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Kim H, Mahmood A, Kedia S, Ogunsanmi DO, Sharma S, Wyant DK. Impact of Residential Segregation on Healthcare Utilization and Perceived Quality of Care Among Informal Caregivers in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02018-9. [PMID: 38758399 DOI: 10.1007/s40615-024-02018-9] [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: 02/01/2024] [Revised: 04/10/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
This study aimed to investigate the impact of racial residential segregation on healthcare utilization and perceived quality of care among informal caregivers in the US. It further assessed potential variations in the estimated impact across caregivers' race and socioeconomic status. We used data from the Health Information National Trends Survey Data Linkage Project (fielded in 2020) for a sample of 583 self-identified informal caregivers in the US. Fitting a series of regression models with the maximum likelihood estimation, we computed the beta coefficients (β) of interest and their associated Wald 95% confidence limits (CI). Caregivers who resided in areas with higher segregation, compared to those living in lower segregated areas, were less likely to visit a healthcare professional [β = - 2.08; Wald 95%CI - 2.093, - 2.067] (moderate); [β = - 2.53; Wald 95%CI - 2.549, - 2.523] (high)]. Further, caregivers residing in moderate [β = - 0.766; Wald 95%CI - 0.770, - 0.761] and high [β = - 0.936; Wald 95%CI - 0.941, - 0.932] segregation regions were less likely to perceive a better quality of care compared to those located in low segregation areas. Moreover, as segregation level increased, Black caregivers were less likely to see a health professional, less frequently used healthcare services, and had poorer perceived healthcare quality when compared to Whites. Our findings indicate that higher residential segregation is associated with lower healthcare utilization, such as visiting a healthcare professional, and poorer perceived healthcare quality among informal caregivers. Given the essential role of informal caregivers in the current healthcare system, it is vital to investigate and address challenges associated with access to and quality of essential healthcare services to improve caregivers' health and well-being, specifically for caregivers of minority backgrounds.
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Affiliation(s)
- Hyunmin Kim
- College of Nursing and Health Professions, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave Avenue, Ste D222A, Memphis, TN, 38103, USA.
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Deborah O Ogunsanmi
- Tennessee Population Health Consortium and Institute for Health Outcomes and Policy Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sadikshya Sharma
- College of Nursing and Health Professions, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - David K Wyant
- Jack C. Massey College of Business, Frist College of Medicine, Belmont University, Nashville, TN, USA
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Cannon CJ, Barry RA. Associations Between Family Caregiving and Romantic Relationships: An Exploratory Study With Nondistressed Couples Caring for an Outside Family Member. THE GERONTOLOGIST 2024; 64:gnad104. [PMID: 37504794 DOI: 10.1093/geront/gnad104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Family caregiving-providing emotional and physical health care for a family member or friend with an illness or disability-can result in many outcomes, including stress and beneficial experiences. Both romantic and caregiving relationships are complex and varied. Nevertheless, little research has examined how caregiving and romantic relationships influence one another. The purpose of this study was to understand ways romantic partners who care for a family member outside of their romantic relationship perceive that their romantic relationship and caregiving experiences influence one another. RESEARCH DESIGN AND METHODS A qualitative study using thematic analysis was conducted. A sample of 5 couples where one or both partners were caring for a relative with dementia participated in interviews about their experiences in family caregiving and in their romantic relationship, as well as how the 2 roles interacted with each other. Couple members were interviewed separately and together. RESULTS From these interviews, themes reflecting ways that caregiving influences romantic relationships, as well as ways romantic relationships influence caregiving emerged. Themes about caregiving influencing romantic relationships were caregiver stress interacting in the romantic relationship, the romantic relationship becoming less of a priority, and benefits experienced in the romantic relationship due to caregiving. Themes about romantic relationships influencing caregiving were partners improving the caregiving experience, and workload inequality. DISCUSSION AND IMPLICATIONS These findings broaden our understanding of how dyadic coping affects family caregiving and may suggest ways that the mutual influences caregivers experience between romantic relationships and caregiving benefits and challenges.
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Affiliation(s)
| | - Robin A Barry
- Department of Family Sciences, University of Toledo Medical Center, Toledo, Ohio, USA
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Ngamasana EL, Zarwell M, Eberly L, Gunn LH. Difference in the physical and mental health of informal caregivers pre- and post-COVID-19 National Emergency Declaration in the United States. SSM Popul Health 2024; 25:101609. [PMID: 38313872 PMCID: PMC10837638 DOI: 10.1016/j.ssmph.2024.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Background The burden of informal caregiving represents a chronic stressor for the informal caregivers (ICs). The study investigates differences in the physical and mental health of ICs and that of non-informal caregivers before and during COVID-19. Methods We used data from the 2019/2020 Behavioral Risk Factor Surveillance System (BRFSS) to investigate differences in the rates of days of poor physical and mental health among ICs compared to non-informal caregivers before and after the COVID-19 National Emergency Declaration (NED). A propensity score model simulated a pseudo experimental design, comparing ICs ("treated") with non-informal caregivers ("control"). A difference-in-difference regression model estimated the incidence rate ratios for days of poor physical and mental health as a function of IC status and time of care provision. Results A total of 44,583 respondents were identified with valid responses on informal caregiving status and key sociodemographic characteristics. Of those, 6.24% (n = 3073) were ICs, matched against 15,365 non-informal caregivers. In the matched sample (n = 18,848), the incidence rate for days of poor physical health among ICs was 17% (p = 0.003) higher compared to non-informal caregivers. The incidence rate for days of poor physical health was 23% (p < 0.001) lower in the post-NED compared to the pre-NED periods. The incidence rate for days of poor mental health was 44% (p < 0.001) higher among ICs compared to non-informal caregivers and 22% higher among respondents who took the survey post-NED compared to those who answered during the pre-NED period. No statistically significant differences were found between the two groups in their incidence rates for days of poor physical and mental health from the pre-to the post-NED period. Conclusion These findings suggest a need to balance between the benefits conferred by public health restrictions versus the mental health burden that may result among certain groups, including ICs, who experience higher negative mental health outcomes.
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Affiliation(s)
- Emery Lady Ngamasana
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Lori Eberly
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Ngamasana EL, Zarwell M, Gunn LH. Physical and mental health of informal caregivers before and during the COVID-19 pandemic in the United States. BMC Public Health 2023; 23:2349. [PMID: 38012592 PMCID: PMC10683238 DOI: 10.1186/s12889-023-17164-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Informal caregiving, a common form of social support, can be a chronic stressor with health consequences for caregivers. It is unclear how varying restrictions during the COVID-19 pandemic affected caregivers' physical and mental health. This study explores pre-post March 2020 differences in reported days of poor physical and mental health among informal caregivers. METHODS Data from the 2019/2020 Behavioral Risk Factor Surveillance System survey were used to match, via propensity scores, informal caregivers who provided care during COVID-19 restrictions to those who provided care before the pandemic. Negative binomial weighted regression models estimated incidence rate ratios (IRRs) and differences by demographics of reporting days of poor physical and mental health. A sensitivity analysis including multiple imputation was also performed. RESULTS The sample included 9,240 informal caregivers, of whom 861 provided care during the COVID-19 pandemic. The incidence rate for days of poor physical health was 26% lower (p = 0.001) for those who provided care during the COVID-19 pandemic, though the incidence rates for days of poor mental health were not statistically different between groups. Informal caregivers with low educational attainment experienced significantly higher IRRs for days of poor physical and mental health. Younger informal caregivers had a significantly lower IRR for days of poor physical health, but higher IRR for days of poor mental health. CONCLUSIONS This study contends that the physical and mental health burden associated with informal caregiving in a period of great uncertainty may be heightened among certain populations. Policymakers should consider expanding access to resources through institutional mechanisms for informal caregivers, who may be likely to incur a higher physical and mental health burden during public health emergencies, especially those identified as higher risk.
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Affiliation(s)
- Emery L Ngamasana
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Fredriksen-Goldsen K, Shuman A, Jen S, Jung HH. Stress and Resilience among Sexual and Gender Diverse Caregivers. Res Aging 2023; 45:654-665. [PMID: 36772866 PMCID: PMC10415531 DOI: 10.1177/01640275231156191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Little is known about caregiving outcomes of sexual and gender diverse, including LGBT, caregivers. Informed by the Health Equity Promotion Model (HEPM) and Pearlin's Stress Process Model, we utilized data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), to examine perceived stress among a sample of 754 sexual and gender diverse caregivers using regressions on background and caregiving characteristics and risk and protective factors. Among caregivers, 38% were providing care to a spouse or partner and about one-third to a friend (29%). Higher stress was associated with younger age, lower income, higher education, partner/spouse care, personal care provision, longer caregiving hours, and caregiver cognitive impairment. After including the risk and protective factors from HEPM, victimization, social support, and community engagement significantly predicted perceived stress. Findings contribute to emergent research on caregiving in diverse populations.
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Affiliation(s)
| | - Abandon Shuman
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Sarah Jen
- School of Social Welfare, University of Kansas, Lawrence, KS, USA
| | - Hailey H Jung
- School of Social Work, University of Washington, Seattle, WA, USA
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Fabà J, Villar F, Westerhof G. Perceived Caregiving Trajectories and their Relationship with Caregivers' Burdens and Gains. THE SPANISH JOURNAL OF PSYCHOLOGY 2023; 26:e12. [PMID: 37144382 DOI: 10.1017/sjp.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The study explores the meanings that family caregivers of people with dementia ascribe to the past, present, and future of their role as a caregiver, and how their integration into caregiving trajectories is related to caregivers' burdens and gains. The sample was made up of 197 family caregivers (Mage = 62.1, SD = 12.3, 70.1% females). They completed three incomplete sentences regarding their past, present, and future caring role, the Zarit Burden Interview and the Gains Associated with Caregiving scale. Sentence completions were content analyzed, and the associations between the resulting trajectories and burdens and gains were studied by means of a one-way ANOVA. Caregivers differed in the meanings ascribed to past, present, and future of their role. Stable-negative (M = 43.6, SD = 13.3), regressive (M = 43.3, SD = 12.7), and present-enhancing (M = 37.4, SD = 13.7) trajectories showed higher levels of burdens than progressive (M = 31.3, SD = 12.3) and/or stable-positive trajectories (M = 26.1, SD = 13.7). Progressive trajectories (M = 38.9, SD = 15.7) were related to more gains than regressive trajectories (M = 28.6, SD = 12.7). Family caregivers' evaluations of their past, present, and future are not only important separately, but their combination into caregiving trajectories is also relevant. Such trajectories might be relevant when designing interventions to help caregivers reduce their burden levels and increase the benefits ascribed to their experience. The most adaptive trajectory identified was the progressive one, whereas the regressive trajectory was the most dysfunctional.
