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Pless A, Ware D, Saggu S, Rehman H, Morgan J, Wang Q. Understanding neuropsychiatric symptoms in Alzheimer's disease: challenges and advances in diagnosis and treatment. Front Neurosci 2023; 17:1263771. [PMID: 37732300 PMCID: PMC10508352 DOI: 10.3389/fnins.2023.1263771] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) affect up to 97% of AD patients, with an estimated 80% of current AD patients experiencing these symptoms. Common AD-associated NPS include depression, anxiety, agitation, aggression, and apathy. The severity of NPS in AD is typically linked to the disease's progression and the extent of cognitive decline. Additionally, these symptoms are responsible for a significant increase in morbidity, mortality, caregiver burden, earlier nursing home placement, and greater healthcare expenditure. Despite their high prevalence and significant impact, there is a notable lack of clinical research on NPS in AD. In this article, we explore and analyze the prevalence, symptom manifestations, challenges in diagnosis, and treatment options of NPS associated with AD. Our literature review reveals that distinguishing and accurately diagnosing the NPS associated with AD remains a challenging task in clinical settings. It is often difficult to discern whether NPS are secondary to pathophysiological changes from AD or are comorbid psychiatric conditions. Furthermore, the availability of effective pharmaceutical interventions, as well as non-pharmacotherapies for NPS in AD, remains limited. By highlighting the advance and challenges in diagnosis and treatment of AD-associated NPS, we aspire to offer new insights into the complexity of identifying and treating these symptoms within the context of AD, and contribute to a deeper understanding of the multifaceted nature of NPS in AD.
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Affiliation(s)
- Andrew Pless
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Destany Ware
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Shalini Saggu
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Hasibur Rehman
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - John Morgan
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Qin Wang
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
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2
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Solimando L, Fasulo M, Cavallero S, Veronese N, Smith L, Vernuccio L, Bolzetta F, Dominguez LJ, Barbagallo M. Suicide risk in caregivers of people with dementia: a systematic review and meta-analysis. Aging Clin Exp Res 2022; 34:2255-2260. [PMID: 35696056 PMCID: PMC9637612 DOI: 10.1007/s40520-022-02160-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Abstract
Background Interest in physical and mental health outcomes in caregivers of patients with dementia is increasing. However, there is limited data available on the prevalence of suicidal ideation, suicidal attempts, and suicide rates among caregivers of those with dementia. Therefore, we aimed to systematically review these outcomes to address this gap in the literature and thus provide information to inform future policy and intervention for the benefit of caregivers of dementia patients. Methods We searched several databases from inception to the 10th November 2021, for studies investigating suicidal ideation, suicidal attempts, and suicide rates of caregivers of patients with dementia. We report data regarding suicidal ideation as prevalence, with the 95% confidence intervals (CIs), applying a random-effect model; since less than three studies were available for suicide attempt and suicide, these data are reported descriptively. Results Among 194 articles, eight comprising 1,209 informal caregivers of people with dementia (mean age: 63.9 years, 74% females) were included. The prevalence of suicide ideation was 32.32% (95% CI: 16.01–48.64%; I2 = 98.5%, p < 0.0001). The prevalence of suicide ideation varied between studies from 4.69% to 77.78%. Two studies reported the rate of suicidal attempt in caregivers of patients with dementia, with the prevalence ranging from 5.9% to 16.1%. One study reported one in 17 caregivers of patients with dementia died by suicide. Conclusions The prevalence of suicide ideation is high, affecting several caregivers of patients with dementia. These findings suggest intervention and/or policy are urgently needed to address suicidal behavior in this at-risk population. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02160-6.
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Affiliation(s)
- Luisa Solimando
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Marta Fasulo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Stefano Cavallero
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy.
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Laura Vernuccio
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Francesco Bolzetta
- Medical Department, Geriatric Unit, Azienda ULSS (Unità Locale Socio Sanitaria) 3 "Serenissima", Dolo-Mirano District, Italy
| | - Ligia J Dominguez
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy.,Faculty of Medicine and Surgery, University of Enna "Kore", Enna, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
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Liu YC, Liao CN, Song CY. Effects of manual massage given by family caregivers for patients with dementia: A preliminary investigation. Geriatr Nurs 2022; 46:112-117. [PMID: 35662019 DOI: 10.1016/j.gerinurse.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the effects of a 10-week manual massage intervention given by caregivers of patients with dementia on the behavioral and psychological symptoms of dementia (BPSD) and caregiver burden. METHODS Twelve pairs of participants-patients with dementia and their family caregivers-were recruited. Before the intervention, caregivers received a four-hour full body manual massage training course. Thereafter, the caregivers gave a 30-min massage to the patients once a week for a 10-week period. The Cornell Scale for Depression in Dementia, Cohen-Mansfield Agitation Inventory, and Zarit Burden Scale were administered pre- and post-intervention. RESULTS Total scores on all questionnaires significantly decreased after the intervention (p < .05). Moreover, two subscale scores of the Cornell Scale for Depression in Dementia-behavioral disturbance and physical signs-reduced significantly (p < .05). CONCLUSIONS This study provides preliminary evidence on the benefits of manual massage given by caregivers for the management of BPSD and caregiver burden.
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Affiliation(s)
- Yi-Chien Liu
- Department of Neurology, Cardinal Tien Hospital, New Taipei, Taiwan; Medical school of Fu-Jen University, New Taipei, Taiwan
| | - Chih-Ning Liao
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chen-Yi Song
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Gao W, Zhang T, Wang H, Wang S, Liu Y, Pang X. Supporting caregivers of people with dementia: A systematic review of guidelines. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e305-e324. [PMID: 34750910 DOI: 10.1111/hsc.13513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
Caregivers of people with dementia (PwD) frequently experience poor physical, mental and social health. Over the past decade, several guidelines have offered recommendations on supporting caregivers to improve their health outcomes. This systematic review aimed to assess the quality and evidence base of guidelines on supporting caregivers of PwD and review the content of their recommendations on caregiver support to facilitate the adoption and implementation of a specific guideline among policymakers and practitioners. A systematic search for guidelines on supporting caregivers of PwD was performed using journal databases, websites of guideline development organisations and professional dementia-related societies from inception to 30 June 2020. Four independent reviewers performed the quality assessment of the included guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. A thematic synthesis was used to analyse the content of recommendations on caregiver support extracted from the included guidelines by two independent reviewers. The strength of recommendations and level of evidence were reclassified and analysed. Literature searches identified nine guidelines. Their quality was variable. The applicability domain on AGREE II yielded the lowest median score (62.2%; range: 18.6%-86.6%), suggesting that some guidelines lacked applicability in certain fields, leaving them open to interpretation. Most evidence underlying the extracted recommendations was rated as Levels 3 (51.3%) and 4 (31.1%). High-quality evidence is required to fortify these recommendations. The nine guidelines covered six themes-assessment, education, skill training, information provision, psychosocial support and general support policies-which can guide future policies and interventions of caregiver support. The recommendations extracted were consistent across guidelines, but each guideline failed to cover all six themes. Thus, more applicable and comprehensive guidelines that fully address all themes of support for caregivers of PwD are needed.
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Affiliation(s)
- Weijie Gao
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tieling Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongyun Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shanshan Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuling Liu
- Community Health Service Centers of Jieyuan Dao, Tianjin, China
| | - Xiaoli Pang
- Office of Academic Studies, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Huang SS. Depression among caregivers of patients with dementia: Associative factors and management approaches. World J Psychiatry 2022; 12:59-76. [PMID: 35111579 PMCID: PMC8783169 DOI: 10.5498/wjp.v12.i1.59] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
As elderly people increasingly come to represent a higher proportion of the world’s population, various forms of dementia are becoming a significant chronic disease burden. The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant, central role in dementia care. Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers. Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient. This review article explores depression in dementia caregivers and summarizes proposed mechanisms, associated factors, management and research findings, and proposes future research directions.
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Affiliation(s)
- Si-Sheng Huang
- Division of Geriatric Psychiatry, Department of Psychiatry, Changhua Christian Hospital, Changhua 500, Taiwan
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Park MB, Kim SM. The influence of cohabitation type on the psychological vulnerability of family caregivers of people with dementia: Results from a community health survey of 324,078 people in Korea. Arch Gerontol Geriatr 2021; 98:104558. [PMID: 34717241 DOI: 10.1016/j.archger.2021.104558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE The purpose of this study was to identify the mental health problems and quality of life of family caregivers of people with dementia, depending on whether they live with people with dementia. METHODS The sample was divided into three groups: those without a family member with dementia, those with a family member with dementia but not living with them, and those living with a family member with dementia. Descriptive statistics, ANCOVA, and post-hoc tests were performed on key variables. We included a total of 324,078 people with at least one family member older than 60 years, whose data were extracted from the Korean Community Health Survey. Dependent variables: depressive symptoms, stress recognition, subjective health, happiness, and quality of life. INDEPENDENT VARIABLES family member with dementia (yes/no), cohabitation type. Control variables: Sex, age, region (urban/rural), household income, and education level. RESULTS Depressive symptoms and stress recognition were higher in people who live with a family member with dementia. Their subjective health, happiness, and quality of life were the lowest of the three groups. Overall, the indicators for people who lived with a family member with dementia were the most negative, followed by those who did not live with their family member with dementia, and then those who did not have such a family member. CONCLUSIONS Family caregivers living with people with dementia must be prioritized in policies regarding dementia; a program that can provide emotional support and reduce the burden of care is needed.
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Affiliation(s)
- Myung-Bae Park
- Department of Gerontology Health and Welfare, Pai Chai University, Daejeon, Republic of Korea.
| | - Sang-Mi Kim
- Department of Health Management, Jeonju University, Jeonju, Republic of Korea.
