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Fowler NR, Perkins AJ, Park S, Schroeder MW, Boustani MA, Head KJ, Bakas T. Relationship between health-related quality of life, depression, and anxiety in older primary care patients and their family members. Aging Ment Health 2024; 28:910-916. [PMID: 38019031 DOI: 10.1080/13607863.2023.2285499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES Patient-family member dyads experience transitions through illness as an interdependent team. This study measures the association of depression, anxiety, and health-related quality of life (HRQOL) of older adult primary care patient-family member dyads. METHODS Baseline data from 1,808 patient-family member dyads enrolled in a trial testing early detection of Alzheimer's disease and related dementias in primary care. Actor-Partner Independence Model was used to analyze dyadic relationships between patients' and family members' depression (PHQ-9), anxiety (GAD-7), and HRQOL (SF-36 Physical Component Summary score and Mental Component Summary score). RESULTS Family member mean (SD) age is 64.2 (13) years; 32.2% male; 84.6% White; and 64.8% being the patient's spouse/partner. Patient mean (SD) age is 73.7 (5.7) years; 47% male; and 85.1% White. For HRQOL, there were significant actor effects for patient and family member depression alone and depression and anxiety together on their own HRQOL (p < 0.001). There were significant partner effects where family member depression combined with anxiety was associated with the patient's physical component summary score of the SF-36 (p = 0.010), and where the family member's anxiety alone was associated with the patient's mental component summary score of the SF-36 (p = 0.031). CONCLUSION Results from this study reveal that many dyads experience covarying health status (e.g. depression, anxiety) even prior to entering a caregiving situation.
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Affiliation(s)
- Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN, USA
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Seho Park
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Matthew W Schroeder
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Malaz A Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN, USA
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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Seibert T, Schroeder MW, Perkins AJ, Park S, Batista-Malat E, Head KJ, Bakas T, Boustani M, Fowler NR. The Impact of the COVID-19 Pandemic on the Mental Health of Older Primary Care Patients and Their Family Members. J Aging Res 2022; 2022:6909413. [PMID: 36285190 PMCID: PMC9588361 DOI: 10.1155/2022/6909413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2023] Open
Abstract
The COVID-19 pandemic introduced mandatory stay-at-home orders and concerns about contracting a virus that impacted the physical and mental health of much of the world's population. This study compared the rates of depression and anxiety in a sample of older primary care patients (aged ≥65 years old) and their family members recruited for a clinical trial before and during the COVID-19 pandemic. Participants were dyads enrolled in the Caregiver Outcomes of Alzheimer's Disease Screening (COADS) trial, which included 1,809 dyads of older primary care patients and one of their family members. Mean scores on the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Scale-7 (GAD-7) were measured and compared before and during the pandemic. We found no difference in depression and anxiety among dyads of older primary care patients and their family members recruited before and during COVID-19. Additionally, we found that older primary care patients and family members who reported their income as comfortable had significantly lower depression and anxiety compared to those who reported having not enough to make ends meet. Along with this, older primary care patients with a high school education or less were more likely to have anxiety compared to those with a postgraduate degree. Moreover, our findings support the notion that certain demographics of older primary care patients and family members are at a higher risk for depression and anxiety, indicating who should be targeted for psychological health interventions that can be adapted during COVID-19. Future research should continue monitoring older primary care patients and their family members through the remainder of the COVID-19 pandemic.