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Chen Y, Zhao H. Long-term care insurance, mental health of the elderly and its spillovers. Front Public Health 2023; 11:982656. [PMID: 36935677 PMCID: PMC10020345 DOI: 10.3389/fpubh.2023.982656] [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: 06/30/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
The paper studies the effects of the long-term care insurance (LTCI) program in China on the mental health of older adults and the wellbeing of their families. We employ the staggered difference-in-differences approach based on the LTCI pilots from 2015 to 2017. First, we find the LTCI program improves older adults' happiness and reduces depression symptoms significantly. The effects on the improvement in memory and cognition are associated with the elderly with activities of daily living-related need for care. Second, the effects of LTCI are partially mediated through providing community services, relieving care burdens, and reducing the incidence of diseases. More importantly, LTCI coverage improves caregivers' physical health and social activities, reflecting its welfare spillover effects. Furthermore, the relationship between LTCI and mental health differs due to the difference in LTCI designs and older adults' demographic characteristics. This presents a need to consider mental health in the services and evaluation criteria of LTCI.
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Affiliation(s)
- Yunfei Chen
- School of Economics, Shanghai University, Shanghai, China
| | - Hong Zhao
- School of Economics, Qingdao University, Qingdao, China
- *Correspondence: Hong Zhao
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Meyer K, Gassoumis Z, Wilber K. The Differential Effects of Caregiving Intensity on Overnight Hospitalization. West J Nurs Res 2022; 44:528-539. [PMID: 33764207 PMCID: PMC8463626 DOI: 10.1177/01939459211002907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to examine how caregiving for a spouse affects caregivers' likelihood of overnight hospitalization. Using data from the Health and Retirement Study, we examine the odds of spousal caregivers experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and change in caregiving intensity. Caregivers were no more likely to experience an overnight hospitalization than noncaregivers (OR = .92; CI [.84, 1.00]). Effects varied by intensity of care. Compared to noncaregivers, caregivers who reported providing no assistance with activities of daily living were less likely to experience overnight hospitalization (OR = .77; CI [.66, .89]); however, caregivers who provided care to someone living with dementia for 4 to <6 years had 2.11 times the odds of experiencing an overnight hospitalization (CI [1.16, 3.85]). Although caregivers overall experience overnight hospitalization at a similar rate as noncaregivers, there are differences between caregivers by the intensity of care.
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Affiliation(s)
- Kylie Meyer
- Caring for the Caregiver, University of Texas Health Science Center at San Antonio
- Glenn Biggs Institute on Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio
| | | | - Kathleen Wilber
- Leonard Davis School of Gerontology, University of Southern California
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Hsu WC, Huang NC, Li DC, Hu SC. The long-term effects of dual caregiving on the caregivers' well-being among middle-aged and older adults in Taiwan. Aging Ment Health 2022:1-8. [PMID: 35585725 DOI: 10.1080/13607863.2022.2076205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES As life expectancy is prolonged, older people may face increased burdens related to supporting multi-generational family members. This study is aimed toward examining the effects of such an emerging type of informal care on the well-being of caregivers. METHODS Participants aged 50 and over from the Taiwan Longitudinal Study on Aging (1996-2007, n = 4,217) were analyzed. We categorized caregiving status according to different care recipients: 1) older adults only, 2) grandchildren only, 3) both older adults and grandchildren (dual caregiving), and 4) non-caregivers. Well-being was measured based on depressive symptoms and degree of life satisfaction. Generalized Estimation Equation models were used to examine the association between types of caregiving and the caregivers' state of well-being. RESULTS After adjusting for all covariates, caregivers of older adults had significantly more depressive symptoms and less life satisfaction than non-caregivers, especially when caregiving for adults with ADL problems. In contrast, caregivers of grandchildren were not significantly affect either depression or life satisfaction as compared with non-caregivers. Interestingly, caregiving for both older adults and grandchildren had no significant effect on depression but positively affected the degree of life satisfaction. CONCLUSION Our findings highlight that simultaneously taking care of both older adults and grandchildren can buffer negative feelings in caregivers or even improve their mental health.
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Affiliation(s)
- Wan-Chen Hsu
- Department of Public Health, College of Medicine, National Cheng Kung, Tainan, Taiwan
| | - Nuan-Ching Huang
- Healthy City Research Center, Innovation Headquarters, National Cheng Kung, Tainan, Taiwan
| | - Der-Chiang Li
- Department of Industrial and Information Management, National Cheng Kung, Tainan, Taiwan
| | - Susan C Hu
- Department of Public Health, College of Medicine, National Cheng Kung, Tainan, Taiwan.,Healthy City Research Center, Innovation Headquarters, National Cheng Kung, Tainan, Taiwan
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Mortality, Morbidity and Health-Related Outcomes in Informal Caregivers Compared to Non-Caregivers: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105864. [PMID: 35627399 PMCID: PMC9141545 DOI: 10.3390/ijerph19105864] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
A systematic overview of mental and physical disorders of informal caregivers based on population-based studies with good methodological quality is lacking. Therefore, our aim was to systematically summarize mortality, incidence, and prevalence estimates of chronic diseases in informal caregivers compared to non-caregivers. Following PRISMA recommendations, we searched major healthcare databases (CINAHL, MEDLINE and Web of Science) systematically for relevant studies published in the last 10 years (without language restrictions) (PROSPERO registration number: CRD42020200314). We included only observational cross-sectional and cohort studies with low risk of bias (risk scores 0–2 out of max 8) that reported the prevalence, incidence, odds ratio (OR), hazard ratio (HR), mean- or sum-scores for health-related outcomes in informal caregivers and non-caregivers. For a thorough methodological quality assessment, we used a validated checklist. The synthesis of the results was conducted by grouping outcomes. We included 22 studies, which came predominately from the USA and Europe. Informal caregivers had a significantly lower mortality than non-caregivers. Regarding chronic morbidity outcomes, the results from a large longitudinal German health-insurance evaluation showed increased and statistically significant incidences of severe stress, adjustment disorders, depression, diseases of the spine and pain conditions among informal caregivers compared to non-caregivers. In cross-sectional evaluations, informal caregiving seemed to be associated with a higher occurrence of depression and of anxiety (ranging from 4 to 51% and 2 to 38%, respectively), pain, hypertension, diabetes and reduced quality of life. Results from our systematic review suggest that informal caregiving may be associated with several mental and physical disorders. However, these results need to be interpreted with caution, as the cross-sectional studies cannot determine temporal relationships. The lower mortality rates compared to non-caregivers may be due to a healthy-carer bias in longitudinal observational studies; however, these and other potential benefits of informal caregiving deserve further attention by researchers.
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Awuviry-Newton K, Tavener M, Wales K, Byles J. Using ethics of care as the theoretical lens to understand lived experiences of caregivers of older adults experiencing functional difficulties. PLoS One 2022; 17:e0267658. [PMID: 35511930 PMCID: PMC9071116 DOI: 10.1371/journal.pone.0267658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
The lived experiences of caregivers of older adults in Ghana are not well understood. The purpose of this study was to explore and discuss the lived experiences of these caregivers using the Ethics of Care as a theoretical lens and Interpretative phenomenological analysis as the methodological approach. Ten caregivers in receipt of social welfare services on behalf of older adults were recruited from the Social Welfare Unit at the Komfo Anokye Teaching Hospital (KATH) in southern Ghana. The analysis identified five interrelated themes: 1) committing the Self to caregiving; 2) caregiving impacting the Self; 3) motivating factors to caregiving; 4) caregiving burdens, and 5) thinking about personal affairs. Their experiences demonstrate that caregivers value the caregiving relationship, as posited by Ethics of Care, and tend to care for their health and well-being. Caregivers’ expression of commitment to caring for older adults is mainly influenced by reciprocity, despite internal and external stressors, and desire to fulfil unmet personal needs. Ethics of care offers an understanding of the lived experiences of caregivers of older adults in Ghana. The findings draw attention to the state to develop specific programs to ensure the health, social and financial well-being of older adults’ caregivers.
