Examining the influence of family dynamics on quality of care by informal caregivers of patients with Alzheimer's dementia in Argentina

Association between family functioning and delay in seeking medical care of Chinese bladder cancer patients: the mediating effect of coping styles

PURPOSE

To explore the mechanism by which coping styles of bladder cancer patients influence the relationship between family functioning and delay in seeking medical care. This knowledge could provide a basis for developing interventions to address delayed medical care for patients with bladder cancer.

METHODS

A total of 312 patients with bladder cancer were investigated using the General Information Questionnaire, Questionnaire on the patient's medical condition, the Medical Coping Style Scale, and the Family Functioning Rating Scale.

RESULT

The median delay time for bladder cancer patients was 44.5 days, and the family functioning score at (124.50 ± 24.86), with the face dimension score at (1.66 ± 0.53), the recuse dimension score at (2.48 ± 0.66), and the yield dimension score at (1.34 ± 0.57). The total score of family functioning and each dimension were positively correlated with the delay time of medical care, the coping styles (face) were negatively correlated with the delay time of medical care, and the coping styles (recuse and yield) were positively correlated with it. The mediating effect model showed that family function had an indirect effect through coping styles (face, recuse, and yield), with a total effect of 0.369, and coping styles (face, recuse, and yield) had a mediating effect on the delay time of medical care (indirect effect sizes were 0.123, 0.096, and 0.114, respectively).

CONCLUSION

The coping styles of patients with bladder cancer play a mediating role between family functioning and the delay in seeking medical care. Medical staff should encourage bladder cancer patients to adopt a proactive coping approach and improve the support capacity of bladder cancer patients' families to effectively shorten the delay time.

Experiences of empathy of caregivers caring for persons with dementia: a qualitative systematic review protocol

OBJECTIVE

The aim of this systematic review will be to explore the experiences of empathy in informal caregivers providing care for persons with dementia.

INTRODUCTION

Positive caregiving experiences of informal caregivers providing care for persons with dementia have many beneficial outcomes, such as improved well-being of both caregivers and care receivers and a higher quality of care for the persons with dementia. Empathy is a factor associated with positive caregiving experiences and is strongly correlated with reduced depression and reduced anxiety in informal caregivers of persons with dementia. Therefore, it is essential to understand the experiences of empathy, especially the caregiver characteristics such as their caring behaviors, relationship with the patient, and cultural beliefs.

INCLUSION CRITERIA

This review will include studies on the empathy experiences of informal caregivers providing care for persons with any type of dementia. It will consider qualitative studies, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, and feminist research.

METHODS

This study will follow the JBI guidance for systematic reviews of qualitative evidence and will use the meta-aggregation approach to synthesise qualitative studies. The search strategy will aim to locate both published and unpublished studies in English, Chinese, and Thai, with no date restrictions. Methodological quality will be evaluated using the standard JBI critical appraisal checklist for qualitative research. The findings will be pooled using the meta-aggregation approach or will be presented in narrative format.

REVIEW REGISTRATION

PROSPERO CRD42023490472.

Empathy Training for Caregivers of Older People: A Systematic Review

OBJECTIVES

To identify empathy training models and the effects on psychological concerns in paid and unpaid caregivers of older people.

METHODS

A systematic review was conducted. Searches for relevant articles were performed in the Embase, LILACS, PsycInfo, Pubmed, Scopus and Web of Science databases using the following search strategy: "Empathy AND (Education OR Training OR Intervention) AND Caregiver." No restrictions were imposed regarding language or year of publication.

RESULTS

Empathy training for caregivers of older people were performed in six studies, three of which identified a significant increase in empathy levels and consequent reduction in psychological concerns. Empathy training focused on aspects of empathy and/or the caregiver had significant effects on the outcome variables. Moreover, training conducted online, by telephone and/or in person can generate satisfactory results. The other three studies that conducted training with a focus on aspects of dementia and/or old age did not present any effect on the outcome variables.

CONCLUSIONS

Empathy training for caregivers of older people can increase levels of this ability, especially in the cognitive domain, as well as diminish psychological concerns caused by the negative impact of providing care.

