The Burden Experience of Formal and Informal Caregivers of Older Adults With Hip Fracture in Nigeria

Prevalence and Predictors of Stress Among Caregivers of Children with Developmental Disorders

Medical care advances pose challenges with rising caregiving costs and fewer informal caregivers, shifting healthcare responsibilities to families. Healthcare systems adapt to technological changes, stressing person-centered care but lack support for caregivers. Addressing parental stress is crucial, given its impact on both parent and child well-being, highlighting the necessity for customized support. The study aimed to evaluate caregivers' perceived stress and its connection with socio-demographic factors and children's characteristics. Conducted at a Rehabiltation Institute's Psychology Outpatient Department, 200 mothers were enrolled using non-probability consecutive sampling. Ethical clearance was obtained, and demographic data were collected. The mean perceived stress score (PSS-10) was 31.94, indicating a positive correlation between stress and socio-demographic and disability-related variables. Significant differences in stress levels were observed between joint and nuclear family caregivers, p < .01, and those with daughters versus sons with disabilities < 0.001. Pearson's correlation analysis revealed positive correlations between perceived stress and caregiver p = < 0.001 and child age p = < 0.001, number of children p = < 0.001, and time since diagnosis p = < 0.001, with negative correlations with caregiver education p = < .001and income p = < 0.001. Multiple linear regression indicated that caregiver and child age, time since diagnosis, and the number of children positively predicted while income and education of the caregiver negatively predicted perceived stress. No significant association was found between other variables like family volunteers' education, disability type, and caregiver stress. Caregivers exhibited high perceived stress levels, highlighting the reciprocal relationship between child characteristics and parental stress, emphasizing the need for comprehensive family interventions.

Aging and Caring: Exploring Older Adults' Motivation for Informal Caregiving to Other Aging Individuals in Nigeria

Background and Objectives

Because of the global population aging, more informal carers become older adults. In Nigeria, the African country with the largest population of adults aged 60 years and older, self-construal rooted in the African collectivist philosophy generally shapes informal caregiving for older adults. However, there is a general paucity of studies on older adults' informal caregiving roles, particularly about their motivations for caregiving. This study explored older adults' motives for informal caregiving to their care recipients in urban Southeast Nigeria.

Research Design and Methods

This study adopted a hermeneutic phenomenological research design. In-depth interviews were conducted with 30 purposively selected older adults aged 54-88 who were the primary carers of other older adults in the family and community. The collected data were analyzed using van Manen's thematic analysis method, using QSR NVivo 12 software.

Results

A total of 4 main themes emerged from the participants' responses: reciprocity of kindness, altruism, a sense of moral responsibility, and eagerness for peaceful longevity. The findings generally showed that religion and culture were the latent factors ingrained in these motivations for informal caregiving.

Discussion and Implications

Although the African philosophy emphasizes altruism, reciprocity seems more prominent in specific traditional African communities, as observed in Southeast Nigeria. It serves as a means to prioritize family members' needs. The findings indicate the need for the government to establish sustainable programs and policies that support older people in their caregiving role. Doing so will enable carers to derive psychosocial gains from informal caregiving and sustain the caregiving culture of Nigeria.

Moderating role of motivational preference in the relationship between attachment quality and emotional empathy among autistic caregivers

The study investigated the moderating role of motivational preference in the relationship between attachment quality and emotional empathy among sixty-five autistic caregivers (42 males and 23 females). Participants were drawn from Therapeutic Inclusive Nursery, Primary, and Secondary School in Abakpa Nike, Enugu State, Nigeria. Attachment Quality Scale, Work Preference Inventory Scale, and Emotional Empathy Scale were used in the study. Hayes PROCESS macro regression-based, path-analytical framework was employed to analyse the data. Motivational preference and the four dimensions of attachment quality predicted emotional empathy. Motivational preference did not moderate the relationship between security, avoidance and ambivalent worry dimensions of attachment quality and emotional empathy. Motivational preference moderated the relationship between ambivalent merger and emotional empathy (β = -.14, t = -3.15, p = <.05). Ambivalent merger predicted emotional empathy for those with low motivational preference (β = 7.22, p = <.05), moderate motivational preference (β = 3.07, p = < .05), and for those with high motivational preference (β = 1.01, p = <.05). Implications and limitations of the findings were discussed and suggestions for further studies were made.