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Affiliation(s)
- Tara Seibert
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Matthew W. Schroeder
- Indiana University Center for Aging Research, Indianapolis, IN 46202, USA
- Regenstrief Institute Inc., Indianapolis, IN 46202, USA
| | - Anthony J. Perkins
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indianapolis, IN 46202, USA
| | - Seho Park
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indianapolis, IN 46202, USA
| | - Eleanor Batista-Malat
- Indiana University Center for Aging Research, Indianapolis, IN 46202, USA
- Regenstrief Institute Inc., Indianapolis, IN 46202, USA
| | - Katharine J. Head
- Indiana University-Purdue University Indianapolis, Department of Communication Studies, Indianapolis, IN 46202, USA
| | - Tamilyn Bakas
- University of Cincinnati College of Nursing, Cincinnati, OH 45219, USA
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202, USA
- Regenstrief Institute Inc., Indianapolis, IN 46202, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis 46202, USA
| | - Nicole R. Fowler
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202, USA
- Regenstrief Institute Inc., Indianapolis, IN 46202, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis 46202, USA
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Gómez-Gallego M, Gómez-Gallego JC. Predictors of Caregiver Burden of Patients with Alzheimer Disease Attending Day-Care Centres. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010707. [PMID: 34682452 PMCID: PMC8535802 DOI: 10.3390/ijerph182010707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
Nowadays, there are plenty of programs and resources to prevent caregiver burden of patients with Alzheimer’s disease. In spite of that, many caregivers suffer high levels of burden and stress, which leads to an earlier institutionalization of patients. This study aimed to explore the predictors of burden in relative caregivers of patients attending day-care centers and the moderating role of caregiver kinship in these associations. A sample of a hundred and two patient–caregiver dyads was recruited. Burden was measured with a Zarit Burden Interview. Measures of patients’ cognition, insight, depression, behavioral disturbances, functional ability and overall physical health were considered as predictors. We found that apathy, irritability and delusions and, patients’ mobility are the main determinants of caregivers’ burden. The strength of relationship between delusions and irritability was higher in spouse caregivers. Interventions to reduce burden should be adapted to the specific needs of a particular type caregiver.
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Affiliation(s)
- María Gómez-Gallego
- Clinical Neuroscience Research Group, Faculty of Health Sciences, Catholic University of Murcia, 30107 Murcia, Spain;
| | - Juan Cándido Gómez-Gallego
- Department of Applied Economics, Faculty of Economic, Espinardo Campus, University of Murcia, 30100 Murcia, Spain
- Correspondence:
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Fowler NR, Head KJ, Perkins AJ, Gao S, Callahan CM, Bakas T, Suarez SD, Boustani MA. Examining the benefits and harms of Alzheimer's disease screening for family members of older adults: study protocol for a randomized controlled trial. Trials 2020; 21:202. [PMID: 32075686 PMCID: PMC7031904 DOI: 10.1186/s13063-019-4029-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple national expert panels have identified early detection of Alzheimer's disease and related dementias (ADRD) as a national priority. However, the United States Preventive Services Task Force (USPSTF) does not currently support screening for ADRD in primary care given that the risks and benefits are unknown. The USPSTF stresses the need for research examining the impact of ADRD screening on family caregiver outcomes. METHODS The Caregiver Outcomes of Alzheimer's Disease Screening (COADS) is a randomized controlled trial that will examine the potential benefits or harms of ADRD screening on family caregivers. It will also compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening. COADS will enroll 1800 dyads who will be randomized into three groups (n = 600/group): the 'Screening Only' group will receive ADRD screening at baseline and disclosure of the screening results, with positive-screen participants receiving a list of local resources for diagnostic follow-up; the 'Screening Plus' group will receive ADRD screening at baseline coupled with disclosure of the screening results, with positive-screen participants referred to a dementia collaborative care program for diagnostic evaluation and potential care; and the control group will receive no screening. The COADS trial will measure the quality of life of the family member (the primary outcome) and family member mood, anxiety, preparedness and self-efficacy (the secondary outcomes) at baseline and at 6, 12, 18 and 24 months. Additionally, the trial will examine the congruence of depressive and anxiety symptoms between older adults and family members at 6, 12, 18 and 24 months and compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening between the two groups randomized to screening (Screening Only versus Screening Plus). DISCUSSION We hypothesize that caregivers in the screening arms will express higher levels of health-related quality of life, lower depressive and anxiety symptoms, and better preparation for caregiving with higher self-efficacy at 24 months. Results from this study will directly inform the National Plan to Address Alzheimer's Disease, the USPSTF and other organizations regarding ADRD screening and early detection policies. TRIAL REGISTRATION ClinicalTrials.gov, NCT03300180. Registered on 3 October.