CLINICAL IMPLICATIONS

Empathy training directed at empathic abilities and/or aspects of providing care can be effective at increasing levels of this ability. Moreover, training in different care contexts can minimize the negative impacts of providing care.

Caregiver burden, mental health, quality of life and self-efficacy of family caregivers of persons with dementia in Malaysia: baseline results of a psychoeducational intervention study

BACKGROUND

The majority of persons with dementia (PWD) are mainly cared for by their family members in the home. Evidence is however scarce on family caregivers' psychosocial burden and quality of life in Asian countries including Malaysia. This study describes the baseline data of a telephone-delivered psychoeducational intervention study and examines the determinants of outcome measures (caregiver burden, depressive and anxiety symptoms, quality of life and caregiving self-efficacy) among Malaysian family caregivers to PWD.

METHODS

This was a cross-sectional study originated from the baseline survey of a randomized control trial of 121 family caregivers recruited from lists of PWD who were registered at memory and psychiatry clinics in three tertiary care hospitals in Malaysia. The participants were assessed for caregiver burden by the Zarit Burden Interview, depressive and anxiety symptoms by the Hospital Anxiety and Depression Scale, quality of life by the Control, Autonomy, Self-Realization, and Pleasure Scale, and caregiving self-efficacy by the Revised Scale for Caregiving Self-Efficacy.

RESULTS

Prevalence of caregiver burden was 69.4%, depressive symptoms 32.2% and anxiety symptoms 32.2%. Family caregivers to PWD having perceived peer support e.g., social/family/friend/significant other supports were less likely to report caregiver burden, depressive and anxiety symptoms, and more likely to report higher levels of quality of life and caregiving self-efficacy. Being married and PWD's ability to self-care were associated with lesser likelihood of experiencing caregiver burden, depressive and anxiety symptoms. The other determinants of greater probability of reporting better quality of life were caregivers' employment and having Islamic faith. Marital status (married), PWD's ability to self-care, spousal relationship with PWD and shared caregiving process were associated with higher likelihood of reporting caregiving self-efficacy.

CONCLUSION

Caregiver burden, depressive and anxiety symptoms are prevalent in family caregivers to PWD in Malaysia. Social support and caregiving related factors influence family caregivers' quality of life and caregiving self-efficacy. Implementing psychoeducational intervention and support in the psychiatry and memory clinics may help improve the psychosocial burden, quality of life and caregiving self-efficacy in family caregivers of PWD.

TRIAL REGISTRATION

ISRCTN14565552 (retrospectively registered).

Effect of family resilience on subjective well-being in patients with advanced cancer: the chain mediating role of perceived social support and psychological resilience

Purposes

Domestic and international research has found that patients with advanced cancer prioritize increasing their quality of life above extending their lives with simple or intensive treatments. The current study investigates the pathways to improve patients' sense of well-being from the family, social, and individual levels, that is to say, it investigates the mediating roles of comprehending social support as well as psychological resilience in the relationship between family resilience and subjective well-being, and it also provides references for future intervention.

Method

The Family Resilience Questionnaire (FRQ), General Well-being Schedule (GWB), Perceived Social Support Scale (PSSS), and the Chinese version of the Cornor-Davidson Resilience Scale 10-item (CD-RISC) were all completed by 338 patients with advanced cancer who took part in the study.

Results

The study's findings demonstrated a significant and positive correlation between family resilience, subjective well-being, perceived social support, and psychological resilience. Additionally, there was a significant direct effect of family resilience on subjective well-being as well as a mediating and chain mediating effect between perceived social support and psychological resilience. The findings of this study will be very helpful in the future when it comes to enhancing the quality of life for patients with advanced cancer through intervention.

Conclusion

Subjective well-being can be influenced directly by the family resilience of advanced cancer patients, or indirectly through the psychological resilience and perceived social support.

Types of Empathy Among Certified Caregivers of Older Adults with Dementia

Purpose

This study identifies the unique phenomena and subjectivity of empathy as exhibited by certified caregivers.

