Subjective burden among spousal and adult-child informal caregivers of older adults: results from a longitudinal cohort study

Financial train, health behaviors, and psychological well-being of family caregivers of older adults during the COVID-19 pandemic

Objectives

This study aims to examine the change in financial strain, health behaviors, and psychological well-being of family caregivers of older adults during the COVID-19 pandemic and explore the differences in mental health outcomes by gender, race, and relationship status.

Methods

Using the 2020 National Health and Aging Trends Study COVID-19 supplement, our sample included 2026 family caregivers of older adults. Structural equation modeling was conducted.

Results

Caregivers with financial strain showed worse mental health than those with no financial strain. Female or adult children caregivers reported significantly less time walking, more financial strain, and a higher level of negative mental health outcomes compared to male or spouse caregivers; non-White caregivers reported greater positive mental health outcomes compared to White caregivers during the pandemic.

Discussion

Health professionals should consider the financial and mental health impact of COVID-19 among family caregivers when designing and delivering caregiver support programs.

Innovation

This study provides nationally representative estimates of several important health behaviors and health outcomes for caregivers of older adults during and after the COVID-19 pandemic, helping to fill the knowledge gap about the characteristics of caregivers whose health and well-being were most affected by the pandemic.

Place-based, intersectional variation in caregiving patterns and health outcomes among informal caregivers in the United States

Introduction

Informal caregiving is a critical component of the healthcare system despite numerous impacts on informal caregivers' health and well-being. Racial and gender disparities in caregiving duties and health outcomes are well documented. Place-based factors, such as neighborhood conditions and rural-urban status, are increasingly being recognized as promoting and moderating health disparities. However, the potential for place-based factors to interact with racial and gender disparities as they relate to caregiving attributes jointly and differentially is not well established. Therefore, the primary objective of this study was to jointly assess the variability in caregiver health and aspects of the caregiving experience by race/ethnicity, sex, and rural-urban status.

Methods

The study is a secondary analysis of data from the 2021 and 2022 Behavioral Risk Factor Surveillance System (BRFSS) from the Centers for Disease Control and Prevention. Multivariable logistic regression or Poisson regression models assessed differences in caregiver attributes and health measures by demographic group categorized by race/ethnicity, sex, and rural-urban status.

Results

Respondents from rural counties were significantly more likely to report poor or fair health (23.2% vs. 18.5%), have obesity (41.5% vs. 37.1%), and have a higher average number of comorbidities than urban caregivers. Overall, rural Black male caregivers were 43% more likely to report poor or fair health than White male caregivers (OR 1.43, 95% CI 1.21, 1.69). Urban female caregivers across all racial groups had a significantly higher likelihood of providing care to someone with Alzheimer's disease than rural White males (p < 0.001). Additionally, there were nuanced patterns of caregiving attributes across race/ethnicity*sex*rural-urban status subgroups, particularly concerning caregiving intensity and length of caregiving.

Discussion

Study findings emphasize the need to develop and implement tailored approaches to mitigate caregiver burden and address the nuanced needs of a diverse population of caregivers.

Depressive Symptoms Among Caregivers of Older Adults With Both Diabetes and Functional Limitations and Moderation by Caregiver Expressive Social Support

PURPOSE

The purpose of the study was to explore how caring for older adults with both diabetes and functional limitations impacts caregiver depressive symptoms and whether this impact is moderated by caregivers' expressive social support and psychological resilience.

METHOD

Cross-sectional data of 278 dyads, each comprising an older adult with functional limitations and his/her primary family caregiver were analyzed. Older adult diabetes status (yes/no) was based on ever-diagnosis of diabetes. Caregiver depressive symptoms, expressive social support, and psychological resilience were measured using standard scales. Multivariable linear regression was used to assess the association of interest and its moderation by caregiver expressive social support and psychological resilience.

RESULTS

Caregivers of older adults with both diabetes and functional limitations had a higher depressive symptoms score compared to caregivers of older adults with only functional limitations. This association was inversely moderated by caregiver expressive social support. As caregiver expressive social support increased, the difference in depressive symptoms between caregivers of older adults with diabetes and functional limitations and caregivers of older adults with only functional limitations reduced.

CONCLUSION

Family caregivers of older adults with functional limitations and diabetes have a higher depressive symptoms score. However, enhancing caregiver expressive social support could mitigate this risk. Service providers should prioritize support for caregivers in such vulnerable situations and strive to enhance their expressive social support.

Impact of caregiving on mental, self-rated, and physical health: evidence from the China health and retirement longitudinal study

OBJECTIVES

Given the escalating demand for care services, understanding the impact of informal caregiving, providing unpaid care for family members, on own health is essential. This study longitudinally analyzed the association of caregiving (and different caregiver types) with mental, physical, and self-rated health. Urban-rural, gender, and employment heterogeneity were further investigated.

METHOD

Based on three-wave data (2011, 2013, and 2018) from the China Health and Retirement Longitudinal Study, we used growth curve models to assess the impact of informal caregiving (providing care to family members) and caregiver types (caregivers to grandchildren, parents, spouses, or multiple family members) on three health outcomes (depressive symptoms, self-rated health, and activities of daily living limitations).

RESULTS

Our study included 13,377 individuals. Results showed a negative correlation of caregiving with mental, physical, and self-rated health. Compared to noncaregivers, spousal caregivers and multiple caregivers were both associated with worsening mental, self-rated, and physical health. In contrast, adult child caregivers were only negatively associated with mental health, and grandparent caregiving did not significantly affect any health outcomes. Further heterogeneity analysis showed that gender did not moderate the relationship between caregiving and health, whereas the negative association between caregiving and health was more pronounced among the rural population and those employed in agriculture.

DISCUSSION

Findings from the present study suggest that caregiving is detrimental to health, and recommend considering caregiver type when examining caregiving and health. These findings have vital implications for policymakers in addressing the challenges of structuring and implementing a sustainable informal care system.

Understanding caregiver burden and quality of life in Kerala's primary palliative care program: a mixed methods study from caregivers and providers' perspectives

BACKGROUND

Family caregivers are vital for long-term care for persons with serious health-related suffering in Kerala. Long-term caregiving and ageing may become burdensome and detrimental to patients and caregivers. We compared the caregiver burden and quality-of-life of ageing caregivers with younger caregivers. We also explored the palliative care nurses' perceptions of the family caregivers' issues.

METHODS

We did a mixed method study focusing on two groups: (i) three in-depth interviews and a cross-sectional survey among 221 caregivers of palliative care patients in five randomly selected panchayats (most peripheral tier of three-tier local self-government system in India concerned with governance of a village or small town) of Kollam district, Kerala, as part of development and validation of the Achutha Menon Centre Caregiver Burden Inventory; (ii) five in-depth interviews with purposively selected primary palliative care nurses as part of a study on local governments and palliative care. We used a structured interview schedule to collect cross-sectional data on sociodemographic and caregiving-related characteristics, caregiver burden, and health-related quality of life using the EuroQol EQ5D5L and interview guidelines on caregiver issues tailored based on participant type for qualitative interviews.

RESULTS

Older caregivers comprised 28.1% of the sample and had significantly poorer health and quality-of-life attributes. More senior caregivers experiencing caregiver burden had the lowest mean scores of 0.877 (Standard deviation (SD 0.066, 95% confidence intervals (CI) 0.854-0.899) followed by younger caregivers with high burden (0.926, SD 0.090, 95% CI 0.907-0.945), older caregivers with low burden (0.935, SD 0.058, 95% CI 0.912-0.958) and younger caregivers with low burden (0.980, SD 0.041, 95% CI 0.970-0.990). Caregivers faced physical, psychological, social, and financial issues, leading to a caregiver burden. The relationships between the palliative care nurses and family caregivers were complex, and nurses perceived caregiver burden, but there were no specific interventions to address this.

