A mixed methods study of hope, transitions, and quality of life in family caregivers of persons with Alzheimer's disease

Health of the Pandemic Dementia Paid Staff and Unpaid Caregiver Workforce in Congregate Care and Community Settings

OBJECTIVES

The objective of this study was to assess the impact of the pandemic on the health, well-being, and access to services of paid staff and unpaid caregivers of persons living with dementia.

DESIGN

Questionnaires were developed to capture the experiences of paid staff and unpaid caregivers throughout the pandemic, leveraging a pre-existing clinical trial collaborative.

SETTING

Community and long-term care locations in Miami, Florida, Boston, Massachusetts, and the greater Baltimore, Maryland, and D.C. areas.

PARTICIPANTS

Paid staff from Miami Jewish and Benchmark who worked with patients with dementia during the first two years of the pandemic. Unpaid caregivers who lived within the catchment area of the study sites and provided care for community-based persons with dementia.

MEASUREMENTS

Measures included the Coronavirus Impact Scale, the Herth Hope Index, NPI-Q, the Modified Caregiver Strain Index, PHQ-8, items about workplace changes, caregiving relationship, and changes to caregiver support.

RESULTS

Paid staff were statistically more likely to have been exposed to, tested for, hospitalized, or seriously ill with COVID-19 and indicated moderate to severe impacts to medical and mental health services compared to unpaid caregivers. Unpaid caregivers exhibited significantly higher rates of depressive symptom severity and overall lower scores on the Herth Hope Scale compared to paid staff.

CONCLUSIONS

Our findings suggest that the pandemic had significant impacts on the mental health and general well-being of unpaid caregivers. While notable that paid staff suffered from increased exposure and decreased access to services, policies supporting both workforces should respond to the unique outcomes that each faced, post-pandemic.

A Literature Review on the Burden of Alzheimer's Disease on Care Partners

BACKGROUND

Many individuals with Alzheimer's disease (AD) are dependent on nonprofessional care partners. Providing informal care can result in emotional, physical, and financial burdens; however, there is a need for a better understanding of the impact of AD on care partners to support the clinical and economic assessment of potential new treatments.

OBJECTIVE

We conducted a literature review to evaluate the burden experienced by care partners of individuals with AD.

METHODS

Electronic screening and supplementary searches identified studies published from 2011 to 2022 describing the association between AD and the quality of life (QoL) and physical health of care partners, and the economic or financial burden of AD.

RESULTS

Following electronic screening, 62, 25, and 39 studies were included on care partner burden, cost, and healthcare resource use in AD, respectively. Supplementary searches identified an additional 32 studies, resulting in 149 unique studies. These studies showed that care partners of individuals with AD report moderate to severe burden. Higher burden and lower QoL were observed in those caring for individuals with more severe AD. Care partners of individuals with AD experience higher burden, lower QoL, and higher levels of stress, depression, and anxiety than those without caring responsibilities. Informal care costs increased with AD severity and accounted for the greatest proportion of overall societal cost.

CONCLUSIONS

Care partners of individuals with AD experience emotional and economic burden, which increases with AD severity. These impacts should be quantified comprehensively in future studies and captured in economic evaluations of AD interventions.

Psychological distress in sons as resident carers of older mothers in Japan

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.

The Unique Role of Hope and Optimism in the Relationship between Environmental Quality and Life Satisfaction during COVID-19 Pandemic

COVID-19 in Malaysia has significantly affected the higher education system of the country and increased the level of distress among university students. Empirical evidence proposed that environment quality is associated with university students’ life satisfaction during COVID-19. It was found that hope and optimism are linked with greater life satisfaction in general. Although past literature has reported the effects of hope and optimism on life satisfaction, there are limited studies examining the underlying mechanism among Malaysian private university students. Therefore, the current study offers the preliminary understanding of the intervening role of hope and optimism on the relationship between environmental quality and life satisfaction among private university students in Malaysia. A total of 133 private university students in Malaysia were recruited through homogenous convenience sampling. Partial least square structure equation modeling (SmartPLS) was used to analyze the mediation models. The results revealed that only hope mediated the relationship between environmental quality and life satisfaction, but not optimism. Hence, it is proposed that mental health providers should focus on providing hope-related interventions to university students in confronting COVID-19 challenges and ultimately improving life satisfaction.

Investigating the relationship between quality of life and hope in family caregivers of hemodialysis patients and related factors

Background

Family caregivers of hemodialysis patients are the first and most crucial source of care at home. They experience many problems in the care of hemodialysis patients, which can affect their quality of life and hope, affecting the quality of care provided to patients. This study aimed to determine the relationship between quality of life and hope in family caregivers of hemodialysis patients.

Methods

A cross-sectional (descriptive-analytical) study performed on 300 family caregivers in the east of Mazandaran province in Iran. Data were collected using the Family Caregiver Quality of Life (FQOL), SF8 and adult hope scale. Data analysis was performed in SPSS version 16, and a P-value of below 0.05 was considered statistically significant.

Results

The results showed that, there was a direct and significant relationship between hope and quality of life. However, the quality of life was significantly lower in suburban residents, the unemployed, spouses, people with lower education and income levels, caregivers who cannot leave their patients alone, those living with their patients in the same house, and those taking care of male patients, compared to other participants (P < 0.05). Suburban residents, the unemployed, people with an insufficient level of income, and those living with their patients in the same house had significantly lower hope, compared to other subjects.

Conclusion

Since an increase of hope and quality of life of caregivers can cause improved quality of patient care, it is recommended that hope-based educational programs and interventions be implemented for caregivers.