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Chang CC, Wang WF, Li YY, Chen YA, Chen YJ, Liao YC, Jhang KM, Wu HH. Using the Apriori Algorithm to Explore Caregivers' Depression by the Combination of the Patients with Dementia and Their Caregivers. Risk Manag Healthc Policy 2021; 14:2953-2963. [PMID: 34285609 PMCID: PMC8286245 DOI: 10.2147/rmhp.s316361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to identify the caring scenarios that result in severe depression in caregivers caring for dementia patients. Patients and Methods A cross-sectional study with 1111 dementia patients and their caregivers in Taiwan from October 2015 to January 2020 was conducted. Gender, age, type of dementia, clinical dementia rating, walking ability, mood symptoms, behavioral symptoms, and psychological symptoms were the variables from the dementia patients. Age, relation to the patient, employment, type of primary care, frequency of care, mood symptoms, and the score from the Center for Epidemiologic Studies Depression Scale were the variables from the caregivers. A comprehensive viewpoint of both dementia patients and their caregivers was evaluated by the Apriori algorithm to find the attributes resulting in different caregiving depressions. Results Forty-seven rules were found with 18 rules of mild depressive symptomatology, 17 rules of moderate depressive symptomatology, and 12 rules of severe depressive symptomatology. A total of 7 general rules were summarized to be the severe depressive symptomatology. The results showed that an unemployed or retired caregiver with the mood symptoms such as helplessness, anger, emotional liability, or anxiety who took care of AD patients or AD patients with a moderate severity would have severe depression. Increased care frequencies (≥6 days per week) and multiple mood problems from caregivers result in severe depression. The composition of adult children, patients' aggression, and caregivers' helplessness as well as the combinations of male patients aged 75-84 years with the caregiver's mood of helplessness or nervousness and hopelessness were highly associated with severe depression. Conclusion For those caring for AD patients, severe depression was associated with the combination of different parameters to constitute each of these seven scenarios. Unlike previous studies which often evaluated one or two variables related to caregiver's depression, this study provided a more comprehensive viewpoint that enabled the collaborative team to efficiently identify and manage different scenarios by summarizing the rules of caregivers with severe depression from a systematic viewpoint.
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Affiliation(s)
- Cheng-Chen Chang
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.,Department of Holistic Wellness, Ming Dao University, Changhua, Taiwan
| | - Yi-Ying Li
- Department of Business Administration, National Changhua University of Education, Changhua, Taiwan
| | - Yu-An Chen
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan
| | - Yen-Jen Chen
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Cheng Liao
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsin-Hung Wu
- Department of Business Administration, National Changhua University of Education, Changhua, Taiwan.,Department of M-Commerce and Multimedia Applications, Asia University, Taichung City, Taiwan.,Faculty of Education, State University of Malang, Malang, East Java, Indonesia
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Jite IE, Adetunji AA, Folasire AM, Akinyemi JO, Bello S. Caregiver burden and associated factors amongst carers of women with advanced breast cancer attending a radiation oncology clinic in Nigeria. Afr J Prim Health Care Fam Med 2021; 13:e1-e8. [PMID: 34212738 PMCID: PMC8252173 DOI: 10.4102/phcfm.v13i1.2812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The responsibility of caring for patients with advanced cancer in sub-Saharan Africa is mostly shouldered by family members because of paucity of institutional facilities. There is a growing concern that the number of women needing treatment for advanced breast cancer is rising at an unprecedented rate in Nigeria. AIM To assess the caregiver burden and its associated factors amongst family caregivers of women with advanced breast cancer. SETTING The study was conducted at the radiation oncology clinic of the University College Hospital, Ibadan, Nigeria. METHODS A cross-sectional descriptive study was conducted amongst 157 eligible family caregivers of women with advanced breast cancer. The family caregivers completed an interviewer-administered questionnaire, which included the socio-demographic data, the caregiving process and the Zarit Burden Interview (ZBI). Logistic regression was used to identify factors, and ethical approval was obtained. RESULTS Over half (53%) of the respondents were males with spousal caregivers dominantly constituting 27.4% of all respondents, closely followed by daughters (25.5%) of the care recipients. The mean ZBI score was 29.84 ± 13.9. Most (72%) of the caregivers experienced burden. Factors associated with caregiver burden were previous hospitalisation of the care recipient (odds ratio [OR] = 3.74, confidence interval [CI]: 1.67 to 8.38) and perceived dysfunction in patients activities of daily living (OR = 2.57, CI: 1.14 to 5.78). CONCLUSION Family caregivers of women with advanced breast cancer experience burden of care. Recognition of this vulnerable population and the care recipient as a dyad is a sine qua non in mitigating the burden associated with their caregiving role.
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Dogan B, Ozmen S, Memis CO, Sair A, Akyol A, Sevincok L. Affective temperament traits may explain high expressed emotion in caregivers of patients with Alzheimer's disease. Psychogeriatrics 2020; 20:746-753. [PMID: 32638506 DOI: 10.1111/psyg.12588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/16/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The negative interactions between Alzheimer's disease (AD) patients and their caregivers may provoke criticism, hostility, and emotional overinvolvement that characterise highly expressed emotion (EE) attitudes. In this study, we hypothesised that affective temperament traits of AD caregivers are related to their high EE levels independent from other patient and caregiver characteristics. METHODS Eighty AD patients were assessed through Clinical Dementia Rating Scale (CDR), and Mini-Mental State Examination. Expressed Emotion Scale (EES), Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire, and Hamilton Depression Rating Scale were applied to the caregivers. The high (n = 41) and low EE caregivers (n = 39) were compared with respect to some sociodemographic and clinical characteristics of the patients and caregivers, and affective temperament traits of caregivers. The associations of caregiver EES scores with multiple variables related to patients and caregivers were examined by Pearson correlation tests. We performed multiple linear regression analysis to determine the possible predictors of total EES scores. RESULTS High EE caregivers had significantly higher depressive, cyclothymic, and anxious temperament traits than in low EE subjects. A weak positive correlation was found between the total EES scores and Personal Care scores of CDR. Home and hobbies subscale scores of CDR had a moderately significant positive correlation with total EES scores. There was also moderate significant positive correlations between total EE scores and depressive, cyclothymic, anxious, and irritable temperament traits. Linear regression analysis indicated that depressive temperament significantly predicted the high levels of caregiver EE. CONCLUSION These findings suggest that caregivers' depressive temperament is predominantly related to their EE levels even after controlling for the severity of AD, and lower educational level of caregivers. Our results may provide evidence that high EE might be a reflection of caregivers' depressive temperament traits, in accordance with the trait hypothesis.
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Affiliation(s)
- Bilge Dogan
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - Simel Ozmen
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | | | - Ahmet Sair
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Ali Akyol
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Levent Sevincok
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
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Chen C, Huang Y, Liu C, Xu Y, Zheng L, Li J. Effects of an Interdisciplinary Care Team on the Management of Alzheimer's Disease in China. J Gerontol Nurs 2019; 45:39-45. [PMID: 31026331 DOI: 10.3928/00989134-20190318-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
The current study aimed to evaluate the multidimensional effects of an interdisciplinary care team in patients with Alzheimer's disease (AD). A total of 129 patients with AD were randomly assigned to an interdisciplinary care group (n = 69) or usual care group (n = 60). Behavioral and psychological symptoms of patients with AD were measured during a 6-month treatment period. No differences were found in the baseline characteristics between the interdisciplinary care and usual care groups. Compared to usual care, interdisciplinary care greatly increased patients' activities of daily living (ADL) scores when measured at 3 and 6 months (p < 0.001). Findings provide evidence that an interdisciplinary care team approach is beneficial in improving ADL performance; thus, an interdisciplinary care team should be implemented in the care arrangements for patients with AD. [Journal of Gerontological Nursing, 45(5), 39-45.].