Methods

Q-methodology was used to define types and describe the characteristics of empathy in certified caregivers. After in-depth interviews with 10 certified caregivers and a review of the related literature, the final 38 Q-samples were selected by collecting experts' opinions. These Q-samples were sorted by 30 certified caregivers (P-samples). The PC-QUNAL program was used to analyze the Q-sort data.

Results

Seven distinctive Q-factors for the empathy of certified caregivers were identified: I. Information-oriented cognition, II. Sensory communication, III. Compassion, IV. Performance-seeking through self-reflection, V. Intuitive empathy, VI. Role-centered sincerity, and VII. Passive obligation. The empathy of certified caregivers caring for older adults with dementia showed various characteristics according to each of their subjective values and judgments.

Conclusion

This study's results help identify the empathy types and characteristics of certified caregivers caring for older adults with dementia and may contribute to improving the quality of care.

Family dynamics in dementia care: A phenomenological exploration of the experiences of family caregivers of relatives with dementia

WHAT IS KNOWN ON THE SUBJECT?: Several studies explore and describe the role of family dynamics in dementia care. However, few focus specifically on the diversity of family relationships that influence family caregivers' experiences of providing care to a relative with dementia. The role of family caregivers engaging in unpaid care of relatives with dementia is becoming more and more critical as the numbers of people living with dementia increase across the globe. Family caregivers are a diverse group of people as there are different categories of kinship relations and thus cannot be viewed as a single collective. They are linked intricately to their family and social support systems, however, they often experience limited family support, and tensions between family members can be a major source of stress. Hence, health professionals need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is unique in that it focuses on a range of family relationships in which a person with dementia finds themselves. It highlights that this network of complex connections influences the caregiving process. The study demonstrates the important role that siblings can play in sharing the caregiving load. However, this sharing is rarely balanced or fair and there is always someone in the family who carries the heaviest load. Communication between family members is frequently a challenge, with family members experiencing denial or an inability to understand the challenges encountered by the family caregiver. Most studies focus on the relationship between the family caregiver and the relative with dementia alone, rather than the family network of the family caregiver and how it influences the caregiving process. This study is unique as it focuses on family dynamics and the family network, particularly the range of family relationships in which family caregivers and their relative with dementia find themselves. Other studies tend to focus on a specific kinship category and the family network, such as an adult child, caring for their parent, but this study presents a wide variety of kinship categories to demonstrate the diversity of family caregiving contexts. The family caregivers in this study all highlighted the need or desire for effective support from the family network. Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: The findings suggest the need for communication (training and therapeutic) interventions between family caregivers and other family members (secondary caregivers). Mental health nurses are often well positioned to offer the family caregiver the option to undertake such an intervention. The findings emphasize the diversity of family caregiving situations and argue that mental health nurses can assess the nature of the care situations and work with families on how best to address the needs of the relative with dementia and the main caregiver. However, tensions frequently exist between family members, some of which existed prior to the relative acquiring dementia and other tensions as a consequence of the relative acquiring dementia. Mental health nurses could assist as a mediator between family members in order to assist families to become more cohesive. ABSTRACT: Introduction This article explores the diverse nature of family caregivers, focusing on the different categories of kinship relations. Family caregivers are linked intricately to their families, but often experience limited family support, causing stress and tension between family members. Aim The article aims to explore the family relationships of family members caring for relatives with dementia in order to provide an insight into the role of such relationships on the caregiver relative with dementia dyad. Method A phenomenological, exploratory-descriptive design was used. Eight participants took part and data were obtained using collages and semi-structured interviews. Results A range of family relationship patterns was highlighted including sibling involvement in the caregiving process; spousal involvement in supporting a caregiver of a parent; and spousal involvement in caring for their spouse. Discussion The family caregivers highlighted the need or desire for effective support from the family network. Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. Implications for Practice Mental health nurses need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers and assist families to become more cohesive.

The Italian version of the Virtual Dementia Tour: Manual translation and an analysis of consistency, validity, and reliability of its pre- post-experience survey

Introduction

Clinical indications on how to approach caregiving with a person living with dementia underline the need "to have an empathic attitude" requiring the caregiver to view the world from the perspective of the person with dementia. However, it is not easy for the caregiver to understand the perspective their patients have on day-to-day experiences. To put the caregivers in the person with dementia's shoes, the Virtual Dementia Tour (VDT) was developed in 2001, and has been administered to millions of health professionals, community leaders, and family caregivers.