A qualitative exploration of how gender and relationship shape family caregivers' experiences across the Alzheimer's disease trajectory

Caregiving experiences are not static. They change across the disease trajectory and care continuum. However, it is not clear how caregiver gender or relationship type is related to evolving caregiver experiences over time. This qualitative study informed by constructivist grounded theory and framework analysis explored the experiences over time of men and women who were adult children and spousal caregivers to persons with Alzheimer's disease. Forty spousal (10 husbands and 10 wives) and adult children (10 sons and 10 daughters) caregivers to persons with Alzheimer's disease were interviewed using a semi-structured interview guide. Our findings suggest the experiences of caregiving, examined through a gender and relationship type lens, are complex and variable. The caregiving experience was not related to gender or relationship type alone, but often to a combination of the two. For instance, spousal caregivers did not immediately accept the diagnosis, with wives being more optimistic than husbands about a slow progression of the disease. Adult children caregivers were concerned about the ways the caregiving role would impact their personal and career obligations and sought ways to mitigate the changes to their daily lives. Sons and husband caregivers largely utilized home and community health services to assist with personal care tasks, whereas daughters and wives utilized the same services to allow them to complete other caregiving tasks (e.g., housekeeping). Recognition of the complex inter-relationships among gender and relationship type on caregiving experiences supports the need for family-centered interventions. This article also extends sex and gender research as it highlights that an in-depth understanding of the caregiving experience cannot be understood by gender alone and relationship type must also be considered.

Caregiver wellbeing during Covid-19: does being hopeful play a role?

Background Informal (unpaid) carers represent a core component of health and social care systems. However, their experiences, health impacts and care needs during Covid-19 have been largely overlooked. This study aimed to explore the health and wellbeing impacts of Covid-19 on carers and the contribution of hopefulness.

Methods Data were collected from an online survey hosted on the Qualtrics platform.

Results Three hundred and sixty-nine participants consented to the survey. Data are reported on 186 participants with an 80% or higher completion rate. Most participants (> 80%) reported poor sleep quality, while nearly half the sample met case threshold for anxiety (46.2%) and 29% for depression. Mood disturbance in carers was associated with higher levels of sleep disturbances. Positive wellbeing in carers was best predicted by having a more hopeful outlook and fewer symptoms of depression.

Limitations A cross-sectional survey-based design that is unable to offer no definitive conclusions about the direction of the results. The study was also limited by having carer participants as the only informants.

Conclusions Though informal carers are found in all areas of society, their experiences and health correlates during Covid-19 have not attracted much research attention. The additional and unique challenges of the pandemic for the health and wellbeing needs of carers must not be overlooked as is sadly so often the case. Instead, the experiences of carers and their needs should be prioritised, publicised, and matched by needs-led interventions. Identifying carers and enquiring about their wellbeing would be a laudable first step.

Family caregivers of rare disease: A survey on health-related quality of life in family caregivers for Gaucher disease patients in China

Background

Rare diseases affect the health‐related quality of life (HRQoL) of patients and their family caregivers (FCs). However, limited evidence is available on the HRQoL of FCs of patients with Gaucher disease (GD). This study aimed to assess HRQoL and related factors among FCs of patients with GD in China.

Methods

A cross‐sectional online survey was conducted with 49 FCs recruited by convenience sampling. Participants completed the Medical Outcome Study Short Form‐36 (SF‐36), Zung's Self‐Rating Anxiety Scale, Zung's Self‐Rating Depression Scale, the Multi‐dimensional Scale of Perceived Social Support, the Herth Hope Index, and a questionnaire about FCs’ and patients’ sociodemographic characteristics. Single‐sample t tests, one‐way analysis of variance, and multivariate linear regression analysis were used to analyze the data analysis.

Results

Participating FCs had significantly lower scores in all eight SF‐36 domains compared with the general population in China (p < 0.01). FCs’ gender, education, daily care time, anxiety, and the perceived disease severity of patients were significant predictors of SF‐36 physical component summary scores. Caregiving help from others, anxiety, perceived disease severity, and medical insurance type were significant predictors of SF‐36 mental component summary scores.

Conclusion

The findings showed FCs of patients with GD had lower HRQoL. There is an urgent need to address the health concerns of FCs of people with rare diseases including their HRQoL.

Does health-related quality of life in Asian informal caregivers differ between early-onset dementia and late-onset dementia?

AIM

Early-onset dementia (EOD) (defined as dementia onset before age 65) presents specific challenges and issues, adding to the negative impact of dementia on the health-related quality of life (HRQOL) of both patients and their caregivers. However, very few published studies have specifically compared the HRQOL of caregivers of people with EOD and late-onset dementia (LOD). This information is critical in allocating and prioritizing scarce health-care resources. We aimed to assess the HRQOL of primary informal caregivers of community-dwelling individuals with EOD in Singapore and compare it with that of caregivers of individuals with LOD.

METHODS

This was a cross-sectional study of consecutive patient-caregiver dyads from a tertiary dementia clinic.

RESULTS

No significant differences in disease severity were found between the 111 EOD and 235 LOD patient-caregiver dyads. The mean Mental Component Summary score of the 36-item Short-Form Health Survey version 2 was significantly worse in caregivers of EOD patients than in LOD caregivers (mean: 41.42 vs 45.12, P = 0.001), although the mean Physical Component Summary scores were comparable (49.71 vs 49.53, P = 0.934). However, the impact of dementia early onset on caregivers' mental health diminished immediately after adjustment for the disease severity indicators, of which the Neuropsychiatric Inventory Questionnaire distress score was the only significant clinical factor (regression coefficient β = -0.29, P < 0.001). The amount of variability in the HRQOL of the caregivers explained by patient and caregiver factors across all the models was rather small (adjusted R² = 19.3% for the Mental Composite Score, 5.2% for Physical Composite Score).