CONCLUSION

In our study from Kollam, Kerala, three out of ten caregivers of palliative care patients were 60 years of age or older. They had significantly lower health-related quality of life, particularly if they perceived caregiver burden. Despite being recognized by palliative care nurses, caregiver issues were not systematically addressed. Further research and suitable interventions must be developed to target such problems in the palliative care programme in Kerala.

Development and validation of risk of CPS decline (RCD): a new prediction tool for worsening cognitive performance among home care clients in Canada

BACKGROUND

To develop and validate a prediction tool, or nomogram, for the risk of a decline in cognitive performance based on the interRAI Cognitive Performance Scale (CPS).

METHODS

Retrospective, population-based, cohort study using Canadian Resident Assessment Instrument for Home Care (RAI-HC) data, collected between 2010 and 2018. Eligible home care clients, aged 18+, with at least two assessments were selected randomly for model derivation (75%) and validation (25%). All clients had a CPS score of zero (intact) or one (borderline intact) on intake into the home care program, out of a possible score of six. All individuals had to remain as home care recipients for the six months observation window in order to be included in the analysis. The primary outcome was any degree of worsening (i.e., increase) on the CPS score within six months. Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of a deterioration in the CPS score. Model performance was assessed on the validation cohort using discrimination and calibration plots.

RESULTS

We identified 39,292 eligible home care clients, with a median age of 79.0 years, 62.3% were female, 38.8% were married and 38.6% lived alone. On average, 30.3% experienced a worsening on the CPS score within the six-month window (i.e., a change from 0 or 1 to 2, 3, 4, 5, or 6). The final model had good discrimination (c-statistic of 0.65), with excellent calibration.

CONCLUSIONS

The model accurately predicted the risk of deterioration on the CPS score over six months among home care clients. This type of predictive model may provide useful information to support decisions for home care clinicians who use interRAI data internationally.

Impact of Caregiving on Cognitive Functioning: Evidence From the China Health and Retirement Longitudinal Study

OBJECTIVES

Few studies have examined the association between caregiving and the cognitive functioning of caregivers. This study explored the association between caring for family members and cognition and how the link differs by caregiving intensity and caregiving types. Furthermore, rural-urban and gender heterogeneity were investigated.

METHODS

This study analyzed Waves 2011, 2013, and 2018 of the China Health and Retirement Longitudinal Study, with cognitive functioning assessed in 3 dimensions: memory, executive function, and orientation function. The cognition trajectories between caregivers and noncaregivers were compared with the growth curve model.

RESULTS

Results demonstrated a positive association between caregiving and cognitive functioning (β = 0.249, p < .001). Considering caregiving intensity, the positive association was only found in low (β = 0.335, p < .001) and moderate-intensity caregivers (β = 0.250, p < .05) but not in high-intensity caregivers. Moreover, grandparents, adult children, and multiple caregivers had a higher average cognition level at age 60 than noncaregivers (all β > 0, all p < .05), and adult child caregivers exhibited a significantly slower rate of decline in cognition across age (β = 0.040, p < .01). However, spousal caregivers showed no significant disparities with noncaregivers. Moreover, the impact of caregiving on memory function is more apparent among urban adults.

DISCUSSION

Results indicate that caregiving can benefit cognitive function. This study proposes considering caregiving intensity and caregiving types when exploring caregiving and cognition. Based on these findings, policy-makers may overcome the challenges involved in establishing and developing a supportive informal care system in China.

Social Networks Effects on Spouse and Adult-Child Dementia Caregivers' Experiences: A Cross-Sectional Study

OBJECTIVES

A large body of literature addresses experiences of spouse and adult-children caregiver of individuals with dementia (IWDs) but has not examined the role and strength of social networks in associations between spouses and adult-children caregivers' experience. Based on the stress process model, we aimed to explore the strength levels of social networks and their association with spouses/adult-children caregivers for IWDs.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

A questionnaire-based survey was conducted with a total of 146 family caregivers of IWDs (78 adult-child, and 68 spouses) in China.

METHODS

Data collection comprised 4 sections: (1) care-related stressors (dementia stage, neuropsychiatric symptoms); (2) caregiver context; (3) social network, using the Lubben Social Network Scale; and (4) caregiving experience, using the short-form Zarit Burden Interview and 9-item Positive Aspects of Caregiving Scale. Linear regression, mediation model analysis, and interactive analysis were performed to explore the mechanisms of associations between variables.

RESULTS

Spouses had weaker social network strength (β = -0.294, P = .001) and reported greater positive aspects of caregiving (β = 0.234, P = .003) than adult-children caregivers; no significant difference was found between them for caregiver burden. Mediation analysis suggests that associations between caregiver type and caregiver burden are indirect-only mediation effects of social networks (β = 0.140, 95% CI = 0.066-0.228). The social network strength suppressed the association between caregiver type and positive aspects of caregiving. The caregiver type/social network interaction statistically significantly (P = .025) affected the "positive aspects": a stronger social network was associated with more positive aspects of caregiving among the spouse subgroup (β = 0.341, P = .003).

CONCLUSIONS AND IMPLICATIONS

Social networks mediate responses to caregiving experiences among different care provider types and are vital intervention targets, especially for spousal caregivers. Our results can serve as references for identifying caregivers for clinical intervention.

Helps you, helps me? Provision of instrumental and personal care and loneliness among adults aged 50 years and older during the COVID-19 pandemic

PURPOSE

To examine the association between provision of instrumental and personal care, and loneliness in adults aged 50 years and older during the COVID-19 pandemic. Instrumental care referred to the provision of assistance with obtaining necessary or essential products and/or services, whereas personal care referred to the assistance with daily life activities or the provision of emotional support. Social capital and caregiver stress theories served as the study's theoretical framework.

MATERIALS AND METHODS

The data were obtained from the two COVID-19 waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE) conducted in 2020 and 2021. The data were analyzed using logistic regression models. The analytical sample consisted of 48,722 adults in the abovementioned age bracket residing in Europe and Israel.

RESULTS

Providing instrumental care negatively related to loneliness. Providing instrumental care to a single category of people negatively related to loneliness, whereas providing personal care to multiple categories of people positively related to loneliness. Providing personal care to children positively related to loneliness.

CONCLUSIONS

The results suggest that different types of care provision correspond differently to the experience of loneliness while partially supporting both theoretical frameworks. Moreover, care indicators correspond differently to loneliness. The results imply that for a better understanding of the link between care provision and loneliness in later life, various parameters as well as various types of care provision should be examined.

The positive impact of informal spousal caregiving on the physical activity of older adults

Introduction

Although physical activity (PA) is crucial for health, the literature is mixed about how individuals' PA decisions are affected by their spouses. To fill this gap, we examined the extent to which providing care for one spouse affects the PA of the other spouse among those aged 50 or older in the United States.

Methods

We analyzed 9,173 older adults living with their spouses or partners from the 2004 to 2016 waves of the Health and Retirement Study. To identify the causal effect of spousal caregiving on the PA of older adults, we estimated individual-fixed effects models using a two-stage least squared instrumental variable approach with spousal falls as our instrument. We also estimated the models by splitting the sample by gender and race/ethnicity to identify heterogeneous impacts of spousal caregiving on PA decisions among subgroups.

Results

We found that a one percentage point increase in the probability of providing care to spouses led to an increase in the probability of initiating moderate or vigorous PA (MVPA) by 0.34-0.52 percentage points. This effect was salient, especially among female and non-Hispanic white older adults.

