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Winslow VA, Lindau ST, Huang ES, Asay S, Johnson AE, Borson S, Thompson K, Makelarski JA. Caring for dementia caregivers: How well does social risk screening reflect unmet needs? J Am Geriatr Soc 2024. [PMID: 39315491 DOI: 10.1111/jgs.19200] [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: 05/14/2024] [Revised: 08/25/2024] [Accepted: 09/01/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Unmet social and caregiving needs can make caregiving for a person with dementia more difficult. Although national policy encourages adoption of systematic screening for health-related social risks (HRSRs) in clinical settings, the accuracy of these risk-based screening tools for detecting unmet social needs is unknown. METHODS We used baseline data from dementia caregivers (N = 343) enrolled in a randomized controlled trial evaluating CommunityRx-Dementia, a social care intervention conducted on Chicago's South Side. We assessed caregivers' (1) unmet social and caregiving needs by querying need for 14 resource types and (2) HRSRs using the Center for Medicare & Medicaid Services (CMS) Accountable Health Communities (AHC) screening tool. Using unmet social needs as the reference, we examined the sensitivity of the AHC tool to detect food, housing, and transportation needs. Analyses were stratified by gender. RESULTS Most caregivers were women (78%), non-Hispanic (96%), Black (81%), partnered (58%) and had an annual household income ≥$50K (64%). Unmet social and caregiving needs were similarly prevalent among women and men caregivers (87% had ≥1 need, 43% had ≥5 needs). HRSRs were also prevalent. The most common HRSR was lack of social support (45%). Housing instability, difficulty with utilities and having any HRSRs were significantly more prevalent among women (all p < 0.05). The AHC screener had low sensitivity for detecting unmet food (39%, 95% confidence interval [CI]: 27%-53%), housing (42%, 95% CI: 31%-53%), and transportation (22%, 95% CI: 14%-31%) needs. Sensitivity did not differ by gender for food (41% for women and 30% for men, p = 0.72) or housing (44% for women and 29% for men, p = 0.37) needs. For transportation needs, sensitivity was 27% for women versus 0% for men (p = 0.01). CONCLUSIONS Men and women caregivers have high rates of unmet social needs that are often missed by the CMS-recommended risk-based screening method. Findings indicate a role for need-based screening in implementing social care.
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Affiliation(s)
- Victoria A Winslow
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Elbert S Huang
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, Illinois, USA
- Department of Medicine - Section of General Internal Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Spencer Asay
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Amber E Johnson
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Soo Borson
- Department of Family Medicine, Keck USC School of Medicine, California, Los Angeles, USA
| | - Katherine Thompson
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer A Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
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Bushuven S, Trifunovic-Koenig M, Klemm V, Diesener P, Haller S, Strametz R. The "Double Victim Phenomenon": Results From a National Pilot Survey on Second Victims in German Family Caregivers (SeViD-VI Study). J Patient Saf 2024; 20:410-419. [PMID: 39051764 DOI: 10.1097/pts.0000000000001251] [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: 07/27/2024]
Abstract
INTRODUCTION Second-victim phenomena may lead to severe reactions like depression or posttraumatic disorder, as well as dysfunction and absenteeism. Medical error as a cause for second victims is not limited to professionals, as family caregivers care for millions of patients at home. It remains unclear whether these are first, second, or double victims in case of error. This explorative study investigated whether second victim effects and signs of moral injury are detectable in family caregivers and whether existing instruments are applicable in lay persons. METHODS In an open convenience sampling online survey, we recruited 66 German family caregivers. Propensity score matching was conducted to obtain a balanced sample of family caregivers and qualified nurses who took part in the previous study by adjusting for age and sex. The groups were compared regarding the German Version of the Second Victim Experience and Support Tool-Revised and the German version of the Moral Injury Symptom and Support Scale for Health Professionals. RESULTS Sixty-six caregivers participated, of whom 31 completed the survey. Of all, 58% experienced a second victim-like effect, 35% experienced a prolonged effect, and 45% reported to still suffer from it. In a matched sample (22 family caregivers and 22 nurses), no significant differences were observed between the groups. DISCUSSION Regarding the limitations of this pilot study, demanding for resampling in larger populations, we could show that second victim effects and moral injury are detectable in family caregivers by validated instruments and are not inferior to professionals' experiences. Concerning the demand for further studies, we confirmed the applicability of the testing instruments but with need for item reduction to lower response burden.
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Affiliation(s)
| | | | - Victoria Klemm
- Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, Rhein-Main University of Applied Sciences, Wiesbaden, Germany
| | - Paul Diesener
- Hegau Jugendwerk Gailingen, Health Care Association District of Constance, Gailingen, Germany, Health Care Association District of Constance
| | - Susanne Haller
- Elisabeth-Kuebler-Ross Academy Stuttgart, Hospice Stuttgart, Stuttgart, Germany
| | - Reinhard Strametz
- Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, Rhein-Main University of Applied Sciences, Wiesbaden, Germany
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Redican E, Meade R, Harrison C, McBride O, Butter S, Murphy J, Shevlin M. The prevalence, characteristics, and psychological wellbeing of unpaid carers in the United Kingdom. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02745-8. [PMID: 39126515 DOI: 10.1007/s00127-024-02745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND This study sought to describe the characteristics of unpaid carers in the UK and assess levels of depression, anxiety, and mental health treatment seeking behaviours in this population. METHODS Data was derived from Wave 9 (n = 2790) of the COVID-19 Psychological Research Consortium (C19PRC) study, a longitudinal survey of adults in the UK. Logistic regression analyses were conducted to examine the characteristics of unpaid carers, association between caregiver status and psychological wellbeing, and caregiver-specific factors associated with risk of poor psychological wellbeing. RESULTS Approximately 15% (n = 417) of the sample reported providing unpaid care. Younger age, having three or more children in the household, and lower income were identified as significant correlates of caregiver status. Unpaid caregivers were at increased risk of depression or anxiety and mental health help-seeking. Unpaid caregivers who were younger, lived in households with one or two children, and had a lower income were at greater risk of depression or anxiety and engaging in mental health help-seeking. Caring for an individual with a terminal illness, long-term illness, learning disability or difficulty, mental health problems, physical disability, and other were linked to increased risk of depression or anxiety, while caring for someone with a learning disability increased risk of mental health help-seeking. CONCLUSIONS This study indicates that at least one in eight people in the UK provide unpaid care, and that those who provide unpaid care have a far higher risk of experiencing depression or anxiety and seeking mental health treatment. The identification of risk factors associated with these mental health outcomes will facilitate the identification of those in most need of support.
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Affiliation(s)
- Enya Redican
- School of Psychology, Ulster University, Cromore Road, Coleraine, NI, BT52 1SA, UK.
| | | | | | - Orla McBride
- School of Psychology, Ulster University, Cromore Road, Coleraine, NI, BT52 1SA, UK
| | - Sarah Butter
- School of Psychology, Ulster University, Cromore Road, Coleraine, NI, BT52 1SA, UK
| | - Jamie Murphy
- School of Psychology, Ulster University, Cromore Road, Coleraine, NI, BT52 1SA, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Cromore Road, Coleraine, NI, BT52 1SA, UK
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Baik S, Crittenden J, Coleman R. Social Capital and Formal Volunteering Among Family and Unpaid Caregivers of Older Adults. Res Aging 2024; 46:127-138. [PMID: 37714189 DOI: 10.1177/01640275231202260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Using data from 1745 caregivers in the National Study of Caregiving (2017), this study explores the connection between caregiving and formal volunteering by identifying the relationship between social capital and formal volunteering among family and other unpaid caregivers of older adults. In addition, this study examines the representative prevalence of formal volunteering in caregivers. We conducted logistic regression models along with established volunteerism correlates from the prior research literature. Approximately a quarter of caregivers participated in volunteering (25.4%). Being male, having higher educational attainment, being a spouse, living separately from the care recipient, caregiving for multiple care recipients, having a better quality of relationship with the care recipient, having better psychological well-being, receiving more social support, attending religious services, and participating in group activity were positively associated with formal volunteer participation. Findings underscore the role of both human and social capital, including the caregiving context, in formal volunteering among caregivers.
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Affiliation(s)
- Sol Baik
- Weldon Cooper Center for Public Service, University of Virginia, Charlottesville, VA, USA
| | - Jennifer Crittenden
- Center on Aging, University of Maine, Bangor, ME, USA
- School of Social Work, University of Maine Sol Baik, Bangor, ME, USA
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LaManna JB, Loerzel V, Conner NE. Lived experiences of older male caregivers: "That was the Worst!". Geriatr Nurs 2024; 55:277-285. [PMID: 38104439 DOI: 10.1016/j.gerinurse.2023.12.006] [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] [Received: 10/23/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Although caregiving is a traditional female role, older men represent an increasing proportion of family caregivers. This study's aim was to describe lived experiences of men who engaged in later-life caregiving. METHOD Streubert's phenomenological method, inclusive of unstructured interviews and respondent validation of a single formalized description, was applied to explore lived experiences of eight older male caregivers. RESULTS Three overarching themes characterized older male caregiving: 1) role and life changes, 2) "taking care of business," and 3) getting over "the worst". All caregivers spent extensive time in anticipatory planning for potential problems and were dissatisfied with existing resources and services. Each man described a profound, mentally-challenging caregiving crisis that triggered important caregiving decisions. DISCUSSION Study findings support an urgent need for research to clarify the mental health needs of older male caregivers and to test interventions that better meet the unique needs of this growing caregiver demographic.
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Affiliation(s)
| | - Victoria Loerzel
- University of Central Florida College of Nursing, Orlando, FL, United States
| | - Norma E Conner
- University of Central Florida College of Nursing, Orlando, FL, United States
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Poisson VO. A mixed method study exploring gender differences in dementia caregiving. DEMENTIA 2023; 22:1862-1885. [PMID: 37740743 PMCID: PMC10644690 DOI: 10.1177/14713012231201595] [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: 09/25/2023]
Abstract
Few studies have investigated the experience of male carers of people with dementia and fewer specifically examined whether male and female carers of people with dementia differ in their approach to the caring role. As such, this research set-out to investigate whether male carers of people with dementia approach the caring role differently to female carers. Data from 167 survey participants (24 males and 143 females) were analysed using a mixed research methodology. Participants' demographics and scores on standardised burden and coping scales were analysed using linear regression. Participants' written responses to open-ended questions were analysed using thematic analysis anchored in theories of hegemonic masculinity. No significant gender differences were identified in carers' coping strategies or self-reported carer burden. However, qualitative analysis revealed strong thematic gender differences like: gendered barriers to help-seeking; gendered service preference; gendered considerations about residential care; gendered expression of burden; and themes of the absent son and exhausted daughter. This research identified that male carers of people with dementia approach help-seeking differently to female carers, typically focusing on addressing functional tasks and refraining from showing emotions, this despite reporting similar carer burden. Rapport building with male carers should start with conversations around functional issues rather than assessing the emotional impact of the caring role. The findings reinforce the need for more qualitative research into the unmet needs of male carers of people with dementia, to inform the design of male-friendly interventions which could facilitate timely access to services by male carers.