Method

In this paper we present the Italian version of the VDT and discuss its internal validity and test-retest reliability for the pre-post experience survey defined by the VDT procedure.

Results

An Italian sample (N = 419; mean age = 44.8; standard deviation 14.2) completed the tour and a 5-item survey provided before and after the experience revealed the disposition toward people with dementia changed.

Discussion

The VDT Italian version wasrevealed to be valid in supporting a positive perspective change in the perception of dementia as is seen in the original VDT used in English-speaking countries.

Highlights

Empathy predicts a higher quality of caregiving for the person living with dementia.The Virtual Dementia Tour (VDT) provides an experience from the person living with dementia's perspective and supports empathy.We present the first Italian version of VDT and its manual translation and validation.Italian VDT internal consistency and test-retest reliability were calculated.Results confirms the reliability and validity of the Italian VDT for empathy.

Brothers and sisters sharing in the care of a parent with dementia

Brothers' and sisters' experiences providing care to a parent with dementia differ, but little is known about how mixed-gender siblings share their caregiving responsibilities or how sharing affects their relationship. This study aimed to explore mixed-gender siblings processes for distributing caregiving tasks when caring for a parent with dementia and the impact of sharing care on their relationship. This descriptive qualitative study recruited fourteen English-speaking mixed-gender sibling pairs caring for a parent with dementia. Online open-ended surveys and individual semi-structured interviews were completed. Interviews and surveys explored division of caregiving responsibilities, conflict resolution, and the effects of sharing care on sibling relationships. Thematic analysis was used to analyze the qualitative data. Five themes were identified: goal of shared caregiving is to meet parents' needs, sisters often take the lead, practical issues affect sharing of caregiving activities, personal resources or skills affect division of responsibilities, and shared caregiving influences relationship quality. Understanding how siblings share caregiving responsibilities can inform the practices of healthcare professionals who care for people with dementia and their family caregivers.

Meeting the Needs of Parents of Children With Scoliosis: A Qualitative Descriptive Study

Needs of parents with children with scoliosis are complex and depend on their child’s treatments. The purpose of this study was to identify needs of parents with children with scoliosis. This qualitative description involved interviews with parents of children at various stages of treatment. A convenience, then purposeful sample of 16 parents (12 mothers, two fathers, and two stepfathers) was interviewed; interviews were transcribed and analyzed using thematic analysis. Parents’ needs included: Needing reliable medical information; Desiring information on complementary treatments; Wanting help in supporting and advocating for their child; Needing to protect the child and family; and Seeking connection and support. Although many parents’ needs are being met, this study recommends a nursing role aimed at providing parents with reliable medical information, discussing alternative treatments, assisting parents in their role of supporting their child, helping parents in their advocacy efforts, and referring parents to appropriate connections.

Relationships between Kazakh elders' disability severity and informal care time in far north-western low-income areas in China: The mediating roles of caregiver health and home-based care quality

BACKGROUND

Elders' disability severity and caregiver health could predict elders' informal care time, but the mechanism by which the degree of disability in the elderly affects informal care time is unclear.

AIM

The aim of this works is to explore the mediating roles of caregiver health and home-based care quality between disability severity of elders and informal care time in far north-western low-income areas in China.

METHOD

From September 2017 to February 2018, three hundred fifty-two dyads of Kazakh disabled elders and informal caregivers in Xinjiang were interviewed. Structural equation modelling analyses were applied.

RESULTS

Significant positive correlations were observed between elders' disability severity and informal care time, caregiver health and informal care time, elders' disability severity and caregiver health. Significant negative correlations were observed between home-based care quality and informal care time, elders' disability severity and home-based care quality, caregiver health and home-based care quality. Elders' disability severity had 71.94% direct effect on informal care time, 28.06% indirect effect on informal care time mediated by home-based care quality and caregiver health.