Discussion

Caregiving experience might provide opportunities to learn about caregiving burdens and trigger an emotional response about the salience of an event (i.e., they need care in the future). Older caregivers might start MVPA in an effort to improve or maintain their health and avoid burdening their families for caregiving in the future. This study demonstrated spousal influence on PA. Instead of delivering PA-promotion information (e.g., the harm of sedentary lifestyle and benefits of regular PA) to individuals, risk communication and education efforts on PA promotion might be more effective considering the family context. Family events such as health shocks or the emergence of caregiving needs from family members provide windows of opportunities for intervening. Subgroup differences should also be considered in targeted interventions.

The Impact of Multidimensional Poverty on Rural Households' Health: From a Perspective of Social Capital and Family Care

Although absolute poverty has been eliminated in rural China, multidimensional poverty has an unstoppable impact on the self-rated health of rural households through multiple dimensions. This study constructed a moderated mediation model with multidimensional poverty as the independent variable to explore the impact on rural households' self-rated health, social capital as a mediating variable, and family care as a moderating variable. We used the survey data of 382 sample out-of-poverty rural households in Jiangxi, China, in 2020. Our results indicated that multidimensional poverty had a detrimental impact on the self-rated health and social capital of rural households, both of which were significant at the 1% level (β = -0.751, t = -4.775, and β = -0.197, t = -7.08). A test of the mediating effect of social capital using the mediation model found the mediating effect accounting for 84.95% of the entire effect of multidimensional poverty on rural households' self-rated health. Further, the interaction term between family care and multidimensional poverty and its beneficial effect on social capital as well as the interaction term between family care and social capital and its negative effect on rural household' self-rated health are both statistically significant at the 1% level (β = 0.558, t = -5.221 and β = -2.100, t = -3.304). It is revealed that multidimensional poverty affects rural households' self-rated health through social capital and that family care moderates the mediating pathway. Family care exacerbates the negative effect of multidimensional poverty on rural households' self-rated health and weakens the beneficial effect of social capital on rural households' self-rated health. The lower (higher) the level of family care, the more significant the positive (negative) effect of social capital on rural households' health. Therefore, rural households should prioritize building social capital and shifting the responsibility for family care. First, through enhancing housing infrastructure and establishing cultural and educational initiatives, households can improve their viability. Second, increasing engagement in group activities will enhance social networks and boost interpersonal connections. Finally, to lessen the stress on family caregivers, building socialized care services can cover the gap in family care.

Informal care in times of a public health crisis: Objective burden, subjective burden and quality of life of caregivers in the Netherlands during the COVID-19 pandemic

In the Netherlands, about one-third of the adult population provides unpaid care. Providing informal caregiving can be very straining in normal times, but the impact of a public health crisis on caregivers is largely unknown. This study focuses on the question of how caregiver burden changed following the COVID-19 pandemic, and what characteristics were related to these changes. We use self-reported data from a sample of 965 informal caregivers from the Netherlands 3 months into the pandemic to investigate how the objective burden (i.e. hours spent on caregiving) and the subjective burden had changed, and what their care-related quality of life (CarerQol) was. We found that on average the subjective burden had increased slightly (from 4.75 to 5.04 on a 0-10 scale). However, our analysis revealed that some caregivers were more affected than others. Most affected caregivers were women, and those with low income, better physical health, decreased psychological health, childcare responsibilities, longer duration of caregiving and those caring for someone with decreased physical and psychological health. On average, time spent on care remained the same (a median of 15 h per week), but certain groups of caregivers did experience a change, being those caring for people in an institution and for people with a better psychological health before the pandemic. Furthermore, caregivers experiencing changes in objective burden did not have the same characteristics as those experiencing changes in perceived burden and quality of life. This shows that the consequences of a public health crisis on caregivers cannot be captured by a focus on either objective or subjective burden measures or quality of life alone. Long-term care policies aiming to support caregivers to persevere during a future crisis should target caregivers at risk of increased subjective burden and a lower CarerQol, such as women, people with a low income and people with childcare responsibilities. Such policies should consider that reducing objective burden may not necessarily lead to a reduction in subjective burden for all caregivers.

The impact of care-recipient relationship type on health-related quality of life in community-dwelling older adults with dementia and their informal caregivers

PURPOSE

To assess whether there was an association between care-recipient relationship type and health-related quality of life (HRQL) of older persons living with dementia (PLWD) and their informal caregivers, and whether this association was affected by PLWD' dementia severity.

METHODS

This was a secondary data analysis study. PLWD (n = 1230) and caregivers (n = 1871) were identified from participants in the National Health and Aging Trends Study (NHATS) Round 5 and the National Study of Caregiving (NSOC) II, respectively. A series of bivariate and multivariable regression models examined the associations among relationship type and HRQL in PLWD and caregivers, adjusted for socio-demographic variables and dementia severity.

RESULTS

PLWD and caregivers' HRQL outcomes varied by relationship type. PLWD cared for by an adult-child caregiver, or multiple caregivers experienced higher functional limitations than those cared for by a spousal caregiver (β = .79, CI [.39, 1.19]; β = .50, CI [.17, .82], respectively). "Other" caregivers, such as extended family members or friends, had lower odds of experiencing negative emotional burden and social strain than spousal caregivers (β = .79, CI [.39, 1.19]; β = .50, CI [.17, .82], respectively). Lower odds of experiencing negative emotional burden were also found with multiple caregivers. The effect of an adult-child caregiver on social strain was no longer significant when the dementia severity of PLWD was included in the analysis.

CONCLUSION

The type of care-recipient relationship impacts the HRQL in both PLWD and their informal caregivers. Dementia severity of the PLWD appears to affect this association.

Understanding the experiences of older caregivers of patients with lung cancer during palliative chemotherapy in China: a qualitative study

PURPOSE

Although there has been an increase in research on caregivers of patients with cancer, there has been little focus on the specific experiences of older caregivers of patients with lung cancer and the effect of their cultural backgrounds on their experiences. This study explored the caregiver experience among the ageing population in China.

METHODS

Older caregivers of patients with lung cancer undergoing palliative chemotherapy were recruited. Data were collected using a qualitative descriptive design involving semi-structured interviews, which were recorded, transcribed verbatim and analysed qualitatively using inductive content analysis.

RESULTS

Eighteen caregivers aged 61-81 years completed the interviews. The following four themes were identified: physical difficulty, living with ambivalence, perception of role and role-related behaviour changes. These themes enabled a greater understanding of role-related behaviours in older caregivers and their challenges in addressing biological and psychosocial challenges related to older age.

CONCLUSION

The present study highlighted the vulnerability and perceived challenges of the role of older caregivers. These findings help lay the foundation for interventions to improve the care provided to caregivers and their health outcomes, especially caregivers with chronic conditions.

Family Caregiver's Loneliness and Related Health Factors: What Can Be Changed?

Background: Loneliness is a public health issue that may affect the entire population. Loneliness is associated with depression, sleep disorders, fatigue, and increased risk of obesity and diabetes. Risk factors for loneliness include having a poor social network and poor physical and mental health. The main objective was to study factors related to loneliness of family caregivers caring for independent older people. Methods: We performed a non-interventional observational cross-sectional study in south-eastern France. Family caregivers caring for people aged 70 and over and living at home were included. These older people were independent, without long-term conditions, and had applied for professional social assistance for daily living. Data were collected through a questionnaire, administered face-to-face or by telephone. Loneliness and perceived health status were measured through a single-question. Burden was assessed through the Mini-Zarit Scale, and frailty was measured through the Gerontopole Frailty Screening Tool. Results: Of the 876 family caregivers included, 10% felt lonely often or always. They reported more physical and mental health issues than those who did not feel loneliness (p < 0.001). Family caregivers with loneliness were more likely to be looking after a parent and were twice as likely to have a moderate to severe burden (OR = 2.6). They were more likely to feel anxious (OR = 5.6), to have sleep disorders (OR = 2.4), to be frail (OR = 2), and to view the status of their health as poor or bad (OR = 2). Conclusions: Loneliness has a negative impact on health, causes frailty, and places a burden on family caregivers. Means must be implemented to anticipate the consequences of the loneliness felt by family caregivers, notably by orienting them towards the relevant services.