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Affiliation(s)
- Vincent O. Poisson
- Vincent O. Poisson, Faculty of Medicine, School of Population Health, University of New South Wales, Wallace Wurth Building (c27) Cnr High St & Botany St., Sydney 2052, Australia.
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Zwar L, König HH, Hajek A. Personal human values, informal caregiving and the relevance of gender and age: Findings from the population-based German Aging Survey. Arch Gerontol Geriatr 2023; 110:104968. [PMID: 36842403 DOI: 10.1016/j.archger.2023.104968] [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: 10/06/2022] [Revised: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES This study analyzed if personal human values and provision of informal care were associated and if this differed as a function of gender or age. METHOD Data from the German Aging Survey were used (wave 2008, N=6,089), which included 748 informal caregivers. Human values were measured with the Human Values Scale from Schwartz (self-enhancement, self-transcendence, conservation, openness to change). Adjusted logistic regression analyses (with gender and age as additional moderators) were conducted. RESULTS Placing higher importance on conservation and self-enhancement values was associated with lower odds for caregiving, while a higher appreciation of self-transcendence was associated with higher odds of caregiving. With older age, a higher score in conservation values was associated with even lower odds for caregiving. Gender did not moderate these associations, still, lower odds of caregiving were found only among men with higher scores in openness to change, and only among women with higher scores in conservation values. Self-transcendence was associated with higher odds of caregiving among both, men and women. DISCUSSION In brief, personal values were significantly associated with informal caregiving and may act as motivators or barriers. The same motivators were found among men and women but different values were associated with lower odds of providing care. When aiming to foster informal care and a gender-equal distribution of caregiving, it could be helpful to take these values into account.
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Affiliation(s)
- Larissa Zwar
- 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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8
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Thorsen K, Johannessen A. How gender matters in demanding caring for a spouse with young-onset dementia. A narrative study. J Women Aging 2023; 35:81-97. [PMID: 35722752 DOI: 10.1080/08952841.2022.2087455] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The gendered aspects of extraordinary demanding spousal caring for people with young-onset dementia have been scarcely researched. AIM To analyze spouses' experiences of the meaning, content, and effort of intensive caring for spouses/partners with young-onset frontotemporal dementia (YO-FTD), concentrating on a female perspective. METHOD A qualitative Norwegian study using narrative interviews with 10 wives and 6 husbands were conducted in 2014 and 2015. FINDINGS The analysis resulted in four gendered main themes: Different caregiving periods, Distancing: experiencing a transformed spouse and relationship, Social isolation, and Needing assistance and relief. A case analysis of wives' and men's stories was applied, especially focusing on a wife's story, to examine the detailed interrelationships between life situation, caring demands, experiences, and reactions. Spousal care is influenced by gendered caring norms and roles. The study finds marked differences between wives and husbands in the meaning, content and sustainability of care, and needs for support vary. Wives endured more stress longer than husbands, with a greater emotional impact and negative health consequences, and their needs are more easily neglected. Husbands presented their needs more efficiently and obtained public relief earlier. CONCLUSION Women may need more support earlier during different stages of caring for a spouse with YO-FTD. They need gender sensitive person-centered support to live their own lives and preserve their selves.
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Affiliation(s)
- Kirsten Thorsen
- Vestfold Hospital Trust, The Norwegian National Centre for Ageing and Health, Tønsberg, Norway.,Oslo Metropolitan University, Oslo, Norway
| | - Aud Johannessen
- Vestfold Hospital Trust, The Norwegian National Centre for Ageing and Health, Tønsberg, Norway.,Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Kongsberg, Norway
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Yous ML, Ploeg J, Kaasalainen S, McAiney C, Fisher K. Feasibility, acceptability, and preliminary effectiveness of the adapted Namaste Care program delivered by caregivers of community-dwelling older persons with moderate to advanced dementia: a mixed methods feasibility study. BMC Geriatr 2022; 22:797. [PMID: 36229789 PMCID: PMC9559259 DOI: 10.1186/s12877-022-03483-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Caregivers have considerable responsibilities in supporting persons in advanced stages of dementia, however they receive little education. Namaste Care is a multisensory program originally designed to be delivered by healthcare providers in long-term care homes for persons with advanced dementia. The program has not yet been adapted and evaluated for use by caregivers of persons with moderate to advanced dementia living at home. The purpose of this feasibility study is to determine the feasibility, acceptability and preliminary effectiveness of the adapted Namaste Care program for use by caregivers of community-dwelling older persons with moderate to advanced dementia. METHODS This feasibility study, with a one-group before-after design and interviews, was part of a larger study using a multiphase mixed methods design. A total of 12 caregivers delivered the program over three months. Caregivers completed questionnaires on caregiver quality of life, perceptions of caregiving, self-efficacy, and burden at baseline and 3-month follow-up. Caregivers participated in interviews at the 3-month follow-up to explore acceptability and perceived benefit. Descriptive statistics and paired t-tests were used to analyze quantitative data. A secondary analysis used multiple imputation to explore the impact of missing data. Experiential thematic analysis was used in analyzing qualitative data. RESULTS The adapted Namaste Care program was judged to be feasible, given that all caregivers used it at least twice a week over the 3-month period. The retention rate of caregivers was 83% (10 of 12). Caregivers perceived that the program was practical, enhanced the wellbeing of persons with dementia, and brought them closer in their relationships with persons with dementia. There were no statistically significant changes for quality of life, perceptions of caregiving, self-efficacy, or burden outcomes. Multiple imputation results revealed promising findings for an improvement in caregiver wellbeing related to quality of life. CONCLUSIONS The adapted Namaste Care program for use by caregivers of community-dwelling older persons with moderate to advanced dementia was feasible and acceptable. The program has the potential to enhance the quality of life and other outcomes of caregivers, however there is a need to conduct a larger trial that is adequately powered to detect these effects.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- School of Public Health Sciences, Schlegel Research Chair in Dementia, Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Kathryn Fisher
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON L8S 4K1 Canada
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Stites SD, Largent EA, Gill J, Gurian A, Harkins K, Karlawish J. Predictors of who Serves as an Alzheimer's Disease Research Participant's Study Partner and the Impact of their Relationship on Study Partners' Reports on Participants. Res Aging 2022; 44:734-746. [PMID: 35324354 PMCID: PMC10108385 DOI: 10.1177/01640275221075739] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) research typically requires participants to enroll with a "study partner" (SP). Little is known about what predicts who steps into the SP role or whether the SP's relationship to the participant affects their reports of disease severity.Methods: Health and Retirement Study data (HRS), collected prior to the Aging, Demographics and Memory Study (ADAMS), was used to identify sociocultural factors that predict who serves as a SP in ADAMS. SP-reported outcomes were compared between three types of participant-SP relationships: spousal, adult child, and other.Results: Spouses (35%) and adult children (39%) were similarly likely to serve as SPs. Factors predicting who served differed. In multivariable analyses, adult children rated participants less impaired than spouses on measures of memory, judgment, and organizational abilities (p < .05). Conclusions: The participant-SP relationship has independent effects on the SP's reports of the severity of cognitive impairments.
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Affiliation(s)
- Shana D Stites
- Department of Psychiatry, Perelman School of Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanine Gill
- Division of Geriatric Medicine, Perelman School of Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Gurian
- 2546Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin Harkins
- Penn Memory Center, Department of Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Karlawish
- Penn Memory Center, Departments of Medicine, Medical Ethics and Health Policy, and Neurology, 6572University of Pennsylvania, Philadelphia, PA, USA
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Psychological distress in sons as resident carers of older mothers in Japan. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
In Japan, care-giving sons are noted for their high rates of abuse of care recipients. This study revealed, for the first time, the difficulties unique to sons caring for their mothers. All sons used long-term care insurance services. However, they provided care that could not be covered by such public services while harbouring psychological distress. In this study, we interviewed 13 sons living with their older mothers as the primary carer and conducted a thematic analysis focusing on their psychological distress. As part of our study findings, we have identified nine themes during analysis: uncomfortable feelings that cannot be mitigated as a son; feeling of futility in being unrecognised as a carer; fear of losing something important; a strong sense of responsibility for one's mother's life; disappointment in being unable to obtain understanding and co-operation from one's siblings in providing care; irritation and anger towards one's wayward mother; guilt about treatment of one's mother; sense of exhaustion due to demanding care; and experiencing hopelessness and despair. Thus, it is important to understand what psychological distress carers experience and to consider possible approaches for their support. The study findings provide suggestions for long-term care support in regions, such as East Asia, where the numbers of son carers are increasing inevitably owing to declining birth rates and ageing population, as in Japan.
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Chávez Sosa JV, Mego Gonzales FM, Aliaga Ramirez ZE, Cajachagua Castro M, Huancahuire-Vega S. Depression Associated with Caregiver Quality of Life in Post-COVID-19 Patients in Two Regions of Peru. Healthcare (Basel) 2022; 10:1219. [PMID: 35885746 PMCID: PMC9323236 DOI: 10.3390/healthcare10071219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/19/2022] Open
Abstract
Due to COVID-19, the workload experienced by caregivers has increased markedly which has led them to experience fatigue, anxiety and depression. This study aims to determine the relationship between quality of life and depression in caregivers of post-COVID-19 patients in two regions of Peru. In a cross-sectional analytical study, the sample was non-probabilistic and by snowball, and consisted of 730 caregivers, to whom the questionnaires "Modified Betty Ferell Quality of Life" and the "Beck Depression Inventory" were applied. It was determined that being a male caregiver (OR: 2.119; 95% CI: 1.332-3.369) was associated with a good quality of life. On the other hand, caregivers who had children (OR: 0.391; 95% CI: 0.227-0.675), were vaccinated against COVID-19 (OR: 0.432; 95% CI: 0.250-0.744), were immediate family members (OR: 0.298; 95% CI: 0.117-0.761) and had high depression (OR: 0.189; 95% CI: 0.073-0.490) were associated with poor quality of life. The results of this study allow us to conclude the association between depression and poor quality of life in caregivers of these patients so it is necessary to monitor the mental health of caregivers, and to develop adaptation strategies to pandemic conditions.