CONCLUSION

Caregivers of EOD patients had worse mental health than LOD caregivers probably because individual with EOD have more behavioural disturbances. This reinforces the indispensable role of managing behavioural problems when caring for a family member with dementia, especially for EOD. HRQOL ideally needs to be assessed based on self-report rather than inferences from indirect data such as the subjective caregiver burden.

Study protocol: pragmatic randomized control trial of my tools 4 care- in care (MT4C-in care) a web-based tool for family Carers of persons with dementia residing in long term care

Background

When a family member resides in long term care facility (LTC), family carers continue caregiving and have been found to have decreases in mental health. The aim of My Tools 4 Care – In Care (an online intervention) is to support carers of persons living with dementia residing in LTC through transitions and increase their self-efficacy, hope, social support and mental health. This article comprises the protocol for a study to evaluate My Tools 4 Care-In Care (MT4C-In Care) by asking the following research questions:

Is there a 2 month (immediately post-intervention) and 4 month (2 months post-intervention) increase in mental health, general self-efficacy, social support and hope, and decrease in grief and loneliness, in carers of a person living with dementia residing in LTC using MT4C-In CARE compared to an educational control group?

Do carers of persons living with dementia residing in LTC perceive My Tools 4 Care- In Care helps them with the transitions they experience?

Methods

This study is a single blinded pragmatic mixed methods randomized controlled trial. Approximately 280 family carers of older persons (65 years of age and older) with dementia residing in LTC will be recruited for this study. Data will be collected at three time points: baseline, 2 month, and 4 months. Based on the feasibility study, we hypothesize that participants using MT4C-In Care will report significant increases in hope, general self-efficacy, social support and mental health quality of life, and significant decreases in grief and loneliness from baseline, as compared to an educational control group. To determine differences between groups and over time, generalized estimating equations analysis will be used. Qualitative descriptive analysis will be used to further evaluate MT4C-In Care and if it supports carers through transitions.

Discussion

Data collection will begin in four Canadian provinces (Alberta, Manitoba, Ontario and Saskatchewan) in February 2020 and is expected to be completed in June 2021. The results will inform policy and practice as MT4C-In Care can be revised for local contexts and posted on websites such as those hosted by the Alzheimer Society of Canada.

Trial registration

NCT04226872 ClinicalTrials.gov Registered 09 January 2020

Protocol Version #2 Feb 19, 2020.

Using focus groups to explore caregiver transitions and needs after placement of family members living with dementia in 24-hour care homes

Objectives: Family caregivers (defined broadly as family and friends) of persons with dementia are challenged to cope with myriad stressors and changes that occur along the dementia trajectory. The purpose of this study was to explore the transitions experienced by caregivers of persons with dementia after their relative relocated to a 24-hour care home.Method: Qualitative thematic and conversational analysis were used: themes were co-created and modes of speech and syntactical patterns analysed to expose discourses related to caregiving after placement in 24-hour care homes.Results: Four main themes were co-constructed from the data analysis: living with loss, relinquishing, redefining the caregiving role, and rediscovering and recreating a new self.Discussion: Caregiving continues after placement of family members with dementia in 24-hour care homes. Caregivers are at-risk group and require ongoing support throughout the caregiving journey. Study participants reported that navigation skills such as relationship building, communication, and advocacy were particularly salient to the post-placement period, when navigating the complex health care environment was a significant obstacle. Ultimately, findings from these focus groups will be used to inform an online intervention to support caregivers of a family member with dementia residing in a 24-hour care home.

Transition Experiences of Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: An Interpretive Description Study

INTRODUCTION

Family caregivers provide most of the care for older persons living with dementia (PLWD) and multiple chronic conditions (MCCs) in the community. Caregivers experience transitions, such as changes to their health, roles, and responsibilities, during the process of caring. Transitions encompass a time when caregivers undergo stressful responses to change. However, we know little about the transition experiences of caregivers of persons living with both dementia and MCCs.

OBJECTIVE

This qualitative study explored the transition experiences of caregivers of PLWD within the context of MCCs, from the perspective of both caregivers and practitioners. The research question was the following: What are the transition experiences of family caregivers in providing care to older PLWD and MCCs living in the community?

METHODS

This study was conducted using an interpretive description approach. Semistructured interviews were conducted with 19 caregivers of older community-dwelling PLWD and MCCs and 7 health-care providers working with caregivers in Ontario, Canada. Concurrent data collection and inductive data analysis were used.

RESULTS

Caregivers of older PLWD and MCCs experienced four key transitions: (a) taking on responsibility for managing multiple complex conditions, (b) my health is getting worse, (c) caregiving now defines my social life, and (d) expecting that things will change. Findings highlight how the coexistence of MCCs with dementia complicates caregiver transitions and the importance of social networks for facilitating transitions.

CONCLUSION

The study provided insight on the transition experiences of caregivers of older PLWD and MCCs. MCCs increased the care load and further complicated caregivers' transition experiences. Health-care providers, such as nurses, can play important roles in supporting caregivers during these transitions and engage them as partners in care.