CONCLUSION

Caregiver health and home-based care quality play mediating roles on the path relationship between the elders' disability severity and informal care time.

Coping strategies mediate the association between family functioning and posttraumatic growth in family caregivers of people with dementia

OBJECTIVES

This study aimed to examine the mediating effect of coping strategies on the relationship between family functioning and posttraumatic growth in family caregivers of people with dementia (PwD).

METHODS

A total of 124 family caregivers of PwD from a memory clinic were investigated from July to October 2017. Family functioning, coping strategies, and posttraumatic growth of family caregivers of PwD were measured. Data were processed using descriptive statistics, correlation analysis, regression analysis, and structural equation modelling.

RESULTS

Posttraumatic growth was observed in family caregivers of PwD. The caregiver's gender, relationship with the patient, and difficulty balancing financial income and expenditures in the past month, as well as disease severity of PwD, are significant predictors of posttraumatic growth. There were significantly positive correlations among posttraumatic growth, family functioning and positive coping strategies (P＜0.01). Positive coping strategies exert a complete mediating effect between family functioning and posttraumatic growth (β = 0.49, P < 0.05).

CONCLUSIONS

A model of the posttraumatic growth of family caregivers of PwD can be established, and the relevant mechanisms can be explored. Healthcare providers should pay attention to the family functioning of caregivers and take effective measures to provide them with positive coping strategies to promote their posttraumatic growth.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Disability Severity and Home-Based Care Quality in Older Adults: The Mediating Effects of Social Support and Caregiver Competence

Background

The lack of adequate medical care, healthcare, and older adult care in remote, low-income, rural Kazakh areas of China is a particular concern that should be prioritized for improvement.

Purpose

This study was designed to explore the relationship between the variables of disability severity, social support, and caregiver competence and the quality of home-based care in a population of Kazakh older adults with disabilities and to analyze the path between severity of disability and quality of home-based care in this population.

Methods

A cross-sectional survey was conducted on 335 Kazakh older adults with disabilities living in Xinjiang, China, and their primary informal caregivers. Disability severity was assessed using the Activities of Daily Living Scale, caregiver competence was assessed using the Family Caregiver Task Inventory, social support was assessed using the Social Support Rating Scale, and home-based care quality was assessed using the Family Caregiving Consequences Inventory Scale. Path analysis was used to check the effects of other variables on the quality of home-based care.

Results

Significant correlations were found among disability severity, caregiver competence, social support, and home-based care quality. Disability severity was shown to have a 29.28% direct effect on home-based care quality and a 70.72% indirect effect through social support and caregiver competence.

Conclusions

The results of this study confirm that better social support and caregiver competence improves the quality of home-based care available to older adults with disabilities. Policymakers should give priority to improving the quality of care provided to community-dwelling older adults with severe disabilities. Furthermore, health management departments should provide informal caregiver training that teaches care and rehabilitation knowledge and skills to improve the competencies of caregivers.

Family Relationships and Alzheimer's Disease: A Systematic Review

BACKGROUND

Family caregivers of people with Alzheimer's disease are the most important support in concrete personal and economic terms. Family dynamics play a fundamental role in the provision of informal caregiving benefits.

OBJECTIVE

This review aims to identify factors related to the family caregiving of relatives with Alzheimer's disease, taking specifically into account the construct of coping and expressed emotion.

METHODS

This is a systematic review including articles selected using search terms including "caregivers," "Alzheimer's," "family," and "relationship" in research databases. Findings were synthesized and categorized into themes.

RESULTS

A total of 454 abstracts were identified. Following screening, lateral searches, and quality appraisal, 36 studies were included for synthesis. A total of 5 themes were identified: burden; demographics; coping strategies; caregiver mental health; and family dynamics and expressed emotions.

CONCLUSION

The quality and level of evidence supporting each theme varied. We need further research into family dynamics ameliorating the caregiving and how to measure it.