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Affiliation(s)
- Janett V. Chávez Sosa
- Escuela Profesional de Enfermería, Universidad Peruana Unión (UPeU), Lima 15464, Peru; (J.V.C.S.); (F.M.M.G.); (Z.E.A.R.); (M.C.C.)
| | - Flor M. Mego Gonzales
- Escuela Profesional de Enfermería, Universidad Peruana Unión (UPeU), Lima 15464, Peru; (J.V.C.S.); (F.M.M.G.); (Z.E.A.R.); (M.C.C.)
| | - Zoila E. Aliaga Ramirez
- Escuela Profesional de Enfermería, Universidad Peruana Unión (UPeU), Lima 15464, Peru; (J.V.C.S.); (F.M.M.G.); (Z.E.A.R.); (M.C.C.)
| | - Mayela Cajachagua Castro
- Escuela Profesional de Enfermería, Universidad Peruana Unión (UPeU), Lima 15464, Peru; (J.V.C.S.); (F.M.M.G.); (Z.E.A.R.); (M.C.C.)
| | - Salomón Huancahuire-Vega
- Escuela Profesional de Medicina, Universidad Peruana Unión (UPeU), Lima 15464, Peru
- Dirección General de Investigación, Universidad Peruana Unión (UPeU), Lima 15464, Peru
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Zhao X, Zhang Q, Ji Y, Liu H, Lou VWQ. Influence of spousal caregiving and living arrangement on depression among husband caregivers in rural China. Aging Ment Health 2022:1-8. [PMID: 35758023 DOI: 10.1080/13607863.2022.2089630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES With sociodemographic changes, men are increasingly taking responsibility for spousal caregiving. Previous studies have described gender differences in the psychological outcomes of caregiving; however, few have focused exclusively on husband caregivers. This study investigates the influence of starting spousal caregiving on the psychological well-being of older husbands in rural areas and examines whether living arrangements can moderate this relationship. METHODS A total of 1,167 baseline non-caregiver husbands aged 60 and above in rural areas were taken from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS). The generalized estimating equation (GEE) was employed to examine the effects of spousal caregiving transitions and living arrangement changes on depressive symptoms over four years. RESULTS Compared with rural husbands who remained non-caregivers, those transitioning into activities of daily living (ADL) caregiving reported higher depressive symptoms at follow-up (B = 1.67, p < 0.05). Moreover, the increase in depressive symptoms when transitioning into ADL caregiving was significantly lower among participants who changed from living with spouse alone to living with spouse and other family members together (B = - 5.37, p < 0.05). CONCLUSION There was an association between transitioning into ADL caregiving and an elevated level of depression over four years among older husbands, which could be alleviated by living with family members. Co-residence with family members could serve as a natural support resource, buffering adverse mental health outcomes when older husbands start a demanding caregiving role.
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Affiliation(s)
- Xinyi Zhao
- School of Health Humanities, Peking University, Beijing, China
| | - Quan Zhang
- National School of Development, Peking University, Beijing, China
| | - Ying Ji
- School of Public Health, Peking University, Beijing, China
| | - Huiying Liu
- Department of Sociology, Central South University, Changsha, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong
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14
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Adapting the Namaste Care Program for Use with Caregivers of Community-Dwelling Older Adults with Moderate to Advanced Dementia: A Qualitative Descriptive Study. Can J Aging 2022; 42:271-283. [PMID: 35722973 DOI: 10.1017/s0714980822000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Family/friend caregivers are highly involved in supporting older adults with dementia who are 65 years of age or older with daily activities, especially when these older adults with dementia are living at home. There is a need for psychosocial interventions for caregivers of older adults with moderate to advanced dementia, as most interventions focus on persons at earlier stages. Namaste Care is a psychosocial, multisensory program intended to enhance quality of life for people with advanced dementia and their caregivers; however, it has not yet been adapted for use in a home setting. In this study, caregivers collaborated in adapting Namaste Care during workshops so that it could be delivered by caregivers of older adults with moderate to advanced dementia at home. Key findings were that Namaste Care resonated with the daily activities of caregivers, but that the intervention required modifications to ensure that it could be tailored to the needs and realities of caregivers and persons with dementia.
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15
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Villars H, Gardette V, Frayssignes P, Deperetti E, Perrin A, Cantet C, Soto‐Martin M. Predictors of nursing home placement at 2 years in Alzheimer's disease: A follow-up survey from the THERAD study. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5724. [PMID: 35574920 PMCID: PMC9323428 DOI: 10.1002/gps.5724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/20/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Nursing Home Placement (NHP) can prove to be the only solution to some dead-end situations in Alzheimer's disease (AD). The predictors of NHP are known and can be related to either the person with dementia or his/her caregiver. We aimed to identify predictors of NHP among people with AD over a 2-year follow-up period, with a particular interest in the modifiable predictors, notably those involving caregivers. METHODS We studied data from the THERAD study, a French monocentric randomized controlled trial, involving 196 community-dwelling dyads, primarily assessing an educational intervention in AD. We performed a bivariate analysis followed by a multivariate Cox model, with a backward stepwise procedure. RESULTS The mean age of the patients was 82 years old, 67.7% were women and 56.9% were living with a partner. The mean age of the caregivers was 65.8 years old, 64.6% were women and half were spouses of the patients with a moderate burden. During the follow-up, 23 patients died and 49 were institutionalized. The majority of NHPs occurred during the first year (35 NHP). The mean time to NHP was 27.77 months after the diagnosis. Five independent predictors of NHP were found: a higher patient education level (aHR 6.31; CI95% = 1.88-21.22), a high caregiver Burden (aHR 3.97; CI95% = 1.33-11.85), the caregiver being the offspring of the patient (aHR 2.92; CI95% = 1.43-5.95), loss of autonomy (aHR 2.75; CI95% = 1.13-6.65) and disinhibition as a behavioural and psychological symptoms of dementia (BPSD) (aHR 2.38; CI95% = 1.26-4.47). CONCLUSIONS Our data are in accordance with the literature in identifying loss of autonomy, burden and BPSD (disinhibition) as risk factors of NHP. We also found high patient education level and status of offspring caregiver as additional factors. It is essential to take into account the caregiver status when designing psychoeducational trials aiming to delay NHP. Further studies need to take into account both the modifiable risk factors related to the patient (productive BPSD) and the needs of offspring caregivers (work-life balance, mental load).
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Affiliation(s)
- Hélène Villars
- Geriatric DepartmentToulouse University HospitalToulouseFrance
- Department of Epidemiology and Public HealthInserm UMR 1295Centre for Research in Population Health (CERPOP)ToulouseFrance
| | - Virginie Gardette
- Geriatric DepartmentToulouse University HospitalToulouseFrance
- Department of Epidemiology and Public HealthInserm UMR 1295Centre for Research in Population Health (CERPOP)ToulouseFrance
| | | | - Eva Deperetti
- Geriatric DepartmentToulouse University HospitalToulouseFrance
| | - Amélie Perrin
- Geriatric DepartmentToulouse University HospitalToulouseFrance
| | - Christelle Cantet
- Department of Epidemiology and Public HealthInserm UMR 1295Centre for Research in Population Health (CERPOP)ToulouseFrance
| | - Maria Soto‐Martin
- Geriatric DepartmentToulouse University HospitalToulouseFrance
- Department of Epidemiology and Public HealthInserm UMR 1295Centre for Research in Population Health (CERPOP)ToulouseFrance
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16
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Velloze IG, Jester DJ, Jeste DV, Mausbach BT. Interventions to reduce loneliness in caregivers: An integrative review of the literature. Psychiatry Res 2022; 311:114508. [PMID: 35334424 DOI: 10.1016/j.psychres.2022.114508] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/07/2023]
Abstract
Older adults are at an increased risk of loneliness. Many also serve as informal caregivers for persons with dementia and other disabling conditions, further predisposing them to loneliness. The primary objective was to assess current loneliness interventions for caregivers to inform development of effective therapies to improve their quality of life. An integrative review of the literature was conducted using five electronic databases and 12 studies were included for further analysis. Data were extracted regarding the type of intervention implemented, caregiver characteristics, and intervention effects. Five main intervention types emerged: mindful meditation, computer applications, music therapy, peer support, and community programs. Most care recipients had dementia, and most caregivers were spouses. Peer support was the most frequently utilized intervention, and common intervention strategies included providing emotional support, expanding one's social network, and supplying psychoeducational materials. Most interventions had methodological limitations and demonstrated small effect sizes. Hence, there remains a continued need for well-designed interventions that target loneliness in informal caregiver. Caregivers may benefit from interventions that expand their social network to improve their emotional regulation and understanding of their role. Further research on the role of group versus individual therapy is necessary to strengthen interventions and broaden their application.
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Affiliation(s)
- Isabelle G Velloze
- Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Dylan J Jester
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, United States of America
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, United States of America; Department of Neurosciences, University of California San Diego, La Jolla, California, United States of America
| | - Brent T Mausbach
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America.
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Tsai CF, Huang MH, Lee JJ, Jhang KM, Huang LC, Huang LK, Lee WJ, Sung PS, Liu YC, Ouyang WC, Cheng CM, Hsu CC, Fuh JL. Factors associated with burden among male caregivers for people with dementia. J Chin Med Assoc 2022; 85:462-468. [PMID: 35286289 DOI: 10.1097/jcma.0000000000000704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a dearth of information on male dementia caregivers in Asia and, in particular, on the factors relating to caregiver burden. We aimed to identify factors that may be associated with burden among male caregivers of people with dementia (PWD). METHODS Data were collected from a national dementia registration survey. The caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). We analyzed the correlation between ZBI scores and variables, such as demographic data of PWD and their male caregivers, caregivers' monthly income, the relationship between PWD and caregivers, the severity of dementia, physical comorbidities and activities of daily living (ADL) of PWD, and neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory (NPI). RESULTS A total of 509 PWD and their male caregivers were included. The majority of caregivers were sons (72.1%) and husbands (22.0%). Sons had higher ZBI scores than husbands (28.5 ± 15.2 vs 22.0 ± 17.0; p < 0.001). Multivariable linear regression showed that sons as caregivers (β = 7.44, p = 0.034), ADL (β = 0.52, p = 0.002), and NPI_severity subscore of apathy (β = 2.74, p = 0.001) were positively associated with ZBI scores. CONCLUSION Poor ADL and apathy in PWD and being a patient's son were associated with higher levels of burden among male dementia caregivers. Effective interventions are needed to assist male caregivers in accomplishing their caregiving role and at the same time to alleviate their caregiver burden.
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Affiliation(s)
- Chia-Fen Tsai
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Mao-Hsuan Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Psychiatry, Suao and Yuanshan Branches of Taipei Veterans General Hospital, Ilan, Taiwan, ROC
| | - Jun-Jun Lee
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan, ROC
- Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Li-Kai Huang
- Department of Neurology, Shuang Ho Hospital, Taipei, Taipei Medical University, New Taipei City, Taiwan, ROC
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wei-Ju Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Yi-Chien Liu
- Neurological Center of Cardinal Tien Hospital, Taipei, Taiwan, ROC
- Fu Jen University School of Medicine, Taipei, Taiwan, ROC
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan, ROC
- Departemnt of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Chih-Ming Cheng
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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18
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Gender differences in the association between unmet support service needs and mental health among American cancer caregivers. Support Care Cancer 2022; 30:5469-5480. [PMID: 35304632 DOI: 10.1007/s00520-022-06966-y] [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: 10/26/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Cancer caregiving can be distressing, and many caregivers have support service needs. Given the role gender has played in shaping norms around caring, gender may influence caregiving experiences. Using Behavioral Risk Factor Surveillance System data, 2015-2018, we aimed to examine gender as an effect modifier of the unmet support service needs and mental health association among cancer caregivers. METHODS Our n = 5814 sample represented approximately 4.8 million caregivers. Mental health was operationalized as number of mentally unhealthy days over the past 30 (MUDs) and Frequent Mental Distress (FMD, MUDs ± 14 days). Unmet supportive care needs included endorsement of needing but not receiving caregiving classes, help accessing services, support groups, counseling, and respite care. We conducted zero-inflated negative binomial (ZINB) and logistic regression analyses to examine the associations between unmet needs with MUDs and FMD and then tested gender as an effect modifier. RESULTS Cancer caregivers reported an average of 6 MUDs. Approximately 20% of caregivers reported FMD, and 17% reported having any unmet needs. Gender moderated the unmet needs and FMD association. Among female caregivers, those with unmet needs were more likely to report FMD (aOR: 2.167; 95%CI: 1.447, 3.243); among male caregivers, no association was found (aOR: 0.970; 95%CI: 0.471, 2.001). In the ZINB model of MUDs, no significant moderation effect of gender was found. CONCLUSION Though distress does not appear to vary by gender, having unmet support needs may negatively affect mental health in female cancer caregivers. Studies on gendered experiences can inform strategies to meet caregiver needs.