Hope predicted quality of life in dyads of community-dwelling patients receiving hemodialysis and their family caregivers

PURPOSE

End-stage renal disease (ESRD) patients on hemodialysis (HD) and their family caregivers (FCGs) reported poor quality of life (QoL). Hope has shown association with QoL at the individual level. However, the association between hope and QoL in dyads has never been examined in particular in dyads of patients and FCGs. The purpose of this study was to examine the associations between hope and QoL in dyads of ESRD patients on HD and their family caregivers (FCGs).

METHODS

This was a cross-sectional study in which data were collected from 123 community-dwelling patient-FCG dyads. Hope was measured using the Herth Hope Index and QoL was measured using the World Health Organization Quality of Life BREF. The Actor-Partner Interdependence Model multilevel modeling dyadic analysis approach was used to analyze the data.

RESULTS

Each individual's hope scores predicted their own better QoL scores. Patients' hope scores predicted better Environmental domain QoL in FCGs.

CONCLUSION

All domains of QoL of patients and their FCGs are related to their own level of hope. Better FCGs' environment domain of QoL was linked to high patients' levels of hope. Improving QoL may be achieved by targeting and improving hope in both members of the dyad.

Lost for words: Perspectives and experiences of people with primary progressive aphasia and Alzheimer's disease and their families of participation in a lexical retrieval intervention

Purpose: Previous qualitative research involving family members' experiences of living with a person with dementia has consistently revealed themes of reduced connectedness and reciprocity of communication, highlighting the importance of education, support and practical strategies to facilitate communication within families. This study aimed to evaluate the perspectives and experiences of both family members and people with dementia following participation in a targeted speech-language pathology intervention involving people with primary progressive aphasia (PPA) and Alzheimer's disease (AD) and their family members. Method: Semi-structured interviews of eight people with dementia (six PPA, two AD) and 10 family members were conducted following an intervention to increase lexical retrieval within functional contexts. Thematic analysis was used to analyse the interview transcripts. Result: Two themes common to participants with dementia and family members emerged: (1) perceived benefits of the intervention and (2) lack of previous information on communication difficulties. Two separate themes emerged for people with dementia, predominantly people with PPA, involving: (1) improved communication and (2) increased participation. Three separate themes emerged for family members: (1) increased awareness and knowledge, (2) increased value of interaction and engagement and (3) uncertainty of the future. Conclusion: The findings of this qualitative study revealed a range of perspectives on the experiences of client and family participants following a communication focussed intervention, examining both the nature of perceived direct gains and gaining insight into the issues faced by these client populations and their families. The provision of individualised information and education should be a fundamental human right for all people with communication impairment with greater attention given to people with progressive conditions where such needs are not currently met.

Quality of life in family caregivers of patients in the intensive care unit: A longitudinal study

BACKGROUND

Family caregivers of patients in the intensive care unit (ICU) experience impairments in the quality of life. Previous studies report that psychological quality of life improves over time, but there has been limited longitudinal research, and measurement points have differed. Factors such as age, gender, and posttraumatic stress symptoms have been found to be associated with the quality of life, but level of hope and its associations with the quality of life have not been investigated.

OBJECTIVES

The objective of this study was (1) to evaluate changes in the quality of life in family caregivers during the first year after a patient's admission to the ICU and (2) to identify associations between patients' and family caregivers' background characteristics, posttraumatic stress symptoms, hope, and quality of life.

METHODS

A longitudinal study design with five measurement points was used. Family caregivers completed study questionnaires at enrolment into the study and at 1, 3, 6, and 12 months after the patient's admission to the ICU. The quality of life was measured with the 12-Item Short Form Health Survey.

RESULTS

Family caregivers (N = 211) reported improved psychological quality of life during the first year after the patient's admission to the ICU, but it was still lower than the psychological quality of life reported in norm-based data. Being on sick leave, consulting healthcare professionals (e.g., general practitioner), and increased level of posttraumatic stress symptoms were significantly associated with psychological quality of life, whereas hope was not. Reported physical quality of life was comparable to norm-based data.

CONCLUSION

Family caregivers of patients in the ICU reported impairments in quality of life during the first year after the patient's admission to the ICU. Being on sick leave, consulting healthcare professionals, and reduced posttraumatic stress symptoms may improve mental quality of life.

Mixed-methods single-arm repeated measures study evaluating the feasibility of a web-based intervention to support family carers of persons with dementia in long-term care facilities

BACKGROUND

Following institutionalization of a relative with Alzheimer disease and related dementias (ADRD), family carers continue to provide care. They must learn to negotiate with staff and navigate the system all of which can affect their mental health. A web-based intervention, My Tools 4 Care-In Care (MT4C-In Care) was developed by the research team to aid carers through the transitions experienced when their relative/friend with ADRD resides in a long-term care (LTC) facility. The purpose of this study was to evaluate MT4C-In Care for feasibility, acceptability, ease of use, and satisfaction, along with its potential to help decrease carer's feelings of grief and improve their hope, general self-efficacy, and health-related quality of life.

METHODS

The study was a mixed-methods single-arm repeated measures feasibility study. Participants accessed MT4C-In Care over a 2-month period. Data were collected at baseline and 1 and 2 months. Using a checklist, participants evaluated MT4C-In Care for ease of use, feasibility, acceptability, and satisfaction. Measures were also used to assess the effectiveness of the MT4C-In Care in improving hope (Herth Hope Index), general self-efficacy (GSES), loss and grief (NDRGEI), and health-related quality of life (SF12v2) of participants. Qualitative data were collected at 2 months and informed quantitative findings.