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Affiliation(s)
- Nicole R. Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN 46202 USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202 USA
| | - Anthony J. Perkins
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202 USA
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202 USA
| | - Christopher M. Callahan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
- Eskenazi Health, Indianapolis, IN 46202 USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH 45219 USA
| | - Shelley D. Suarez
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
| | - Malaz A. Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN 46202 USA
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Bangerter LR, Liu Y, Zarit SH. Longitudinal trajectories of subjective care stressors: the role of personal, dyadic, and family resources. Aging Ment Health 2019; 23:255-262. [PMID: 29171960 PMCID: PMC6097957 DOI: 10.1080/13607863.2017.1402292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Stressors are critical to the caregiver stress process, yet little work has examined resources that contribute to longitudinal changes in subjective stressors. The present study examines a variety of factors that contribute to changes in subjective stressors across time. METHOD Dementia caregivers (N = 153) completed an in-person interview and eight daily telephone interviews at baseline, and follow up interviews at 6 and 12 months. Growth curve analyses examine how care- and non-care stressors, respite, dyadic relationship quality, family support/conflict and care transitions (e.g. nursing home placement) are associated with changes in role overload and role captivity across 12 months. RESULTS Caregivers who transitioned out of their role had higher overload and captivity at baseline. Among caregivers who transitioned out of caregiving, higher captivity at baseline was associated with declines in captivity and overload; more non-care stressors at baseline was linked to increased captivity and greater overload across time. Adult day service use and family support were associated with lesser captivity over time; taking more breaks from caregiving was linked to lower overload. Higher dyadic relationship quality was associated with lower captivity and overload. CONCLUSION Findings contribute to caregiver intervention efforts by highlighting important resources associated with subjective stressors across time.
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Affiliation(s)
- Lauren R. Bangerter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905
| | - Yin Liu
- Department of Family, Consumer, and Human Development, Utah State University, Logan, UT 84322
| | - Steven H. Zarit
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802
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Kovaleva M, Spangler S, Clevenger C, Hepburn K. Chronic Stress, Social Isolation, and Perceived Loneliness in Dementia Caregivers. J Psychosoc Nurs Ment Health Serv 2018; 56:36-43. [DOI: 10.3928/02793695-20180329-04] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/08/2018] [Indexed: 01/02/2023]
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Abstract
OBJECTIVES Family responsibilities and social expectations often prompt conflict in caregivers' decision-making processes. Janis and Mann's (1977) conflict model describes vigilance as high-quality decision-making resulting in optimal outcomes. The purpose of our research was threefold: (1) to describe decision styles in a population of family caregivers of persons with dementia; (2) to examine the socio-economic characteristics associated with caregivers who are more likely to be vigilant decision-makers; and (3) to assess differences in caregiving experiences between vigilant and non-vigilant caregivers. METHOD Our analysis was based on 639 survey respondents recruited from a university-affiliated memory disorders clinic. RESULTS Our typical caregiver was Caucasian non-Hispanic, was currently married, and had two children. Approximately half of our sample used a 'pure vigilant' decision style. Vigilance was associated with more positive and fewer negative caregiving outcomes. CONCLUSION Supporting caregivers to become vigilant decision-makers is a functionally viable intervention that could significantly improve the caregiving experience.
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Affiliation(s)
- Sarah B Wackerbarth
- a Health Management & Policy, College of Public Health, University of Kentucky , Lexington , KY , USA
| | - Yelena N Tarasenko
- b Jiann-Ping Hsu College of Public Health, Georgia Southern University , Statesboro , GA , USA
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Roland KP, Chappell NL. Caregiver Experiences Across Three Neurodegenerative Diseases: Alzheimer’s, Parkinson’s, and Parkinson’s With Dementia. J Aging Health 2017; 31:256-279. [DOI: 10.1177/0898264317729980] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: This article asks whether distinct caregiver experiences of Alzheimer’s disease (AD), Parkinson’s disease (PD), and Parkinson’s disease with dementia (PDD) spouses are accounted for by disease diagnosis or by a unique combination of symptoms, demands, support, and quality of life (QOL) cross disease groups. Method: One hundred five live-in spouse caregivers (71.4 ± 7 years) were surveyed for persons with AD (39%), PD (41%), and PDD (20%). A hierarchical cluster analysis organized caregivers across disease diagnosis into clusters with similar symptom presentation, care demands, support, and QoL. Results: Four clusters cut across disease diagnosis. “Succeeding” cared for mild symptoms and had emotional support. “Coping” managed moderate stressors and utilized formal supports. “Getting by with support” and “Struggling” had the greatest stressors; available emotional support influenced whether burden/depression was moderate or severe. The results remain the same when diagnostic category is added to the cluster analysis. Discussion: This study supports going beyond disease diagnosis when examining caregiver experiences.