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Affiliation(s)
- Kofi Awuviry-Newton
- Centre for Women’s Health Research, The University of Newcastle, Australia
- African Health and Ageing Research Centre, New Castle, Australia
- * E-mail:
| | - Meredith Tavener
- Centre for Women’s Health Research, The University of Newcastle, Australia
- African Health and Ageing Research Centre, New Castle, Australia
| | - Kylie Wales
- Centre for Women’s Health Research, The University of Newcastle, Australia
- Lecturer, School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Julie Byles
- Centre for Women’s Health Research, The University of Newcastle, Australia
- African Health and Ageing Research Centre, New Castle, Australia
- Global Innovation Chair in Responsive Transitions in Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Drine R, Georges A, de Stampa M. Séjours longs en hospitalisation à domicile : impacts des facteurs sociodémographiques, cliniques et des parcours de soins. Rev Epidemiol Sante Publique 2022; 70:97-102. [DOI: 10.1016/j.respe.2022.03.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/15/2022] Open
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Tseliou F, Ashfield-Watt P. The association between resilience resources, contextual factors and mental health status: a national population-based study. BMC Public Health 2022; 22:602. [PMID: 35351041 PMCID: PMC8962564 DOI: 10.1186/s12889-022-13013-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/15/2022] [Indexed: 12/13/2022] Open
Abstract
Background Although a range of risk factors have been linked with poor mental health across the population, the underlying pathways leading to mental ill health remain unclear. There is a need to investigate the effects and interplay of both protective and risk factors. This population-based study aimed to explore the effects of individual and contextual factors on mental health status. Record-linkage was implemented between health and lifestyle data drawn from HealthWise Wales (HWW), a national population health survey of people > 16 years who live or access their healthcare in Wales, and treatment data from primary healthcare records. Mental health status was assessed using three different measures, including the self-reported MHI-5 and WEMWBS scales and mental health treatment in electronic healthcare records (EHR). Result Using cross-sectional data from 27,869 HWW participants aged over 16 years, lifestyle factors, resilience, social cohesion and neighbourhood attraction were associated with mental health across all measures. However, compared to contextual factors, the cluster of individual factors was more closely associated with poor mental health, explaining more of the variance across all measures used (MHI-5: 9.8% versus 5.4%; WEMWBS: 15.9% versus 10.3%; EHR: 5.5% versus 3.0%). Additional analysis on resilience sub-constructs indicated that personal skills were the most closely correlated with poorer mental health. Conclusion Mental health status was more closely linked with individual factors across the population than contextual factors. Interventions focusing on improving individual resilience and coping skills could improve mental health outcomes and reduce the negative effect of contextual factors such as negative neighbourhood perceptions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13013-2.
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Hernandez R, Pyatak EA, Vigen CLP, Jin H, Schneider S, Spruijt-Metz D, Roll SC. Understanding Worker Well-Being Relative to High-Workload and Recovery Activities across a Whole Day: Pilot Testing an Ecological Momentary Assessment Technique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10354. [PMID: 34639654 PMCID: PMC8507775 DOI: 10.3390/ijerph181910354] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/21/2022]
Abstract
Occupational health and safety is experiencing a paradigm shift from focusing only on health at the workplace toward a holistic approach and worker well-being framework that considers both work and non-work factors. Aligned with this shift, the purpose of this pilot study was to examine how, within a person, frequencies of high-workload and recovery activities from both work and non-work periods were associated with same day well-being measures. We analyzed data on 45 workers with type 1 diabetes from whom we collected activity data 5-6 times daily over 14 days. More frequent engagement in high-workload activities was associated with lower well-being on multiple measures including higher stress. Conversely, greater recovery activity frequency was mostly associated with higher well-being indicated by lower stress and higher positive affect. Overall, our results provide preliminary validity evidence for measures of high-workload and recovery activity exposure covering both work and non-work periods that can inform and support evaluations of worker well-being.
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Affiliation(s)
- Raymond Hernandez
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (E.A.P.); (C.L.P.V.); (S.C.R.)
| | - Elizabeth A. Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (E.A.P.); (C.L.P.V.); (S.C.R.)
| | - Cheryl L. P. Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (E.A.P.); (C.L.P.V.); (S.C.R.)
| | - Haomiao Jin
- Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles, CA 90089, USA; (H.J.); (S.S.); (D.S.-M.)
| | - Stefan Schneider
- Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles, CA 90089, USA; (H.J.); (S.S.); (D.S.-M.)
| | - Donna Spruijt-Metz
- Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles, CA 90089, USA; (H.J.); (S.S.); (D.S.-M.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (E.A.P.); (C.L.P.V.); (S.C.R.)
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15
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Rodrigues R, Simmons C, Schmidt AE, Steiber N. Care in times of COVID-19: the impact of the pandemic on informal caregiving in Austria. Eur J Ageing 2021; 18:195-205. [PMID: 33727905 PMCID: PMC7952831 DOI: 10.1007/s10433-021-00611-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/23/2022] Open
Abstract
Much attention has been paid to the effects of the COVID-19 pandemic on long-term care but the impact on informal caregivers has remained speculative. In Austria, like in other European countries, informal care is carried out overwhelmingly by (non-cohabiting) relatives. Limited care services available during the pandemic, social-distancing, increased unemployment and competing care needs within households (e.g. due to school closures) may have changed the prevalence and intensity of informal caregiving. Moreover, these changes may have increased the psychological strain experienced by caregivers. Focusing on Austria, this study aims to empirically analyse the following research questions: how have the prevalence and intensity of informal care changed due to the pandemic? How has the psychological well-being of informal caregivers been affected? We use a pre- and post-onset of the pandemic research design based on a representative survey carried out in Austria in June 2020 (N = 2000) in combination with comparable 2015 data from the European Social Survey. Findings suggest that neither prevalence nor intensity of informal care changed significantly due to the pandemic. However, the psychological well-being gap between carers and non-carers increased with the start of the pandemic, especially among men. Findings are discussed in relation to the policy measures implemented and possible policy implications for the future. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10433-021-00611-z.
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Affiliation(s)
- Ricardo Rodrigues
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Cassandra Simmons
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | | | - Nadia Steiber
- Department of Sociology, University of Vienna, Vienna, Austria
- Institute for Advanced Studies, Vienna, Austria
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Jawahir S, Tan EH, Tan YR, Mohd Noh SN, Ab Rahim I. The impacts of caregiving intensity on informal caregivers in Malaysia: findings from a national survey. BMC Health Serv Res 2021; 21:391. [PMID: 33906646 PMCID: PMC8077883 DOI: 10.1186/s12913-021-06412-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Provision of informal care may adversely affect health, daily and social activities of the informal caregivers, but few studies have examined these effects in relation to caregiving intensity. This study examined the predictive factors associated with the effects of caregiving roles on health, daily and social activities of informal caregivers, accounting for caregiving intensity. METHODS Data of adults aged 18 years and over from the National Health and Morbidity Survey 2019 were used. Respondent's demographic, socioeconomic, health, and caregiving-related characteristics were described using complex samples analysis. Logistic regression analysis was performed to examine the factors affecting health, daily and social activities of caregivers, accounting for caregiving intensity. RESULTS Five point one percent of adults in Malaysia provided informal care. High intensity caregivers were more likely to be actively employed and provided longer duration of care compared with low intensity caregivers. For low intensity caregiving, females, those aged 35-59 years, and those with long-term condition were more likely to have negative effects on health. Daily activities of non-Malays were more likely to be affected, while no factor was found significantly associated with effect on social activities. For high intensity caregiving, caregivers aged 60 and over, those received training and those without assistance were more likely to have negative effects on health. Daily activities of those without assistance were more likely to be affected. Social activities of non-Malays, those received training and those providing care for 2 years or more were more likely to be affected. CONCLUSIONS Our study indicates that both low- and high-intensity caregivers have common features, with the exception of employment status and care duration. Caregiving, regardless of intensity, has a significant impact on caregivers. In order to reduce the negative consequences of caregiving responsibilities, all caregivers need assistance from the community and government, that is customised to their needs. By addressing the factors contributing to the negative effects of caregiving, a continuation of informal caregiving can be sustained through policies supporting the growing demand for informal care necessitated by an ageing population and higher life expectancy in Malaysia.
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Affiliation(s)
- Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Ee Hong Tan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Yeung R'ong Tan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Sarah Nurain Mohd Noh
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Iqbal Ab Rahim
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
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Wranker LS, Elmståhl S, Cecilia F. The Health of Older Family Caregivers - A 6-Year Follow-up. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:190-207. [PMID: 33155521 DOI: 10.1080/01634372.2020.1843098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
It is unclear whether caregiving has an impact on the physical, mental and functional health of older caregivers. This study aimed to describe physical, mental and functional health in relation to family caregiving in old age (60+) over a six-year period. The study comprised 2,294 randomly selected individuals (60-96 years) from the Swedish National Study on Aging and Care, who answered the question on whether they were caregivers and who were followed up six years later. The prevalence of family caregivers was 13.1% and the incidence was 12.4%. Four tracks (T) were identified; T1) Family caregiver both at baseline and follow-up (n = 74), T2) Family caregiver at baseline but not at follow-up (n = 226), T3) non-caregiver at baseline but family caregiver at follow-up (n = 218), T4) non-caregiver both at baseline and follow-up (1,776). Only non-caregivers (T4) reported a decline in mental health, p < .036. Worries about health increased significantly in T2 and T4. The prevalence of caregivers was 13.1% with a high turnover. There are differences between family caregivers and non-caregivers in deterioration in physical and mental health as well as physical function over a six-year period.
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Affiliation(s)
- Lena Sandin Wranker
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University , Lund, Sweden
- Centre for Ageing and Health, AGECAP, University of Gothenburg , Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University , Lund, Sweden
| | - Fagerström Cecilia
- Department of research and development, Blekinge Center of Competence , Karlskrona, Sweden
- Department of Health and Caring Science, Linnaeus University , Kalmar, Sweden
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18
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Mikkola TM, Kautiainen H, Mänty M, von Bonsdorff MB, Koponen H, Kröger T, Eriksson JG. Use of antidepressants among Finnish family caregivers: a nationwide register-based study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2209-2216. [PMID: 33646320 PMCID: PMC8558159 DOI: 10.1007/s00127-021-02049-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to compare the use of antidepressants over 6 years between family caregivers providing high-intensity care and a matched control population using register-based data. METHODS The study includes all individuals, who received family caregiver's allowance in Finland in 2012 (n = 29,846 females, mean age 66 years; n = 12,410 males, mean age 71 years) and a control population matched for age, sex, and municipality of residence (n = 59,141 females; n = 24,477 males). Information on purchases of antidepressants, including the number of defined daily doses (DDD) purchased, between 2012 and 2017 was obtained from the national drugs reimbursement register. RESULTS During the follow-up, 28.5% of female caregivers and 23.5% of the female controls used antidepressants, while the numbers for males were 21.1% and 16.4%, respectively. Adjusted for socioeconomic status, female caregivers used 43.7 (95% confidence interval 42.4-45.0) and their controls used 36.2 (35.3-37.2) DDDs of antidepressants per person-year. Male caregivers used 29.6 (27.6-31.6) and their controls used 21.6 (20.2-23.0) DDDs of antidepressants per person-year. Among female caregivers, the relative risk for use of antidepressants was similar (about 1.3) from 20 to 70 years, after which the relative risk declined. In male caregivers, the relative risk was highest (about 1.4-1.5) between 45 and 65 years. CONCLUSIONS Family caregivers providing high-intensity care use more antidepressants and hence, are likely to have poorer mental health than the age-matched general population in virtually all age groups. However, the magnitude of the higher use varies as a function of age and gender.