RESULTS

The majority of the 37 participants were female (65%; 24/37), married (73%; 27/37), and had a mean age of 63.24 years (SD = 11.68). Participants reported that MT4C-In Care was easy to use, feasible, and acceptable. Repeated measures ANOVA identified a statistically significant increase over time in participants hope scores (p = 0.03) and a significant decrease in grief (< 0.001). Although significant differences in mental health were not detected, hope (r = 0.43, p = 0.03) and grief (r = - 0.66, p < 0.001) were significantly related to mental health quality of life.

CONCLUSION

MT4C-In Care is feasible, acceptable, and easy to use and shows promise to help carers of family members with ADRD residing in LTC increase their hope and decrease their grief. This study provides the foundation for a future pragmatic trial to determine the efficacy of MT4C-In Care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03571165. June 30, 2018 (retrospectively registered).

Web-Based Intervention for Family Carers of Persons with Dementia and Multiple Chronic Conditions (My Tools 4 Care): Pragmatic Randomized Controlled Trial

Background

My Tools 4 Care (MT4C) is a Web-based intervention that was developed based on the transitions theory. It is an interactive, self-administered, and portable toolkit containing six main sections intended to support carers of community-living persons with Alzheimer’s disease and related dementia and multiple chronic conditions through their transition experiences.

Objective

The objective of our study was to evaluate the effectiveness of MT4C with respect to increasing hope, self-efficacy, and health-related quality of life in carers of community-living older persons with Alzheimer’s disease and related dementia and multiple chronic conditions.

Methods

A multisite, pragmatic, mixed methods, longitudinal, repeated-measures, randomized controlled trial was conducted between June 2015 and April 2017. Eligible participants were randomized into either treatment (MT4C) or educational control groups. Following baseline measures, carers in the treatment group received 3 months of password-protected access to MT4C. Trained research assistants collected data from participants via phone on hope (Herth Hope Index [HHI]), self-efficacy (General Self-Efficacy Scale), and health-related quality of life (Short Form-12 item [version 2] health survey; SF-12v2) at baseline, 1, 3, and 6 months. The use and cost of health and social services (Health and Social Services Utilization Inventory) among participants were measured at baseline, 3, and 6 months. Analysis of covariance was used to identify group differences at 3 months, and generalized estimating equations were used to identify group differences over time.

Results

A total of 199 carers participated in this study, with 101 participants in the treatment group and 98 in the educational control group. Of all, 23% (45/199) participants withdrew during the study for various reasons, including institutionalization or death of the person with dementia and lack of time from the carer. In the treatment group, 73% (74/101) carers used MT4C at least once over the 3-month period. No significant differences in the primary outcome measure (mental component summary score from the SF-12v2) by group or time were noted at 3 months; however, significant differences were evident for HHI-factor 2 (P=.01), with higher hope scores in the treatment group than in the control group. General estimating equations showed no statistically significant group differences in terms of mental component summary score at all time points. Attrition and the fact that not all carers in the treatment group used MT4C may explain the absence of statistically significant results for the main outcome variable.

Conclusions

Despite no significant differences between groups in terms of the primary outcome variable (mental component score), the significant differences in terms of one of the hope factors suggest that MT4C had a positive influence on the lives of participants.

Trial Registration

ClinicalTrials.gov NCT02428387; https://clinicaltrials.gov/ct2/show/NCT02428387 (Archived by Webcite at http://www.webcitation.org/708oFCR8h).

A Web-Based Intervention to Help Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: Qualitative Study

BACKGROUND

Caregivers (ie, family members and friends) play a vital role in the ongoing care and well-being of community-living older persons with Alzheimer disease and related dementia in combination with multiple chronic conditions. However, they often do so to the detriment of their own physical, mental, and emotional health. Caregivers often experience multiple challenges in their caregiving roles and responsibilities. Recent evidence suggests that Web-based interventions have the potential to support caregivers by decreasing caregiver stress and burden. However, we know little about how Web-based supports help caregivers.

OBJECTIVE

The objectives of this paper were to describe (1) how the use of a self-administered, psychosocial, supportive, Web-based Transition Toolkit, My Tools 4 Care (MT4C), designed by atmist, Edmonton, Alberta, Canada, helped caregivers of older adults with Alzheimer disease and related dementia and multiple chronic conditions; (2) which features of MT4C caregivers found most and least beneficial; and (3) what changes would they would recommend making to MT4C.

METHODS

This study was part of a larger multisite mixed-methods pragmatic randomized controlled trial. The qualitative portion of the study and the focus of this paper used a qualitative descriptive design. Data collectors conducted semistructured, open-ended, telephone interviews with study participants who were randomly allocated to use MT4C for 3 months. All interviews were audio-taped and ranged from 20 to 40 min. Interviews were conducted at 1 and 3 months following a baseline interview. Qualitative content analysis was used to analyze collected data.

RESULTS

Fifty-six caregivers from Alberta and Ontario, Canada, participated in either one or both of the follow-up interviews (89 interviews in total). Caregivers explained that using MT4C (1) encouraged reflection; (2) encouraged sharing of caregiving experiences; (3) provided a source of information and education; (4) provided affirmation; and for some participants (5) did not help. Caregivers also described features of MT4C that they found most and least beneficial and changes they would recommend making to MT4C.

CONCLUSIONS

Study results indicate that a self-administered psychosocial supportive Web-based resource helps caregivers of community-dwelling older adults with Alzheimer disease and related dementia and multiple chronic conditions with their complex caregiving roles and responsibilities. The use of MT4C also helped caregivers in identifying supports for caring, caring for self, and planning for future caregiving roles and responsibilities. Caregivers shared important recommendations for future development of Web-based supports.