Changes in Family Dynamics in Caregiving for People With Dementia in South Korea: A Qualitative Meta-Synthesis Study

Living with a person with dementia considerably affects the lives of both the primary caregiver and the entire family. This study aimed to synthesize the findings of qualitative studies that explored dementia caregivers' experiences, to further understand the impact of dementia caregiving on family dynamics. Thirty-seven qualitative studies were analyzed and synthesized according to the meta-synthesis methods suggested by Sandelowski and Barroso. Four themes were identified to describe the impact of dementia caregiving on the family: cracked foundation of the family caused by dementia, voluntary or involuntary setup of a marked boundary of care, family as supportive foreground versus reluctant or interfering background, and re-established relationships within and outside the family. The findings illuminate that dementia caregiving has a destructive impact on the entire family, and therefore, it is imperative to develop interventions and infrastructures for both the caregiver and the entire family of individuals with dementia.

Experiences of caregivers of people with dementia in a Korean dementia simulation program

OBJECTIVES

Experiencing dementia-related challenges in a dementia simulation program can be useful for caregivers to understand perspectives of people with dementia possibly leading to improvement in the quality of care and positive outcomes in caregivers and people with dementia. Previous studies about dementia simulation programs have been conducted in Western countries and no research has been conducted in Asian countries. The purpose of this qualitative study was to explore experiences of caregivers of people with dementia who participated in a Korean dementia simulation program.

METHODS

A descriptive phenomenological study using thematic analysis with ATLAS.ti 8 software was used. A total of 28 Korean caregivers were interviewed about two weeks after participating in the Korean dementia simulation program that was modified from a program developed in USA by considering Korean cultures.

RESULTS

Three key themes with seven subthemes emerged. The present study demonstrated that participation in the program helped caregivers have more empathy, affected their care strategies positively leading to emotional and social benefits on the care dyads, and increased awareness in possible changes due to aging and the risk of dementia.

CONCLUSIONS

The present study was the first study that demonstrated caregivers' positive experiences in and benefits from participation in a dementia simulation program in an Asian country. Caregivers in the other Asian countries may have similar benefits from participation in dementia simulation programs.

Empathy in informal dementia caregivers and its relationship with depression, anxiety, and burden

Background/Objective: Recent interventions aim to heighten informal caregivers’ empathy levels assuming that this will lead to better well-being. However, previous studies have explored linear associations between empathy and aspects of well-being and yielded mixed results. We hypothesized that quadratic models may be more fitting to describe these relationships. Method: A cross-sectional study, with two groups (201 informal caregivers, and 187 non-caregivers) was conducted. Participants completed questionnaires on cognitive and affective empathy, and depression, anxiety, and caregiver burden. AN(C)OVA's and multiple hierarchical regression analyses including linear and quadratic terms were used to analyze the data. Results: For caregivers, there was a negative quadratic relationship between depression and cognitive empathy, and a positive linear relationship between anxiety and affective empathy, irrespective of sociodemographic characteristics. For non-caregivers, there were positive quadratic relationships between depression and cognitive and affective empathy, and between anxiety and affective empathy. The empathy levels did not differ between the groups. Conclusions: While caregivers and non-caregivers had the same amount of empathy, the relationships between empathy and depression and anxiety differed between the groups. Interventions for informal caregivers could aim to heighten cognitive empathy and to lower affective empathy to diminish depression and anxiety symptoms.

The impact of institution use on the wellbeing of Alzheimer's disease patients and their caregivers

In France, temporary institutionalization solutions for dependent elders have been encouraged since the early 2000s. They are targeting patients who are maintained at home, but may need temporary solutions to adjust the constraints of caregivers, e.g. to facilitate transitions between several informal care providers or to allow informal caregivers to leave for holidays. However, the influence of these solutions on dependent elders and their caregivers has not been explored yet. We use French longitudinal data (REAL.FR, 686 elders and their primary caregivers followed between 2000 and 2006) to explore the impact of institution placement on the wellbeing of both Alzheimer's disease patients and their primary informal caregivers. The data distinguishes permanent placements in institution from temporary stays. Using fixed-effect models, we quantify the change in patients' quality of life and caregivers' burden of care following the placement of patients. We find that permanent and temporary stays are associated with a decrease in informal caregivers' burden. However, only permanent stays lead to an improvement of patients' quality of life. Hence, taken together, the results suggest that while long-run placements may maximize the wellbeing of all the members of a household (patient and caregiver), this is not necessarily the case of short-term placements.