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Affiliation(s)
- Tuija M. Mikkola
- Folkhälsan Research Center, PO Box 211, 00251 Helsinki, Finland ,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, PO Box 211, 00251 Helsinki, Finland ,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Minna Mänty
- Unit of Strategy and Research, City of Vantaa, Vantaa, Finland ,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Mikaela B. von Bonsdorff
- Folkhälsan Research Center, PO Box 211, 00251 Helsinki, Finland ,Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Koponen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teppo Kröger
- Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland
| | - Johan G. Eriksson
- Folkhälsan Research Center, PO Box 211, 00251 Helsinki, Finland ,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore ,Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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19
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Gentin M, Marquestaut O, de Stampa M. [Clinical characteristics, care professionals' intervention and care complexity for elderly patients in home hospitalization]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2020; 31:269-276. [PMID: 33263377 DOI: 10.3917/spub.192.0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The number of elderly patients in home care in France is currently increasing. Our objective is to describe the clinical characteristics, the care professionals' intervention and the complexity of follow-up care for this elderly population. METHODS This is a cross-sectional study with a sample of 50 elderly patients aged 75 and over living at home and followed-up in home hospitalization in 2016 by the Assistance Publique Hôpitaux de Paris. The collection of data used the interRAI-CA tool (Resident Assessment Instrument - Contact Assessment). RESULTS The average age of the sample was 84 years with 48% women, 26% living alone and 96% having a caregiver who had difficulty in caring in 33.3% of cases. Patients had numerous diseases with 68% of the sample who had cognitive difficulties with functional disabilities; Most of them reported pain and 52% had unstable clinical situation. The main care interventions were complex wounds, supportive care and palliative care with technical care and 80% of the sample mobilized more than 3 professionals. Care was considered to be of a high level of complexity for 74% of the elderly patients. CONCLUSION Our study showed that elderly patients had care complexity with technical and multi-faceted care implying coordination of stakeholders and support for caregivers. Implementing at-home hospitalization allows to transfer some geriatric patients from hospitalization to the home care and helps the structuration of the geriatric expertise among the primary care services.
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20
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Grenard DL, Valencia EJ, Brown JA, Winer RL, Littman AJ. Impact of Caregiving During Emerging Adulthood on Frequent Mental Distress, Smoking, and Drinking Behaviors: United States, 2015-2017. Am J Public Health 2020; 110:1853-1860. [PMID: 33058707 DOI: 10.2105/ajph.2020.305894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine associations between caregiving mental or behavioral health outcomes among emerging US adults, defined as persons aged 18 to 25 years.Methods. The study sample included emerging adult respondents to the 2015-2017 Behavioral Risk Factor Surveillance System's caregiving module. Exposures were caregiver (n = 3087), expectant caregiver (n = 2303), and noncaregiver (n = 12 216) status. Expectant caregivers were defined as persons not currently providing care but anticipating doing so within the next 2 years. Outcomes included frequent mental distress (FMD), drinking (binge or heavy), and current smoking (cigarette or e-cigarette use). We used robust Poisson regression to calculate adjusted prevalence ratios (APRs) and corresponding 95% confidence intervals (CIs). We adjusted all models for income.Results. Caregivers had a similar prevalence of FMD when compared with both expectant caregivers (APR = 1.67; 95% CI = 1.28, 2.17) and noncaregivers (APR = 1.50; 95% CI = 1.23, 1.82). Caregivers had a higher prevalence of current cigarette smoking compared with noncaregivers (APR = 1.44; 95% CI = 1.21, 1.71).Conclusions. Among emerging adults, providing care is associated with poorer mental health. Point estimates looking at FMD were higher when we compared caregivers with expectant caregivers, suggesting a difference in exchangeability between comparison groups.Public Health Implications. This study highlights the importance of including emerging adults in caregiving research.
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Affiliation(s)
- Deborah L Grenard
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Esteban J Valencia
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Jennifer A Brown
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Rachel L Winer
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Alyson J Littman
- All authors are with the Department of Epidemiology, University of Washington School of Public Health, Seattle. Deborah L. Grenard is also with the University of Washington Center of Excellence in Maternal and Child Health and the University of Washington Leadership Excellence in Neurodevelopmental and Related Disabilities Program, Seattle. Esteban J. Valencia is also with University of Washington Center of Excellence in Maternal and Child Health and University of Washington Center for the Study of Demography and Ecology, Seattle. Jennifer A. Brown is also with the University of Washington Center of Excellence in Maternal and Child Health. Alyson J. Littman is also with Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, and Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
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21
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Mikkola TM, Kautiainen H, Mänty M, von Bonsdorff MB, Kröger T, Eriksson JG. Age-dependency in mortality of family caregivers: a nationwide register-based study. Aging Clin Exp Res 2020; 33:1971-1980. [PMID: 33040307 PMCID: PMC8249300 DOI: 10.1007/s40520-020-01728-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/26/2020] [Indexed: 01/08/2023]
Abstract
Background Evidence on family caregivers' health is conflicting. Aim To investigate all-cause and cause-specific mortality in Finnish family caregivers providing high-intensity care and to assess whether age modifies the association between family caregiver status and mortality using data from multiple national registers. Methods The data include all individuals, who received family caregiver's allowance in Finland in 2012 (n = 42,256, mean age 67 years, 71% women) and a control population matched for age, sex, and municipality of residence (n = 83,618). Information on dates and causes of death between 2012 and 2017 were obtained from the Finnish Causes of Death Register. Results Family caregivers had lower all-cause mortality than the controls over the follow-up (8.1 vs. 11.6%) both among women (socioeconomic status adjusted hazard ratio [HR]: 0.64, 95% CI 0.61–0.68) and men (adjusted HR: 0.73, 95% CI 0.70–0.77). When modelling all-cause mortality as a function of age, younger caregivers had only slightly lower or equal mortality to their controls, but older caregivers had markedly lower mortality than their controls, up to more than 10% lower. Caregivers had a lower mortality rate for all the causes of death studied, namely cardiovascular, cancer, neurological, external, respiratory, gastrointestinal and dementia. The lowest risk was for dementia (subhazard ratio = 0.29, 95% CI 0.25–0.34). Conclusions Older family caregivers had lower mortality than the age-matched general population while mortality did not differ according to caregiver status in young adulthood. This age-dependent advantage in mortality is likely to reflect the selection of healthier individuals into the family caregiver role.
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Affiliation(s)
- Tuija M Mikkola
- Folkhälsan Research Center, Helsinki, Finland.
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Minna Mänty
- City of Vantaa, Vantaa, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Teppo Kröger
- Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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22
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Koopman E, Heemskerk M, van der Beek AJ, Coenen P. Factors associated with caregiver burden among adult (19-64 years) informal caregivers - An analysis from Dutch Municipal Health Service data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1578-1589. [PMID: 32207221 PMCID: PMC7496310 DOI: 10.1111/hsc.12982] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/23/2020] [Accepted: 03/04/2020] [Indexed: 05/25/2023]
Abstract
Due to the ageing population and the rising prevalence of chronic diseases, it is expected that the demand on informal caregivers will increase. Many informal caregivers experience burden, which can have negative consequences for their own health and that of the care recipient. To prevent caregiver burden, it is important to investigate factors associated with this burden. We aimed to identify factors associated with caregiver burden in adult informal caregivers. Among a sample of adult informal caregivers (n = 1,100) of the Dutch region of Zaanstreek-Waterland, perceived caregiver burden, demographic factors, caregiving situation, health-related factors and socio-financial factors were measured as part of the national Health Survey in 2016. Using univariate and multivariate logistic regression analysis, for which a backward selection method was applied, associations with caregiver burden were studied. In the multivariate model, time spent providing informal care was significantly associated with perceived caregiver burden, with an odds ratio (OR) [95% confidence interval] of 7.52 [3.93-14.39] for those spending >16 hr compared to 1-2 hr on informal care. Also providing care to their child(ren) (OR: 2.55 [1.51-4.31]), poor perceived health (OR: 1.80 [1.20-2.68]) and loneliness of the caregiver (OR: 2.05 [1.41-2.99]) were significantly associated with caregiver burden. To possibly prevent and reduce informal caregiver burden, factors associated with such burden should be intervened on. As such, special attention should be paid to caregivers who provide many hours of care or provide care to their child(ren), as well as those who have a poor perceived health themselves and/or experience feelings of loneliness.
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Affiliation(s)
- Emma Koopman
- Public Health Service Zaanstreek‐WaterlandZaanstadThe Netherlands
| | | | - Allard J. van der Beek
- Department of Public and Occupational HealthAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Pieter Coenen
- Department of Public and Occupational HealthAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Cohen SA, Sabik NJ, Cook SK, Azzoli AB, Mendez-Luck CA. Differences within Differences: Gender Inequalities in Caregiving Intensity Vary by Race and Ethnicity in Informal Caregivers. J Cross Cult Gerontol 2020; 34:245-263. [PMID: 31407137 DOI: 10.1007/s10823-019-09381-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Among the 50+ million informal caregivers in the US, substantial gender, racial/ethnic, and socioeconomic disparities in caregiving intensity are well-documented. However, those disparities may be more nuanced: gender disparities in caregiving intensity may vary by race/ethnicity (White, Black, and Hispanic) and socioeconomic status (SES). We used data from the 2011 National Study of Caregiving and applied generalized linear models to estimate associations between three measures of caregiver intensity (ADLs, IADLs, and hours caregiving/month) and the three sociodemographic factors with their interaction terms. Black female caregivers provided significantly higher levels of care than White females and males for both IADL caregiving and hours/month spent caregiving. Black caregivers spent an average of 28.5 more hours/month (95%CI 1.7-45.2) caregiving than White caregivers. These findings highlight the need to understand the complex disparities within population subgroups and how intersections between gender, race/ethnicity, and SES can be used to develop effective policies to reduce disparities and improve caregiver quality-of-life.