Study protocol: pragmatic randomized control trial of an internet-based intervention (My tools 4 care) for family carers

Background

Family carers of older persons with Alzheimer’s’ disease and related dementia (ADRD) and multiple chronic conditions (MCC) experience significant, complex, and distressing transitions such as changes to their environment, roles and relationships, physical health, and mental health. An online intervention (My Tools 4 Care) was developed for family carers of persons with ADRD and MCC living at home, with the aim of supporting these carers through transitions and increasing their self-efficacy, hope, and health related quality of life (HRQoL). This study will evaluate My Tools 4 Care (MT4C) by asking the following research questions:

Does use of MT4C result in a 3 month (immediately post intervention) and 6-month (3 months after intervention) increase in HRQoL, self-efficacy, and hope, in carers of persons with ADRD and MCC compared to an educational control group?

Does use of MT4C help carers of community-dwelling older adults with ADRD and MCC deal with significant changes they experience as carers? and

Are the effects/benefits of the MT4C intervention achieved at no additional cost compared to an educational control group?

Methods/Design

Using a pragmatic mixed methods randomized controlled trial design, 180 family carers of community dwelling older persons (65 years of age and older) with ADRD and MCC will participate in the study. Data will be collected from the intervention and an educational control group at four time points: baseline, 1 month, 3 and 6 months. We expect to find that family carers using MT4C will show greater improvement in hope, self-efficacy and HRQoL, at no additional cost from a societal perspective, compared to those in the educational control group. General estimating equations will be used to determine differences between groups and over time.

Discussion

Data collection began in Ontario and Alberta Canada in June 2015 and is expected to be completed in June 2017. The results will inform policy and practice as MT4C can be easily revised for local contexts and is scalable in terms of posting on websites such as those hosted by the Alzheimer Society.

Trial registration

ClinicalTrials.gov Identifier: NCT02428387

Hope and spirituality among patients with chronic kidney disease undergoing hemodialysis: a correlational study

Objective

to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis.

Method

this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through individual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS).

Results

the average HHI score was 38.06 (±4.32) while the average PP-RSS score was 3.67 (±0.62) for "beliefs" and 3.21 (±0.53) for "hope/optimism". Spearman's coefficient indicated there was a moderate positive correlation between the HHI and PP-RSS dimensions of "beliefs" (r=0.430; p<0.001) and "hope/optimism" (r=0.376; p<0.001).

Conclusion

Since a relationship between the sense of hope and spirituality of patients with chronic kidney disease was found, these constructs should be taken into account at the time health professionals deliver care to help patients coping with the disease and treatment.

The family's experience and perception of phases and roles in the progression of dementia: An explorative, interview-based study

This paper examines how the relatives of a person with dementia experience challenges in everyday life. A model of phases is developed on the basis of interviews with 14 relatives from eight families. Data were subjected to a thematic content analysis, which found that the progression of dementia - from the perspective of the family - had three phases. These phases involved small changes in everyday life, adaptations to everyday life, and the loss of everyday life. The analysis further identified the following two archetypes of relatives that develop throughout the progression of dementia: the protective relative and the decisive relative. The study found that the two types of relatives experience different challenges during the three phases. It is important for health professionals to be familiar with these changes, when they evaluate whether the relatives of a person with dementia require help.

'All I can do is help': Transition experiences of male spouse caregivers of women with breast cancer

The transition experience of male spouses of women with breast cancer is largely unknown. Ninety-one open-ended surveys of male spouses were analyzed using thematic analysis to understand the transition experience of this population when their partners were diagnosed and treated for breast cancer. While 10 participants indicated they experienced no changes, the majority experienced changes to their roles and relationships, their mental health, and their share of household work. Spouses took on a supportive role. They adjusted to the changes they faced by proactively becoming aware of their situation, fostering a positive approach, and being actively involved in their partners' experiences. Implications for nurses entail recognizing the role of the spouse, as well as facilitating access to reliable information and support networks.

"It Just Consumes Your Life": Quality of Life for Informal Caregivers of Diverse Older Adults With Late-Life Disability

Little is known about the quality of life (QoL) for informal caregivers of disabled older adults aged 65+ with diverse backgrounds. Forty-two caregivers were interviewed in English and Cantonese about their caregiving experiences, their recollections of QoL over time, and the factors influencing their appraisals. Overall, 52% of caregivers experienced a decline in QoL. Factors associated with decreased QoL were less time for self, competing financial demands, and the physical and emotional impact of the patient's illness. Factors associated with no change in QoL were minimal caregiving responsibilities, a sense of filial duty, and QoL being consistently poor over time. Factors associated with improved QoL were perceived rewards in caregiving, receiving institutional help, and increased experience. Chinese caregivers were more likely to cite filial duty as their motivator for continued caregiving than were Caucasian caregivers. In conclusion, informal caregivers take on a huge burden in enabling older adults to age in the community. These caregivers need more support in maintaining their QoL.

Factors influencing changes in health related quality of life of caregivers of persons with multiple chronic conditions

Background

The majority of care for older adults with multiple chronic conditions (MCC) is provided by family (including friends) caregivers. Although caregivers have reported positive benefits to caregiving they also experience decreases in their physical and mental health. As there is a critical need for supportive interventions for this population, it is important to know what influences the health of family caregivers of persons with MCC. This research examined relationships among the changes from baseline to 6 months in health related quality of life (SF12v2) of family caregivers caring for older adults with multiple chronic conditions and the following factors: a) demographic variables, b) gender identity [Bem Sex Role Inventory (BSRI)] c) changes in general self-efficacy [General Self Efficacy Scale (GSES) (baseline to 6 months) and d)) changes in caregiver burden [Zarit Burden Inventory (ZBI)] baseline to 6 months. Specific hypothesis were based on a conceptual framework generated from a literature review.