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See F, Teo I, Malhotra C. Longitudinal trajectories of caregiving experiences among primary informal caregivers of patients with metastatic solid cancer (Stage IV). Psychooncology 2022; 31:1161-1168. [PMID: 35199404 DOI: 10.1002/pon.5904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/14/2021] [Accepted: 02/11/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Cancer is a significant cause of mortality worldwide. The diagnosis of advanced cancer affects both patients and their family caregivers. Understanding the course of both negative and positive experiences of caregiving provides a more comprehensive understanding of the caregiving experience. The study aims to identify joint trajectories of burden and esteem among family caregivers of patients with solid metastatic cancer, and to identify caregiver characteristics that predict membership for each delineated trajectory. METHODS A prospective longitudinal study of 346 informal family caregivers of patients with solid metastatic cancer were recruited between July 2016 and December 2019. Surveys were conducted every 3 months for 2 years. We assessed caregiver burden and positive aspects of caregiving using the modified Caregiver Reaction Assessment. We estimated the joint trajectories for these outcomes using group-based multi-trajectory modelling. RESULTS We identified 4 trajectories describing caregivers with 1) low burden, moderate esteem (38.3%), 2) low burden, high esteem (20.3%), 3) high burden, low esteem (16.4%), 4) high burden, high esteem (24.9%). Compared to the "low burden, high esteem" trajectory, male and non-spousal caregivers were more likely to experience high burden and esteem while caregivers from low socioeconomic status were more likely to belong to trajectories with a high burden. CONCLUSION Recognising caregivers at high risk of belonging to trajectories with high burden or low esteem may enable healthcare professionals to anticipate and provide appropriate support to mitigate the impact of negative outcomes.
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Affiliation(s)
- Faith See
- Lien Center for Palliative Care, Duke-NUS Medical School, Blk 541 Pasir Ris St 51 #04-14, Singapore, 169857
| | - Irene Teo
- Lien Center for Palliative Care, Duke-NUS Medical School, 8 College Rd, Singapore
| | - Chetna Malhotra
- Lien Center for Palliative Care, Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore National Cancer Center, 8 College Road, Level 4, Singapore
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20
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Fisher E, Crawley S, Sampson EL, Cooper C, Jones R, Anantapong K, Moore K. Practical and emotional preparation for death: A mixed methods study investigating experiences of family carers of people with dementia. DEMENTIA 2022; 21:934-956. [PMID: 35125034 PMCID: PMC9003776 DOI: 10.1177/14713012211066674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background When family carers are more prepared for the end of the life of a person they care for, they report improved bereavement outcomes. Few studies have explored how carers prepare for the death of a person with dementia. We aimed to explore how carers for people with all stages of dementia experience preparing for end of life care and death. Methods This was a mixed methods cross-sectional study. Family carers of people with dementia (n = 150) completed a structured interview with validated scales, alongside questions about death preparedness and advance decisions. A sub-sample (n = 16) completed qualitative interviews exploring their experiences of planning for end of life. We fitted logistic regression models to explore associations with preparedness, and thematically analysed qualitative data. Results We addressed practical and emotional preparation separately for 143 participants. Fifty seven percent of participants were very practically prepared for death, while only 29% were very emotionally prepared. Male carers were more likely than female carers to report being very emotionally and practically prepared. Higher engagement with healthcare professionals was associated with feeling very practically prepared; although we found that formal discussions of end of life care issues with healthcare professionals did not impact carers’ feelings of preparation. Higher levels of dementia severity and carer depression were associated with feeling very emotionally prepared. Three qualitative themes related to practical and emotional preparation were identified: (1) ambiguity and uncertainty; (2) support from the system; and (3) how death is perceived by the carer. Conclusions While most carers felt practically prepared for death, emotional preparation was much lower. Further research is needed to understand how engagement with healthcare professionals or other forms of social or emotional support could help carers, particularly female carers, to emotionally prepare for their relative’s death.
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Affiliation(s)
- Emily Fisher
- Research Department of Clinical, Educational and Health Psychology, 4919University College London, London, UK
| | - Sophie Crawley
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust
| | - Claudia Cooper
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; Division of Psychiatry, 325312University College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry, 325312University College London, London, UK
| | - Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; National Ageing Research Institute, Parkville, Victoria, Australia
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21
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Kokorelias KM, Rittenberg N, Law A, Wan NTC, Machon J, Arfeen Y, Cameron JI. Brothers and sisters sharing in the care of a parent with dementia. DEMENTIA 2022; 21:765-780. [PMID: 35114815 PMCID: PMC8996302 DOI: 10.1177/14713012211053970] [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: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Kristina M Kokorelias
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, St. John's Rehab, 71545Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Nira Rittenberg
- Faculty of Medicine to Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
| | - Amy Law
- Department of Occupational Science and Occupational Therapy, Temerty 12366Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Natasha T Chin Wan
- Department of Occupational Science and Occupational Therapy, Temerty 12366Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Machon
- Department of Occupational Science and Occupational Therapy, Temerty 12366Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yasmin Arfeen
- Department of Occupational Science and Occupational Therapy, Temerty 12366Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Temerty 12366Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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22
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Koukouli S, Kalaitzaki AE, Panagiotakis S, Markakis G, Werner P, Tziraki C. Factors associated with the perception of services by dementia informal caregivers in Greece: the role of familism. Aging Ment Health 2022; 26:305-313. [PMID: 33345603 DOI: 10.1080/13607863.2020.1857694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To investigate perceptions of informal caregivers of community-dwelling persons with dementia (PwD) regarding health and social care services and their correlates using the Behavioral Model of Healthcare Utilization as the theoretical framework. METHODS This was a cross-sectional study using a purposive sampling technique to identify, through community-based health and social care services, caregivers of PwD. Face-to-face interviews were conducted with 118 informal caregivers (78.8% female, mean age = 58.9 years) via a structured questionnaire. RESULTS Three 'Perceptions of Services' subscales were identified: 'Availability and Adequacy of Services' (AAS), 'Physicians' Competence' (COMP), and 'Professionals' Behavior' (PB). Predisposing factors (gender, employment, familism) and enabling/impeding factors (caregiving impedes work, quality of life aspects - environment and social relationships, information about dementia) were significant correlates of the AAS and COMP subscales. Familism was negatively associated with the AAS subscale. PwD's perceived declined physical and behavioral functioning was related to worse perceptions regarding professionals' behavior (PB) toward the PwD. CONCLUSION Understanding the factors associated with caregivers' perceptions of health and social care community services may guide the development of interventions that facilitate the appropriate use of those services, provide increased support to PwD and their caregivers, and delay potential institutionalization.
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Affiliation(s)
- Sofia Koukouli
- Department of Social Work & Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life, Faculty of Health Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Argyroula E Kalaitzaki
- Department of Social Work & Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life, Faculty of Health Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Symeon Panagiotakis
- Internal Medicine Department, Geriatric Clinic, Heraklion University Hospital, Crete, Greece
| | - Georgios Markakis
- Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Chariklia Tziraki
- Research and Evaluation Department, Community Elders Club Melabev, Jerusalem, Israel
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Deskins BP, Letvak S, Kennedy-Malone L, Rowsey PJ, Bedini L, Rhew D. The Experiences of African American Male Caregivers. Healthcare (Basel) 2022; 10:healthcare10020252. [PMID: 35206867 PMCID: PMC8871800 DOI: 10.3390/healthcare10020252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
Aging of the population has led to an increasing number of caregivers. While research has been conducted on caregiver experiences, less is known about the experiences of African American males in the U.S. This qualitative descriptive study describes the experiences of 13 African American men who acted as caregivers to adult chronically ill or debilitated loved ones, the majority of whom provided care during the COVID-19 pandemic. The revised Sociocultural Stress and Coping Model (R-SSCM) guided this study. Individual interviews were conducted via the Zoom application. Content analysis revealed four themes: (1) “My time to take the reins”, (2) “It’s a male thang”, (3) “Caring amid a pandemic”, and (4) “Effects of the caregiver’s journey”. This study’s findings in relation to the literature provide overdue attention to the African American male caregiving experience, especially in relation to the COVID-19 pandemic. The implications of our findings include the need for more culturally congruent support services for African American male caregivers, as well as increased efforts to encourage trust in the healthcare system—especially in relation to vaccination for the SARS-CoV-2 virus.
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Affiliation(s)
| | - Susan Letvak
- School of Nursing, UNC Greensboro, Greensboro, NC 27402, USA; (L.K.-M.); (P.J.R.)
- Correspondence: ; Tel.: +1-336-256-1024
| | | | | | - Leandra Bedini
- School of Health and Human Sciences, UNC Greensboro, Greensboro, NC 27402, USA;
| | - Denise Rhew
- Cone Health, Greensboro, NC 27401, USA; (B.P.D.); (D.R.)
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Kane T, Hammad SH, Islam N, Al-Wattary N, Clark J, Daher-Nashif S. Dementia caregiving in the Middle East and North Africa: A scoping review. Transcult Psychiatry 2021; 58:844-858. [PMID: 34407707 DOI: 10.1177/13634615211036404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Care for persons with dementia in the Middle East and North Africa (MENA) is undertaken predominantly by family members, domestic workers, and private nurses within the home. Domestic caregivers possess different understandings and varying degrees of knowledge of dementia that are influenced by complex socio-cultural and religious factors. With much of the burden falling on the shoulders of "invisible" caregivers, the role and needs of these individuals require deeper scrutiny. The purpose of this scoping review was to examine the empirical studies published on caring for persons with dementia in Arab countries of the MENA region. Using a systematic review technique, searches were conducted on PubMed, Embase, Web of Science, Scopus, and Google Scholar using database-specific terms associated with caregiving, dementia, aging, and the MENA region. To ensure local and regional research was captured, hand searches of regional journals, reference lists of included articles, and Arabic databases Al-Manhal and e-Marefa were also searched. No date restrictions were imposed. Twenty studies met inclusion criteria and the following themes were identified: caregiving experiences and the burden of care; barriers to caregiving; and caregiver recommendations to improve care. Results demonstrate that studies about informal caregivers and dementia within Arab-Muslim populations are underrepresented in the research. This review highlights the paucity of literature on service users' experiences and underscores the need for future research specific to dementia care within the Arab-Islamic sociocultural context. These trajectories are especially pertinent given the unprecedented aging demographics of the MENA populations.
