 1 diabetes and their spouses have different perspectives regarding diabetes support and responsibility and may not always realize what support is being provided or needed to optimize effective diabetes management. Advancing age with or without diabetes complications may necessitate that spouses provide diabetes support. Diabetes management training for spouses would likely be helpful.
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Affiliation(s)
- Michelle L. Litchman
- University of Utah College of Nursing, Salt Lake City, UT
- Utah Diabetes and Endocrinology Center, Salt Lake City, UT
| | | | - Nancy A. Allen
- University of Utah College of Nursing, Salt Lake City, UT
| | - Eunjin L. Tracy
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Caitlin S. Kelly
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Vicki S. Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA
| | - Cynthia A. Berg
- Department of Psychology, University of Utah, Salt Lake City, UT
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Carr D, Cornman JC, Freedman VA. Do Family Relationships Buffer the Impact of Disability on Older Adults' Daily Mood? An Exploration of Gender and Marital Status Differences. JOURNAL OF MARRIAGE AND THE FAMILY 2019; 81:729-746. [PMID: 31182882 PMCID: PMC6555429 DOI: 10.1111/jomf.12557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 01/05/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVE We evaluate whether non-spousal family support and strain moderate the effect of disability on two daily emotions (happiness and frustration) among older adults, and whether these patterns differ by gender among married persons, and by marital status among women. BACKGROUND Stress buffering perspectives predict that harmful effects of stress on well-being are buffered by family support, whereas stress proliferation models suggest these effects are intensified by family strain. The extent to which family relationships moderate associations between stress and well-being may vary on the basis of gender and marital status, as non-spousal family ties are considered especially salient for women and those without a romantic partner. METHOD Daily diary data are from the 2013 Disability and Use of Time supplement to the Panel Study of Income Dynamics (n=1,474), a national sample of adults ages 60+. Multivariate regression models are estimated for married/partnered men and women, and formerly married women. RESULTS Neither family support nor strain moderated the effect of severe impairment on married men's daily emotions. Family support buffered the effect of severe impairment on frustration among divorced and widowed women, but not their married counterparts. Counterintuitively, family arguments mitigated against frustration and increased happiness among married women with severe impairment. CONCLUSION Consistent with stress buffering perspectives, family support was most protective for the vulnerable population of formerly married older women with severe impairment. IMPLICATIONS This study underscores the importance of family support for the large and growing population of formerly married women managing health-related challenges in later life.
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Affiliation(s)
- Deborah Carr
- Boston University, Department of Sociology, 100 Cummington Mall, Boston, MA 02215,
| | | | - Vicki A Freedman
- University of Michigan, Institute for Social Research, 426 Thompson St., Ann Arbor, MI 48106,
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Wilkins VM, Sirey JA, Bruce ML. Caregiver Reward and Burden: Differing Constructs in Family Members Providing Care for Medically Ill Homebound Older Adults. J Aging Health 2019; 32:361-370. [DOI: 10.1177/0898264319825760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: This study examined the relationship between caregiver burden and reward and how each relates to factors, such as depression, within the caregiving dyad. Method: A total of 101 older adults and their primary family caregivers were recruited upon enrolling in home health care services. Patients were assessed for sociodemographic information, depression, disability, pain, and caregiver support at baseline and at 8 weeks. Caregivers were assessed at baseline for sociodemographic information, depression, caregiver burden, caregiver reward, and caregiving tasks they provide. Results: Burden and reward were significantly inversely correlated, but differentially associated with distinct patient and caregiver variables. Patients whose caregivers reported higher baseline levels of caregiver reward were more likely to have lower depression scores at follow-up. Discussion: Given that different aspects of patients and caregivers influence reward and burden, assessing caregivers for both burden and reward may better target caregiver interventions at the individual and family levels, particularly for older adult depression.