Methods

This is a secondary analysis of a study of 194 family caregivers who were recruited from two Canadian provinces Alberta and Ontario. Data were collected in-person, by telephone, by Skype or by mail at two time periods spaced 6 months apart. The sample size for this secondary analysis was n = 185, as 9 participants had dropped out of the study at 6 months. Changes in the scores between the two time periods were calculated for SF12v2 physical component score (PCS) and mental component score (MCS) and the other main variables. Generalized Linear Modeling was then used to determine factors associated with changes in HRQL.

Results

Participants who had significantly positive increases in their MCS (baseline to 6 months) reported lower burden (ZBI, p < 0.001), and higher general self-efficacy (GSES, p < 0.001) and Masculine BSRI (p = 0.025). There were no significant associations among variables and changes in PCS (baseline to 6 months).

Conclusions

Our findings suggest that a masculine gender identity (which incorporates assertive and instrumental approaches to caregiving), and confidence in the ability to deal with difficult situations was positively related to improvement in mental health for caregivers of persons with MCC. Decreases in perceptions of burden in this populations was also associated with improvements in mental health. Further research is needed to explore ways to support caregivers of older persons with multiple chronic conditions living at home.

Living well with dementia: enhancing dignity and quality of life, using a novel intervention, Dignity Therapy

AIMS AND OBJECTIVES

To assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to improve the quality of life and reduce psychological and spiritual distress in older people with early stage dementia.

BACKGROUND

Dementia is a syndrome with several causes that leads to a progressive decline in multiple areas of functioning. The maintenance of dignity and enhancement of quality of life are key elements of care. Meaningful communication may become more difficult with condition progression. Improvements in communication may have positive effects on the person's quality of life. Dignity Therapy is a short psychotherapeutic intervention that uses a trained therapist to take the person with dementia through a guided interview process, producing a 'generativity' document that creates a lasting, written legacy during a time when they are still able to communicate well.

DESIGN AND METHOD

This was a feasibility mixed method study. Dignity Therapy was undertaken with patients diagnosed as having early stage dementia. Data were gathe-red from pre- and post-Dignity Therapy interviews, a focus group, interviews with key stakeholders, and three outcome measures: The Herth Hope Index; The Patient Dignity Inventory; Perceived Quality of Life/Satisfaction with Quality Life Ratings.

FINDINGS

This study demonstrated that Dignity Therapy is feasible, acceptable and potentially effective for older people with dementia. Three overarching themes emerged: A life in context, A key to connect and Personal legacy.

CONCLUSIONS

We recommend that this feasibility study forms the basis for further study, advocating the prospective benefits to patients with dementia, families and nursing practice.

IMPLICATIONS FOR PRACTICE

Dignity Therapy, as a psychosocial intervention, has the potential to improve the quality of life and enhance person centred care for people with dementia.

Transition from the spouse dementia caregiver role: A change for the better?

One in 15 Australians over 65 experience dementia, and are commonly supported by spouses. Evidence demonstrates declining wellbeing for these caregivers as their role continues. There are indications of improvement once caregivers transition out of the role (recovery) but alternate suggestions that caregiving stress may be too damaging to be appeased (wear and tear). It seems plausible that reason for transition (care recipient's move into residential care or death) will affect caregivers' outcomes. A synthetic cohort method compared caregivers' stress and wellbeing prior to, and one and two years post-transition. There was evidence of wear and tear for physical wellbeing but recovery for psychological wellbeing over time; with little difference based on reason for transition. Caregiver outcomes seem to be a function of the action rather than the reason for transition, but factors such as age must be considered when designing methods to support post-transition wellbeing.

Fatigue management in patients with IBD: a randomised controlled trial

OBJECTIVE

To assess the effectiveness of solution-focused therapy (SFT) on fatigue and quality of life (QoL) in patients with fatigued inflammatory bowel disease (IBD).

DESIGN

Randomised controlled trial in two Dutch hospitals. Patients with IBD with quiescent IBD and with a Checklist Individual Strength--Fatigue (CIS--fatigue) score of ≥ 35 were enrolled. Patients were 1:1 randomised to receive SFT or care as usual (CAU) for 3 months. Patients were followed for a further 6 months after the SFT. Primary endpoint was defined as changes in fatigue and QoL during follow-up. Secondary endpoints included change in anxiety and depression, medication use, side effects to medication, disease activity, laboratory parameters (C-reactive protein, leucocytes and haemoglobin) and sleep quality.

RESULTS

Ninety-eight patients were included, of whom 63% were women, mean age was 40.1 years. After the SFT course, 17 (39%) patients in the SFT group had a CIS-fatigue score below 35 compared with eight (18%) of patients in the CAU group (p=0.03). The SFT group also showed a greater reduction in fatigue across the first 6 months compared with the CAU group (CIS-fatigue: p=<0.001 and CIS-total: p=0.001). SFT was associated with a significant higher mean IBD questionnaire change at 3 months (p=0.020). At 9 months, no significant differences between the two groups were observed.

CONCLUSIONS

SFT has a significant beneficial effect on the severity of fatigue and QoL in patients with quiescent IBD. However, this effect diminished during follow-up.