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Affiliation(s)
- Steven A Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI, USA.
| | - Natalie J Sabik
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Sarah K Cook
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | | | - Carolyn A Mendez-Luck
- College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, USA
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Jacob L, Smith L, Jackson SE, Shin JI, Haro JM, Vancampfort D, Stubbs B, Koyanagi A. Informal caregiving and physical activity among 204,315 adults in 38 low- and middle-income countries: A cross-sectional study. Prev Med 2020; 132:106007. [PMID: 32001307 DOI: 10.1016/j.ypmed.2020.106007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
Abstract
Data on the association between informal caregiving and physical activity (PA) levels are scarce, especially from low- and middle-income countries (LMICs). Furthermore, previous research has yielded conflicting results. Thus, we investigated this association in adults from 38 LMICs. Data from the World Health Survey (WHS), a cross-sectional, predominantly nationally representative survey conducted in 2002-2004, were analyzed. PA was assessed by the International Physical Activity Questionnaire and participants were dichotomized into those who do (≥150 min of moderate-to-vigorous PA per week) and do not (<150 min = low PA) comply with the World Health Organization PA recommendations. Those who provided help to a relative or friend (adult or child), because this person has a long-term physical or mental illness or disability, or is getting old and weak in the past year were considered to be informal caregivers. Multivariable logistic regression analysis was conducted to assess the associations. There were 204,315 adults aged ≥18 years from 38 LMICs included in this study [mean (standard deviation) age 38.6 (16.1) years; 50.7% female]. Overall, the prevalence of caregiving and low PA was 19.5% and 29.9%, respectively. After adjustment for potential confounders, caregivers were at a lower risk for low PA compared to non-caregivers (OR = 0.79; 95% CI = 0.72-0.86). Engagement in greater number of caregiving activities was associated with lower odds for low PA dose-dependently. Informal caregiving was associated with higher levels of PA in adults in LMICs. Future studies of longitudinal design are warranted to understand causality and the underlying mechanisms of this association.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux 78180, France; Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain.
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom.
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, United Kingdom.
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Republic of Korea.
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain.
| | - Davy Vancampfort
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven, Kortenberg, Belgium.
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom.
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; ICREA, Pg. Lluis Companys 23, Barcelona, Spain.
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Rahman A, Anjum R, Sahakian Y. Impact of Caregiving for Dementia Patients on Healthcare Utilization of Caregivers. PHARMACY 2019; 7:E138. [PMID: 31554156 PMCID: PMC6958358 DOI: 10.3390/pharmacy7040138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 12/24/2022] Open
Abstract
The elderly, whom are vulnerable to the physical, mental and chronic diseases of aging, are the fastest growing segment of the US population. Dementia is of particular concern in this population, and caregivers of people with dementia are subjected to psychological, physical, emotional and functional stress. The purpose of this study was to investigate the impact of caregiving for dementia patients on health care services utilization of caregivers and to examine if caregivers utilize more healthcare services than the control group. The study recruited a total of 143 people in control and non-control groups through non-probability convenience sampling. The control group (non-caregivers) comprised of 71 people, whereas the experimental group (caregivers) consisted of 72 participants. The focus of the study was the health care utilization questionnaire, asking the caregiver about the frequency of specific health care services utilization-including medication use in the last six months, on the scale from 0 to 10. Results were statistically significant for each of the healthcare service utilization when comparing caregivers to the control group. By providing adequate support and assistance in form of support groups, we can alleviate caregivers' burden and more effectively address the needs of caregivers-thereby reducing the utilization of healthcare services.
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Affiliation(s)
- Ateequr Rahman
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA.
| | | | - Yelena Sahakian
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA.
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Hardardottir IH, Bjornsdottir A. Intergenerational Support Contributions of Older People in Iceland to Their Families and Society. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2019. [DOI: 10.1080/15350770.2018.1535345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Amalia Bjornsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, University of Iceland, Reykjavik, Iceland
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Abstract
OBJECTIVES Providing care for a person with dementia or other chronic illness at home often places stress on the primary caregiver. In an Irish population, ~67% of carers reported experiencing extreme physical or mental tiredness. This study aimed to identify factors that influence carer burden and identify the sub-populations of carers who are most susceptible to burden. METHODS Consecutive carers referred to a local carers' support organisation completed the following measurements: the Neuropsychiatric Inventory, Zarit Burden Interview, Social Network Index, General Health Questionnaire, Short Form Survey, Hamilton Depression Rating Scale, Brown's Locus of Control scale and provided demographic data on themselves and their patient. RESULTS The sample consisted 53 carers, mean age: 64.5±11.7, of whom 43 (81.1%) were females. A linear regression model found significant independent (p<0.05) factors for carer burden were: increased behavioural problems of the patient, carer characteristics including female gender, younger age, high number of contacts, lower physical functioning and emotional problems, while protective factors were marriage and higher number of embedded networks. CONCLUSIONS The ability to predict which carers are more susceptible to burden allows service providers to more quickly and accurately identify 'higher risk' carers, facilitating routine check-ups by physicians and carer support services.
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The experience of patients and family caregivers during hospital-at-home in France. BMC Health Serv Res 2019; 19:470. [PMID: 31288804 PMCID: PMC6617632 DOI: 10.1186/s12913-019-4295-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 06/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background Public health policies tend to generalize the use of Hospital-At-Home (HAH) to answer the growing will of patients to be treated or to die at home. HAH is a model of care that provides acute-level services in the patient’s home with the interventions of variety of health care professionals. Relatives participate also in the interventions by helping for sick patients at home, but we lack data on the care of patients and caregivers in HAH. The aim of this study was to make an inventory of the experiences of patients and family caregivers in HAH. Methods The research was qualitative using nineteen semi-directed interviews from nine patients and ten caregivers of one care unit of Greater Paris University Hospitals’ HAH, and the grounded theory was used to analyze the transcripts. Caregivers were also asked, after the interview, to fill in the Zarit Burden Inventory. Results HAH remained mostly unknown for patients and caregivers before the admission proposition and the outlook of being admitted in HAH was perceived as positive, for both of them. Caregivers had a versatile role throughout HAH, leading to situations of suffering, but also had sources of support. The return home was considered satisfactory by both caregivers and patients, related to the quality of care and increased morale despite HAH’s organizational constraints. We noted an impact of HAH on the relationship between the patient and the caregiver(s), but caused by multiple factors: the fact that the care takes places at home, its consequences but also the disease itself. Conclusion HAH strongly involved the patient’s caregiver(s) all along the process. HAH’s development necessitates to associate both patients and caregivers and to take into account their needs at every step. This study highlights the need to better assess the ability of the caregiver to cope with his or her relative in HAH with acute and subacute care at home. Electronic supplementary material The online version of this article (10.1186/s12913-019-4295-7) contains supplementary material, which is available to authorized users.
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29
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Ślusarska B, Bartoszek A, Kocka K, Deluga A, Chrzan-Rodak A, Nowicki G. Quality of life predictors in informal caregivers of seniors with a functional performance deficit - an example of home care in Poland. Clin Interv Aging 2019; 14:889-903. [PMID: 31190775 PMCID: PMC6529176 DOI: 10.2147/cia.s191984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/07/2019] [Indexed: 01/25/2023] Open
Abstract
Background: There is insufficient research into informal caregivers' quality of life (QoL) in Poland. The purpose of this work is to study predictors that considerably affect QoL of informal caregivers (IC) providing home care for seniors with chronic diseases and a functional performance deficit. Materials and methods: In the cross-sectional research design, ICs were randomly chosen among the geriatric population receiving care in 5 primary health care settings. The WHOQoL-AGE questionnaire was used to assess QoL of ICs (n=138). The Barthel scale and Polish version of the Abbreviated Mental Test Score (AMTS) were applied to assess individuals with chronic diseases and functional and mental performance deficits (n=138). The Geriatric Depression Scale Short Form (GDS-SF) was used to measure the extent of risk of depressive symptoms in care-receivers. A hierarchical regression analysis was carried out to determine predictors of caregivers' QoL. Results: Mean values in the group of seniors provided with home care were as follows: the Barthel scale M=43.20, SD=27.06, the AMTS M=7.78 (SD=1.65), and the GDS-SF M=7.34 (SD=3.10). QoL of ICs (the WHOQoL-AGE) was M=70.14 (SD=15.31). Significant predictors of caregivers' QoL turned out to be support in care given by others β =0.605, p<0.001, experience in care β =-0.220; p<0.001, caregivers' health self-assessment β =0.174, p<0.001, and depressive disorders in care-receivers GDS β = -0.178, p<0.001. Conclusions: The QoL of ICs who provide care for individuals with chronic diseases and a functional performance deficit improves with an increase in the support they receive from others, their higher health self-assessment, and greater experience in care. An increase in depressive symptoms in care-receivers determines a lower level of caregivers' QoL.
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Affiliation(s)
- Barbara Ślusarska
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Bartoszek
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Kocka
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Alina Deluga
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Chrzan-Rodak
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Nowicki
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
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Gratão ACM, Brigola AG, Ottaviani AC, Luchesi BM, Souza ÉN, Rossetti ES, de Oliveira NA, Terassi M, Pavarini SCI. Brief version of Zarit Burden Interview (ZBI) for burden assessment in older caregivers. Dement Neuropsychol 2019; 13:122-129. [PMID: 31073389 PMCID: PMC6497029 DOI: 10.1590/1980-57642018dn13-010015] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The degree of burden related to the demands of daily care provided to a dependent older adult is important to evaluate due to the negative influence exerted on caregivers’ physical and psychological health.