I just can't please them all and stay sane: Adult child caregivers' experiences of family dynamics in care-giving for a parent with dementia in Australia

Family caregivers of people with dementia who live within the community often experience stress and poor quality of life due to their care-giving role. While there are many factors that affect this, one influential factor is the family context. This study focussed on adult child caregivers. It examined the specific ways that family dynamics contribute to adult child caregivers' distress in the context of caring for a parent with dementia. Semi-structured interviews were conducted with 17 participants who were adult child primary caregivers for a parent with dementia who was living within the community. Interviews were audiotaped and transcribed verbatim. Transcripts were analysed using thematic analysis. Four themes were identified that represented areas of particular concern and distress for the caregivers: family expectations and caregivers' lack of choice in adopting the care-giving role; denial and differential understandings of dementia among family members; differential beliefs and approaches to care-giving among family members; and communication breakdown between family members. The findings demonstrate several avenues for further research including the development of interventions to support adult child caregivers and address problematic family dynamics within the context of caring for a parent with dementia.

Family Functioning and Communication in Spouses of Patients with Parkinsonism

Background

Patients with parkinsonism exhibit motor symptoms, cognitive impairment, and neuropsychiatric changes, and these symptoms increase caregiver burden. Family dynamics can be influenced by the presence of comorbidities, which is especially important in diseases causing caregiver burden. We investigated the effects of spousal parkinsonism on family functioning and communication.

Methods

Couples without parkinsonism, who visited hospital-based family practices, were recruited by 28 family physicians from 22 hospitals between April 2009 and June 2011; patients with parkinsonism and their spouses were recruited from a single institution. The participants completed questionnaires on demographic characteristics, lifestyle factors, family functioning (the Korean version of the Family Adaptation and Cohesion Evaluation Scale [FACES] III), and family communication (the Family Communication Scale of the FACES-IV). We compared family functioning and communication between spouses of the patients with and without parkinsonism.

Results

The mean family adaptability and cohesion scores of the spouses of the patients with parkinsonism were 23.09±6.48 and 32.40±8.43, respectively, whereas those of the control group were 23.84±5.88 and 34.89±7.59, respectively. Family functioning and family communication were significantly different between the spouses of individuals with and without parkinsonism. After adjusting for age, sex, income, and cardiovascular disease in the logistic regression analysis, family functioning was found to significantly deteriorate in the spouses of patients with parkinsonism but not the control group. Family communication decreased significantly in spouses of patients with parkinsonism.

Conclusion

Family functioning and family communication significantly deteriorated in spouses of patients with parkinsonism.

Family cohesion: A study on caregiving daughters of parents with Alzheimer’s disease

In this regard, investigating these aspects might facilitate the evaluation of family relations and the development of interventions that create, keep, restore, or enhance the skills families need to better deal with the disease. Based on this information, the objective of this chapter is to present and discuss investigative research on family cohesion and hierarchy from the perspective of caregiver daughters of elderly with Alzheimer’s in four situations: before the disease, currently, in conflict, and ideally. 32 women caretakers and their respective parents (6 fathers and 26 mothers) diagnosed with possible or probable AD participated in the survey. The instruments used were the Mini-Mental State Examination (MMSE) in an Open Interview with a Semi-Structured Script, and the Family System Test (FAST). We observed that before onset of the disease, the caregivers generally perceived themselves to have more hierarchy than their siblings, χ²(2) = 4.92, p < .10. The current situation showed a greater number of caregivers in higher hierarchical positions than their siblings (72%), and a lesser number of siblings than expected in higher hierarchical positions than the caregivers, χ²(2) = 18.32, p < .001. The ideal representation showed that most caregivers did not want themselves or any of their siblings to have more power than the other (66.7%), χ²(2) = 14.89, p < .001. Comparing conflict representations to ideal representations showed that family members demonstrated lower cohesion in conflict situations than in ideal situations, z = -2.86, p < .01.