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Abstract
BACKGROUND Caring for people with dementia is highly challenging, and family carers are recognised as being at increased risk of physical and mental ill-health. Most current interventions have limited success in reducing stress among carers of people with dementia. Mindfulness-based stress reduction (MBSR) draws on a range of practices and may be a promising approach to helping carers of people with dementia. OBJECTIVES To assess the effectiveness of MBSR in reducing the stress of family carers of people with dementia. SEARCH METHODS We searched ALOIS - the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (all years to Issue 9 of 12, 2017), MEDLINE (Ovid SP 1950 to September 2017), Embase (Ovid SP 1974 to Sepetmber 2017), Web of Science (ISI Web of Science 1945 to September 2017), PsycINFO (Ovid SP 1806 to September 2017), CINAHL (all dates to September 2017), LILACS (all dates to September 2017), World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and Dissertation Abstracts International (DAI) up to 6 September 2017, with no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) of MBSR for family carers of people with dementia. DATA COLLECTION AND ANALYSIS Two review authors independently screened references for inclusion criteria, extracted data, assessed the risk of bias of trials with the Cochrane 'Risk of bias' tool, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information, then conducted meta-analyses, or reported results narratively in the case of insufficient data. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included five RCTs involving 201 carers assessing the effectiveness of MBSR. Controls used in included studies varied in structure and content. Mindfulness-based stress reduction programmes were compared with either active controls (those matched for time and attention with MBSR, i.e. education, social support, or progressive muscle relaxation), or inactive controls (those not matched for time and attention with MBSR, i.e. self help education or respite care). One trial used both active and inactive comparisons with MBSR. All studies were at high risk of bias in terms of blinding of outcome assessment. Most studies provided no information about selective reporting, incomplete outcome data, or allocation concealment.1. Compared with active controls, MBSR may reduce depressive symptoms of carers at the end of the intervention (3 trials, 135 participants; standardised mean difference (SMD) -0.63, 95% confidence interval (CI) -0.98 to -0.28; P<0.001; low-quality evidence). We could not be certain of any effect on clinically significant depressive symptoms (very low-quality evidence).Mindfulness-based stress reduction compared with active control may decrease carer anxiety at the end of the intervention (1 trial, 78 participants; mean difference (MD) -7.50, 95% CI -13.11 to -1.89; P<0.001; low-quality evidence) and may slightly increase carer burden (3 trials, 135 participants; SMD 0.24, 95% CI -0.11 to 0.58; P=0.18; low-quality evidence), although both results were imprecise, and we could not exclude little or no effect. Due to the very low quality of the evidence, we could not be sure of any effect on carers' coping style, nor could we determine whether carers were more or less likely to drop out of treatment.2. Compared with inactive controls, MBSR showed no clear evidence of any effect on depressive symptoms (2 trials, 50 participants; MD -1.97, 95% CI -6.89 to 2.95; P=0.43; low-quality evidence). We could not be certain of any effect on clinically significant depressive symptoms (very low-quality evidence).In this comparison, MBSR may also reduce carer anxiety at the end of the intervention (1 trial, 33 participants; MD -7.27, 95% CI -14.92 to 0.38; P=0.06; low-quality evidence), although we were unable to exclude little or no effect. Due to the very low quality of the evidence, we could not be certain of any effects of MBSR on carer burden, the use of positive coping strategies, or dropout rates.We found no studies that looked at quality of life of carers or care-recipients, or institutionalisation.Only one included study reported on adverse events, noting a single adverse event related to yoga practices at home AUTHORS' CONCLUSIONS: After accounting for non-specific effects of the intervention (i.e. comparing it with an active control), low-quality evidence suggests that MBSR may reduce carers' depressive symptoms and anxiety, at least in the short term.There are significant limitations to the evidence base on MBSR in this population. Our GRADE assessment of the evidence was low to very low quality. We downgraded the quality of the evidence primarily because of high risk of detection or performance bias, and imprecision.In conclusion, MBSR has the potential to meet some important needs of the carer, but more high-quality studies in this field are needed to confirm its efficacy.
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Affiliation(s)
- Zheng Liu
- Peking UniversityDepartment of Maternal and Child Health, School of Public Health38 Xueyuan RoadBeijingChina100191
| | - Yu‐Ying Sun
- The Chinese University of Hong KongPublic HealthPrince of Wales HospitalHong KongChina
| | - Bao‐liang Zhong
- The Chinese University of Hong KongPsychiatryTai Po HospitalHong KongChina
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Hamdy RC, Lewis JV, Copeland R, Depelteau A, Kinser A, Kendall-Wilson T, Whalen K. Repetitive Questioning Exasperates Caregivers. Gerontol Geriatr Med 2018; 4:2333721417738915. [PMID: 29349099 PMCID: PMC5768244 DOI: 10.1177/2333721417738915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/12/2017] [Accepted: 09/29/2017] [Indexed: 11/15/2022] Open
Abstract
Repetitive questioning is due to an impaired episodic memory and is a frequent, often presenting, problem in patients with Alzheimer’s disease (amnestic type). It is due to the patients’ difficulties learning new information, retaining it, and recalling it, and is often aggravated by a poor attention span and easy distractibility. A number of factors may trigger and maintain repetitive questioning. Caregivers should try to identify and address these triggers. In the case discussion presented, it is due to the patient’s concerns about her and her family’s safety triggered by watching a particularly violent movie aired on TV. What went wrong in the patient/caregiver interaction and how it could have been avoided or averted are explored. Also reviewed are the impact of repetitive questioning, the challenges it raises for caregivers, and some effective intervention strategies that may be useful to diffuse the angst that caregivers experience with repetitive questioning.
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Affiliation(s)
- R C Hamdy
- East Tennessee State University, Johnson City, USA
| | - J V Lewis
- East Tennessee State University, Johnson City, USA
| | - R Copeland
- East Tennessee State University, Johnson City, USA
| | - A Depelteau
- East Tennessee State University, Johnson City, USA
| | - A Kinser
- East Tennessee State University, Johnson City, USA
| | - T Kendall-Wilson
- East Tennessee State University, Johnson City, USA.,Alzheimer's Tennessee, Knoxville, TN, USA
| | - K Whalen
- East Tennessee State University, Johnson City, USA
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Henry J, Jagannathan A, Bhavana K, Thomas B, Bharath S, Varghese M, Jhirwal OP, Sivakumar PT. Group intervention for carers of geriatric patients: experiences from a clinic in India. Int Psychiatry 2018. [DOI: 10.1192/s1749367600005683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sixty per cent of the global elderly population live in low-and middle-income countries, and this proportion was expected to rise to 70% by 2010 (International Institute of Ageing, 2001; Ferri et al, 2005). The 2001 Indian census found over 70 million people aged 60 years or more (considered senior citizens according to the Indian National Policy on Older Persons). Most of those senior citizens live with younger family members and are dependent on them for financial and social support. Hence, any physiological and psychological changes in the older family members affect the younger supportive members as well.
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14
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Yoon KH, Moon YS, Lee Y, Choi SH, Moon SY, Seo SW, Park KW, Ku BD, Han HJ, Park KH, Han SH, Kim EJ, Lee JH, Park SA, Shim YS, Kim JH, Hong CH, Na DL, Ye BS, Kim HJ, Moon Y, Lee SS, Kim DH. The moderating effect of religiosity on caregiving burden and depressive symptoms in caregivers of patients with dementia. Aging Ment Health 2018; 22:141-147. [PMID: 27661263 DOI: 10.1080/13607863.2016.1232366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study explored whether religiosity/spirituality has a protective role against negative caregiving outcomes, in a large multicenter nationwide sample of caregivers of patients with dementia in South Korea. Additionally, this study was the first to examine whether religiosity/spirituality could affect caregiving outcomes according to the various religious affiliations of caregivers. METHODS The study was conducted on a sample of 476 caregivers of patients with dementia participated in the Clinical Research Center for Dementia of South Korea (CREDOS). We examined the moderating effect of each of the three dimensions of religiosity/spirituality (organizational religious activity, ORA; non-organizational religious activity, NORA; intrinsic religiosity, IR) on the relationship between activities of daily living (ADL) of patients with dementia and caregiving burden and depressive symptoms of caregivers, using a series of hierarchical regression analyses. In addition, these analyses were conducted according to the religious affiliations of the caregivers. RESULTS ORA, NORA, and IR of religiosity/spirituality alleviated the effect of ADL of patients on caregiving burden. ORA and IR moderated the relationship between ADL of patients and depressive symptoms of caregivers. These moderating effects of religiosity on caregiving outcomes were different according to various religious groups. CONCLUSION We have identified religiosity/spirituality as a protective factor for caregivers of patients with dementia. The sub-dimensions of religiosity as moderators were different by religious affiliations of caregivers. Further studies are needed to investigate the specific religiosity-related factors which could positively impact the mental health of the caregivers of patients with dementia by religions.
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Affiliation(s)
- Kyung Hee Yoon
- a Department of Psychiatry, Chuncheon Sacred Heart Hospital , Hallym University College of Medicine , Chuncheon , South Korea.,b Institute for Skeletal Aging, Chuncheon Sacred Heart Hospital , Hallym University College of Medicine , Chuncheon , South Korea
| | - Yoo Sun Moon
- a Department of Psychiatry, Chuncheon Sacred Heart Hospital , Hallym University College of Medicine , Chuncheon , South Korea.,b Institute for Skeletal Aging, Chuncheon Sacred Heart Hospital , Hallym University College of Medicine , Chuncheon , South Korea
| | - Yunhwan Lee
- c Department of Preventive Medicine and Public Health , Ajou University School of Medicine , Suwon , South Korea.,d Institute on Aging , Ajou University Medical Center , Suwon , South Korea
| | - Seong Hye Choi
- e Department of Neurology , Inha University School of Medicine , Incheon , South Korea
| | - So Young Moon
- d Institute on Aging , Ajou University Medical Center , Suwon , South Korea.,f Department of Neurology , Ajou University School of Medicine , South Korea
| | - Sang Won Seo
- g Department of Neurology, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , South Korea.,h Neuroscience Center, Samsung Medical Center , Seoul , South Korea.,i Department of Clinical Research Design and Evaluation , SAIHST, Sungkyunkwan University , Seoul , South Korea
| | - Kyung Won Park
- j Department of Neurology , Dong-A University College of Medicine , Pusan , South Korea
| | - Bon D Ku
- k Department of Neurology , Catholic Kwandong University College of Medicine , Gangneung , South Korea
| | - Hyun Jeong Han
- l Department of Neurology , Myongji Hospital , Goyang , South Korea
| | - Kee Hyung Park
- m Department of Neurology , Gachon University Gil Medical Center , Incheon , South Korea
| | - Seol-Heui Han
- n Department of Neurology , Konkuk University College of Medicine , Seoul , South Korea
| | - Eun-Joo Kim
- o Department of Neurology , Pusan National University School of Medicine , Pusan , South Korea
| | - Jae-Hong Lee
- p Department of Neurology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Sun A Park
- q Department of Neurology , Soonchunhyang University Bucheon Hospital, College of Medicine , Bucheon , South Korea
| | - Yong S Shim
- r Department of Neurology , Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Bucheon , South Korea
| | - Jong Hun Kim
- s Department of Neurology , Ilsan Hospital, National Health Insurance Service , Goyang , South Korea
| | - Chang Hyung Hong
- d Institute on Aging , Ajou University Medical Center , Suwon , South Korea.,t Department of Psychiatry , Ajou University School of Medicine , Suwon , South Korea
| | - Duk L Na
- g Department of Neurology, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , South Korea.,h Neuroscience Center, Samsung Medical Center , Seoul , South Korea.,i Department of Clinical Research Design and Evaluation , SAIHST, Sungkyunkwan University , Seoul , South Korea
| | - Byoung Seok Ye
- u Department of Neurology , Yonsei University College of Medicine , Seoul , South Korea
| | - Hee Jin Kim
- g Department of Neurology, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , South Korea.,h Neuroscience Center, Samsung Medical Center , Seoul , South Korea.,i Department of Clinical Research Design and Evaluation , SAIHST, Sungkyunkwan University , Seoul , South Korea
| | - Yeonsil Moon
- n Department of Neurology , Konkuk University College of Medicine , Seoul , South Korea
| | - Sang Soo Lee
- b Institute for Skeletal Aging, Chuncheon Sacred Heart Hospital , Hallym University College of Medicine , Chuncheon , South Korea
| | - Do Hoon Kim
- a Department of Psychiatry, Chuncheon Sacred Heart Hospital , Hallym University College of Medicine , Chuncheon , South Korea
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Hamdy RC, Lewis JV, Copeland R, Depelteau A, Kinser A, Kendall-Wilson T, Whalen K. Patients With Dementia Are Easy Victims to Predators. Gerontol Geriatr Med 2017; 3:2333721417734684. [PMID: 29051913 PMCID: PMC5639964 DOI: 10.1177/2333721417734684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/12/2017] [Accepted: 08/29/2017] [Indexed: 11/16/2022] Open
Abstract
Patients with dementia, especially Alzheimer’s disease and particularly those in early stages, are susceptible to become victims of predators: Their agnosia (see Case 1) prevents them from detecting and accurately interpreting subtle signals that otherwise would have alerted them that they are about to fall for a scam. Furthermore, their judgment is impaired very early in the disease process, often before other symptoms manifest themselves and usually before a diagnosis is made. Patients with early stages of dementia are therefore prime targets for unscrupulous predators, and it behooves caregivers and health care professionals to ensure the integrity of these patients. In this case study, we discuss how a man with mild Alzheimer’s disease was about to fall for a scam were it not for his vigilant wife. We discuss what went wrong in the patient/caregiver interaction and how the catastrophic ending could have been avoided or averted.