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Schaffler-Schaden D, Krutter S, Seymer A, Eßl-Maurer R, Flamm M, Osterbrink J. Caring for a Relative with Dementia: Determinants and Gender Differences of Caregiver Burden in the Rural Setting. Brain Sci 2021; 11:brainsci11111511. [PMID: 34827510 PMCID: PMC8615550 DOI: 10.3390/brainsci11111511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Dementia is a progressive disease that puts substantial strain on caregivers. Many persons with dementia (PwDs) receive care from a relative. Since male and female caregivers experience different issues related to stress, it is important to meet their different needs to prevent the early nursing home placement of PwDs. This study investigated the multifactorial aspects of caregiver burden and explored gender differences in caregiver burden in a rural setting. This was a cross sectional study that administered anonymous questionnaires to family caregivers of PwDs. Caregiver burden was assessed using the Burden Scale for Family Caregivers-short version. A path model was used to determine the multivariate associations between the variables. To reflect the multifaceted aspects of caregiver burden, we used Pearlin's model with its four dimensions. A total of 113 family caregivers responded to our survey. The overall burden of caregivers was moderate. According to the path model, gender differences were predictors of caregiver burden. The behaviour of the person with dementia and cohabitation had direct effects on caregiver burden. Our results suggest that the experiences of men and women caring for a PwD are different and highlight the need for tailored support in dementia care.
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Affiliation(s)
- Dagmar Schaffler-Schaden
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, 5020 Salzburg, Austria;
- Correspondence:
| | - Simon Krutter
- Institute for Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria; (S.K.); (R.E.-M.); (J.O.)
| | - Alexander Seymer
- Department of Sociology, Paris Lodron University, 5020 Salzburg, Austria;
| | - Roland Eßl-Maurer
- Institute for Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria; (S.K.); (R.E.-M.); (J.O.)
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Jürgen Osterbrink
- Institute for Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria; (S.K.); (R.E.-M.); (J.O.)
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So MKP, Yuk H, Tiwari A, Cheung STY, Chu AMY. Predicting the burden of family caregivers from their individual characteristics. Inform Health Soc Care 2021; 47:211-222. [PMID: 34709118 DOI: 10.1080/17538157.2021.1988955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined the association between caregivers' burdens and their individual characteristics and identified characteristics that are useful for predicting the level of caregiver burden. We successfully surveyed 387 family caregivers, having them complete the caregiver burden inventory scale (CBI) and an individual characteristic questionnaire. When we compared the average CBI scores between groups with a particular individual characteristic (including caring for older adult(s), educational level, employment status, place of birth, marital status, financial status, need for family support, need for friend support, and need for nonprofit organizational support), we found a significant difference in the average scores. From a logistic regression model, with burden level as the outcome, we found that caring for older adult(s), educational level, employment status, place of birth, financial situation, and need for nonprofit organizational support were significant predictors of the burden level of caregivers. The research findings suggest that certain individual characteristics can be adopted for identifying and quantifying caregivers who may have a higher level of burden. The findings are useful to uncover caregivers who may need prompt support and social care.
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Affiliation(s)
- Mike K P So
- Department of Information Systems, Business Statistics and Operations Management, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong
| | - Helina Yuk
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Agnes Tiwari
- School of Nursing, The University of Hong Kong, Pokfulam Road, Hong Kong.,School of Nursing, Hong Kong Sanatorium & Hospital, Hong Kong
| | - Sam T Y Cheung
- Department of Social Sciences, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Amanda M Y Chu
- Department of Social Sciences, The Education University of Hong Kong, Tai Po, Hong Kong
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Zwar L, Angermeyer MC, Matschinger H, Riedel-Heller SG, König HH, Hajek A. Are informal family caregivers stigmatized differently based on their gender or employment status?: a German study on public stigma towards informal long-term caregivers of older individuals. BMC Public Health 2021; 21:1868. [PMID: 34656105 PMCID: PMC8520205 DOI: 10.1186/s12889-021-11955-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Stigma and informal caregiving are determinants for health and wellbeing, but few studies have examined stigma towards informal caregiving. Public stigma may be expressed differently towards caregivers depending on their gender and employment status due to societal norms. Therefore, this study analyzes if there is a difference in public stigma shown by the general population toward informal caregivers of care recipients aged 65 years or older based on the observed caregiver’s gender or working status. Methods A cross-sectional study was conducted in Germany. Data from 1038 adult participants from the general population in Germany were assessed with an Online-Survey. They were recruited with a quota-system based on the German micro census. Participants were randomly assigned to one of 16 vignettes describing a caregiving situation, which varied in the caregiver’s gender and working status, and care recipient’s gender and type of impairment. After reading the vignette, they were asked to provide sociodemographic information and complete three questionnaires on public stigma assessing their emotional (Emotional Reactions), behavioral (Social Distance) and cognitive reaction (Statements on informal caregivers) to the caregiver described in the vignette. Regression analyses, adjusted for sociodemographic data of the participants, were conducted. Results Findings indicated an association between reading about male caregivers and increased social distance, compared with reading about female caregivers. Reading about working caregivers was associated with decreased social distance and increased appreciative statements, compared to reading about non-working caregivers. Analyses after stratifying by gender of the caregiver in the vignette indicated an association between reading about female working caregivers and increased appreciative statements, compared to reading about female non-working caregivers. When stratifying by working status, an association was found between reading about male working caregivers and increased social distance, when compared to reading about female working caregivers. Conclusions This study’s findings indicate that gender and working status of the perceived informal caregivers are of relevance to the public stigma directed towards these caregivers. Male and non-working informal caregivers were shown more public stigma than female and working informal caregivers. Thus, interventions to reduce public stigma, in particular towards male and non-working caregivers, are recommended.
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Affiliation(s)
- Larissa Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | | | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.,Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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Liu R, Chi I, Wu S. Caregiving Burden among Caregivers of People with Dementia through the Lens of Intersectionality. THE GERONTOLOGIST 2021; 62:650-661. [PMID: 34606599 DOI: 10.1093/geront/gnab146] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Caregivers may be at different risks of various types of burdens by virtue of their gender and racial/ethnic status. This paper explores the differences in caregiving burdens across the intersectionality of race and gender. RESEARCH DESIGN AND METHODS Using Round 5 (conducted in 2015) and Round 7 (conducted in 2017) of National Study of Caregiving and National Health and Aging Trends Study data, the study examined differences in caregiver burdens across and within different gender and racial/ethnic groups, within the realms of financial, emotional, and physical burdens. The sample consisted of 1,206 caregivers who provided services to Medicare beneficiaries. Logistic regressions were performed to assess the three types of burdens each subgroup was experiencing. RESULTS Results indicated that within the intersectionality framework, compared to White female caregivers, Black male caregivers were 3.3 times (95% CI 1.77-6.22) more likely to experience financial burden, and Black female caregivers were 54% less likely to experience physical burden. Surprisingly, compared to White female caregivers, all the other groups were 37% (95% CI 0.41-0.95) to 71% (95% CI 0.15-0.56) less likely to have emotional burden. DISCUSSION AND IMPLICATIONS The findings highlighted that Black male caregivers are experiencing financial burden and White female caregivers are experiencing emotional burden disproportionately. To develop effective interventions and programs for dementia caregivers, a special focus should be put on monitoring the differences in the types of burdens that the above-mentioned population subgroups experience.
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Affiliation(s)
- Ruotong Liu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.,Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, California, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.,Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, California, USA
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.,Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
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Stefánsdóttir OÁ, Munkejord MC, Sveinbjarnardóttir EK. Maintaining or letting go of couplehood: Perspectives of older male spousal dementia caregivers. Scand J Caring Sci 2021; 36:742-751. [PMID: 34569074 DOI: 10.1111/scs.13035] [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: 05/04/2021] [Revised: 09/01/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022]
Abstract
Despite the negative implications for their own health, spouses continue to support each other and maintain their couplehood for as long as possible, including when one of them develops a severe illness. However, with some exceptions, the experiences of older male spousal caregivers have been largely overlooked, and our knowledge of the relational aspects of spousal dementia care is scarce. To respond to this knowledge gap, this article explores the following research questions: How do older male spousal caregivers of wives with dementia talk about changes in their couplehood? What transitions or phases in the relationship can be identified as the caring process evolves and the wife's health continues to deteriorate? To answer these questions, we analyse in-depth interviews with eight purposefully selected men aged 67-92 years old from Iceland and Norway. Our findings reveal that the participants felt that they were gradually losing their couplehood in the sense that they lost their shared everyday life routines, intimacy, joint activities, meaningful communication, and dreams and hopes for the future. Four phases of the dementia caring process were identified: the denial phase, the battle phase, the new reality phase and the redefinition phase. We hope that our findings spur more research on relational challenges as experienced by spouses caring for partners with cognitive decline. In conclusion, we argue that interdisciplinary clinical guidelines for a couple-centred approach in elder care should be developed to urge professional care providers to pay attention to the various changes and challenges that dementia couples undergo to meet not only the health and care needs of dementia patients but also those of their spouses.
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Affiliation(s)
| | - Mai Camilla Munkejord
- Dept of Business Administration, Western Norway University of Applied Sciences, Bergen, Norway.,NORCE, Bergen, Norway.,Centre for Care Research West, Western Norway of Applied Sciences, Bergen, Norway
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30
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Schwab-Reese LM, Murfree L, Coppola EC, Liu PJ, Hunter AA. Homicide-suicide across the lifespan: a mixed methods examination of factors contributing to older adult perpetration. Aging Ment Health 2021; 25:1750-1758. [PMID: 32686960 DOI: 10.1080/13607863.2020.1795620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this study is to determine how individual and contextual factors that contribute to homicide-suicide (HS) differ between young adults, middle-aged adults, and older adults, and to describe, in detail, the circumstances that lead to HS by older adults. METHODS Data were obtained from the Center for Disease Control and Prevention (CDC) National Violent Death Reporting System. We used a sequential mixed methods approach to the analysis. Guided by the Marzuk HS framework, we conducted quantitative analyses to identify characteristics distinguishing older adult HS perpetrators from younger HS perpetrators. These results guided the qualitative content analysis, which further described the circumstances surrounding HS incidents perpetrated by older adults. RESULTS While HS perpetrated by young and middle-aged adults were quite similar, the demographic characteristics, victim-perpetrator relationship, and contributing factors in HS incidents perpetrated by older adults were substantially different. Mental health and depressed mood were more common among older adult perpetrators, and jealousy, fights, and substance use issues were less common, relative to younger perpetrators. Escalating intimate partner violence and caregiving/health-related issues, including caregiving strain, housing transitions, and financial problems, were the primary contributors to older adult HS. CONCLUSION HS perpetrated by older adults was both similar and different from incidents perpetrated by younger adults. Programs that prevent or de-escalate intimate partner violence would likely prevent many HS incidents perpetrated by older adults, but health and aging-related issues must also be considered.