Factors Related to the Caregiving Burden on Families of Korean Patients With Lung Cancer

The purposes of this study were to describe caregiver burden on families of patients with lung cancer and to examine its associated factors, including patient symptoms and symptom clusters. In this cross-sectional study, 120 patient-caregiver dyads were recruited from an outpatient clinic in a tertiary care hospital. Patient symptoms and caregiver burden were measured with structured questionnaire. Descriptive and inferential statistics were used to analyze data. Three patient symptom clusters were identified. Hierarchical regression showed that a patient's smoking history; caregiver age, education, health status, depression, social support, monthly family income, relationship with patient, and time spent on nursing each day; and presence of another caregiver explained 41.4% of the total variance in caregiver burden. When patient symptom clusters were added to regression model, change in total variance in caregiver burden was significant. To reduce their burden, caregivers should be taught how cancer progresses and its major symptoms after chemotherapy.

Dyadic Interdependence in Non-spousal Caregiving Dyads' Wellbeing: A Systematic Review

Caregiving dyads (i.e., an informal caregiver and a care recipient) work as an interdependent emotional system, whereby it is assumed that what happens to one member of the dyad essentially happens to the other. For example, both members of the dyad are involved in care giving and care receiving experiences and therefore major life events, such as a serious illness affect the dyad and not only the individual. Consequently, informal caregiving may be considered an example of dyadic interdependence, which is "the process by which interacting people influence one another's experience." This systematic review aimed to synthesize studies of dyadic interdependence, specifically in non-spousal caregiving dyads (e.g., adult children-parents, siblings, other relatives, or friends). Electronic databases (PsycINFO, Pubmed, and CINAHL) were systematically searched for dyadic studies reporting on interdependence in the emotional and relational wellbeing of non-spousal caregiving dyads. A total of 239 full-text studies were reviewed, of which 14 quantitative and qualitative studies met the inclusion criteria with a majority of dyads consisting of adult daughters caring for their older mothers. A narrative synthesis suggested mutual influences between non-spousal caregiving dyad members based on: (1) associations between intrapersonal (e.g., psychological functioning) and interpersonal (e.g., relationship processes) variables and emotional and relational wellbeing of the dyad; (2) associations between care context variables (e.g., socio-demographics and care tasks) and emotional and relational wellbeing of the dyad; and (3) patterns of covariation between caregivers' and care recipients' wellbeing. Evidence supporting dyadic interdependence among non-spousal caregiving dyads shed light on the ways dyad members influence each other's wellbeing while providing and receiving care (e.g., via the exchange of support). Future studies investigating mutual influences in dyads, should differentiate subsamples of caregivers based on relationship type, and adopt dyadic and longitudinal designs.

Systematic Review Registration

[https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42021213147].

Exploring the Needs of Spousal, Adult Child, and Adult Sibling Informal Caregivers: A Mixed-Method Systematic Review

Informal caregivers (ICGs) provide care to their family or friends in case of an illness, disability, or frailty. The caregiving situation of informal caregivers may vary based on the relationship they have with the care recipient (CR), e.g., being a spouse or being an adult child. It might be that these different ICGs also have different needs. This study aims to explore and compare the needs of different groups of ICGs based on the relationship they have with their CR. We conducted a systematic review, performing a search in the databases PubMed, CINAHL, and PsycINFO. We included studies with qualitative, quantitative, or mixed-method study designs. We analyzed the data using the thematic analysis method. We included 22 articles (18 qualitative; 4 quantitative). The included articles reported the needs of ICGs taking care of a spouse (spousal ICGs), parent (adult child ICG), or sibling aged 18 years or above (adult sibling ICGs). We did not include other relationships due to the limited number of articles on these relationships. The most prominent needs reported by the spousal, adult child, and adult sibling ICGs were the need for information and need for support. The three groups differed in their needs as well. Adult child and adult sibling ICGs indicated a need to be acknowledged by the people around them for their role of carer, while they also needed to be seen as an individual having their own personal needs. Moreover, spousal ICGs indicated a unique need of redefining their role and relationship with their CR. Overall, the findings indicate that along with experiencing common needs, the investigated groups have unique needs as well. Knowing the needs of different groups of ICGs can help develop tailored solutions to improve the quality of life of the ICGs and their CR.

Systematic Review Registration: [www.crd.york.ac.uk/prospero/], identifier [CRD42020188560].

Stressors and coping strategies in Chinese family caregivers of people with dementia in long-term care facilities: A qualitative descriptive study

OBJECTIVES

This study aimed to explore the stressors along with coping strategies in Chinese family caregivers whose relative with dementia had been placed into a long-term care facility.

METHODS

A qualitative descriptive study was conducted with 17 Chinese family caregivers of institutionalised older adults with dementia, recruited via purposeful sampling. Information regarding stressors along with coping strategies was collected through face-to-face semi-structured individual interviews. The interviews were audio-recorded, transcribed, anonymised and imported into MAXQDA 2018.2. Data were analysed with qualitative content analysis.

FINDINGS

Three categories of stressors emerged: socioeconomic pressure, hassles arising from continuing caregiving and suboptimal care provided by the facility. In particular, the family caregivers' experienced tremendous pressure of negative comments from people around since long-term care placement was traditionally viewed as unfilial in Chinese societies. Various coping strategies were adopted by Chinese family caregivers to deal with the stressors; however, they were not always adaptive.

IMPLICATIONS

Health care authorities and professionals should recognise family caregivers' stressors after long-term care placement of a relative with dementia with the consideration of the unique socio-cultural needs. Appropriate and effective interventions should be developed and implemented to facilitate family caregivers to cope with stressful situations after long-term care placement and further to safeguard their psychosocial well-being.

Care provided by older adult caregivers to a spouse in active cancer treatment: a scoping review

PURPOSE

Due to population aging, the number of older adults with cancer will double in the next 20 years. There is a gap in research about older adults who are the caregiver of a spouse with cancer. Therefore, this review seeks to answer the overarching research question: What is known about the association of providing care on Health-Related Quality of Life (HRQOL), psychological distress, burden, and positive aspects of caregiving for an older adult caregiver to a spouse with cancer?

METHODS

This scoping review was guided by the framework of Arksey and O'Malley and refined by Levac et al. Comprehensive search strategies were conducted in Medline, Excerpta Medica Database (EMBASE), PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception until April 15, 2021. Two independent reviewers screened abstracts, full text, and completed data abstraction. A gray literature search and two stakeholder consultations were conducted.

RESULTS

A total of 8132 abstracts were screened, and 17 articles were included. All studies outlined caregivers provided preventive, instrumental, and protective care to a spouse in active cancer treatment. However, the time spent on caregiving was rarely examined (n = 4). Providing care had a negative association on HRQOL, perceived burden, and psychological distress outcomes. Five studies examined positive experiences of caregivers.

CONCLUSION

The scoping review findings highlight the informal care provided by older adult caregivers to a spouse with cancer and how the care provided is associated with HRQOL, burden, psychological distress, and the positive aspects of caregiving.

Subjective burdens among informal caregivers of critically ill patients: a cross-sectional study in rural Shandong, China

BACKGROUND

Informal caregivers are the main source of care for the critically ill, especially after discharge or during the terminal stages at home. However, the concern for informal caregivers is often overshadowed by critically ill patients. The purpose of this study is to determine the influencing factors of the subjective burden of informal caregivers and to seek solutions accordingly.

METHODS

Between July and August 2019, a cross-sectional study was conducted in Shandong, China, focusing on family caregivers and critically ill patients. Subjective caregiver burden was measured by the Chinese version of Zarit Burden Interview (ZBI). The stress process model was used to identify conditions relevant to the caregiving burden and to assess their impact on family caregivers.