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Affiliation(s)
| | - Allan Gustavo Brigola
- MSc. Candidate, Graduate Nursing Program, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Ana Carolina Ottaviani
- MSc. Candidate, Graduate Nursing Program, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Bruna Moretti Luchesi
- PhD. Professors, Universidade Federal do Mato Grosso do Sul - Três Lagoas, MS, Brazil
| | - Érica Nestor Souza
- MSc. Candidate, Graduate Nursing Program, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Estefani Serafim Rossetti
- MSc. Candidate, Graduate Nursing Program, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | | | - Marielli Terassi
- PhD. Professors, Universidade Federal do Mato Grosso do Sul - Três Lagoas, MS, Brazil
| | - Sofia Cristina Iost Pavarini
- PhD. Professors, Undergraduate Program in Gerontology, Universidade Federal de São Carlos, São Carlos, SP, Brazil
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Jamani K, Onstad LE, Bar M, Carpenter PA, Krakow EF, Salit RB, Flowers MED, Lee SJ. Quality of Life of Caregivers of Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2018; 24:2271-2276. [PMID: 29935213 PMCID: PMC6242735 DOI: 10.1016/j.bbmt.2018.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022]
Abstract
Caregivers are critical to recipient recovery after hematopoietic cell transplant (HCT); however, little is known about their long-term health and quality of life (QoL). In this study we surveyed 4446 caregiver-recipient pairs in the post-HCT period to describe their QoL and its determinants. In total, 849 caregiver-recipient pairs at a median of 6 years after autologous or allogeneic HCT responded. Among 849 responding caregivers at a median of 6 years post-HCT, 67% of caregivers were women and 68% indicated they were still providing care to the recipient. Mean and median QoL measures of caregivers were at or above general population norms; however, approximately 20% of caregivers reported poor QoL relative to general population norms. Multivariate analysis revealed that caregiver characteristics, including age, gender, and educational attainment, were important determinants of caregiver QoL. Additional determinants of caregiver QoL included recipient QoL, relapse after autologous HCT, and ongoing use of immunosuppression after allogeneic HCT. Additionally, the prevalence of depression and sleep disorders appear to be higher in caregivers than in the general population. We have identified a population of caregivers who may benefit from interventions aimed at improving QoL and health outcomes. HCT clinical practice should also consider caregiver well-being.
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Affiliation(s)
- Kareem Jamani
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Lynn E Onstad
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Merav Bar
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elizabeth F Krakow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rachel B Salit
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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32
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Stacey AF, Gill TK, Price K, Taylor AW. Differences in risk factors and chronic conditions between informal (family) carers and non-carers using a population-based cross-sectional survey in South Australia. BMJ Open 2018; 8:e020173. [PMID: 30037861 PMCID: PMC6059288 DOI: 10.1136/bmjopen-2017-020173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is growing discussion on the impact of informal caregiving on the health status and morbidity of family carers. Evidence suggests a proportion of carers may be at risk of poor health outcomes. However, there are limited population-based studies that provide representative data on specific risk factors among carers (eg, blood pressure, cholesterol, smoking status, activity and body mass index) and major chronic conditions (eg, asthma, diabetes and arthritis). This study aimed to redress that imbalance. METHOD Self-reported data were from the South Australian Monitoring and Surveillance System (SAMSS), a representative cross-sectional state-wide population-based survey of 600 randomly selected persons per month. SAMSS uses computer-assisted telephone interviewing (CATI) to monitor chronic health-related problems and risk factors and to assess health outcomes. In total, 2247 family carers were identified from 35 195 participants aged 16 years and older for the 5-year period from 2010 to 2015. Logistic regression analyses examined associations of being a carer with self-reported chronic diseases and health risk factors. In addition, the population attributable risk (PAR) of being a carer was examined for selected chronic conditions. RESULTS The prevalence of carers was 6.4%, and peak age group for carers was 50-59 years. Adjusted ORs for chronic conditions in carers were significant for all chronic conditions examined. Although there is a high prevalence of self-reported risk factors and chronic conditions among carers compared with non-carers at the population level, PAR findings suggest that caregiving is associated with a small to moderate increased risk of having these chronic conditions. CONCLUSIONS Monitoring of carer health and morbidity particularly 'at risk' individuals such as female carers with asthma or diabetes remains important and provides an ongoing baseline for future surveys. To achieve this, caregiver-based studies need to become part of mainstream biomedical research at both epidemiological and clinical levels.
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Affiliation(s)
- Anne F Stacey
- Population Research & Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tiffany K Gill
- Population Research & Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kay Price
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Population Research & Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Marzorati C, Renzi C, Russell-Edu SW, Pravettoni G. Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review. J Med Internet Res 2018; 20:e223. [PMID: 29914858 PMCID: PMC6028768 DOI: 10.2196/jmir.9812] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined. OBJECTIVE We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers. METHODS We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework. RESULTS We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions. CONCLUSIONS Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results.
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Affiliation(s)
- Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Saban KL, Griffin JM, Urban A, Janusek MA, Pape TLB, Collins E. Perceived health, caregiver burden, and quality of life in women partners providing care to Veterans with traumatic brain injury. ACTA ACUST UNITED AC 2018; 53:681-692. [PMID: 27997670 DOI: 10.1682/jrrd.2015.07.0143] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/17/2015] [Indexed: 11/05/2022]
Abstract
Families of Veterans with traumatic brain injury (TBI) are often faced with providing long-term informal care to their loved one. However, little is known about how their perceived health and caregiving burden contribute to their quality of life (QOL). The purpose of this descriptive study was to describe perceived health, somatic symptoms, caregiver burden, and perceived QOL and to identify the extent to which these variables are associated with QOL in female partners/spouses of Veterans with TBI. Participants completed a written questionnaire including the Patient Health Questionnaire-15, Caregiver Reaction Assessment, Quality of Life Index, and the general health subscale of the 12-Item Short Form Survey version 2. Caregivers reported moderate levels of QOL, and over a quarter of the sample reported high levels of somatic symptoms, particularly fatigue and sleep disturbance. Age, perceived general health, somatic symptoms, the five subscales of caregiver burden (self-esteem, disrupted schedule, effect on finances, lack of family support, and effect on health) predicted QOL and explained 64% of its variance (adjusted r2 = 0.64, F(8,31) = 9.59). However, only somatic symptoms and the caregiver burden subscales of self-esteem and effect on finances were significant predictors in the model. These findings have implications for development of family-centered interventions to enhance the QOL of informal caregivers of Veterans with TBI.
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Affiliation(s)
- Karen L Saban
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL.,Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
| | | | | | - Theresa Louise-Bender Pape
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL.,Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eileen Collins
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL.,Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL
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Tkatch R, Bazarko D, Musich S, Wu L, MacLeod S, Keown K, Hawkins K, Wicker E. A Pilot Online Mindfulness Intervention to Decrease Caregiver Burden and Improve Psychological Well-Being. J Evid Based Complementary Altern Med 2017; 22:736-743. [PMID: 29228806 PMCID: PMC5871316 DOI: 10.1177/2156587217737204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Interventions to reduce caregiver burden are of great interest as the number of informal family caregivers continues to grow. The purpose of this study was to test the feasibility of an online mindfulness meditation intervention for community-dwelling older adult caregivers and to evaluate its impact on quality of life, caregiver burden, and psychological well-being. A total of 40 caregivers were recruited from 2 community center support groups to participate in an 8-week online mindfulness intervention. Pre and post surveys were administered. Retention rates were high with 55% completing the post surveys and attending at least 5 out of 8 sessions. Matched pairs t test indicated that the intervention reduced caregiver burden, perceived stress, anxiety, and loneliness and improved mental well-being. Online interventions offer flexibility for caregivers regardless of their responsibilities. Future research should expand this opportunity and explore the scalability of online mindfulness interventions.
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Affiliation(s)
| | | | | | - Lizi Wu
- 1 Advanced Analytics, Optum, Ann Arbor, MI, USA
| | | | - Karen Keown
- 3 UnitedHealth Group, Medicare and Retirement, Minneapolis, MN, USA
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36
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Wulandari SK, Hermayanti Y, Yamin A, Efendi F. Family Process with Breast Cancer Patient in Indonesia. JURNAL NERS 2017. [DOI: 10.20473/jn.v12i2.5970] [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
Introduction: Breast cancer occupies the first position in Asia’s women cancer cases in recent years. Signs and symptoms experienced by the patient affect the stress condition of the patient as well as the family as a caregiver. The condition changes to deal with problems during patient assistance as a major problem in an outpatient setting. The demands of adaptation to through the needs during the period of assistance by the family is more complex. The study aimed to determine the experience of stress and adaptation of breast cancer patient’s family.Methods: The qualitative method used with in-depth interviews on seven respondents who were the family caregiver of breast cancer patients. Setting carried out at the shelter house in Bandung. The analysis process used thematic analysis based on Braun & Clarke.Results: The results found five main themes are: 1) Stressor on breast cancer patients, 2) Crisis fulfillment of companion needs, 3) Crisis accompaniment, 4) Coping mechanisms of caregiver, and 5) Ability in adaptation.Conclusion: Family experience in assisting breast cancer patients who undergo outpatient also impact families tension who traversed with a subjective effort optimally to adapt in accompanying patients and the needs of other resource support system. Suggestions for future step are early recognition of stress by health workers especially nurses to be able to provide targeted interventions to develop positive adaptation to clients. The development through research is needed in applying family center care both the outpatient and inpatient care in an integrated manner.