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Affiliation(s)
| | - Lauren Murfree
- Department of Health & Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Elizabeth C Coppola
- Department of Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Pi-Ju Liu
- School of Nursing and Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | - Amy A Hunter
- Injury Prevention Center at Connecticut Children's and Hartford Hospital, Departments of Pediatrics and Public Health Sciences, UCONN School of Medicine, Hartford, CT, USA
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Zygouri I, Cowdell F, Ploumis A, Gouva M, Mantzoukas S. Gendered experiences of providing informal care for older people: a systematic review and thematic synthesis. BMC Health Serv Res 2021; 21:730. [PMID: 34301248 PMCID: PMC8306003 DOI: 10.1186/s12913-021-06736-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background and purpose The caregiving’s impact on informal carers’ quality of life and gender-based stereotypes make older individuals’ informal care a complex process for which our knowledge is still limited. The purpose of this review is to identify how gender relates to informal carers’ experiences of providing care for people aged 60 years and over with mental and physical health needs by synthesising the available empirical data published between 2000 to 2020. Design and methods The systematic method for reviewing and synthesising qualitative data was performed using the PRISMA checklist and ENTREQ statement. The CASP tool was used to examine the quality of the included papers. Thematic synthesis was used as the methodological framework. Results This review produced two analytical themes, the impact of gender on the caregivers’ labour and negotiating gender identity with self, society, and cultural norms. While informal caregivers share motivators, a linkage between traditional gender stereotypes impacts caregiving burden and coping strategies. Informal carers’ experiences entail a constant pursuit of self-agency after acquiring the caregiver role. Cultural values and their intersection with gender appear to influence caregivers’ healthy adjustment into their new caregiving identities. The flexibility to move beyond gender boundaries could mediate caregivers’ negotiations between self and society on developing their new caregiving identity. Providing intensive informal primary care to older people affects both men’s and women’s mental and physical health. Gender ideals of the feminine nurturing role further disadvantage women as they determine the caregiving arrangements, the strategies and resources to sustain the caring burden, and the adaptability to experience their new caregiving role positively. Men appear more flexible to debate their hegemonic masculinity and defend their existence in the caregiving role. Conclusion and implications Transgressing gender lines and expanding gender possibilities can ease the caregiving burden and strengthen caregivers coping potentials. Health professionals can empower informal careers to challenge gender binaries and expand gender possibilities by intentionally injecting the language of diversity in caring information and caring processes. The review findings outline a path for research on gender identity development in older people’s care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06736-2.
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Affiliation(s)
- Ioanna Zygouri
- Department of Medicine, Faculty of Medicine, University of Ioannina, University Campus, P.O. Box: 1186, Zip: 451 10, Ioannina, Greece.
| | - Fiona Cowdell
- School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
| | - Avraam Ploumis
- Department of Medicine, Faculty of Medicine, University of Ioannina, University Campus, P.O. Box: 1186, Zip: 451 10, Ioannina, Greece
| | - Mary Gouva
- Department of Nursing, University of Ioannina, Ioannina, Greece
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Wiegelmann H, Wolf-Ostermann K, Brannath W, Arzideh F, Dreyer J, Thyrian R, Schirra-Weirich L, Verhaert L. Sociodemographic aspects and health care-related outcomes: a latent class analysis of informal dementia care dyads. BMC Health Serv Res 2021; 21:727. [PMID: 34301241 PMCID: PMC8299572 DOI: 10.1186/s12913-021-06708-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Studies revealed the importance to assess dementia care dyads, composed of persons with dementia and their primary informal caregivers, in a differentiated way and to tailor support services to particular living and care circumstances. Therefore, this study aims first to identify classes of dementia care dyads that differ according to sociodemographic, care-related and dementia-specific characteristics and second, to compare these classes with regard to healthcare-related outcomes. METHODS We used data from the cross-sectional German DemNet-D study (n = 551) and conducted a latent class analysis to investigate different classes of dementia care dyads. In addition, we compared these classes with regard to the use of health care services, caregiver burden (BIZA-D), general health of the informal caregiver (EQ-VAS) as well as quality of life (QoL-AD) and social participation (SACA) of the person with dementia. Furthermore, we compared the stability of the home-based care arrangements. RESULTS Six different classes of dementia care dyads were identified, based on best Bayesian Information Criterion (BIC), significant likelihood ratio test (p < 0.001), high entropy (0.87) and substantive interpretability. Classes were labelled as "adult child parent relationship & younger informal caregiver", "adult child parent relationship & middle aged informal caregiver", "non family relationship & younger informal caregiver", "couple & male informal caregiver of older age", "couple & female informal caregiver of older age", "couple & younger informal caregiver". The classes showed significant differences regarding health care service use. Caregiver burden, quality of life of the person with dementia and stability of the care arrangement differed also significantly between the classes. CONCLUSION Based on a latent class analysis this study indicates differences between classes of informal dementia care dyads. The findings may give direction for better tailoring of support services to particular circumstances to improve healthcare-related outcomes of persons with dementia and informal caregivers.
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Affiliation(s)
- Henrik Wiegelmann
- grid.7704.40000 0001 2297 4381Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Karin Wolf-Ostermann
- grid.7704.40000 0001 2297 4381Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Werner Brannath
- grid.7704.40000 0001 2297 4381Competence Centre for Clinical Trials, University of Bremen and Clinic Bremen-Mitte, Bremen, Germany
| | - Farhad Arzideh
- grid.7704.40000 0001 2297 4381Competence Centre for Clinical Trials, University of Bremen and Clinic Bremen-Mitte, Bremen, Germany
| | - Jan Dreyer
- grid.424247.30000 0004 0438 0426German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Germany
| | - Rene Thyrian
- grid.424247.30000 0004 0438 0426German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Germany
| | - Liane Schirra-Weirich
- grid.466086.a0000 0001 1010 8830Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Cologne, Germany
| | - Lisa Verhaert
- grid.466086.a0000 0001 1010 8830Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Cologne, Germany
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Lee K, Yefimova M, Puga F, Pickering CE. Gender Differences in Caregiver Burden Among Family Caregivers of Persons With Dementia. J Gerontol Nurs 2021; 47:33-42. [PMID: 34191655 DOI: 10.3928/00989134-20210610-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The current study aimed to identify gender-dependent factors that influence caregiver burden among family caregivers of persons with dementia through secondary data analysis. We used a nationally representative survey of 379 family caregivers of persons with dementia completed in 2014. We examined factors affecting the burden experience of male and female caregivers, guided by the stress process model, using hierarchical regression. The analytic sample included 159 males (42%) and 220 females (58%). For males, age of care recipient, being an adult child, social support, instrumental activities of daily living performed, and caregiving impact on caregivers' health influenced burden. For females, co-residence, social support, caregivers' current health, and caregiving impact on caregivers' health impacted burden. Understanding gender differences related to caregiving burden is beneficial for developing effective targeted interventions that support the caregiving role and improve the quality of life of caregivers. [Journal of Gerontological Nursing, 47(7), 33-42.].
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Leggett AN, Meyer OL, Bugajski BC, Polenick CA. Accentuate the Positive: The Association Between Informal and Formal Supports and Caregiving Gains. J Appl Gerontol 2021; 40:763-771. [PMID: 32326797 PMCID: PMC7584731 DOI: 10.1177/0733464820914481] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: To promote resilience among caregivers for persons living with dementia (PLWDs), we examine how formal and informal supports are linked to caregiving gains, and whether gender moderates the association between supports and gains. Method: Using the National Health and Aging Trends Study and associated National Study of Caregiving, sources of informal (emotional support, practical support, and help with the PLWD) and formal support (respite care, training program, support group) are considered as predictors of caregiving gains, with gender as a moderator of these associations. The sample included 707 caregivers for 502 PLWDs. Results: Greater caregiving gains were significantly associated with emotional support from friends/family (β = 0.14, SE = 0.09, p = .03). Furthermore, attending a caregiver training program was only associated with increased caregiving gains among men (β = 0.11, SE = 0.08, p = .02). Conclusion: Emotional support from family/friends appears particularly consequential for caregiving gains, and male caregivers may benefit most from programs that emphasize skill building.
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Affiliation(s)
| | - Oanh L Meyer
- University of California Davis School of Medicine, Sacramento, USA
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35
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Velissaris SL, Hosken R, Gluyas C. Pilot investigation into the need and feasibility of a psychoeducation and support group for male caregivers of those with Huntington's disease. J Community Genet 2021; 12:679-684. [PMID: 34142345 DOI: 10.1007/s12687-021-00535-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022] Open
Abstract
The psychosocial sequelae of caregiving in Huntington's disease (HD) have been shown to be extensive, even in comparison with other progressive neurological disorders. Based on observed clinical need, this investigation aimed to identify psychoeducational and emotional support needs of male HD caregivers and to explore the feasibility and utility of a carer support group. Six male caregivers completed quantitative measures assessing depression, anxiety, carer burden, and carer support needs. The men participated in two education and support group sessions, four weeks apart, which were developed with consideration of male support preferences. Qualitative themes arising in these sessions were documented. Questionnaire results showed overall low levels of psychological distress and carer burden. Despite this, the group sessions facilitated disclosure of significant emotional, practical, and relationship challenges arising from HD. Further, a range of psychoeducational and emotional support needs were identified on quantitative and qualitative assessments. Participants strongly endorsed the format of the group and the benefits of participation, highlighting in particular the importance of meeting other men who understood the experience of living with a spouse with HD.
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Affiliation(s)
- Sarah L Velissaris
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Caulfield South, Victoria, Australia.
| | - Ruth Hosken
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Caulfield South, Victoria, Australia
| | - Cathy Gluyas
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Caulfield South, Victoria, Australia
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Mental Health Problems of Female Spouses of Men Living With HIV in Sichuan, China: A Qualitative Study. J Assoc Nurses AIDS Care 2021; 31:526-534. [PMID: 31261287 DOI: 10.1097/jnc.0000000000000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HIV disclosure to spouses can promote HIV prevention and facilitate support from those spouses; it can also cause mental health challenges for the spouses. We conducted a qualitative study of the mental health status and potential contributing factors of mental health challenges of spouses of men living with HIV in Sichuan, China. We interviewed 31 spouses whose husbands were living with HIV. Qualitative data were analyzed using content and thematic analyses. We found that mental health challenges were common among the spouses; leading challenges were themed as hopelessness, depression, and anxiety. Greater HIV knowledge, close relationship with husband, and psychological support may protect spouses from mental health challenges, whereas HIV-related stigma, heavy caregiving burden, and an unsupportive environment might be detrimental to mental health. Spouses of men living with HIV need mental health services, which should take into account a wide spectrum of contributors at individual, couple, and social levels.
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Wiegelmann H, Speller S, Verhaert LM, Schirra-Weirich L, Wolf-Ostermann K. Psychosocial interventions to support the mental health of informal caregivers of persons living with dementia - a systematic literature review. BMC Geriatr 2021; 21:94. [PMID: 33526012 PMCID: PMC7849618 DOI: 10.1186/s12877-021-02020-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Background Informal caregivers of persons living with dementia have an increased risk of adverse mental health effects. It is therefore important to systematically summarize published literature in order to find out which mental health interventions generate effective support for informal caregivers of persons living with dementia. The objective of this study is to conduct a systematic review of intervention content, effectiveness and subgroup differentiation of mental health interventions for informal caregivers of persons with dementia living at home. Method We searched four electronic databases (PubMed, PsychINFO, Scopus and CINAHL) and included only methodically high-quality randomized controlled trials (RCTs), published in English or German language between 2009 and 2018. The intervention programmes focused on mental health of family caregivers. A narrative synthesis of the included studies is given. Results Forty-eight publications relating to 46 intervention programmes met the inclusion criteria. Burden, depression and quality of life (QoL) are the predominant parameters that were investigated. Twenty-five of forty-six interventions (54.3%) show positive effects on at least one of the outcomes examined. Most often, positive effects are reported for the outcome subjective burden (46.2%). Only six studies explicitly target on a certain subgroup of informal dementia caregivers (13%), whereas all other interventions (87%) target the group as a whole without differentiation. Conclusion The most beneficial results were found for cognitive behavioural approaches, especially concerning the reduction of depressive symptoms. Besides this, leisure and physical activity interventions show some good results in reducing subjective caregiver burden. In order to improve effectiveness, research and practice may focus on developing more targeted interventions for special dementia informal caregiver subgroups. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02020-4.