Qualitative research in physiotherapy: A systematic mapping review of 20 years literature from sub-Saharan Africa

STUDY AIM

To summarize the current state and quality of qualitative research conducted by physiotherapists in sub-Saharan Africa (SSA).

METHODS

We systematically searched multiple databases from 2000 to December 2020 and included peer-reviewed qualitative studies conducted by physiotherapists in SSA countries. Two reviewers independently screened citations, extracted data, and assessed the quality of the included studies using the 45-items checklist by Lundgren, and colleagues. Conventional content analysis was employed to create physiotherapy subject areas from the included studies.

RESULTS

We included 114 studies, a majority of 84 (74%) conducted in South Africa. Included studies were categorized into five subject areas: sports (n = 2), disability (n = 16), professional practice (n = 24), education and training (n = 36), and care provision (n = 36). We rated 74 (65%), 29 (25%), and 11 (10%) of the included research as low reporting quality, moderate- and high reporting quality, respectively. There was a significant lack of reporting on researchers' team characteristics, reflexivity, and member checking.

CONCLUSION

We conclude that the reporting of published qualitative studies in SSA shows variable quality, albeit mostly low, focused mainly on care provision, education, and training. Physiotherapy-researchers are encouraged to report reflexive practice and member checking when conducting qualitative research.

The Malay version of the caregiver assessment of function and upset instrument (Malay-CAFU): a translation and validation study among informal stroke caregivers

BACKGROUND

Post-stroke complications affect the informal caregivers equally as the stroke survivors, especially those who have a moderate to worst prognosis in functional capacity recovery. Caregiver Assessment of Function and Upset (CAFU) is one of the common tools used in both research and clinical practice to measure the patient's dependency level and the stroke caregivers' upset level.

OBJECTIVE

This study aimed to translate and validate the CAFU instrument into the Malay language and test the validity and reliability of the CAFU among informal stroke caregivers in Malaysia.

METHODS

A standard forward-backward translation method was employed to translate CAFU. Subsequently, 10 expert panels were included in the validation process, and thereafter reliability testing was conducted among 51 stroke caregivers. The validation of the instrument was determined by computing the content validity indices (CVIs), and we used the Cronbach's alpha method to explore the internal consistency of the overall score and subscales scores of the Malay-CAFU. Finally, the explanatory factor analysis used principal component extraction and a varimax rotation to examine construct validity.

RESULTS

All items of the Malay-CAFU had satisfactory item-level CVI (I-CVI), with values greater than 0.80, and the scale-level CVI (S-CVI) was 0.95. These results indicate that the Malay-CAFU had good relevancy. The internal consistency for the reliability test showed a Cronbach's alpha value of 0.95 for the overall score. The eigenvalues and scree plot supported a two-factor structural model of the instrument. From the explanatory factor analysis, the factor loadings ranged from 0.82 to 0.90 and 0.56 to 0.83, respectively.

CONCLUSION

The Malay-CAFU questionnaire is a valid and reliable instrument to assess the dependence level of stroke survivors and the upset level of informal stroke caregivers in Malaysia.

Perceived factors contributing to the care provided by informal (family) and formal caregivers of older adults with noncommunicable diseases in rural communities: A qualitative focus group study

BACKGROUND

Informal and formal caregivers of older adults with noncommunicable diseases (NCDs) are important in every aspect of current caregiving for older adults by understanding reality specific to direct experiences perceived by each person in caring for older adults in order to develop nursing knowledge and using knowledge to plan care for older adults with NCDs to have a good quality of life. The current study aimed to investigate the points of view on factors concerning the care provided by informal and formal caregivers providing care for older adults with chronic diseases in the community.

MATERIALS AND METHODS

This study was conducted with a qualitative design. The sample was 5 informal and 20 formal caregivers providing care for patients with chronic diseases, namely hypertension and diabetes mellitus. Furthermore, a qualitative approach was used with four focus groups (FGs) with 25 informants. Data were collected during March-August 2021 in rural communities of Nakhon Phanom Province, Thailand. Finally, the qualitative analysis used content analysis; FG data were analyzed using content analysis in which a preliminary set of codes was determined according to other documented experiences of patients.