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37
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Messiah A, Lacoste J, Gokalsing E, Shultz JM, Rodríguez de la Vega P, Castro G, Acuna JM. Mental Health Impact of Hosting Disaster Refugees: Analyses from a Random Sample Survey Among Haitians Living in Miami. South Med J 2017; 109:458-64. [PMID: 27490654 DOI: 10.14423/smj.0000000000000502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Studies on the mental health of families hosting disaster refugees are lacking. This study compares participants in households that hosted 2010 Haitian earthquake disaster refugees with their nonhost counterparts. METHODS A random sample survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants were assessed regarding their 2010 earthquake exposure and impact on family and friends and whether they hosted earthquake refugees. Using standardized scores and thresholds, they were evaluated for symptoms of three common mental disorders (CMDs): posttraumatic stress disorder, generalized anxiety disorder, and major depressive disorder (MDD). RESULTS Participants who hosted refugees (n = 51) had significantly higher percentages of scores beyond thresholds for MDD than those who did not host refugees (n = 365) and for at least one CMD, after adjusting for participants' earthquake exposures and effects on family and friends. CONCLUSIONS Hosting refugees from a natural disaster appears to elevate the risk for MDD and possibly other CMDs, independent of risks posed by exposure to the disaster itself. Families hosting refugees deserve special attention.
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Affiliation(s)
- Antoine Messiah
- From the INSERM U-1178, Hôpital Paul Brousse, Villejuif, France, the Center for Disaster & Extreme Event Preparedness, University of Miami Miller School of Medicine, Miami, Florida, and the Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Jérôme Lacoste
- From the INSERM U-1178, Hôpital Paul Brousse, Villejuif, France, the Center for Disaster & Extreme Event Preparedness, University of Miami Miller School of Medicine, Miami, Florida, and the Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Erick Gokalsing
- From the INSERM U-1178, Hôpital Paul Brousse, Villejuif, France, the Center for Disaster & Extreme Event Preparedness, University of Miami Miller School of Medicine, Miami, Florida, and the Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami
| | - James M Shultz
- From the INSERM U-1178, Hôpital Paul Brousse, Villejuif, France, the Center for Disaster & Extreme Event Preparedness, University of Miami Miller School of Medicine, Miami, Florida, and the Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Pura Rodríguez de la Vega
- From the INSERM U-1178, Hôpital Paul Brousse, Villejuif, France, the Center for Disaster & Extreme Event Preparedness, University of Miami Miller School of Medicine, Miami, Florida, and the Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Grettel Castro
- From the INSERM U-1178, Hôpital Paul Brousse, Villejuif, France, the Center for Disaster & Extreme Event Preparedness, University of Miami Miller School of Medicine, Miami, Florida, and the Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Juan M Acuna
- From the INSERM U-1178, Hôpital Paul Brousse, Villejuif, France, the Center for Disaster & Extreme Event Preparedness, University of Miami Miller School of Medicine, Miami, Florida, and the Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami
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James CL, Rusli N, Broady TR. Carers and manual handling: Survey results. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.4.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: There is limited literature specific to manual handling practices among informal carers, with most literature relating to nurses and paid carers. This study aimed to identify the current experiences and practices of informal carers in relation to manual handling and their perceived manual handling needs for this role. Methods: A quantitative cross-sectional study design utilising an online questionnaire was used to survey informal carers who were members of Carers NSW—an organisation for carers in New South Wales, Australia. Seventy-five returned surveys were eligible for inclusion. The data was analysed with descriptive statistics using JMP software (version 10.0.0). Findings: Respondents were predominantly female (74.7%), over 45 years of age (81.1%) and were on a pension (35.8%). Respondents carried out a variety of caring tasks; however, they used limited equipment and received active/interactive training (workshop and training from health professionals) more than passive training (written materials in brochures, books, websites and posters). Conclusions: The study provides information on the manual handling experiences and practices of informal carers. The information can be used by health professionals to develop specific education programmes or appropriate manual handling literature to assist informal carers with this role.
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Affiliation(s)
- Carole L James
- Associate professor, School of Health Sciences, University of Newcastle, Australia
| | - Norsyamimi Rusli
- Assistant director (occupational therapy), Special Education Division, Ministry of Education, Malaysia
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Caregivers for older adults: Prevalence, characteristics, and health care utilization and expenditures. Geriatr Nurs 2017; 38:9-16. [DOI: 10.1016/j.gerinurse.2016.06.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/24/2022]
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Development of a measure to evaluate gains among spanish dementia caregivers: The gains associated with caregiving (GAC) scale. Arch Gerontol Geriatr 2017; 68:76-83. [DOI: 10.1016/j.archger.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 08/02/2016] [Accepted: 09/12/2016] [Indexed: 12/26/2022]
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Abstract
The concept of age-friendliness has been globally coined by the World Health Organization (WHO) to give value to the physical, social, and environmental factors that can promote or hinder older residents' ability to age in place in cities. The initiative has been very successful in raising awareness among public health policy makers about the generic needs of older adults and urban features that promote active aging. However, the movement has been less focused on highlighting divergent needs of different older adult populations and their informal caregivers. The objective of this mixed method study is to analyze the ratings of 397 caregivers of urban age-friendly features relative to the ratings of 1737 noncaregivers collected as part of a baseline assessment of the age-friendliness of the city of Chicago. Using the approved WHO Vancouver Protocol, the research team also conducted six mixed caregiver/noncaregiver focus groups (n = 84) and three caregiver-only focus groups (n = 21). Survey findings show that informal caregivers rate all eight age-friendly domains with less satisfaction than do noncaregivers. Discussion in focus groups highlighted some of the reasons for these less favorable ratings and foregrounded the domains and themes that mattered most to caregivers. In conclusion, while our study revealed few systematic differences between caregiver and noncaregiver survey satisfaction ratings, caregivers report significantly poorer health than do noncaregivers. In addition, caregiver-only focus groups foregrounded "missing" priority issues specific to caregivers such as respite and the quality of training and flexibility of home help care. Results suggest that one productive next step for researchers would be to widen the usual range of factors considered essential for maintaining the well-being of informal caregivers of community-dwelling older adults. The age-friendly domains provide a starting point for this. Another would be to develop integrated support and improve service responsiveness to particular caregiver/care recipient dyad's physical, psychological, and social needs.
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Affiliation(s)
- Rebecca Johnson
- Buehler Center on Aging, Health and Society, Feinberg School of Medicine Northwestern University, Chicago, IL, USA.
| | - Jon Hofacker
- The University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Lara Boyken
- Buehler Center on Aging, Health and Society, Feinberg School of Medicine Northwestern University, Chicago, IL, USA
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Bailes CO, Kelley CM, Parker NM. Caregiver burden and perceived health competence when caring for family members diagnosed with Alzheimer's disease and related dementia. J Am Assoc Nurse Pract 2016; 28:534-540. [PMID: 27073005 DOI: 10.1002/2327-6924.12355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 01/30/2016] [Indexed: 11/08/2022]
Abstract
PURPOSE To identify if there is a relationship between perceived health competence and burden of care of informal caregivers of family members with Alzheimer's disease and related dementia (ADRD). DATA SOURCES Informal caregivers 18 years and older who received services from the Alzheimer's Resource of Alaska were invited to complete a survey. CONCLUSIONS Findings indicate that there was a negative correlation between perceived health competence and burden of care (N = 64, r = -.54, p < .001). Additionally, there was a negative correlation within the three subscales of the Modified Montgomery-Borgatta Caregiver Burden Scale: objective burden (r = -.65, p = < .001), stress burden (r = -.41, p = .001), and relationship burden (r = -.29, p = .021, p = .001). IMPLICATIONS FOR PRACTICE Based on the findings of an association between increased caregiver burden and the perception of decreased health competence, nurse practitioners (NPs) can play an important role in assessing caregiver burden. The results of this study enlighten NPs about informal caregiver burden and will help guide discussions and assessments during routine healthcare visits with the goal of achieving optimal health for informal caregivers.
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Affiliation(s)
- Christine O Bailes
- Department School of Nursing, University of Alaska Anchorage, Anchorage, Alaska. ,
| | - Colleen M Kelley
- Department School of Nursing, University of Alaska Anchorage, Anchorage, Alaska
| | - Nadine M Parker
- Department School of Nursing, University of Alaska Anchorage, Anchorage, Alaska
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Burns EJ, Quinn SJ, Abernethy AP, Currow DC. Caregiver Expectations: Predictors of a Worse Than Expected Caregiving Experience at the End of Life. J Pain Symptom Manage 2015; 50:453-61. [PMID: 26004400 DOI: 10.1016/j.jpainsymman.2015.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 04/16/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT The gap between informal caregivers' expectations of caregiving at the end of life and their actual caregiving experience has important affective and behavioral consequences. OBJECTIVES This study analyzes for the first time the characteristics of those caregivers who report a worse or much worse than expected caregiving experience, providing a potential for future targeted intervention into the caregiving experience. METHODS The South Australian Health Omnibus is an annual, random, face-to-face, and cross-sectional survey. From 2000 to 2007, respondents were asked a range of questions about end-of-life care, including in several years a question about how the caregiving experience compared with caregivers' expectation(s). Family members and friends who reported a worse or much worse than expected caregiving experience were the focus of this analysis. Univariable and multivariable logistic regression models were created to better define this group. RESULTS Of the 1628 active caregivers for people at the end of life, almost half (48.3%) reported a worse or much worse than expected caregiving experience. A worse or much worse than expected caregiving experience was significantly associated with gender and with level of care provided. Women who provided daily hands-on care were significantly more likely to have a worse than expected experience compared with women who provided intermittent care (odds ratio [OR] 0.65; 95% CI 0.48-0.88; P = 0.005) or rare care (OR 0.39; 95% CI 0.27-0.56; P < 0.001). Of all those providing rare care, women were significantly less likely than men to report a worse than expected caregiving experience (OR 0.61; 95% CI 0.41-0.93; P = 0.020). CONCLUSION Caregiver expectations represent a novel and important focus for investigation into the caregiver experience. Explicitly eliciting expectations may in future lead to ways of better supporting caregivers.