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Affiliation(s)
- Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany.
| | - Sarah Speller
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
| | - Lisa-Marie Verhaert
- Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Robert-Schuman-Straße 25, 52066, Aachen, Germany
| | - Liane Schirra-Weirich
- Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Robert-Schuman-Straße 25, 52066, Aachen, Germany
| | - Karin Wolf-Ostermann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
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Langner LA, Furstenberg FF. After the Burden Is Lifted: Caregivers' Recovery of Life Satisfaction After the Death or Recovery of a Spouse. J Gerontol B Psychol Sci Soc Sci 2020; 75:2170-2180. [PMID: 31501869 DOI: 10.1093/geronb/gbz117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE How does caregivers' life satisfaction shift upon the recovery of an ill spouse? Paradoxically, there is a greater increase in life satisfaction upon death than recovery of a spouse. Our analysis explores this paradox. METHOD We follow the two groups of exiting caregivers longitudinally for 4 years from when the partner is still in need of care until the death (N = 152) or recovery (N = 112) of a previously ill partner, comparing their trajectory of life satisfaction. We use the years 2001-2016 of the German-Socio-Economic Panel Study and a growth curve analysis. RESULTS Contrary to our expectations, bereaved caregivers experience a significantly stronger increase in life satisfaction than spouses whose partners recover from a serious illness, even when we stratify by age, gender and initial life satisfaction to account for significantly different subsample composition. Surprisingly, life satisfaction remains unchanged when the partner recovers. Only if a heavy burden in terms of unpaid care and housework hours or prior care need is lifted, do we observe an increase in life satisfaction among spouses with recovering partners, which is like the one experienced by bereaved caregivers. DISCUSSION More support for caregivers with high caregiving burdens may alleviate some of the strain associated with spousal caregiving, as-even if the partner dies-a decrease in spousal caregiving hours results in an uplift in life satisfaction.
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Affiliation(s)
- Laura A Langner
- Department of Sociology, University of Oxford, Philadelphia.,Department of Sociology, University of Pennsylvania, Philadelphia
| | - Frank F Furstenberg
- Department of Sociology, University of Oxford, Philadelphia.,Department of Sociology, University of Pennsylvania, Philadelphia
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Finn C, Boland P. Male family carers' experiences of formal support - a meta-ethnography. Scand J Caring Sci 2020; 35:1027-1037. [PMID: 33107643 DOI: 10.1111/scs.12919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/11/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Men represent a growing proportion of unpaid family carers across Europe. Comparative studies have proposed male carers experience their caring role differently to females; men are less likely to avail of formal support services than women. Social ideas around masculinity have been linked to the help-seeking behaviours of male carers, as well as men's attitudes around accessing formal support. More understanding about this role from the perspective of male carers is required. METHODS The study followed a meta-ethnography process starting with a systematic literature search of five electronic databases. The methodological quality of the selected studies was evaluated using the Mc Master checklist. Using NVivo 12 software, primary data were analysed and themes throughout the papers were identified. Results were synthesised as a meta-ethnography that retained direct quotes from the studies. RESULTS Two themes and five sub-themes were developed from the data. The first theme was 'Men's experiences of formal support' which contained sub-themes 'Reluctance to step back', 'A space to share emotions' and 'Education diminishes burden'. The second theme was 'Coping without Formal Support' with sub-themes 'Satisfied without help' and 'Duty prevents help seeking'. CONCLUSIONS Fear of perceived failure and a loss of control in the caring relationship were key factors in men's low trust and dissatisfaction with available services. To engage more male carers, formal service providers should acknowledge men's wish to be seen as competent in the care role as well as their desire to stay involved in decision-making around care for their family member. Support services that were collaborative, education-based and gender-sensitive were favoured by male carers.
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Affiliation(s)
- Caroline Finn
- Castletroy, University of Limerick, Limerick, Ireland
| | - Pauline Boland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Ageing Research Centre (ARC), Health Research Institute, University of Limerick, Limerick, Ireland
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Langner LA, Furstenberg FF. Gender Differences in Spousal Caregivers' Care and Housework: Fact or Fiction? J Gerontol B Psychol Sci Soc Sci 2020; 75:173-183. [PMID: 30085145 DOI: 10.1093/geronb/gby087] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Many studies reveal a gender gap in spousal care during late life. However, this gap could be an artifact of methodological limitations (small and unrepresentative cross-sectional samples). Using a data set that overcomes these limitations, we re-examine the question of gender differences in spousal care and housework adjustment when a serious illness occurs. METHOD We use biannual waves between 2001 and 2015 of the German Socio-Economic Panel Study and growth curve analyses. We follow couples longitudinally (identified in the household questionnaire) to analyze shifts in spousal care hours and housework plus errand hours that occur as a response to the spousal care need. We test for interactions with levels of care need and with gender. RESULTS We found that men increase their care hours as much as women do, resulting in similar care hours. They also increase their housework and errand hours more than women do. Yet at lower levels of spousal care need, women still do more housework and errands because they spent more time doing housework before the illness. DISCUSSION Even in a context of children's decreasing availability to care for parents, male spouses assume the required caregiving role in systems relying on a mixture of public and private care.
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Fee A, McIlfatrick S, Ryan A. Examining the support needs of older male spousal caregivers of people with a long-term condition: A systematic review of the literature. Int J Older People Nurs 2020; 15:e12318. [PMID: 32367662 DOI: 10.1111/opn.12318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/06/2020] [Accepted: 04/03/2020] [Indexed: 11/27/2022]
Abstract
AIM The aim of this review was to identify and synthesise literature reporting on support needs of older male caregivers, who are providing care for a chronically ill spouse/partner at home. BACKGROUND Traditionally, informal caregiving has been perceived as a feminised activity. Consequently, caregiving research has been dominated by female samples, and male caregivers are grossly under-represented. Given the growing recognition of caregiving as a gendered concept, and the rise in number of male caregivers, particularly in later life, the need for better understanding of the needs of male caregivers is important in order to plan effective support for this population. DESIGN A systematic literature review. METHODS Four electronic databases and grey literature were systematically searched. RESULTS The systematic search resulted in 3,646 papers, eligibility criteria were applied to the full texts of 104 papers, and 11 papers met the inclusion criteria. Two core themes were identified: the need to maintain masculinity and the provision of social support. CONCLUSION Findings suggest that men may have a gendered approach to caregiving based on dominant masculine norms. This can be manifested in a reluctance to ask for or accept help and a desire to retain control over caregiving. Findings also revealed isolation and loneliness experienced by older male caregivers, along with a preference for support to address this within a male-specific context. It is suggested that healthcare professionals should be cognisant of the male caregiver approach and should have an increased awareness of male caregivers support preferences, and of their own gendered assumptions, in order to provide effective support for this population. IMPLICATIONS FOR PRACTICE Nurses have a key role in providing family support. Findings from this review suggest that nurses should be aware of the specific needs of older male spousal caregivers if they are to provide effective care and support to this population group.
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Affiliation(s)
- Anne Fee
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Sonja McIlfatrick
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Assumpta Ryan
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Londonderry, UK
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Swinkels JC, Broese van Groenou MI, de Boer A, Tilburg TGV. Male and Female Partner-Caregivers' Burden: Does It Get Worse Over Time? THE GERONTOLOGIST 2020; 59:1103-1111. [PMID: 30321338 DOI: 10.1093/geront/gny132] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The general view is that partner-caregiver burden increases over time but findings are inconsistent. Moreover, the pathways underlying caregiver burden may differ between men and women. This study examines to what degree and why partner-caregiver burden changes over time. It adopts Pearlin's Caregiver Stress Process Model, as it is expected that higher primary and secondary stressors will increase burden and larger amounts of resources will lower burden. Yet, the impact of stressors and resources may change over time. The wear-and-tear model predicts an increase of burden due to a stronger impact of stressors and lower impact of resources over time. Alternatively, the adaptation model predicts a decrease of burden due to a lower impact of stressors and higher impact of resources over time. RESEARCH DESIGN AND METHODS We used 2 observations with a 1-year interval of 279 male and 443 female partner-caregivers, derived from the Netherlands Older Persons and Informal Caregivers Survey Minimum Data Set. We applied multilevel regression analysis, stratified by gender. RESULTS Adjusted for all predictors, caregiver burden increased over time for both men and women. For female caregivers, the impact of poor spousal health on burden increased and the impact of fulfillment decreased over time. Among male caregivers, the impact of predictors did not change over time. DISCUSSION AND IMPLICATIONS The increase of burden over time supports the wear-and-tear model, in particular for women. This study highlights the need for gender-specific interventions that are focused on enabling older partners to be better prepared for long-term partner-care.
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Affiliation(s)
- Joukje C Swinkels
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam
| | | | - Alice de Boer
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam.,The Netherlands Institute for Social Research, The Hague, The Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam
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Mahomed A, Pretorius C. Availability and utilization of support services for South African male caregivers of people with Alzheimer’s disease in low-income communities. DEMENTIA 2020; 20:633-652. [DOI: 10.1177/1471301220909281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to explore the needs of male caregivers of people with Alzheimer’s disease, by ascertaining the availability and utilization of Alzheimer’s disease-related resources in low-income communities in the Western Cape. Semi-structured interviews were conducted with 11 adult males who were familial caregivers of persons with Alzheimer’s disease. They were recruited via purposeful sampling methods. Thematic analysis of the data generated four major themes, namely Awareness, Knowledge and Education; Caregivers who do not use services; Caregivers who use services and Service needs identified by male caregivers. Predominant findings were that male caregivers in lower income communities do not make use of formal Alzheimer’s disease-related services – albeit being aware of them – because they do not perceive a need for its utilization. Instead, male caregivers prefer assistance in the form of respite care in the home environment to relieve and assist them with household needs. The role of culture may have a substantial influence on these patterns of help-seeking behavior due to the emphasis on a collective approach to caregiving using wider, informal social networks. Needs that were identified by the male caregivers in this study included the general awareness of Alzheimer’s disease, access to information regarding service provision, psychoeducation and affordable services within improved care facilities for low-income communities. The findings of this study suggest a starting point for the needs that should be prioritized to facilitate culturally appropriate service use amongst male caregivers in similar settings.