RESULTS

The findings revealed three main themes emerging in the data obtained on the perceived factors contributing to the care provided by informal and formal caregivers: "caregivers' knowledge," "factors related to caregivers" and "community factors."

CONCLUSION

Points of view on the factors correlated with the care provided by informal and formal caregivers of older adults with chronic diseases that explain and confirm the findings can be used to plan care with effects on quality of life among older adults with chronic diseases.

Challenges of caregivers providing care to children with disabilities at non-governmental organisations in Tshwane townships, South Africa

Background

Caregivers of children with disabilities are vital stakeholders when it comes to safeguarding the health, well-being and overall survival of the children that they care for. Caregivers, however, face many challenging conditions that make it difficult for them to optimally fulfil their caregiving role. Understanding these challenges is crucial for developing empowerment programmes for caregivers, which will ensure that children with disabilities receive comprehensive, optimal care and that caregivers experience a good quality of life.

Objectives

The aim of this study was to explore and describe the experiences of caregivers providing care to children with disabilities at non-governmental organisations (NGOs) in townships of Tshwane, South Africa.

Method

This study followed an exploratory, descriptive and contextual research design within a qualitative methodology. The population in this study included caregivers who care for children with disabilities at NGOs (n = 10). Participants for the study were selected using the purposive sampling technique. Data were collected by conducting semistructured interviews with caregivers. Data were analysed according to the six phases of thematic analysis proposed by.

Results

The study revealed six themes that represent the challenges experienced by caregivers, namely (1) initial impressions, (2) rendering care, (3) stress, (4) lack of outside support, (5) coping and (6) poor community recognition.

Conclusion

Support from the Departments of Health and Social Development and other institutions providing community rehabilitation services to townships should be provided to caregivers in order to empower them with skills and knowledge to effectively address the challenges they face so that they can render optimal care to the children they care for.

Contribution

Results of this study could assist in ensuring improved recognition, resilience and supportive resources for caregivers in collaboration with community based rehabilitation stakeholders in the community that would ultimately lead to improved care for children with disabilities in townships within South Africa.

The estimated benefits of increasing cigarette prices through taxation on the burden of disease and economic burden of smoking in Nigeria: A modeling study

BACKGROUND

Globally, tobacco consumption continues to cause a considerable burden of preventable diseases. Although the smoking prevalence in Nigeria may be declining over the last years, the absolute number of active smokers remains one of the highest in Africa. Little is known about the disease burden and economic costs of cigarette smoking in Nigeria. Consequently, there is an evidence gap to inform the design and implementation of an effective policy for tobacco control.

METHODS

We applied a microsimulation model to estimate the burden attributable to smoking in terms of morbidity, mortality, disability-adjusted life-years (DALYs), and direct medical costs and indirect costs (e.g., productivity loss costs, informal caregivers' costs). We also modeled the health and economic impact of different scenarios of tobacco price increases through taxes.

RESULTS

We estimated that smoking is responsible for approximately 29,000 annual deaths in Nigeria. This burden corresponds to 816,230 DALYs per year. In 2019, the total economic burden attributable to tobacco was estimated at ₦ 634 billion annually (approximately U$D 2.07 billion). If tobacco cigarettes' prices were to be raised by 50% through taxes, more than 30,000 deaths from smoking-attributable diseases would be averted in 10 years, with subsequent savings on direct and indirect costs of ₦597 billion and increased tax revenue collection of ₦369 billion.

CONCLUSION

In Nigeria, tobacco is responsible for substantial health and economic burden. Increasing tobacco taxes could reduce this burden and produce net economic benefits.

Setting priorities for ageing research in Africa: A systematic mapping review of 512 studies from sub-Saharan Africa

Background

In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA.

Methods

This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas.

Results

We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions.

Conclusions

There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research.

Setting priorities for ageing research in Africa: A systematic mapping review of 512 studies from sub-Saharan Africa

BACKGROUND

In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA.