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Affiliation(s)
- R C Hamdy
- East Tennessee State University, Johnson City, TN, USA
| | - J V Lewis
- East Tennessee State University, Johnson City, TN, USA
| | - R Copeland
- East Tennessee State University, Johnson City, TN, USA
| | - A Depelteau
- East Tennessee State University, Johnson City, TN, USA
| | - A Kinser
- East Tennessee State University, Johnson City, TN, USA
| | - T Kendall-Wilson
- East Tennessee State University, Johnson City, TN, USA.,Alzheimer's Tennessee, Knoxville, TN, USA
| | - K Whalen
- East Tennessee State University, Johnson City, TN, USA
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16
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Liu Z, Chen QL, Sun YY. Mindfulness training for psychological stress in family caregivers of persons with dementia: a systematic review and meta-analysis of randomized controlled trials. Clin Interv Aging 2017; 12:1521-1529. [PMID: 29026290 PMCID: PMC5626236 DOI: 10.2147/cia.s146213] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Caring for a relative with dementia is extremely challenging; conventional interventions may not be highly effective or easily available on some occasions. This study aimed to explore the efficacy of mindfulness training in improving stress-related outcomes in family caregivers of people with dementia using a meta-analytic review. We searched randomized controlled trials (RCT) through April 2017 from five electronic databases, and assessed the risk of bias using the Cochrane Collaboration tool. Seven RCTs were included in our review. Mindfulness interventions showed significant effects of improvement in depression (standardized mean difference: -0.58, [95% CI: -0.79 to -0.37]), perceived stress (-0.33, [-0.57 to -0.10]), and mental health-related quality of life (0.38 [0.14 to 0.63]) at 8 weeks post-treatment. Pooled evidence did not show a significant advantage of mindfulness training compared with control conditions in the alleviation of caregiver burden or anxiety. Future large-scale and rigorously designed trials are needed to confirm our findings. Clinicians may consider the mindfulness program as a promising alternative to conventional interventions.
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Affiliation(s)
- Zheng Liu
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Hong Kong SAR, China
| | - Qian-lin Chen
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Hong Kong SAR, China
| | - Yu-ying Sun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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17
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Hamdy RC, Lewis JV, Kinser A, Depelteau A, Copeland R, Kendall-Wilson T, Whalen K. Too Many Choices Confuse Patients With Dementia. Gerontol Geriatr Med 2017; 3:2333721417720585. [PMID: 28904992 PMCID: PMC5588787 DOI: 10.1177/2333721417720585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/22/2017] [Accepted: 06/09/2017] [Indexed: 12/02/2022] Open
Abstract
Choices are often difficult to make by patients with Alzheimer Dementia. They often become acutely confused when faced with too many options because they are not able to retain in their working memory enough information about the various individual choices available. In this case study, we describe how an essentially simple benign task (choosing a dress to wear) can rapidly escalate and result in a catastrophic outcome. We examine what went wrong in the patient/caregiver interaction and how that potentially catastrophic situation could have been avoided or defused.
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Affiliation(s)
- R C Hamdy
- East Tennessee State University, Johnson City, USA
| | - J V Lewis
- East Tennessee State University, Johnson City, USA
| | - A Kinser
- East Tennessee State University, Johnson City, USA
| | - A Depelteau
- East Tennessee State University, Johnson City, USA
| | - R Copeland
- East Tennessee State University, Johnson City, USA
| | - T Kendall-Wilson
- East Tennessee State University, Johnson City, USA.,Alzheimer's Tennessee, USA
| | - K Whalen
- East Tennessee State University, Johnson City, USA
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18
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Liu Z, Sun YY, Zhong BL. Mindfulness-based stress reduction for family carers of people with dementia. Hippokratia 2017. [DOI: 10.1002/14651858.cd012791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Zheng Liu
- The Chinese University of Hong Kong; Psychiatry; Tai Po Hospital Hong Kong China
| | - Yu-Ying Sun
- The Chinese University of Hong Kong; Public Health; Prince of Wales Hospital Hong Kong China
| | - Bao-liang Zhong
- The Chinese University of Hong Kong; Psychiatry; Tai Po Hospital Hong Kong China
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19
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Schmotz C, Richinger C, Lorenzl S. High Burden and Depression Among Late-Stage Idiopathic Parkinson Disease and Progressive Supranuclear Palsy Caregivers. J Geriatr Psychiatry Neurol 2017; 30:267-272. [PMID: 28747135 DOI: 10.1177/0891988717720300] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Caregivers of patients with late-stage idiopathic Parkinson disease (IPD) and late-stage progressive supranuclear palsy (PSP) often suffer from severe psychological strain themselves. This study investigates the influence of the different kind of symptoms in IPD and PSP on the psychological burden of the caregivers. METHODS Twenty patients with late-stage IPD and 20 patients with late-stage PSP and their caregivers were investigated. To measure the degree of motor, cognitive, and affective impairment of the patients, the instruments Subscale III of the Unified Rating Scale for Parkinsonism (UPDRS-III), a shortened 24-item version of the Mini-Mental State Examination, and the Geriatric Depression Scale (GDS-30) were used. Psychological burden of the caregivers was determined by using the Beck Depression Inventory (BDI-II) and the Zarit Caregiver Burden Inventory (ZBI). RESULTS Patients with IPD suffered from a higher level of depression (GDS-30: 15.9 vs 10.2, P = .020), whereas patients with PSP showed greater motor impairment (UPDRS-III: 38.3 vs 29.9, P = .002). Caregivers of both groups reported high psychological burden (ZBI: 36.5 in IPD vs 42.8 in PSP) and symptoms of a depression (BDI-II: 12.5 in IPD vs 15.1 in PSP). No significant influence of motor impairment, cognitive dysfunction, and depressive symptoms of the patient on the burden of the caregiver could be found. CONCLUSIONS Psychological strain and depression among caregivers seem to become even more relevant in the late stages of IPD and PSP. Further studies will be necessary to investigate the specific determining factors in late-stage parkinsonian syndromes.
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Affiliation(s)
- Christian Schmotz
- 1 Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
- 2 Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Carmen Richinger
- 1 Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
- 2 Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Lorenzl
- 1 Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
- 2 Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- 3 Department of Neurology, Agatharied Hospital, Norbert-Kerkel-Platz, Hausham, Germany
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20
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Abstract
Sleep disorders and neurologic illness are common and burdensome in their own right; when combined, they can have tremendous negative impact at an individual level as well as societally. The socioeconomic burden of sleep disorders and neurologic illness can be identified, but the real cost of these conditions lies far beyond the financial realm. There is an urgent need for comprehensive care and support systems to help with the burden of disease. Further research in improving patient outcomes in those who suffer with these conditions will help patients and their families, and society in general.
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21
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Safavi R, Berry K, Wearden A. Expressed Emotion in relatives of persons with dementia: a systematic review and meta-analysis. Aging Ment Health 2017; 21:113-124. [PMID: 26569025 DOI: 10.1080/13607863.2015.1111863] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Expressed Emotion (EE) refers to a number of key aspects of interpersonal relationships which have been shown to relate to outcomes in relatives of people with health conditions. DESIGN A systematic review and meta-analysis of EE and outcomes in relatives of persons with dementia is reported. Potential research studies were identified via a search of three electronic databases; PsychINFO, MEDLINE and the Web of Science between 1960 and 2015. RESULTS We reviewed 12 studies investigating correlations between EE and well-being in relatives of patients with dementia. Factors hypothesised to influence EE including attributions, social support, coping strategies and relationship quality were also reviewed. CONCLUSION High-EE relatives were found to have increased levels of burden (Z = 6.967, P < 0.001) and greater levels of depression (Z = 5.842, P < 0.001). Compared to low-EE relatives, high-EE relatives were more likely to attribute the patient's problems to factors that were personal to and controllable by the patient. Relatives with less social support, inefficient coping strategies and a poor relationship with the patients, were more likely to be classified as high-EE.