Factors associated with quality of life among family members of patients with dementia in Cyprus

BACKGROUND

Numerous studies have reported that caring for a person with dementia is a stressful experience. Nevertheless, quality of life (QoL) measures have commonly focused on patients, while factors that influence caregivers' QoL have not been clearly identified. In order to contribute to the understanding of caregivers' QoL, we explored how QoL among caregivers is related to their perceived level of burden, their reported number of depressive symptoms, and the level of care recipients' dependency.

METHODS

Seventy-six caregivers referred by the two main referral centers of patients with dementia in Cyprus participated in a cross-sectional survey with a descriptive correlational design. Caregivers completed four instruments, measuring burden (ZBI), depression (CES-D), quality of life-Alzheimer's disease (QoL-AD), and activities of daily living (ADL) of the care recipients and provided socio-demographic information.

RESULTS

The majority of the participants scored high levels of burden (M = 43.32/SD = 15.23) and depression (59.2% scored over the cut-off point of 16). QoL was only moderate (M = 30.89/SD = 8.21) and negatively correlated with burden (r = -32, p = 0.01) and depression (r = -0.296, p < 0.05). Only a weak correlation was observed between QoL and ADL (r = 0.167, p = 0.15). Hierarchical multiple regression analyses revealed that overall burden scores and income were associated with QoL, explaining 20% of the overall variance of the caregiver's QoL.

CONCLUSION

Further research is necessary to investigate which additional domains determine QoL and further our understanding of the factors that may reduce the burden imposed on dementia caregivers.

Hope against hope: exploring the hopes and challenges of rural female caregivers of persons with advanced cancer

BACKGROUND

This paper focuses on the qualitative component of a study evaluating a hope intervention, entitled Living with Hope Program (LWHP), designed to foster hope in female caregivers of family members living with advanced cancer. The purpose of this research is to share, in the form of a story, the experiences of rural female caregivers caring for family members with advanced cancer, focusing on what fosters their hope. Hope is a psychosocial and spiritual resource that has been found to help family caregivers live through difficult transitions and challenges.

METHODS

Twenty-three participants from rural Western Canada completed daily journal entries documenting their hopes and challenges. Cortazzi's (2001) method of narrative analysis was used to analyze the data, which was then transcribed into a narrative entitled 'hope against hope.'

RESULTS

The journal entries highlighted: the caregivers' hopes and what fostered their hope; the various challenges of caregiving; self-care strategies, and; their emotional journey. Hope was integrated throughout their entire experience, and 'hope against hope' describes how hope persists even when there is no hope for a cure.

CONCLUSIONS

This research contributes to the assessment of caregiver interventions that impact hope and quality of life, while illustrating the value of a narrative approach to both research and practice. Journaling may be particularly valuable for rural caregivers who are isolated, and may lack direct professional and peer support. There is an opportunity for health professionals and other providers to foster a relationship of trust with family caregivers, in which their story can be told openly and where practitioners pay closer attention to the psychosocial needs of caregivers.

Evaluation of the living with hope program for rural women caregivers of persons with advanced cancer

BACKGROUND

Hope has been identified as a key psychosocial resource among family caregivers to manage and deal with the caregiver experience. The Living with Hope Program is a self-administered intervention that consists of watching an international award winning Living with Hope film and participating in a two week hope activity ("Stories of the Present"). The purpose of this study was to examine the effects of the Living with Hope Program on self-efficacy [General Self-Efficacy Scale], loss and grief [Non-Death Revised Grief Experience Inventory], hope [Herth Hope Index] and quality of life [Short-Form 12 version 2 (SF-12v2)] in rural women caring for persons with advanced cancer and to model potential mechanisms through which changes occurred.

METHODS

A time-series embedded mixed method design was used, with quantitative baseline outcome measures repeated at day 7, day 14, and 3, 6 and 12 months. Qualitative data from the hope activity informed the quantitative data. Thirty-six participants agreed to participate with 22 completing all data collection. General estimating equations were used to analyze the data.

RESULTS

Herth Hope Index scores (p=0.05) had increased significantly from baseline at day 7. General Self Efficacy Scale scores were significantly higher than baseline at all data time points. To determine the mechanisms of the Living with Hope Program through which changes occurred, results of the data analysis suggested that as General Self Efficacy Scale scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01) Herth Hope Index scores increased. In addition as Herth Hope Index scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01), SF-12v2 mental health summary scores increased. Qualitative data suggested that through the hope activity (Stories of the Present) the participants were able to find positives and hope in their experience.

CONCLUSIONS

The Living with Hope Program has potential to increase hope and improve quality of life for rural women caregivers of persons with advanced cancer. The possible mechanisms by which changes in hope and quality of life occur are by decreasing loss and grief and increasing self-efficacy.

TRIAL REGISTRATIONS

Registration ClinicalTrials.gov, NCT01081301.

Combined qualitative and quantitative research designs

PURPOSE OF REVIEW

Mixed methods research designs have been recognized as important in addressing complexity and are recommended particularly in the development and evaluation of complex interventions. This article reports a review of studies in palliative care published between 2010 and March 2012 that combine qualitative and quantitative approaches.

RECENT FINDINGS

A synthesis of approaches to mixed methods research taken in 28 examples of published research studies of relevance to palliative and supportive care is provided, using a typology based on a classic categorization put forward in 1992.

SUMMARY

Mixed-method studies are becoming more frequently employed in palliative care research and resonate with the complexity of the palliative care endeavour. Undertaking mixed methods research requires a sophisticated understanding of the research process and recognition of some of the underlying complexities encountered when working with different traditions and perspectives on issues of: sampling, validity, reliability and rigour, different sources of data and different data collection and analysis techniques.