RESULTS

554 samples were selected for analysis. The average scores of Zarit Caregiver Burden Interview (ZBI) scores in this study was 30.37±19.04 (n=554). ZBI scores of older, less educated, and spouse caregivers were significantly lower (4.12; 95%CI, 0.42 to 7.81; P =0.029). Objective and subjective burdens increased proportionally. Secondary role stress factors included the higher out-of-pocket (OOP) costs of critical diseases and lower household income, both of which increased caregivers' subjective burdens (1.28; 95%CI, -0.06 to 2.63; p=0.062). Formal medical aid systems played a positive role in reducing subjective caregiving burdens (-7.31; 95%CI, -13.23 to -1.40; p=0.016).

CONCLUSIONS

Health policies should address both the direct medical burdens and the intangible psychological burdens of critical diseases.

Social Isolation Among Spousal and Adult-Child Caregivers: Findings From the Canadian Longitudinal Study on Aging

OBJECTIVES

The caregiving outcomes of spousal and adult-child caregivers are widely studied since they are the most common source of support provided to adults. However, the literature on social isolation among spousal and adult-child caregivers is very limited. In order to further elaborate and specify unique caregiving outcomes, this study focuses on social isolation, both longitudinally and comparatively between spousal and adult-child caregivers.

METHODS

This study was based on the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 5,226 participants (1,293 spousal caregivers and 3,933 adult-child caregivers) were selected. The Linear mixed models were used to examine the effect of caregiver type and caregiving intensity on social isolation over the course of survey.

RESULTS

Spousal and adult-child caregivers reported greater social isolation over time, and spousal caregivers exhibited a steeper increase in social isolation from Baseline to Follow-up 1 than adult-child caregivers. Also, an increase in caregiving hours resulted in greater social isolation. Finally, male spousal or adult-child caregivers were more likely to be socially isolated over time than their female counterparts.

DISCUSSION

The findings of this study contribute to the existing literature on caregiving outcomes by demonstrating an association between family caregiving and social isolation. The results indicate a strong need for intervention programs that aim to enhance social connectedness among family caregivers, and especially for those who perform intensive caregiving, are older age, and are from a lower socioeconomic status.

Burden of caregivers who care for oldest-old parents with disability: A cross-sectional study

OBJECTIVE

To describe the characteristics of oldest-old Chinese with disability and their adult-child caregivers, and the extent to which these characteristics were associated with caregiver burden.

METHODS

The study was based on 168 pairs of disabled oldest-old adults and their adult-child caregivers, derived from the Chinese Longitudinal Healthy Longevity Survey. Descriptive analyses of care recipients' and caregivers' characteristics were conducted respectively, in reference to caregiver burden. Statistically significant characteristics identified in these bivariate analyses were then jointly evaluated in multiple linear regression models with caregiver burden as the outcome.

RESULTS

Care recipients positive emotion status [(β = -0.227 (-0.412, -0.042)], multiple chronic disease [(β = 0.513 (0.081, 0.945)], and caregivers spent more caregiving time [(β = 0.225 (0.061, 0.389)] were main factors associated with caregiver burden.

CONCLUSION

Adult-children caregivers perceived heavier burden if care recipients had low positive emotions, had multiple chronic diseases, and caregivers spent more time caregiving.

Burdens and Educational Needs of Informal Caregivers of Older Adults With Urinary Incontinence: An Internet-Based Study

PURPOSE

The purpose of this study was to describe the burden and educational needs of informal caregivers of care-dependent older adults with urinary incontinence (UI).

DESIGN

A cross-sectional, descriptive survey of informal caregivers recruited through Google Ads was performed.

METHODS

An online survey, including the Overactive Bladder-Family Impact Measure, was used to assess five areas of the experience of the informal caregiver that may be affected by caring for a person with UI and their educational needs.

FINDINGS

Respondents (n = 77) reported a substantial impact of their care recipients' UI on their lives, with concern, travel, and social subscales most affected. However, 42% never sought treatment on behalf of their care recipient. Educational needs included UI treatment strategies and guidance to select appropriate supplies.

CONCLUSIONS

Caregivers underreported their care recipient's UI and need substantially more support from healthcare providers to manage the condition.

CLINICAL RELEVANCE

Nurses should assess for UI among care-dependent older adults and, if present, provide information and strategies to lessen the impact on caregiver lives.

METAMORFOSIS IN THE LIVES OF ELDERLY PEOPLE CARING FOR DEPENDENT ELDERLY IN BRAZIL

ABSTRACT Objective: to understand the phenomenon concerning the change in life and routine of elderly family caregivers who care for dependent elderly family members in Brazil. Method: qualitative, exploratory and descriptive study, developed with 33 elderly family caregivers, from June to September 2019, in the cities of Belo Horizonte, Rio de Janeiro, Porto Alegre, Araranguá, Manaus, Fortaleza and Teresina. Semi-structured interviews were conducted based on the theme of care, facilitating circumstances and difficulties. The analysis of the information was guided by the theoretical-methodological framework of hermeneutics-dialectics. Results: a comprehensive model of the experience of being an elderly caregiver of a dependent elderly family member. This process was part of two categories: "Assuming care" and "Unmet needs". The facilitating circumstances to assume care were positive emotions and bonds with the older person, acceptance of the disease, stable clinical status and support from health professionals, formal caregivers, domestic employees and family support. The difficulties were when the behavior of the dependent elderly becomes aggressive, experiencing loneliness, poor health, social isolation, financial restrictions and absence of social and health support. Conclusion: elderly caregivers are important agents in the exercise of care for the dependent elderly. When they have support, they can perform the care activities and have time to take care of themselves. However, for the most part, these people give up their lives, withdraw from the labor market, isolate themselves and suffer from the lack of material resources and support from health services.

The Impact of Risk and Resistance Factors on Quality of Life in Caregivers of Individuals with Dementia

OBJECTIVES

The present study investigates the effect of caregiver and care recipient risk and resistance factors on caregiver quality of life (QOL). Risk factors are those characteristics that contribute to psychosocial maladjustment of the caregiver and reduce QOL, while resistance factors promote caregiver adjustment and improve QOL.

METHODS

One-hundred and three caregiver/care recipient dyads were recruited from a memory assessment clinic in Midwestern United States. Caregivers completed questionnaires estimating perceived social support, spirituality, social problem-solving, and care recipient functional dependence. Care recipients' results from the Mini-Mental State Examination and Animal Naming task were also collected.

RESULTS

In the final model, caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence each accounted for a significant portion of variance in caregiver QOL. The final model accounted for 46.1% of the variance in caregiver QOL.

CONCLUSION

Caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence are important contributors to caregiver QOL. Further research is needed to specify which caregiver and care recipient characteristics are most important to caregiver QOL.

CLINICAL IMPLICATIONS

Health professionals should assess caregiver problem-solving skills, social support, and care recipient functional dependence, as these may provide important information about caregiver QOL. Study results also suggest that caregiving has more of a negative impact on caregiver QOL for midlife adult caregivers compared to older adult caregivers, and appears to have a greater negative effect on spouses than on children.

Stressors and Resources Related to Medication Management: Associations With Spousal Caregivers' Role Overload

BACKGROUND AND OBJECTIVES

Managing medications can be stressful for spousal caregivers, but little is known about particular aspects of medication management that are most consequential for caregiving outcomes. We examined care stressors and resources related to medication management, their associations with role overload among spousal caregivers, and whether these links vary by care recipients' number of chronic health conditions and dementia status.