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Affiliation(s)
- Roxanne Safavi
- a Department of Clinical Psychology , University of Manchester , Manchester , UK
| | - Katherine Berry
- a Department of Clinical Psychology , University of Manchester , Manchester , UK
| | - Alison Wearden
- a Department of Clinical Psychology , University of Manchester , Manchester , UK
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22
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Brown KW, Coogle CL, Wegelin J. A pilot randomized controlled trial of mindfulness-based stress reduction for caregivers of family members with dementia. Aging Ment Health 2016; 20. [PMID: 26211415 PMCID: PMC5070659 DOI: 10.1080/13607863.2015.1065790] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The majority of care for those with Alzheimer's disease and other age-related dementias is provided in the home by family members. To date, there is no consistently effective intervention for reducing the significant stress burden of many family caregivers. The present pilot randomized controlled trial tested the efficacy of an adapted, eight-week mindfulness-based stress reduction (MBSR) program, relative to a near structurally equivalent, standard social support (SS) control condition for reducing caregiver stress and enhancing the care giver-recipient relationship. METHOD Thirty-eight family caregivers were randomized to MBSR or SS, with measures of diurnal salivary cortisol, and perceived stress, mental health, experiential avoidance, caregiver burden, and relationship quality collected pre- and post-intervention and at three-month follow-up. RESULTS MBSR participants reported significantly lower levels of perceived stress and mood disturbance at post-intervention relative to SS participants. At three-month follow-up, participants in both treatment conditions reported improvements on several psychosocial outcomes. At follow-up, there were no condition differences on these outcomes, nor did MBSR and SS participants differ in diurnal cortisol response change over the course of the study. CONCLUSION Both MBSR and SS showed stress reduction effects, and MBSR showed no sustained neuroendocrine and psychosocial advantages over SS. The lack of treatment condition differences could be attributable to active ingredients in both interventions, and to population-specific and design factors.
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Affiliation(s)
| | - Constance L. Coogle
- Virginia Center on Aging, Virginia Commonwealth University 730 East Broad St., 2nd floor, Richmond, VA 23219
| | - Jacob Wegelin
- Department of Biostatistics, Virginia Commonwealth University Medical Center One Capitol Square, Room 732, 830 East Main St., Richmond, VA 23219
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23
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Abstract
Thirty caregivers of people living with dementia were investigated to examine the caregivers' experience of burden. The Clinical Dementia Rating Scale (CDRS), Burden Interviews and open-ended questions were administered on patients attending inpatient and outpatient services at the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore (India). Findings indicate that only 30 percent of the cases fell into the high burden group. No statistically significant results were observed between caregiver relationship and burden scores. Burden experienced in extended families was less compared to the other types of families. To conclude, the need to create awareness about the illness among different sections of the general population and interventions suited to the Indian caregivers are discussed.
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Choo WY, Low WY, Karina R, Poi PJH, Ebenezer E, Prince MJ. Social Support and Burden among Caregivers of Patients with Dementia in Malaysia. Asia Pac J Public Health 2016; 15:23-9. [PMID: 14620494 DOI: 10.1177/101053950301500105] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study aims to examine selected factors of dementia patients and their caregivers that were associated with the burden of family caregivers. This cross sectional study involves face-to-face interview with family caregivers of patients with dementia. Participants were recruited through convenient sampling from geriatric and psychiatry outpatient clinics from three government hospitals, one university hospital, one rural health centre and Alzheimer Disease caregivers' support groups. 70 caregivers took part in the study. Measures included patient and caregiver demographic variables and caregiver burden using the Zarit Burden Interview (ZBI). Caregiver burden was found to be significantly associated with both ethnicity and informal support. Chinese caregivers were found to have a higher level of burden compared to Indians and Malays. Informal support, in particular assistance from family members, was significantly associated with a lower burden perceived by the caregivers. However, the study shows that formal support such as assistance from maids and private nurses did not alleviate the burden of caregivers. Results highlighted the importance of improving the coping skills in burdened caregivers particularly among family members with dementia relatives. Interventions should be designed for specific needs of caregivers of different ethnicities. Asia Pac J Public Health 2003; 15(1): 23-29.
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Affiliation(s)
- Wan-Yuen Choo
- Health Research Development Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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25
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Butt ZA, Strauss ME, Smyth KA, Rose-Rego SK. Negative Affectivity and Emotion-Focused Coping in Spouse Caregivers of Persons With Alzheimer's Disease. J Appl Gerontol 2016. [DOI: 10.1177/073346402237633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Several studies have noted that spouse caregivers'negative affectivity, or neuroticism, is associated with the use of emotion-focused coping strategies. This association may be artificially inflated, however, due to the common mode of assessment used in these studies or to the reactive relationship between negative affectivity and coping. To address this issue, this study examined the relationship between self-reporting and informant reporting of negative affectivity and selfreported coping. Informants, adult children (N = 39) of caregivers, completed the NEO–Five Factor Index, in which they described their caregiver parent prior to the onset of dementia in their other parent. Caregivers completed measures of current coping and distress. Only emotion-focused coping showed a tendency to be more highly correlated with self-reported than with informant-reported negative affectivity. Correlations between self-reports of negative affectivity and use of emotion-focused coping may reflect a reciprocal interaction between these two variables and therefore may overestimate their association.
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Crawford K, Digby R, Bloomer M, Tan H, Williams A. Transitioning from caregiver to visitor in a long-term care facility: the experience of caregivers of people with dementia. Aging Ment Health 2016; 19:739-46. [PMID: 25266371 DOI: 10.1080/13607863.2014.962008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Transitioning from the primary caregiver to the visitor in a long-term care facility may be challenging for the caregiver; they are required to surrender their caring duties to the medical and nursing staff. The aim of this study was to explore the experiences of caregivers during their transition from day-to-day caregiver of a person with dementia to a visitor in a long-term care facility. METHODS This study utilised a qualitative descriptive design. Twenty caregivers of people with dementia were recruited from the one Aged Rehabilitation and Geriatric Evaluation and Management facility, located in Victoria, Australia. Semi-structured interviews were used to explore the caregiver's experiences. Interviews were analysed using thematic analysis. RESULTS The interview data revealed that the participants were undergoing similar experiences. The findings revealed that it was difficult for the caregiver to transition to their new role of visitor; negative reactions of grief, loss of motivation and loneliness were also coupled with positive feelings of relief and the reassurance that their relative or friend would be well cared for and safe within the long-term care facility. CONCLUSION The findings offer insight into the experiences felt by caregivers when their relative or friend with dementia is admitted to hospital. Implications of this study include the need to improve the transition process for the caregiver by allowing them to be involved in the decision-making process, keeping them informed of care decisions, and importantly, providing emotional support to help the caregiver positively adapt to this transition.
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Affiliation(s)
- K Crawford
- a School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences , Monash University , Melbourne , Australia
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27
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Huang SS, Liao YC, Wang WF. Association between caregiver depression and individual behavioral and psychological symptoms of dementia in Taiwanese patients. Asia Pac Psychiatry 2015; 7:251-9. [PMID: 25704825 DOI: 10.1111/appy.12175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 01/14/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The aim of this study was to investigate caregiver depression associated with neuropsychiatric symptoms in Taiwanese people. METHODS A cross-sectional design was used in this study. Two hundred seventy-six pairs of patients with dementia and their caregivers who visited the memory clinic of a general hospital from July 2001 to October 2008 were recruited. Caregiver depression was evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D); the behavioral and psychological symptoms of dementia were evaluated using the Neuropsychiatric Inventory. Demographic data of the patients and caregivers, including cognitive functions and clinical dementia ratings, were collected. In addition to descriptive statistics, we examined the relationship between each parameter and caregiver depression using Pearson correlation, independent t-test, or analysis of variance. RESULTS The results showed a statistically significant positive correlation between the total Neuropsychiatric Inventory score and CES-D score (r = 0.345, P < 0.001) in the bivariate analyses. For individual behavioral and psychological symptoms of dementia, agitation/aggression, anxiety, nighttime behavior disturbances, irritability/lability, and hallucinations were the five leading symptoms significantly associated with caregiver depression (CES-D). DISCUSSION Carefully managing these symptoms is likely to reduce depression in dementia caregivers.
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Affiliation(s)
- Si-Sheng Huang
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan (R.O.C.)
| | - Yi-Cheng Liao
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan (R.O.C.)
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan (R.O.C.)