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Affiliation(s)
- Emma J Burns
- Central Adelaide Palliative Care Services, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Stephen J Quinn
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Amy P Abernethy
- Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - David C Currow
- Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
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Abstract
Caring for a person with Alzheimer's disease often sees the elderly carer at risk of succumbing to frailty. The chronic stress which comes with this caregiving can lead to physical and emotional exhaustion, for which the physiological reserves of the ageing person may be insufficient. The concept of frailty may help to improve the understanding of this vulnerability.
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Affiliation(s)
- Eva de Peretti
- Gérontopôle, CHU de Toulouse, Hôpital de jour gériatrique Pavillon Junod, 170 chemin de Casselardit, 31300 Toulouse, France
| | - Hélène Villars
- Gérontopôle, CHU de Toulouse, Hôpital de jour gériatrique Pavillon Junod, 170 chemin de Casselardit, 31300 Toulouse, France.
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Dahlrup B, Ekström H, Nordell E, Elmståhl S. Coping as a caregiver: A question of strain and its consequences on life satisfaction and health-related quality of life. Arch Gerontol Geriatr 2015; 61:261-70. [DOI: 10.1016/j.archger.2015.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/17/2022]
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Moriarty J, Maguire A, O'Reilly D, McCann M. Bereavement After Informal Caregiving: Assessing Mental Health Burden Using Linked Population Data. Am J Public Health 2015; 105:1630-7. [PMID: 26066918 DOI: 10.2105/ajph.2015.302597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared the mental health risk to unpaid caregivers bereaved of a care recipient with the risk to persons otherwise bereaved and to nonbereaved caregivers. METHODS We linked prescription records for antidepressant and anxiolytic drugs to characteristics and life-event data of members of the Northern Ireland Longitudinal Study (n = 317 264). Using a case-control design, we fitted logistic regression models, stratified by age, to model relative likelihood of mental health problems, using the proxy measures of mental health-related prescription. RESULTS Both caregivers and bereaved individuals were estimated to be at between 20% and 50% greater risk for mental health problems than noncaregivers in similar circumstances (for bereaved working-age caregivers, odds ratio = 1.41; 95% confidence interval = 1.27, 1.56). For older people, there was no evidence of additional risk to bereaved caregivers, though there was for working-age people. Older people appeared to recover more quickly from caregiver bereavement. CONCLUSIONS Caregivers were at risk for mental ill health while providing care and after the death of the care recipient. Targeted caregiver support needs to extend beyond the life of the care recipient.
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Affiliation(s)
- John Moriarty
- John Moriarty is with the Administrative Data Research Centre for Northern Ireland, Queen's University Belfast, Belfast, Ireland. Aideen Maguire and Dermot O'Reilly are with the Centre for Public Health, Queen's University Belfast. Mark McCann is with the Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Aideen Maguire
- John Moriarty is with the Administrative Data Research Centre for Northern Ireland, Queen's University Belfast, Belfast, Ireland. Aideen Maguire and Dermot O'Reilly are with the Centre for Public Health, Queen's University Belfast. Mark McCann is with the Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Dermot O'Reilly
- John Moriarty is with the Administrative Data Research Centre for Northern Ireland, Queen's University Belfast, Belfast, Ireland. Aideen Maguire and Dermot O'Reilly are with the Centre for Public Health, Queen's University Belfast. Mark McCann is with the Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Mark McCann
- John Moriarty is with the Administrative Data Research Centre for Northern Ireland, Queen's University Belfast, Belfast, Ireland. Aideen Maguire and Dermot O'Reilly are with the Centre for Public Health, Queen's University Belfast. Mark McCann is with the Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
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Abstract
OBJECTIVES Studies investigating health effects of work and family stress usually consider these factors in isolation. The present study investigated prospective interactive effects of job strain and informal caregiving on allostatic load (AL), a multisystem indicator of physiological dysregulation. METHODS Participants were 7007 British civil servants from the Whitehall II cohort study. Phase 3 (1991-1994) served as the baseline, and Phases 5 (1997-1999) and 7 (2002-2004) served as follow-ups. Job strain (high job demands combined with low control) and caregiving (providing care to aged or disabled relatives) were assessed at baseline. AL index (possible range, 0-9) was assessed at baseline and both follow-ups based on nine cardiovascular, metabolic, and immune biomarkers. Linear mixed-effect models were used to examine the association of job strain and caregiving with AL. RESULTS High caregiving burden (above the sample median weekly hours of providing care) predicted higher AL levels, with the effect strongest in those also reporting job strain (b = 0.36, 95% confidence interval = 0.01-0.71); however, the interaction between job strain and caregiving was not significant (p = .56). Regardless of job strain, participants with low caregiving burden (below sample median) had lower subsequent AL levels than did non-caregivers (b = -0.22, 95% confidence interval = -0.06--0.37). CONCLUSIONS The study provides some evidence for adverse effects of stress at work combined with family demands on physiological functioning. However, providing care to others may also have health protective effects if it does not involve excessive time commitment.
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Thomas GPA, Saunders CL, Roland MO, Paddison CAM. Informal carers' health-related quality of life and patient experience in primary care: evidence from 195,364 carers in England responding to a national survey. BMC FAMILY PRACTICE 2015; 16:62. [PMID: 25975608 PMCID: PMC4446949 DOI: 10.1186/s12875-015-0277-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 05/06/2015] [Indexed: 01/21/2023]
Abstract
Background We aim to describe the health-related quality of life of informal carers and their experiences of primary care. Methods Responses from the 2011-12 English General Practice Patient Survey, including 195,364 informal carers, were analysed using mixed effect logistic regressions controlling for age, gender, ethnicity and social deprivation to describe carer health-related quality of life (mobility, self-care, usual activities, pain, and anxiety/depression, measured using EQ-5D) and primary care experience (access, continuity and communication). Results Informal carers reported poorer health-related quality of life than non-carers of similar age, gender, ethnicity and social deprivation. Increasing caring commitment was associated with worse EQ-5D scores, with carers of 50+ hours a week scoring 0.05 points lower than non-carers (95 % CI 0.05 to 0.04), equivalent to 18 fewer days of full health annually. Considering each domain of EQ-5D separately, carers of 50+ hours/week were more likely to report pain OR = 1.53 (1.50-1.57), p < 0.0001, and anxiety/depression OR = 1.69 (1.66-1.73), p < 0.0001, than non-carers. Younger carers scored lower on EQ-5D than non-carer peers but the converse was true among over-85s. In the most deprived areas carers reported the equivalent of 37 fewer days of full health annually than carers in the most affluent areas. On average, carers reported poorer patient experiences in all areas of primary care than non-carers (odds ratios 0.84-0.97), with this difference being most marked in the domain of access. Conclusions Informal carers experience a double disadvantage of poorer health-related quality of life and poorer patient experience in primary care. We find no evidence for health benefits of caregiving. We recommend physicians identify and treat carer health problems, including pain and anxiety/depression, particularly among young, deprived and high time-commitment carers. Improving patient experience for carers, including access to primary care, should be a priority. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0277-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gwilym P A Thomas
- Cambridge Centre for Health Services Research Primary Care Unit, University of Cambridge, Cambridge, UK.
| | | | - Martin O Roland
- Cambridge Centre for Health Services Research Primary Care Unit, University of Cambridge, Cambridge, UK.
| | - Charlotte A M Paddison
- Cambridge Centre for Health Services Research Primary Care Unit, University of Cambridge, Cambridge, UK. .,Department of Psychology, Anglia Ruskin University, Cambridge, UK.
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Tuithof M, ten Have M, van Dorsselaer S, de Graaf R. Emotional disorders among informal caregivers in the general population: target groups for prevention. BMC Psychiatry 2015; 15:23. [PMID: 25884352 PMCID: PMC4337323 DOI: 10.1186/s12888-015-0406-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 02/03/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are indications that informal caregiving negatively impacts caregivers' mental health, but this was hardly examined using diagnoses of mental disorders and most studies used convenience samples without including non-caregivers as reference group. We examine whether informal caregivers more often have any emotional disorder, i.e. mood or anxiety disorder, than non-caregivers. Identify key risk indicators for any emotional disorder among informal caregivers in the general population. METHODS Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face survey (n = 5,303; aged 21-68). Respondents were defined as informal caregiver when they provided unpaid care in the 12 months preceding the second wave to a family member, partner or friend who needed care because of physical or mental problems, or ageing. Twelve-month DSM-IV diagnoses of emotional disorders were assessed using the Composite International Diagnostic Interview 3.0. Key risk indicators were identified using the following aspects: prevalence, odds ratio, attributable risk proportion, and number needed to treat. Sociodemographic, caregiving-related and other characteristics were considered as risk indicators. RESULTS In the past year, 31.1% of the respondents provided informal care, which ranged in time spent (8 or more hours/week: 32.1%) and duration (longer than 1 year: 48.7%). Informal caregiving was not associated with having any 12-month emotional disorder. Among caregivers, giving care to a first-degree relative, partner or close friend and giving emotional support increased the risk for any emotional disorder. Moreover, using all aspects, target groups were identified for prevention: caregivers without a job, living without a partner, and with a lack of social support. CONCLUSIONS Although informal caregivers do not have an increased risk of emotional disorders, key risk indicators were identified using four aspects. Especially informal caregivers with limited resources (unemployment, living without a partner, lack of social support) may benefit from targeted prevention whereas general prevention measures may be desirable for carers with a burdensome care situation (giving care to a close loved one or providing emotional support).
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Affiliation(s)
- Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, the Netherlands.
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, the Netherlands.
| | - Saskia van Dorsselaer
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, the Netherlands.
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, the Netherlands.
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The Physical Health of Patients with Advanced Pancreatic Cancer and the Psychological Health of their Family Caregivers When Newly Enrolled in Hospice. J Hosp Palliat Nurs 2015; 17:235-241. [PMID: 26617469 DOI: 10.1097/njh.0000000000000154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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