RESEARCH DESIGN AND METHODS

This cross-sectional study included 377 spousal caregivers of adults aged 65 and older from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate how medication-related stressors (ordering medication, keeping track of medications, giving injections) and resources (medication reminder systems, shared medication management within the spousal dyad) are associated with caregivers' role overload. Care recipients' number of chronic health conditions and dementia status were considered as moderators. Models controlled for caregivers' sociodemographic characteristics, chronic health conditions, and other care tasks.

RESULTS

Caregivers who administered injections reported more role overload, whereas those who worked with care recipients to jointly manage medications reported less role overload. Keeping track of medications was linked to caregivers' greater role overload when care recipients had 5 or more chronic health conditions. Finally, care recipients' use of medication reminder systems was linked to less role overload for caregivers of a partner with dementia.

DISCUSSION AND IMPLICATIONS

Devising strategies to assist spousal caregivers in the more onerous components of medication management and promote resources that mitigate medication-related stress may improve caregiver well-being.

Till Death Do Us Part: Intersecting Health and Spousal Dementia Caregiving on Caregiver Mortality

OBJECTIVE

We consider whether it is the healthiest dementia caregivers who experience a mortality benefit and whether a protective association is consistent for leading causes of mortality.

METHOD

Using the Health and Retirement study (2000-2012), Cox survival models predict time to death for dementia caregivers, including an interaction between dementia caregiver status and self-rated health. The nationally representative sample consisted of 10,650 married adults aged 51 or older (917 dementia caregivers).

RESULTS

A significant interaction between dementia caregiver status and self-rated health suggested that relative to noncaregivers, dementia caregivers had reduced mortality, with this effect particularly strong at lower levels of self-rated health. The protective effect of dementia caregiver status was consistent across death by heart disease, cancer, and cerebrovascular disease.

DISCUSSION

These findings add to a growing body of literature suggesting that caregiving may provide a mortality benefit and a reason to maintain health.

Perceived social support and health-related quality of life in older adults who have multiple chronic conditions and their caregivers: a dyadic analysis

RATIONALE

Patients who have multiple chronic conditions (MCCs) and their informal caregivers experience poorer health-related quality of life (HRQOL). Perceived social support has been shown to influence HRQOL.

OBJECTIVES

This study aimed at identifying the differences between patients' and caregivers' physical and mental HRQOL; and determining the association between their perception of social support from different sources, and their own and their dyad partner's HRQOL.

METHOD

Patients with MCCs and their caregivers (345 dyads) were enrolled in a multicenter cross-sectional study conducted in Italy. The Multidimensional Scale of Perceived Social Support measured perceived social support from family, friends, and significant others, and the 12-Item Short-Form Health Survey measured the physical and mental component of HRQOL in dyads. The dyadic analysis was conducted using the Actor-Partner Interdependence Model through structural equation modelling.

RESULTS

Family support perceived by each member of the dyad was associated positively with their own mental HRQOL, and that family support perceived by caregivers was also associated positively with patients' mental HRQOL. Greater family support perceived by caregivers was also associated with better physical HRQOL in both caregivers and patients. Moreover, greater friend-support perceived by each member of the dyad was positively associated with own physical HRQOL.

CONCLUSIONS

The study suggests the reciprocal influence of perceived social support from family and friends on physical and mental HRQOL in MCC dyads. Healthcare professionals should identify those people who are the main sources of support for each member of the dyad, and develop care plans that promote the maintenance and enhancing of this support.

Care Recipient Multimorbidity and Health Impacts on Informal Caregivers: A Systematic Review

BACKGROUND AND OBJECTIVES

Caregiving outcomes have often been reported in terms of care recipients of single disease, rather than multiple health conditions. A systematic review was conducted to outline caregiving health outcomes and its association with care recipient multimorbidity for informal caregivers of older adults.

RESEARCH DESIGN AND METHODS

A search strategy was applied in six databases and grey literature. Inclusion criteria were primary observational studies on informal caregiving for care recipients aged 60 years and above, in the English language. Informal caregivers were those not formally hired and multimorbidity referred to presence of at least two health conditions. From a total of 2,101 titles, 230 abstracts were screened, and 19 articles were included. Quality assessment was conducted with application of the Newcastle-Ottawa-Scale.

RESULTS

Health-related and caregiving-related outcomes have been assessed for informal caregivers of older adults with multimorbidity. Caregiver subjective burden was most commonly evaluated and often reported to be low to moderate. In association with care recipient multimorbidity, caregiver burden, quality of life, and perceived difficulty in assisting the older adults were examined in 14 of the studies with mixed results. Studies were heterogeneous, with nonuniform definitions of informal caregivers and multimorbidity as well as measurement tools.

DISCUSSION AND IMPLICATIONS

This narrative review found that caring for older adults with multimorbidity impacts caregivers, although overall evidence is not conclusive. Despite caregiving-related outcomes being most commonly assessed among the caregivers, particularly subjective burden, findings suggest that it is worthwhile to examine other outcomes to enrich the evidence base.

Shared Decision Making About Housing Transitions for Persons With Dementia: A Four-Case Care Network Perspective

BACKGROUND

Persons with dementia (PWDs) and their caregivers often face difficult housing decisions, that is, decisions about their living arrangements, in which the perspectives of all members of the care network should be involved.

OBJECTIVE

We performed a qualitative data analysis to assess the extent to which housing decisions for PWDs with their formal and informal caregivers correspond to an interprofessional shared decision making (IP-SDM) approach, and what light this approach sheds on their experiences with decision making.

RESEARCH DESIGN AND METHODS

We used the IP-SDM model to content-code and analyze data from 4 care networks, each consisting of a PWD, 2 informal and 2 formal caregivers.

RESULTS

Decision making in all networks corresponded to most IP-SDM elements, but never included all network members. Decision making was guided by the wishes of the PWD, but their actual involvement decreased over time.

DISCUSSION

Results show that while the IP-SDM model was helpful, the options change with cognitive decline and moving to a nursing home can become inevitable in spite of preferences.

IMPLICATIONS

Timely and honest communication helps to mitigate the distress of deciding against patient preferences, as could advance care planning about future housing transitions.

Male and Female Partner-Caregivers' Burden: Does It Get Worse Over Time?

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.

Can We Hit Two Birds with One Stone: An Effectiveness Study of Peer-support Groups for Low-income Spousal and Adult Children Caregivers of Hong Kong Older Adults

This study aims to assess the effectiveness of peer support groups for low-income older adults' caregivers in the Hong Kong community. It compares the effectiveness of peer support groups on spouse and adult children caregivers. The peer support program was structured into three stages, including six training sessions for peer specialists, eight caregiver support group sessions, and non-structured informal contact. The study adopted a quasi-experiment design supplemented with qualitative data collected from focused group interviews. It involved a user group of 58 participants and a control group of 42 participants. Both quantitative and qualitative data were collected before, after the peer support groups, and at a three-month follow-up. The quantitative results showed that the peer support program was more effective in promoting social support for adult children caregivers but not for spousal caregivers. Three focus group interviews suggested that the community-based peer-support group could be helpful to improve stress management, emotional regulation skills, and social networks of the caregivers. Based on the research findings, we discuss the various needs of spousal and adult children caregivers, provide recommendations for service providers and practitioners to consider homogenous group services to address the diverse needs of spousal and adult children caregivers.

Predictors of Secondary Role Strains Among Spousal Caregivers of Older Adults With Functional Disability

BACKGROUND AND OBJECTIVES

Aging spouses commonly care for a partner with functional disability, but little is known about how spousal caregiving may impact different life domains. This study evaluated how caregiving characteristics are associated with secondary role strains among spousal caregivers.

RESEARCH DESIGN AND METHODS

This cross-sectional study examined 367 spousal caregivers and their partners from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Hierarchical regressions were estimated to determine how caregiver background factors (sociodemographics, health conditions) along with primary objective (care activities, care recipient health conditions, and dementia status) and subjective (emotional caregiving difficulties, role overload) stressors are linked to care-related valued activity restriction, negative caregiving relationship quality, and care-related family disagreements. Gender differences were considered.