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Hou PY, Lai CKY, Chung CS, Sham AKK, Yeung CL. Young adults' experiences of their parents caring for a relative with dementia. Geriatr Gerontol Int 2015; 16:873-9. [DOI: 10.1111/ggi.12559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Pik Yi Hou
- School of Nursing; The Hong Kong Polytechnic University; Hong Kong
| | | | - Ching Sum Chung
- School of Nursing; The Hong Kong Polytechnic University; Hong Kong
| | | | - Ching Lai Yeung
- School of Nursing; The Hong Kong Polytechnic University; Hong Kong
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Ae-Ngibise KA, Doku VCK, Asante KP, Owusu-Agyei S. The experience of caregivers of people living with serious mental disorders: a study from rural Ghana. Glob Health Action 2015; 8:26957. [PMID: 25967587 PMCID: PMC4429259 DOI: 10.3402/gha.v8.26957] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/07/2015] [Accepted: 04/10/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Families and friends who give care to people with mental disorders (MDs) are affected in a variety of ways and degrees. The interplay of caregiving consequences: poverty, discrimination and stigma, lack of support from others, diminished social relationships, depression, emotional trauma, and poor or interrupted sleep are associated caregiver burden. OBJECTIVE The burden of care on caregivers of people living with MDs was assessed in two districts located in the middle part of Ghana. Coping strategies and available support for caregivers of MDs were also assessed. DESIGN A qualitative study was carried out involving 75 caregivers of participants with MDs registered within the Kintampo Health and Demographic Surveillance Systems. Data were gathered from caregivers about their experiences in providing care for their relations with MDs. RESULTS Caregivers reported various degrees of burden, which included financial, social exclusion, emotional, depression, and inadequate time for other social responsibilities. Responsibilities around caregiving were mostly shared among close relatives but to a varying and limited extent. Religious prayers and the anticipation of cure were the main coping strategies adopted by caregivers, with expectation of new treatments being discovered. CONCLUSIONS Emotional distress, stigma, financial burden, lack of support networks, social exclusion, health impact, and absence of decentralised mental health services were experienced by family caregivers. These findings highlight the need for interventions to support people with MDs and their caregivers. This might include policy development and implementation that will decentralise mental health care provision including psychosocial support for caregivers. This will ameliorate families' financial and emotional burden, facilitate early diagnosis and management, reduce travel time to seek care, and improve the quality of life of family caregivers of persons with MDs.
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Affiliation(s)
| | - Victor Christian Korley Doku
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
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Cummings JL, Isaacson RS, Schmitt FA, Velting DM. A practical algorithm for managing Alzheimer's disease: what, when, and why? Ann Clin Transl Neurol 2015; 2:307-23. [PMID: 25815358 PMCID: PMC4369281 DOI: 10.1002/acn3.166] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/21/2014] [Accepted: 12/04/2014] [Indexed: 12/02/2022] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia and its prevalence is increasing. Recent developments in AD management provide improved ways of supporting patients and their caregivers throughout the disease continuum. Managing cardiovascular risk factors, maintaining an active lifestyle (with regular physical, mental and social activity) and following a Mediterranean diet appear to reduce AD risk and may slow cognitive decline. Pharmacologic therapy for AD should be initiated upon diagnosis. All of the currently available cholinesterase inhibitors (ChEIs; donepezil, galantamine, and rivastigmine) are indicated for mild-to-moderate AD. Donepezil (10 and 23 mg/day) and rivastigmine transdermal patch (13.3 mg/24 h) are indicated for moderate-to-severe AD. Memantine, an N-methyl-d-aspartate receptor antagonist, is approved for moderate-to-severe AD. ChEIs have been shown to improve cognitive function, global clinical status and patients' ability to perform activities of daily living. There is also evidence for reduction in emergence of behavioral symptoms with ChEI therapy. Treatment choice (e.g., oral vs. transdermal) should be based on patient or caregiver preference, ease of use, tolerability, and cost. Treatment should be individualized; patients can be switched from one ChEI to another if the initial agent is poorly tolerated or ineffective. Memantine may be introduced in moderate-to-severe disease stages. Clinicians will regularly monitor symptoms and behaviors, manage comorbidities, assess function, educate and help caregivers access information and support, evaluate patients' fitness to drive or own firearms, and provide advice about the need for legal and financial planning. Review of caregiver well-being and prompt referral for support is vital.
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Affiliation(s)
- Jeffrey L Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada and Cleveland, Ohio
| | | | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky Medical Center Lexington, Kentucky
| | - Drew M Velting
- Novartis Pharmaceuticals Corporation East Hanover, New Jersey
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Bauab JP, Emmel MLG. Mudanças no cotidiano de cuidadores de idosos em processo demencial. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2014. [DOI: 10.1590/s1809-98232014000200011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
À medida que o número de idosos aumenta devido ao envelhecimento populacional, a prevalência de doenças crônico-degenerativas cresce significativamente. Dentre estas, a demência se destaca como fator de risco para a incapacidade e a perda funcional, podendo promover uma relação de aumento de assistência nas atividades/ocupações cotidianas do idoso e modificações no contexto diário de quem cuida. Este artigo teve como objetivo apreender a percepção do cuidador de idosos em processo demencial frente ao seu cotidiano, identificando o status de suas ocupações/atividades em decorrência das relações de cuidado assumidas. Trata-se de estudo transversal, correlacional comparativo, com abordagem quantitativa. Para tanto, foi selecionada uma amostra de 22 cuidadores de idosos com diagnóstico de processo demencial, sendo seis cuidadores formais e 16 cuidadores informais. Para a coleta de dados, foram utilizados uma lista de ocupações e um questionário de caracterização do cuidador. Os dados mostraram que os cuidadores informais dedicam maior tempo às atividades de cuidado, com abandono de várias atividades cotidianas produtivas, de lazer e de cuidados pessoais após assumirem a atividade de cuidado. Nos cuidadores formais esses impactos são bem menores, uma vez que a atividade de cuidado compõe sua vida laborativa. Em ambos os grupos, constatou-se um baixo número de cuidadores que se capacitam para a atividade e estes referiram sentir dificuldades em lidar e orientar famílias no manejo para o cuidado do idoso. Conforme os dados obtidos nesta pesquisa e com base na literatura existente, o cuidadores informais são os principais responsáveis pelo cuidado e caracterizam-se por ter suas atividades cotidianas alteradas ou substituídas pela responsabilidade do cuidado.
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Cruz MDN, Hamdan AC, Fonseca RP. Adaptação transcultural da Dementia Management Strategies Scale ao português brasileiro. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2012. [DOI: 10.1590/s0103-166x2012000500006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo tem por objetivo apresentar a adaptação transcultural da Dementia Management Strategies Scale ao português brasileiro. Essa escala foi desenvolvida para verificar a frequência do uso de três tipos de estratégias de gerenciamento da demência, utilizadas por familiares cuidadores de idosos: crítica, gerenciamento ativo e encorajamento. Participaram do processo de adaptação 3 tradutores, 100 juízes não especialistas, 5 juízes especialistas e 15 cuidadores. Os procedimentos utilizados foram duas traduções independentes, elaboração de uma versão síntese das duas traduções, avaliação do instrumento pelos juízes e, por fim, a condução de estudo piloto com 15 cuidadores de idosos com demência do tipo Alzheimer. Após as adaptações realizadas em todas as etapas do processo de adaptação transcultural, constatou-se equivalência satisfatória entre as versões.
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Miller EA, Rosenheck RA, Schneider LS. Caregiver burden, health utilities, and institutional service use in Alzheimer's disease. Int J Geriatr Psychiatry 2012; 27:382-93. [PMID: 21560160 PMCID: PMC3204397 DOI: 10.1002/gps.2730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 03/08/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined the moderating effect of caregiver burden on the relationship between the health status of Alzheimer's disease (AD) patients and their use of institutional services (i.e., hospitalization, nursing home, and residential care). METHODS Data were obtained at baseline and at 3, 6, and 9 months following study entry on 421 community-dwelling patients with AD in the Clinical Antipsychotic Trials of Intervention Effectiveness for AD. The outcome variable includes use of any institutional services. Logistic regression was employed to estimate the interaction between Health Utility Index Mark III score (a general health status measure) and four concurrent caregiver burden measures at outcome. Marginal effects were calculated and plotted using random effects models for observations at multiple time points per individual. Average effects were calculated across all observations using models without random effects. RESULTS Random effects results suggest that caregiver burden weakens the inverse relationship between health utilities and institutional service use, leading to greater likelihood of institutional use than would be expected at a given level of health. This is indicated by positive and significant signs on the Health Utility Index Mark III*caregiver burden interaction when burden is measured using the Caregiver Distress Scale, Beck Depression Inventory, and Caregiver Assessment Survey (all p < 0.05). It is reinforced by positive and significant average effects deriving from Caregiver Distress and Beck Depression Inventory models without random effects (both p < 0.10). Results derived from the Burden Interview Scale, although positive, were non-significant and weak by comparison. CONCLUSION Caregiver support interventions should be offered to individuals caring for less-advanced AD patients. Otherwise, healthy patients may be at increased risk for institutionalization when caregivers experience high levels of burden.
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Affiliation(s)
- Edward Alan Miller
- Department of Gerontology and Gerontology Institute, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.
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Borghi AC, Sassá AH, de Matos PCB, Decesaro MDN, Marcon SS. [Quality of life of elders with Alzheimer's disease and of their caregivers]. Rev Gaucha Enferm 2012; 32:751-8. [PMID: 22299278 DOI: 10.1590/s1983-14472011000400016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The objective of the study was to identify the quality of life (QoL) of elders with Alzheimer's Disease (AD) and of their caregivers. This is a descriptive-exploratory study carried out with 50 elders and caregivers in the city of Maringá, state of Paraná, Brazil. The data were collected from November, 2010, to January, 2011, with the use of the Quality of Life in Alzheimer's Disease Scale. The average of the total scores for patients and caregivers were 26.36 and 35.04 points, respectively. The fields home (98%) and family (72%) presented greater satisfaction for both caregivers and elders. The fields memory and tasks (92%) for the caregivers, and leisure (52%) for the elders reached larger dissatisfaction indexes. It is considered that the caregiver's QoL reflects directly upon the care and, therefore, it should also be considered in the planning and implementation of care to the elderly with AD.
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Affiliation(s)
- Ana Carla Borghi
- Universidade Estadual de Maringá (UEM), Maringá, Paraná, Brasil.