METHODS

This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas.

RESULTS

We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions.

CONCLUSIONS

There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research.

Intergenerational Support between Older Adults and Adult Children in Nigeria: The Role of Reciprocity

The rapid change in the family support structure in developing countries could jeopardize the concept of reciprocal support an older adult receives in later life. This study explored the perception of reciprocity between older parents and adult children on intergenerational support in Northern Nigeria. We purposely selected 18 participants and conducted face-to-face interviews. We analyzed the data using descriptive phenomenological method analysis. Three major themes emerged: characteristics of support, perceived support given and received to/from children, and perceived indebtedness/credit. Financial support is one of the most common types of support received by older adults. The perceived support given to adult children was expressed as "huge and sacrificial" by older adults. The adult children felt they are providing less support than they have received from their parents and expressed the feeling of indebtedness to their older parents. Generally, adult children perceived the need to reciprocate past support received from their older parents. The perception of reciprocity remains strong among Nigerians and plays a vital role in promoting intergenerational support between older parents and adult children. We discuss the implications of the findings, including the role of professionals to promote provision of other forms of support to older adults.

Resuming Normal Life as a Family Caregiver During Drip-Like Recovery of Older Persons With Cognitive Impairment Recovering From Hip Surgery: A Grounded Theory

PURPOSE

This study was undertaken to develop a theoretical framework explaining family caregiving processes for older persons with cognitive impairment recovering from hip fracture surgery.

DESIGN AND METHODS

In this grounded theory study, data were collected in audio-recorded face-to-face interviews with 21 family caregivers. Among these caregivers, 14 cared for hip-fractured persons with cognitive impairment, and seven cared for those without cognitive impairment. Caregivers were interviewed five times after patients' discharge: at 1 week and at 1, 3, 6, and 12 months. Data were analyzed by constant comparative analysis.

FINDINGS

The core category explaining the family caregiving process for hip-fractured persons with cognitive impairment was "resuming normal life during drip-like recovery." This category captures the slowness of the recovery process, as slow as dripping water. During the early postoperative period, caregivers attempted to gain control of the postoperative situation, using various maintenance and improvement strategies to deal with the chaos in individuals and the family and to protect hip-fractured persons with cognitive impairment from further harm. The goal of recovery was to get back to their original life.

CONCLUSIONS

Family caregivers of hip-fractured older persons with cognitive impairment needed to deal with more complex chaotic situations, exerted more efforts to administer safety measures, and required more time to achieve a stable life pattern.

CLINICAL RELEVANCE

Since postoperative recovery was perceived as extremely slow, family caregivers of hip-fractured older persons with cognitive impairment should be patient regarding recovery and be informed before hospital discharge of different strategies to resume normal life during postoperative recovery.

Caring for the seniors with chronic illness: The lived experience of caregivers of older adults

BACKGROUND

Caregivers of the elderly with chronic illnesses are exposed to the burden associated with their caregiving activities. This study described the lived experience of caregivers of older adults in Nigeria.

METHODS

A qualitative design guided by interpretive phenomenology informed the design of the research, whereby 15 in-depth interviews were conducted with caregivers of older adults with chronic illnesses. The interview sessions were audiotaped and transcribed verbatim and analysed using constant comparison analysis method.

RESULTS

Fifteen caregivers, from different parts of Osun State, Nigeria, took part in the in-depth interviews. The caregivers were aged between 19 and 70 years, ten were women, five of them had secondary education, seven were self-employed and six were in a spousal relationship. The study uncovered four interrelated themes with explanatory subthemes-commitment to preservation of life (managing challenges associated with daily routine, problem with mobility, bathing and grooming, feeding, and problem with hygiene) (ii) denial (refusal to accept that burden exists), other things suffer (disruption of family process, suffering from poor health and social isolation), (iv) reciprocity of care (pride in caregiving, caregiving as a necessity and not by choice, and law of karma).

CONCLUSION

This study provides insight into the burden of care of older adults with chronic illness. Caregivers' commitment to preserving life makes them provide assistance whose performance even run contrary to their own wellbeing. Intervention programme should be designed to support the caregivers thereby improving their wellbeing.