RESULTS

After accounting for all predictors, older caregivers and caregivers providing more help with activities of daily living and health system interactions (e.g., scheduling appointments) were more likely to report activity restriction, whereas caregivers with more emotional difficulties reported higher negative caregiving relationship quality. Role overload was positively associated with all three secondary strains. For husbands only, caring for a partner with more chronic conditions was linked to higher negative caregiving relationship quality and caring for a partner with dementia was associated with a greater likelihood of family disagreements.

DISCUSSION AND IMPLICATIONS

Secondary role strains may develop through similar and unique pathways for caregiving wives and husbands. Further research is needed to identify those who could benefit from support in managing their care responsibilities alongside other life areas.

Health Status and Burden in Caregivers of Patients With Multimorbidity

Caregivers of patients with multimorbidity are important for improving patient outcomes. This descriptive study examines health status and burden of 22 caregivers of patients with multimorbidity discharged from the hospital who were enrolled in a self-management intervention study. Caregivers did not receive an intervention. Factors that increased caregiver burden were financial issues, caring for others (e.g., family members), and home obligations. Caregivers averaged between 2 and 3 chronic conditions themselves. Perceived caregiver burden remained unchanged over time for the caregiver whether the patient was in the intervention or the usual care group. We recommend rigorous research with larger samples to better understand the caregiver role, needed resources and potential interventions to mitigate caregiver burden in the multimorbid population during and after care transitions. Longitudinal studies that include assessment and interventions for the caregivers of patients with multimorbidity are needed.

Multiple Chronic Conditions in Spousal Caregivers of Older Adults With Functional Disability: Associations With Caregiving Difficulties and Gains

OBJECTIVES

Multiple chronic conditions (MCCs) are common and have harmful consequences in later life. Along with managing their own health, many aging adults care for an impaired partner. Spousal caregiving may be more stressful when caregivers have MCCs, particularly those involving complex management. Yet, little is known about combinations of conditions that are most consequential for caregiving outcomes.

METHOD

Using a U.S. sample of 359 spousal caregivers and care recipients from the 2011 National Aging Trends Study and National Study of Caregiving, we examined three categories of MCCs based on similarity of management strategies (concordant only, discordant only, and both concordant and discordant) and their associations with caregiving difficulties and gains. We also considered gender differences.

RESULTS

Relative to caregivers without MCCs, caregivers with discordant MCCs reported fewer gains, whereas caregivers with both concordant and discordant MCCs reported greater emotional and physical difficulties. Wives with discordant MCCs only reported a trend for greater physical difficulties. Caregivers with concordant MCCs did not report more difficulties or gains.

DISCUSSION

Spousal caregivers with MCCs involving discordant management strategies appear to be at risk for adverse care-related outcomes and may benefit from support in maintaining their own health as well as their caregiving responsibilities.

Perceptions of Purpose in Life Within Spousal Care Dyads: Associations With Emotional and Physical Caregiving Difficulties

Background

Greater feelings of purpose in life are associated with better health and may reduce the negative impact of chronic stress. Yet little is known about how purpose in life may buffer the negative effects of caregiving, a common chronic stressor in middle and later life.

Methods

This cross-sectional study utilized a U.S. sample of 315 spousal caregivers and their partners with functional disability drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving to examine how both parties' perceptions of purpose in life are associated with caregivers' emotional and physical caregiving difficulties. We also evaluated whether care recipients' purpose in life moderates the association between caregivers' purpose in life and care-related difficulties. Finally, we considered whether these links differed by caregiver gender. Models controlled for caregivers' sociodemographics, care tasks, support resources, valued activity participation, and each care partner's health conditions.

Results

Caregivers' greater purpose in life was significantly linked to fewer physical caregiving difficulties. Caregivers' greater purpose in life was significantly associated with fewer emotional care-related difficulties among caregiving wives and when care recipients' purpose in life was low.

Conclusions

Although the associations between purpose in life and care-related difficulties are likely bidirectional, purpose in life may represent an important resource for combating the adverse consequences of caregiving. This study highlights the value of considering personal resources and their implications for caregivers' well-being within a dyadic context.

[Do caregivers of non-dependent elderly have specific characteristics? Study among 876 elderly-caregiver dyads]

BACKGROUND

The increase in life expectancy and the aging of the population have a significant impact on the informal care provided by caregivers. Protecting caregivers against excessive burden has become a public health priority. The majority of studies target only those providing care for dependent elderly people. The aim of this study was to describe the characteristics of informal caregivers of non-dependent elderly persons, their difficulties and their level of burden.

METHODS

A cross-sectional study was conducted among 876 dyads: elderly people (over 70 years of age, non-dependent, living at home and having requested assistance from CARSAT South-East) and their caregivers. Two questionnaires were administered: one for the elderly (including the Frailty Group Iso-Resource Evaluation) and one for caregivers (including the Mini-Zarit Scale). A multi-component analysis and a logistic regression were performed.

RESULTS

The elderly were mainly women (77.6%) with a mean age of 82.2±5.8 years and most were frail (94.7%). Most of the caregivers were women (64.5%) with a mean age of 62.7±13.7 years. The multi-component analysis showed three categories of caregivers: spouses, children and others. Among them, spouses performed the most tasks (4.8±2.6) and had the greatest burden. Caregivers in the "others" category were the least burdened and were the least impacted in their daily life. The children category caregivers were divided into two subgroups: those with characteristics similar to "others" caregivers and those with characteristics similar to "spouse" caregivers. Heavy burden was related to greater impact on daily life, poor relationships with the elderly and caregivers' difficulties in performing their role.

CONCLUSION

This study confirms the heterogeneous nature of informal caregiver profiles. It also shows that the characteristic features and the burden of these caregivers are similar whether the elderly person is dependent or non-dependent but frail.

Patterns of use of time by family caregivers of elderly persons with dementia

Abstract Objectives: to describe patterns of use of time in family caregivers of elderly people with dementia, considering the characteristics of the caregivers, the care recipients and the context. Method: Fifty family caregivers of elderly people with intermediate and high levels of physical and cognitive disability participated in an interview about time spent on obligatory care activities over four periods of six hours during a 24-hour period. In addition, a questionnaire about social activities, scales of physical and cognitive functionality of the elderly and an inventory of burden in the family caregivers were applied. Results: 88.0% of the caregivers were women, with a mean age of 57.9 (±11.2) years; 45.92% of the time of the caregivers was used in care activities, 36.92% in discretionary activities, 31.17% in recuperation, and 25.67% in the obligatory activities of the life of the caregiver. The greater the dependence, the longer the care, the less time for self-care and greater the caregivers’ subjective burden. Conclusion: The level of dependence of elderly persons affected by dementia results in an increase in caregiving time and competes with other activities performed by the caregiver. Reorganization of the use of time by family caregivers and provision of formal support can reduce the caregiving burden and benefit the well-being of caregivers.

Longitudinal Outcomes Among Family Caregivers of Power Mobility Users

OBJECTIVE

To examine the change over 1 year in the burden, wheelchair skills, social support, social participation, and mental health of family caregivers providing assistance to older adult powered wheelchair users.

DESIGN

Longitudinal study.

SETTING

Community.

PARTICIPANTS

Participants (N=35) included family caregivers (mean age ± SD=63.7±10.2y) who provided at least 2 hours of general care per week for a powered wheelchair user.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

The Power Mobility Caregiver Assistive Technology Outcome Measure (frequency of care and subjective burden), the Wheelchair Skills Test Questionnaire for caregivers (wheelchair skills), the Interpersonal Support Evaluation List-6 (social support), the Late-Life Function and Disability Instrument (social participation), the Hospital Anxiety and Depression Scale (mental health). Measures were taken at baseline, 1, 3, 6, and 12 months. Descriptive statistics were calculated, and a linear mixed model was used to assess changes over time in the outcomes.