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Mohamed S, Rosenheck R, Lyketsos CG, Kaczynski R, Sultzer DL, Schneider LS. Effect of second-generation antipsychotics on caregiver burden in Alzheimer's disease. J Clin Psychiatry 2012; 73:121-8. [PMID: 21939611 PMCID: PMC4040971 DOI: 10.4088/jcp.10m06574] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 02/18/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) imposes a severe burden upon patients and their caregivers. Severity of psychiatric symptoms and behavioral disturbances is an important determinant of caregivers' experience of burden. These symptoms may be improved with atypical antipsychotic treatment. OBJECTIVE Data from the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) trial were used to evaluate the effect of atypical antipsychotics versus placebo on the experiences of caregivers of outpatients with AD. METHOD We compared the effect of atypical antipsychotic drugs (olanzapine, risperidone, or quetiapine-considered together as a group) versus placebo on the experiences of caregivers of AD outpatients (diagnosed according to DSM-IV-TR). We also evaluated whether improvement in patients' psychiatric and behavioral symptoms mediated the relationship between drug treatment and caregiver burden. The CATIE-AD trial, conducted from April 2001 through November 2004, included outpatients (mean age = 77.9 years [SD = 7.5 years]) in usual care settings and assessed treatment effectiveness over a 9-month period at 42 US sites. In a set of secondary analyses, data from CATIE-AD participants who had at least 1 postbaseline outcome assessment and data from their caregivers were examined in an intention-to-treat (ITT) analysis (N = 361). A phase 1-only analysis was conducted including only observations while patients were receiving the initially randomized drug (N = 153). The Burden Interview, the Beck Depression Inventory, and the Neuropsychiatric Inventory (NPI) Caregiver Distress Scale were used to evaluate caregiver burden. RESULTS In both ITT and phase 1-only analyses, caregivers of patients treated with second-generation antipsychotics scored significantly lower than caregivers of patients receiving placebo on both the Burden Interview (P = .0090) and the NPI Caregiver Distress Scale (P = .0209). These differences appeared to have been mediated by lower levels of agitation, hostility, and psychotic distortions. CONCLUSION In AD patients with symptoms of psychosis, agitation, or aggressive behavior, medications can have a small but significant impact on caregiver burden.
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Affiliation(s)
- Somaia Mohamed
- Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, CT, USA.
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Ponce CC, Ordonez TN, Lima-Silva TB, Dos Santos GD, Viola LDF, Nunes PV, Forlenza OV, Cachioni M. Effects of a psychoeducational intervention in family caregivers of people with Alzheimer's disease. Dement Neuropsychol 2011; 5:226-237. [PMID: 29213748 PMCID: PMC5619483 DOI: 10.1590/s1980-57642011dn05030011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Psychoeducational activities are a way of promoting help for caregivers of
patients with Alzheimer’s disease, representing a forum for knowledge sharing,
and in which the primary focus is on psychological themes aimed at carers
developing coping skills and strategies.
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Affiliation(s)
- Cinthia Costa Ponce
- Graduate student in Gerontology, School of Arts, Sciences and Humanities of the University of São Paulo, São Paulo SP, Brazil
| | - Tiago Nascimento Ordonez
- Bachelors in Gerontology, School of Arts, Sciences and Humanities of the University of São Paulo, São Paulo SP, Brazil
| | - Thaís Bento Lima-Silva
- Bachelors in Gerontology, Post-graduate in Neurosciences from the ABC School of Medicine, Santo André Foundation, Santo André SP, Brazil and Masters Student in Neurology at the University of São Paulo, School of Medicine, São Paulo SP, Brazil
| | - Glenda Dias Dos Santos
- Bachelors in Gerontology, School of Arts, Sciences and Humanities of the University of São Paulo, São Paulo SP, Brazil
| | - Luciane de Fátima Viola
- Masters in Psychiatry from the University of São Paulo, School of Medicine, São Paulo SP, Brazil
| | - Paula Villela Nunes
- PhD in Biological Sciences, Medicine Modality from the Institute of Psychiatry of Hospital das Clinicas, University of São Paulo, School of Medicine, São Paulo SP, Brazil
| | - Orestes Vicente Forlenza
- Masters and MD in Medicine at the Department of Psychiatry of the University of São Paulo. Full Professor at FMUSP. Associate Professor of the Department of Psychiatry of the University of São Paulo, School of Medicine. Vice-Director of the Laboratory of Neurosciences and Head of the Out-patient Unit of Geriatric Psychiatry of the LIM27 Medical Laboratory, Department and Institute of Psychiatry of the FMUSP, São Paulo SP, Brazil
| | - Meire Cachioni
- Professor PhD in Gerontology at the State University of Campinas and Lecturer at the School of Arts, Sciences and Humanities of the University of São Paulo. Head of Psychoeducational Intervention Group for Caregivers of Elderly with Alzheimer's Disease of the Rehabilitation Center and Day-care Hospital for the Aged within the Institute of Psychiatry of the Hospital das Clínicas of the University of São Paulo, School of Medicine, São Paulo SP, Brazil
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Huang SS, Lee MC, Liao YC, Wang WF, Lai TJ. Caregiver burden associated with behavioral and psychological symptoms of dementia (BPSD) in Taiwanese elderly. Arch Gerontol Geriatr 2011; 55:55-9. [PMID: 21601931 DOI: 10.1016/j.archger.2011.04.009] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 04/13/2011] [Accepted: 04/14/2011] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to investigate caregiver burden associated with BPSD in Taiwanese people. The study had a cross-sectional design. Eighty-eight patients with dementia and 88 caregivers who visited the memory clinic of a medical center from January 2007 to December 2007 were recruited. The BPSD were assessed using the neuropsychiatric inventory (NPI); caregiver burden was evaluated using the NPI caregiver distress scale (NPI-D). Demographic data on the patients and caregivers along with patients' cognitive functions and clinical dementia ratings were collected. In addition to descriptive statistics, we analyzed the relationship between each parameter and caregiver burden using binary correlation. The results showed a statistically significant positive correlation between the total NPI-D score and the total NPI score (r=0.898, p<0.001). For individual BPSD, delusions had the highest mean NPI-D score, followed by agitation/aggression, anxiety, irritability/lability, and dysphoria/depression. The symptom frequency of anxiety, delusions, and agitation/aggression showed a statistically significant positive correlation with caregiver's NPI-D score. These findings suggest that improvement of treatments for delusions, agitation/aggression, anxiety, irritability/lability, and dysphoria/depression among dementia patients may reduce caregiver burden.
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Affiliation(s)
- Si-Sheng Huang
- Center of General Education, Central Taiwan University of Science and Technology, 666, Pu-Tzu Road, Pei-tun District, Taichung 406, Taiwan
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Miller EA, Rosenheck RA, Schneider LS. Caregiver burden, health utilities, and institutional service costs among community-dwelling patients with Alzheimer disease. Alzheimer Dis Assoc Disord 2010; 24:380-9. [PMID: 20625266 PMCID: PMC3951163 DOI: 10.1097/wad.0b013e3181eb2f2e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the moderating effect of caregiver burden on the relationship between patients' health status and institutional costs in Alzheimer disease (AD). Data were obtained on whether 421 community-dwelling patients with AD in the CATIE-AD trial received institutional services in the month preceding baseline and at 3-month, 6-month, and 9-month follow-up. All participants had a caregiver who lived with or visited them regularly. Outcome variables include hospital, nursing home, residential, and combined institutional costs. Mixed models were employed to estimate the interaction of Health Utility Index (HUI)-III scores (a health status measure) and 5 measures of caregiver burden. Wherever significant, results indicate that greater caregiver burden weakens the inverse relationship between health utilities and institutional costs, leading to greater costs than would be expected at a given level of health. Altogether 45.0% of the models (9/20) showed this effect (positive coefficient on the burden-HUI interaction term). Interventions to support caregivers should be based on caregiver burden, regardless of care recipient health status, for even seemingly manageable patients may be at heightened risk for institutionalization if caregivers experience sufficiently high levels of burden.
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Affiliation(s)
- Edward Alan Miller
- Associate Professor of Gerontology and Public Policy, and Fellow, Gerontology Institute, McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts
| | - Robert A. Rosenheck
- Professor of Psychiatry and Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, and Co-director, New England Mental Illness, Research, Education, and Clinical Center, VA Connecticut System, West Haven, CT
| | - Lon S. Schneider
- Professor of Psychiatry, Neurology, and Gerontology, University of Southern California Keck School of Medicine, Los Angeles, CA
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Mohamed S, Rosenheck R, Lyketsos CG, Schneider LS. Caregiver burden in Alzheimer disease: cross-sectional and longitudinal patient correlates. Am J Geriatr Psychiatry 2010; 18:917-27. [PMID: 20808108 PMCID: PMC3972419 DOI: 10.1097/jgp.0b013e3181d5745d] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Alzheimer disease (AD) imposes a severe burden on patients and their caregivers. Although there is substantial evidence of the adverse impact of burden, considerably less is known about its specific correlates and potential causes. DESIGN The authors use data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)-AD study to examine the relationship of burden and depression among AD caregivers to patient and caregiver sociodemographic characteristics, patients' cognitive status, psychiatric and behavioral symptoms, functional abilities, quality of life, and intensity of care provided by caregivers. SETTING CATIE-AD included outpatients in usual care settings and assessed treatment outcomes during 9 months. PARTICIPANTS Data were examined from 421 ambulatory outpatients with a diagnosis of dementia of the Alzheimer type or probable AD with agitation or psychosis. MEASURES The Burden Interview, the Beck Depression Inventory, and the Caregiver Distress Scale were used to evaluate caregiver burden. RESULTS More severe psychiatric and behavioral problems and decreased patient quality of life, as well as lower functional capability were significantly associated with higher levels of burden and depression among caregivers at baseline. Six-month changes showed that decreased symptoms and improved quality of life were associated with decreased burden and accounted for most of the explained variance in change in burden measures. CONCLUSION Severity of psychiatric symptoms, behavioral disturbances, and patients' quality of life are the main correlates of caregivers' experience burden. Psychosocial and pharmacologic interventions targeting these two aspects of the disorder are likely to not only alleviate patient suffering but also promote caregiver well-being.