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Abstract
OBJECTIVES Describe the development of a competent workforce committed to providing patient-centered care to persons with dementia and/or depression and their caregivers; to report on qualitative analyses of our workforce's case reports about their experiences; and to present lessons learned about developing and implementing a collaborative care community-based model using our new workforce that we call care coordinator assistants (CCAs). METHOD Sixteen CCAs were recruited and trained in person-centered care, use of mobile office, electronic medical record system, community resources, and team member support. CCAs wrote case reports quarterly that were analyzed for patient-centered care themes. RESULTS Qualitative analysis of 73 cases using NVivo software identified six patient-centered care themes: (1) patient familiarity/understanding; (2) patient interest/engagement encouraged; (3) flexibility and continuity of care; (4) caregiver support/engagement; (5) effective utilization/integration of training; and (6) teamwork. Most frequently reported themes were patient familiarity - 91.8% of case reports included reference to patient familiarity, 67.1% included references to teamwork and 61.6% of case reports included the theme flexibility/continuity of care. CCAs made a mean number of 15.7 (SD = 15.6) visits, with most visits for coordination of care services, followed by home visits and phone visits to over 1200 patients in 12 months. DISCUSSION Person-centered care can be effectively implemented by well-trained CCAs in the community.
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Affiliation(s)
- Mary Guerriero Austrom
- Department of Psychiatry, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA
- Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA
- Office for Diversity and Inclusion, IUSM, Indianapolis, IN, USA
| | - Carly A. Carvell
- Department of Psychiatry, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA
| | | | - Sujuan Gao
- Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA
- Department of Biostatistics, IUSM, Indianapolis, IN, USA
| | - Malaz Boustani
- Michael LaMantia, Eskenazi Health, Indianapolis, IN, USA
- Michael LaMantia, IUSM, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Center for Health Innovation and Implementation, IUSM, Indianapolis, IN, USA
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Qualitative study on needs and wishes of early-stage dementia caregivers: the paradox between needing and accepting help. Int Psychogeriatr 2015; 27:927-36. [PMID: 25566686 DOI: 10.1017/s1041610214002804] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early individualized interventions for informal dementia caregivers can prevent overburdening in the later stages. However, the needs of early-stage dementia caregivers (EDC) remain largely unknown. This study aimed to explore the needs and wishes and need for care of EDC to maximize the benefit of potential programs for EDC and tailor interventions accordingly. METHODS Four focus group interviews with 28 informal caregivers of people with dementia (PwD) were analyzed using inductive content analysis. Both EDC and caregivers in the later stages were included to compare perceived EDC needs from different points in the caregiver career. RESULTS Four themes were identified: the early-stage needs paradox, barriers in acceptance, facilitators in acceptance, and a transition from loss to adaptation. The retrospective view provided by later-stage caregivers differed from the view of EDC; EDC struggled with acknowledging needs due to fear of stigma and low acceptance. EDC stressed the importance of acceptance as a prerequisite for adequate adaptation, but were hindered by lack of knowledge, difficulty acknowledging changes, and focus on loss. In contrast, better understanding of the disease, increasing personal time, structuring ones day, and using appropriate humor can reduce negative communication, increase positive encounters and caregiver-confidence, contributing to positive interaction with the care recipient and an increase in well-being. CONCLUSIONS Early therapeutic interventions could help caregivers identify their needs, increase knowledge about changes in roles and relationship reciprocity, and focus on enhancement of the positive, intact experiences to prevent caregiver burden.
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