RESULTS

The results showed that the caregivers helped on average with 3 powered wheelchair-related activities and 10 other caregiving activities. They also experienced moderate subjective burden and social participation and were within the normal range for depression and anxiety. Moreover, those outcomes remained stable over the 1-year study period. However, the wheelchair skills scores showed significant changes over time, as the scores improved during the first 6 months of the study.

CONCLUSION

Given that previous research indicated that subjective burden tends to decline over time among caregivers, the findings of stability in this study may reflect increasing needs among this population of caregivers, who may benefit from additional support and interventions. This would need further consideration.

Time use by family caregivers of elderly with dementia: an integrative review

OBJECTIVE

To describe the development of measures used between 1993 and 2016 to evaluate time use by family caregivers of elderly with dementia and to find out the patterns of time use identified in the literature.

METHOD

An integrative review of articles was performed, indexed by the following terms: time use management, family caregiver and elderly.

RESULTS

A total of 17 articles were found, of which seven were methodological. Among these seven articles, five were psychometric. The most frequently used measures were self-reporting (matrices, questionnaires and inventories), validated through objective measures of occurrence and duration. Longitudinal, prospective, clinical and correlational studies showed that care time covaries with the receptors' dependence and that the caregivers' subjective well-being is more affected by the time restriction to free choice activities than the burden resulting from obligatory activities. Final considerations: Valid self-reporting measures are widely used nowadays and they are considered to be effective to assess the objective and subjective costs of health care for dementia.

Socioeconomic and demographic factors modify observed relationship between caregiving intensity and three dimensions of quality of life in informal adult children caregivers

Background

The relationship between informal caregiving intensity and caregiver health is well-established, though research suggests this may vary by caregiver demographics. The aim of this exploratory study is to assess the association between caregiving intensity and three dimensions of quality of life outcomes, and determine how caregiver sociodemographics change the nature of this relationship among informal adult children caregivers.

Methods

Using the 2011 National Study of Caregiving, associations between caregiving intensity and quality of life were examined in caregivers providing care to an aging parent (n = 1014). Logistic regression was used to model caregiver quality of life on caregiving intensity using an ordinal composite measure of caregiving activities, including Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), hours per month, and length of caregiving, stratified by race/ethnicity, gender, age, and family income. Odds ratios and corresponding 95% confidence intervals were calculated.

Results

Associations between caregiving intensity and quality of life varied substantially by race/ethnicity, gender, age, and annual family income. White caregivers were significantly more likely to experience negative emotional burden when providing high intensity care (ADL: 1.92, Hours: 3.23). Black caregivers were more likely to experience positive emotions of caregiving (ADL: 2.68, Hours: 2.60) as well as younger caregivers (Hours: 8.49). Older caregivers were more likely to experience social burden when providing high ADL, IADL, and monthly hours of care.

Conclusions

These findings demonstrate the complex and multi-dimensional nature of caregiving, and emphasize the need to develop approaches that are tailored to the specific health needs of subpopulations of informal caregivers.

Mobility Analysis of AmpuTees II: Comorbidities and Mobility in Lower Limb Prosthesis Users

Supplemental digital content is available in the text.

Objective

The aim of the study was to determine the impact of comorbidities on mobility in patients with lower limb prostheses.

Design

Cohort database chart review was conducted to examine mobility in lower limb prosthesis users grouped according to comorbidities. Regression models were used to determine significant predictor comorbidities for mobility. General linear univariate models were implemented to investigate differences in mobility among cohorts (N = 596).

Results

Patient age and history of stroke, peripheral vascular disease, and anxiety/panic disorders were predictors of decreased mobility. After adjusting for covariates, the differences in mobility reported by patients older than 65 yrs was compared with those younger than 65 yrs; in addition, we compared those with a history of peripheral vascular disease with those without. The comparative analyses for both categories did not satisfy the minimal clinically important difference. There were no significant differences when comparing overall comorbid health after adjusting for covariates.

Conclusions

Clinicians should consider patient age and history of stroke, peripheral vascular disease, or anxiety/panic disorders when optimizing a lower limb prosthesis users' mobility because these variables may be predictive of modest but clinically meaningful decreased prosthetic mobility. By contrast, common comorbid health conditions such as arthritis, chronic obstructive pulmonary disease, congestive heart failure, and diabetes do not seem predictive of decreased mobility among lower limb prosthesis users.

Trajectories of caregiver burden and related factors in family caregivers of patients with lung cancer

OBJECTIVE

This study aimed to (1) identify the changes of 5 domains of family caregiver (FC) burden, overall burden, and its subtrajectories when caring for newly diagnosed advanced lung cancer patients during the first 6 months following cancer diagnosis; and (2) identify the FC-related and patient-related factors most associated with the overall FC burden and each of its subtrajectories.

METHODS

A total of 150 newly diagnosed advanced lung cancer patient-FC dyads were recruited from a Taiwanese medical center. The overall FC burden was evaluated 4 times: before treatment, and 1, 3, and 6 months after treatment. The potential subtrajectory of the caregiver burden was investigated by latent class growth analysis. The FC-related and patient-related factors having the greatest effect on the overall FC burden and its subtrajectories over time were identified by generalized estimating equations.

RESULTS

The highest level of burden domain was "Impact on daily schedule" over time. Generally, most of the FC reported a moderate level of overall burden over the investigation period. Three subtrajectories of the overall FC burden over time (% caregivers) were identified: high burden (34.7%), moderate burden (56.0%), and low burden (9.3%), respectively. The self-efficacy of FC was the strongest factor related to the changes of the FC's burden and burden in each subtrajectory.

CONCLUSION

The results support the existing and different types of subtrajectories of the FC's burden. Health care professionals should provide care based on those differences. Further research to test interventions which integrate those important factors related to FC's burden, particularly FC's self-efficacy, is strongly suggested.

Trajectories of caregiver burden in families of adult cystic fibrosis patients

ABSTRACTObjectives:Little is known about the experience of family caregivers of adults with cystic fibrosis (CF). This information is important for the identification of caregivers at risk for burden.

METHODS

This was a longitudinal analysis of survey data obtained from caregivers of adult CF patients participating in an early intervention palliative care trial. Caregivers completed the validated Brief Assessment Scale for Caregivers (BASC) repeatedly over a 28-month period. Mixed-effects modeling evaluated multivariate associations with positive and negative caregiver perceptions over time.

RESULTS

Of the 54 caregivers, 47.9% were spouses. The mean age was 50.9 years (SD = 13.2); 72.2% were women; 75.9% were married; and 63.0% were employed. At baseline, the BASC revealed large variations in positive and negative perceptions of caregiving. Although average scores over time were unchanging, variation was greater across caregivers than within caregivers (0.49 vs. 0.27, respectively). At baseline, the positive impact of caregiving in the sample was higher than the negative impact. Multivariate analysis revealed that patients' baseline pulmonary function and their full-time employment status predicted caregiver burden over time.

SIGNIFICANCE OF RESULTS

Caregivers of CF patients varied in their positive and negative caregiving experiences, although burden levels in individual caregivers were stable over time. When the disease was advanced, caregivers of CF patients experienced more overall burden but also more positive impact. This suggests that the role of caregivers may become more meaningful as disease severity worsens. In addition, full-time patient employment was associated with lower caregiver burden regardless of disease severity. This suggests that burden in CF caregivers may be predicted by financial strain or benefits conferred by patient employment. These associations require further investigation to determine whether highly burdened caregivers can be identified and assisted using tailored interventions.