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Affiliation(s)
- Somaia Mohamed
- New England Mental Illness, Research, Education and Clinical Center, West Haven, CT, USA.
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Garcés J, Carretero S, Ródenas F, Alemán C. A review of programs to alleviate the burden of informal caregivers of dependent persons. Arch Gerontol Geriatr 2010; 50:254-9. [DOI: 10.1016/j.archger.2009.04.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 04/16/2009] [Accepted: 04/20/2009] [Indexed: 10/20/2022]
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Pinto MF, Barbosa DA, Ferreti CEDL, Souza LFD, Fram DS, Belasco AGS. Qualidade de vida de cuidadores de idosos com doença de Alzheimer. ACTA PAUL ENFERM 2009. [DOI: 10.1590/s0103-21002009000500009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a qualidade de vida de cuidadores de idosos com doença de Alzheimer e relacioná-la ao Índice de Katz dos pacientes e ao escore do Inventário de Depressão de Beck dos cuidadores. MÉTODOS: O estudo foi desenvolvido no Núcleo de Envelhecimento Cerebral da Universidade Federal de São Paulo/ Hospital São Paulo. A amostra foi constituída, respectivamente, por 118 cuidadores e seus pacientes com doença de Alzheimer (DA). As informações coletadas nos prontuários dos pacientes foram sociodemográficas e mórbidas, Índice de Katz e Miniexame de estado mental (MEEM). Os dados do cuidador, obtidos por questionários, foram sociodemográficos e mórbidos , o SF - 36 e o Inventário de Depressão de Beck (IDB). RESULTADOS: Os escores mais comprometidos do SF -36 dos cuidadores foram: vitalidade (56,8) e os físicos e emocionais com 58,1, respectivamente. Houve correlação negativa entre o IDB do cuidador e o índice de Katz dos pacientes; entre o SF - 36 e o IDB e as correlações positivas entre os escores do SF -36 e Índice de Katz e entre os domínios deste índice e os escores do MEEM. CONCLUSÃO: A qualidade de vida dos cuidadores de pacientes com DA mostrou-se alterada, podendo comprometer os cuidados por eles prestados e, evidenciou piora quando a capacidade funcional do idoso esteve mais comprometida.
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Borges LDL, Albuquerque CR, Garcia PA. O impacto do declínio cognitivo, da capacidade funcional e da mobilidade de idosos com doença de Alzheimer na sobrecarga dos cuidadores. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000300010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo foi avaliar capacidade funcional, mobilidade e função cognitiva de idosos com a doença de Alzheimer (DA), bem como o nível de sobrecarga de seus cuidadores, verificando possíveis associações entre essas variáveis. Foram selecionados 28 idosos (77,8±8,3 anos) diagnosticados com DA por meio do manual diagnóstico e estatístico das doenças mentais e da Classificação Internacional de Doenças; e também os respectivos cuidadores (58,0±13,9 anos), todos participantes da Associação Brasileira de Alzheimer em Goiás. Foram avaliadas função cognitiva, mobilidade e capacidade funcional dos idosos, por meio do miniexame do estado mental, Southampton assessment of mobility e Disability assessment for dementia, respectivamente. O nível de sobrecarga dos cuidadores foi avaliado pela Zarit burden interview. As associações foram calculadas pelo teste de correlação de Spearman e o nível de significância fixado em 0,05. Obtiveram-se correlações fracas significativas entre o nível cognitivo e a escolaridade dos idosos (r=0,389; p=0,041), nível de funcionalidade dos idosos e nível de sobrecarga dos cuidadores (r=-0,398; p=0,036), e mobilidade e tempo de diagnóstico da DA (r=0,401; p=0,042). Os resultados sugerem que o deficit cognitivo não interferiu na capacidade funcional e a perda cognitiva foi proporcionalmente maior que a perda da mobilidade. Foi possível associar a sobrecarga dos cuidadores ao nível de funcionalidade dos idosos com doença de Alzheimer.
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Gaugler JE, Mittelman MS, Hepburn K, Newcomer R. Predictors of change in caregiver burden and depressive symptoms following nursing home admission. Psychol Aging 2009; 24:385-96. [PMID: 19485656 PMCID: PMC2699253 DOI: 10.1037/a0016052] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Prior research has yielded discrepant findings regarding change in caregiver burden or depressive symptoms after institutionalization of persons with dementia. However, earlier studies often included small postplacement samples. In samples of 1,610 and 1,116 dementia caregivers with up to 6 months' and 12 months' postplacement data, respectively, this study identified predictors of change in caregiver burden and depressive symptoms following nursing home admission. Descriptive analyses found that caregivers reported significant and considerable decreases in burden in the 6- and 12-month postplacement panels. A number of variables predicted increased burden and depressive symptoms in the 6- and 12-month postplacement panels. Preplacement measures of burden and depressive symptoms, site (Florida), overnight hospital use, and spousal relationship appear to result in impaired caregiver well-being following nursing home admission. Incorporating more specific measures of stress, considering the influence of health-related transitions, and coordinating clinical strategies that balance caregivers' needs for placement with sustainability of at-home care are important challenges for future research.
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Affiliation(s)
- Joseph E Gaugler
- Center on Aging, School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA.
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Lee SE, Damron-Rodriguez J, Lawrance FP, Volland PJ. Geriatric social work career tracking: graduates of the Hartford Partnership Program for Aging Education (HPPAE). JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2009; 52:336-353. [PMID: 19382023 DOI: 10.1080/01634370802609262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Despite a growing need for geriatric social workers, there is a question as to whether MSW graduates who are gerontologically prepared actually enter the workforce to serve older adults. By tracking MSW graduates who had special training in aging, this study aims to explore their job search and career experience. Findings show that most graduates located aging-related jobs 4 months postgraduation and remained committed to the field 1 to 2 years later. The majority were working in direct service provision in clinical settings. Their salaries compare favorably with those of generic social workers. Implications for geriatric social work education are discussed.
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Affiliation(s)
- Sang E Lee
- School of Social Work, San Jose State University, San Jose, California 95192-0124, USA.
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Rizzo DC, Schall VT. Representações sociais de cuidadores principais de pacientes com demência. ACTA ACUST UNITED AC 2008. [DOI: 10.1590/s0101-81082008000100010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUÇÃO: As síndromes depressivas e demenciais são os problemas mentais mais prevalentes na população idosa. A qualidade de vida de pacientes com demência depende, primordialmente, daqueles que são responsáveis pelos seus cuidados. Assim, é fundamental a realização de estudos que possam descrever as percepções, interpretações e reações dos cuidadores frente aos diversos tipos de síndromes demenciais, as estratégias encontradas para enfrentá-las associadas aos diferentes atores e a mobilização de referentes culturais em torno da experiência da demência. MÉTODO: No presente estudo, com base na teoria das representações sociais, foram entrevistados 15 cuidadores, visando compreender como estes reconhecem e vivenciam a síndrome demencial e quais são as ações realizadas por eles para lidar com a mesma. RESULTADOS: A análise de conteúdo indicou que o prejuízo nas atividades instrumentais foram os primeiros sinais que alertaram os cuidadores para o problema de seus familiares. Ao mesmo tempo em que os cuidadores consideram eventos de vida, organicidade e hereditariedade para explicar o problema do familiar, levantam também outros aspectos que estão intimamente associados ao contexto sociocultural, influenciando as ações diante das manifestações da síndrome demencial. CONCLUSÃO: Essas são informações essenciais para o planejamento de intervenções e políticas públicas adequadas às características dessa população.
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Searson R, Hendry AM, Ramachandran R, Burns A, Purandare N. Activities enjoyed by patients with dementia together with their spouses and psychological morbidity in carers. Aging Ment Health 2008; 12:276-82. [PMID: 18389409 DOI: 10.1080/13607860801956977] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Caring for a spouse with dementia is stressful and respite care is sometimes used to reduce this burden. Spouses may find some aspects of caring rewarding but the literature on positive aspects of caring is limited. To describe activities enjoyed by patients with dementia together with their spouses, and examine their relationship with psychological morbidity in carers. A convenience sample of 46 patients with mild to moderate dementia (91% with Alzheimer's disease, AD) and their spouses were interviewed at home. Spouses completed the Pleasant Events Schedule (PES-AD) to identify activities enjoyed by patients and spouses on their own and together. Psychological morbidity in spouses was assessed using the General Health Questionnaire (GHQ-12). Cognitive functions, and non-cognitive symptoms were also assessed in patients. Multiple regression analysis using age, Mini-Mental State Examination, Cornell Scale for Depression in Dementia, Revised Memory and Behaviour Problems (RMBP) checklist frequency, and PES-AD- together scores as independent variables found PES-AD-together and RMBP-frequency to be independent predictors of GHQ-12 scores in spouses, but the model could explain only 28% of variance. Facilitating activities that are enjoyed by both patients with dementia and spouses may be an alternative intervention strategy to reduce carer burden.
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Affiliation(s)
- R Searson
- Old Age Psychiatry, North Manchester General Hospital, Manchester Mental Health & Social Care Trust, Manchester, UK
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