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Maxwell CJ, Campitelli MA, Diong C, Mondor L, Hogan DB, Amuah JE, Leslie S, Seitz D, Gill S, Thavorn K, Wodchis WP, Gruneir A, Teare G, Bronskill SE. Variation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex. BMC Geriatr 2018; 18:211. [PMID: 30208884 PMCID: PMC6134755 DOI: 10.1186/s12877-018-0899-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022] Open
Abstract
Background The identification of contextual factors that modify associations between client frailty and their health and service use outcomes is essential for informed home health care and policy planning. Our objective was to examine variation in the associations between frailty and select 1-year health outcomes by caregiver distress and client sex among community-residing older care recipients. Methods We conducted a retrospective cohort study using linked population-based clinical and health administrative databases for all long-stay home care clients (n = 234,552) aged 66+ years assessed during April 2010–2013 in Ontario, Canada. Frailty was assessed using a previously validated 72-item frailty index (FI). Presence of caregiver distress was derived from clinical assessment items administered by trained home care assessors. Multivariable log-binomial regression models were used to examine variations in the associations between frailty and outcomes of interest (mortality, nursing home [NH] placement, all-cause and prolonged hospitalization) by caregiver distress, with further model stratification by client sex. Results Frailty prevalence varied little by sex (19.3% women, 19.9% men) despite significant sex-differences in clients’ sociodemographic and health characteristics. In both sexes, frailty was significantly associated with all outcomes, particularly NH placement (RR = 3.84, 95%CI 3.75–3.93) and death (RR = 2.32, 95%CI 2.27–2.37), though risk ratios were greater for women. Caregiver distress was more common with increasing frailty and for male clients, and a significant independent predictor of NH placement and prolonged hospitalization in both sexes. The association between frailty and NH placement (but not other outcomes) varied by caregiver distress for both men and women (p < 0.001 interaction terms), showing a greater magnitude of association among clients without (vs. with) a distressed caregiver. Conclusions As caregiver distress varies by client sex, represents a key driver of NH placement (even among relatively robust clients), and modifies the impact of other risk factors such as frailty, it should be routinely assessed. Further, sex-differences should be considered when developing and evaluating community-based services for older adults and their caregivers. Electronic supplementary material The online version of this article (10.1186/s12877-018-0899-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colleen J Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada. .,Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
| | - Michael A Campitelli
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Christina Diong
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Luke Mondor
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Health System Performance Research Network, Toronto, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, HSC-3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Joseph E Amuah
- School of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Sarah Leslie
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada
| | - Dallas Seitz
- Division of Geriatric Psychiatry, Queen's University & Providence Care Hospital, 752 King Street W, Kingston, ON, K7L 4X3, Canada
| | - Sudeep Gill
- Department of Medicine, Queen's University & Providence Care Hospital, 752 King Street W, Kingston, ON, K7L 4X3, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, 501 Smyth Road, PO Box201B, Ottawa, ON, K1H 8L6, Canada
| | - Walter P Wodchis
- Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Gary Teare
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Health Science Building, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
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Gaugler JE, Reese M, Mittelman MS. The Effects of a Comprehensive Psychosocial Intervention on Secondary Stressors and Social Support for Adult Child Caregivers of Persons With Dementia. Innov Aging 2018; 2:igy015. [PMID: 30009268 PMCID: PMC6037049 DOI: 10.1093/geroni/igy015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Many evaluations of nonpharmacologic interventions for family members of persons with Alzheimer's disease or related dementias (ADRDs) exist, but few consider effects on outcomes that are pertinent to caregivers' roles and relationships. The current study evaluated the efficacy of the New York University Caregiver Intervention-Adult Child (NYUCI-AC) on perceptions of family conflict, role conflict (effects of family caregiving and time, family, and social life), and perceived social support for adult child caregivers of relatives with ADRD over a 3-year period. Research Design and Methods A single-blinded randomized controlled trial design was used. One-hundred and seven adult child caregivers were enrolled in the NYUCI-AC and randomly assigned to a treatment or contact control group. Assessments were scheduled to be completed every 4 months during the first year of participation and every 6 months thereafter for up to 3 years. Individual growth curve models were utilized to ascertain the effects of the NYUCI-AC on change in family conflict, role conflict, and perceptions of social support. Results Among the entire sample, role conflict significantly (p < .05) declined and satisfaction with instrumental assistance increased over the course of the study, whereas family conflict slightly increased over the initial study period and then declined slightly. The findings indicated that the NYUCI-AC did not exert statistically significant effects on changes in family conflict, role conflict, or perceptions of social support over the 3-year study period. Discussion and Implications Although the clinical content of some dementia caregiver interventions is tailored to the specific needs of each caregiver and family, the outcomes selected to judge the efficacy of these interventions might not follow similar principles. Incorporating clinical content and evaluation outcomes that are family-centered will help to advance the state of the art of dementia caregiving interventions.
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Affiliation(s)
- Joseph E Gaugler
- Division of Health Policy & Management, School of Public Health, Minneapolis
| | - Mark Reese
- Families and LTC Projects, School of Nursing, University of Minnesota, Minneapolis
| | - Mary S Mittelman
- Department of Psychiatry, NYU School of Medicine, NYU Langone Health, New York, New York
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