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Affiliation(s)
- Aqeela Mahomed
- Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa
| | - Chrisma Pretorius
- Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa
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Caprioli T, Martindale S, Mengiste A, Assefa D, H/Kiros F, Tamiru M, Negussu N, Taylor M, Betts H, Kelly-Hope LA. Quantifying the socio-economic impact of leg lymphoedema on patient caregivers in a lymphatic filariasis and podoconiosis co-endemic district of Ethiopia. PLoS Negl Trop Dis 2020; 14:e0008058. [PMID: 32126081 PMCID: PMC7069637 DOI: 10.1371/journal.pntd.0008058] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 03/13/2020] [Accepted: 01/14/2020] [Indexed: 12/11/2022] Open
Abstract
Background Lymphoedema caused by lymphatic filariasis (LF) or podoconiosis can result in physical disability and social exclusion, which is exacerbated by painful acute dermatolymphangioadenitis (ADLA) episodes. These conditions have a significant impact on patients, however, little is known about the indirect effects on their caregivers. This study, therefore, aimed to determine the impact on caregivers for patients with leg lymphoedema in a co-endemic district of Ethiopia. Methodology/Principal findings A cross-sectional survey of lymphoedema patients and their caregivers was conducted using semi-structured questionnaires in the Southern Nation Nationalities Peoples Region (SNNPR) of Ethiopia. Lymphoedema patient information on clinical severity (mild, moderate, severe), frequency of ADLAs, their socio-demographic characteristics and the identity of main caregiver(s) was collected. Caregiver information on socio-demographic characteristics, types of care provided, their quality of life (QoL) measured across nine domains, and productivity was collected, with key indicators compared in the presence and absence of patients’ ADLAs. A total of 73 patients and 76 caregivers were included. Patients were grouped by mild/moderate (n = 42, 57.5%) or severe (n = 31, 42.5%) lymphoedema, and reported an average of 6.1 (CI± 2.18) and 9.8 (CI± 3.17) ADLAs respectively in the last six months. A total of 48 (65.8%) female and 25 (34.2%) male patients were interviewed. Caregivers were predominately male (n = 45, 59.2%), and spouses formed the largest caregiving group for both female and male patients. In the absence of an ADLA, most caregivers (n = 42, 55.2%) did not provide care, but only one caregiver did not provide care during an ADLA. In the absence of an ADLA, the average time (hour:minute) spent by mild/moderate (00:17, CI: ± 00:08) and severe (00:10, CI: ± 00:07) patient caregiver per task was minimal. The time mild/moderate (00:47, CI: ± 00:11) and severe (00:51, CI: ± 00:16) patient caregivers spent per task significantly increased in the presence of an ADLA. In addition, caregivers’ QoL was negatively impacted when patients experienced an ALDA, and they had to forfeit an average of 6 to 7 work/school days per month. Conclusion/Significance Lymphoedema and ADLAs impact negatively on patients’ and their caregivers’ lives. This emphasises the importance of increasing access to effective morbidity management and disability prevention services to reduce the burden and help to address the Sustainable Development Goal (SDG) 5, target 5.4, which seeks to recognise and value unpaid care and domestic work. Lymphatic filariasis and podoconiosis can result in chronic severe lymphoedema of the limbs, which is aggravated by frequent painful episodes of acute bacterial infection known as ‘acute attacks’. The debilitating impact of these conditions on patients are well documented, however, the extent to which the hardship extends to their caregivers is unknown. To address this knowledge gap, a survey of 73 lymphoedema patients and their caregivers was conducted in an endemic region of Ethiopia. Patients were found to be predominately female and caregivers predominately male, mostly spouses. Caregivers provided a wide range of care, and the type, frequency and time spent on tasks significantly increased when patients experienced an acute attack. Caregivers reported a negative impact on their quality of life and provided care for an average of 15 days and forfeited an average of 7 days of work or school per month. This study has revealed a previously hidden burden of lymphoedema that not only affects patients, but their caregivers who are mostly family members. This emphasises the importance of increasing access to effective morbidity management and disability prevention programmes to reduce the burden and help to address the Sustainable Development Goal (SDG) 5, target 5.4, which seeks to recognise and value unpaid and domestic work.
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Affiliation(s)
- Thais Caprioli
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah Martindale
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Dereje Assefa
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Fikre H/Kiros
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | | | | | - Mark Taylor
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hannah Betts
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Kenny K, Broom A, Kirby E, Oliffe JL, Wyld D, Lwin Z. Reciprocity, Autonomy, and Vulnerability in Men's Experiences of Informal Cancer Care. QUALITATIVE HEALTH RESEARCH 2020; 30:491-503. [PMID: 31216932 DOI: 10.1177/1049732319855962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Men are increasingly participating, and acknowledging their roles, as informal carers. Yet, there has been comparatively little exploration of their experiences therein, especially within the context of cancer care. Here, drawing on semi-structured qualitative interviews with 16 Australian male carers for a relative with cancer, and using constructivist grounded theory, we explore their experiences of informal caring. Our analysis highlights a series of tensions, including the following: the meanings and practicalities of care provision including notions of reciprocity, duty, autonomy, and interdependence; the discomforts of dependency and vulnerability; and the complicated moralities that inflect "caring well." Given the shifting dynamics around informal care, we argue for increased attention to the affective tensions that arise at the nexus of moralities and masculinities in informal caring relations, especially as they are articulated in the context of illness, affliction, and dependency.
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Affiliation(s)
- Katherine Kenny
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Alex Broom
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Emma Kirby
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - John L Oliffe
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - David Wyld
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
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Robinson CA, Bottorff JL, Pesut B, Zerr J. Development and Implementation of the Family Caregiver Decision Guide. QUALITATIVE HEALTH RESEARCH 2020; 30:303-313. [PMID: 31744378 DOI: 10.1177/1049732319887166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Care provided by family is the backbone of palliative care in Canada. The critical roles performed by caregivers can at the same time be intensely meaningful and intensely stressful. However, experiences of caregiving can be enhanced when caregivers feel they are making informed and reflective decisions about the options available to them. With this in mind, the purpose of this five-phase research project was to create a Family Caregiver Decision Guide (FCDG). The Guide entails four steps: thinking about the current caregiving situation, imagining how the caregiving situation may change, exploring available options, and considering best options if caregiving needs change. The FCDG was based on available evidence and was developed and refined using focus groups, cognitive interviewing, and a feasibility and acceptability study. Finally, an interactive version of the Guide was created for online use ( https://www.caregiverdecisionguide.ca ). In this article, we describe the development, evaluation, and utility of the FCDG.
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Affiliation(s)
- Carole A Robinson
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Joan L Bottorff
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Barbara Pesut
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Janelle Zerr
- The University of British Columbia, Kelowna, British Columbia, Canada
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Nel K, Board M. What is an older husband's experience of caring for his wife who has dementia? Nurs Older People 2019; 31:22-27. [PMID: 31691551 DOI: 10.7748/nop.2019.e1214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 11/09/2022]
Abstract
A significant number of informal carers look after people who have dementia. Women's caring experiences are well documented. However, a substantially smaller amount of research exists specifically investigating the male carer perspective. This literature review explores older husbands' experiences of caring for their wives who have dementia. The findings suggest that husbands are committed to their caring role but can feel socially isolated. The caring role of older men has altered the dynamic in the marriage. Husbands continue to show commitment towards their spouses but feel that male-only support groups could offer some respite from their responsibilities. Nurses need to take time to listen to husbands' experiences, offering emotional support and signposting them to other services. Further research on the long-term effects and support needs of older male carers is needed.
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Affiliation(s)
- Kerry Nel
- Department of Nursing and Clinical Sciences, Bournemouth University, England
| | - Michele Board
- Faculty of Health and Social Sciences, Bournemouth University, England
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‘When it faded in her … it faded in me’: a qualitative study exploring the impact of care-giving on the experience of spousal intimacy for older male care-givers. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractOlder male care-givers play an increasingly important role in informal care-giving, yet they have received little attention in the literature. The aim of this study was to explore the impact of care-giving on the experience of spousal intimacy for older male care-givers. Twenty-four older male care-givers, drawn from a region of the United Kingdom, participated in one-to-one interviews about their care-giving role. Thematic analysis was used to analyse data, and the study was underpinned by theories of masculinity. Three main themes were identified: (a) ‘Impact of care-giving on the experience of sexual intimacy’; (b) ‘Impact of care-giving on the experience of emotional intimacy’; and (c) ‘Not up for discussion’. When sexual intimacy declined, some older male care-givers prioritised emotional intimacy; some struggled with the decline; and some were reluctant to discuss the issue. Additionally, some care-givers reported that they had not received support from external support providers for declining sexual or emotional intimacy. Intimacy has been highlighted as important for care-givers given its link with care-giver wellbeing and quality of life. Results of this study suggest that sexual and emotional intimacy was an issue for older male care-givers, and that this issue should be considered by external support providers as part of a holistic assessment of need in order to tailor effective support.
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Abstract
OBJECTIVES Providing care for a person with dementia or other chronic illness at home often places stress on the primary caregiver. In an Irish population, ~67% of carers reported experiencing extreme physical or mental tiredness. This study aimed to identify factors that influence carer burden and identify the sub-populations of carers who are most susceptible to burden. METHODS Consecutive carers referred to a local carers' support organisation completed the following measurements: the Neuropsychiatric Inventory, Zarit Burden Interview, Social Network Index, General Health Questionnaire, Short Form Survey, Hamilton Depression Rating Scale, Brown's Locus of Control scale and provided demographic data on themselves and their patient. RESULTS The sample consisted 53 carers, mean age: 64.5±11.7, of whom 43 (81.1%) were females. A linear regression model found significant independent (p<0.05) factors for carer burden were: increased behavioural problems of the patient, carer characteristics including female gender, younger age, high number of contacts, lower physical functioning and emotional problems, while protective factors were marriage and higher number of embedded networks. CONCLUSIONS The ability to predict which carers are more susceptible to burden allows service providers to more quickly and accurately identify 'higher risk' carers, facilitating routine check-ups by physicians and carer support services.
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Understanding Male Caregivers' Emotional, Financial, and Physical Burden in the United States. Healthcare (Basel) 2019; 7:healthcare7020072. [PMID: 31121905 PMCID: PMC6627587 DOI: 10.3390/healthcare7020072] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/10/2019] [Accepted: 05/17/2019] [Indexed: 12/04/2022] Open
Abstract
Men caregivers face caregiving burden, have weak support networks and are less likely to seek out programs which increase their caregiving capabilities and help them cope with this burden. Using the 2011 and 2015 National Study of Caregiving (NSOC) database and hierarchical regressions, we studied the emotional, financial, and physical burden of male caregivers as spouses, sons, and other caregivers by assessing the impact of caregiver characteristics, tasks and resources for each subgroup. We highlighted the importance of using a nationally representative database for men caregivers only and emphasized that these caregivers are not a monolithic group. We found that all caregivers experienced these three burden types, particularly elevated emotional stress, with sons reporting the highest emotional and financial strain levels. Assisting with personal care was the most stressful task and caregivers vastly under-utilized support and training. Our results suggest that burden suppressants included having family and friends help with caregiving, having time to decompress, and feeling appreciated by the care recipient. These findings offer insight for devising future policies that intentionally include relationship and burden type to encourage improved and more caregiving from men while supporting their well-being.
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