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Monteiro I, Brito L, Pereira MG. Burden and quality of life of family caregivers of Alzheimer's disease patients: the role of forgiveness as a coping strategy. Aging Ment Health 2024; 28:1003-1010. [PMID: 38425032 DOI: 10.1080/13607863.2024.2320138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES This study aimed to evaluate the variables that were associated, contributed and moderated quality of life (QoL) and burden in family caregivers. METHODS A total of 130 participants were evaluated using the following instruments: Depression, Anxiety and Distress Scale; Index of Family Relations; Heartland Forgiveness Scale; Burden Interview Scale; Short Form Health Survey. RESULTS Being a younger caregiver, less distress, better family relationships and greater use of forgiveness were associated with more QoL. Also, family caregivers who chosethe caregiving role, less distress, better family relationships and greater use of forgiveness showed lower levels of burden. Age, distress and forgiveness contributed to QoL. In turn, the choice to become a family caregiver, distress, and forgiveness contributed to burden. Forgiveness played a moderating role in the relationship between family relationships and burden. CONCLUSION Based on the results, there is a need to intervene in older family caregivers, particularly those who did not choose to become a caregiver, who report greater distress, have worse family relationships, and display less use of forgiveness, in order to decrease their burden and promote QoL.
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Affiliation(s)
- Isabela Monteiro
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Laura Brito
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - M Graça Pereira
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
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2
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Strupp J, Kasdorf A, Karneboge J, Voltz R. What Keeps the Family Caregiver Motivated to Care for Their Dying Relative at Home? A Brief Report of a Qualitative Interview Study. Palliat Med Rep 2024; 5:201-205. [PMID: 39044762 PMCID: PMC11262578 DOI: 10.1089/pmr.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 07/25/2024] Open
Abstract
Background Dying at home poses many challenges for family carers and is particularly distressing for those with limited social support. In addition to financial hardship, this perceived burden may be a deciding factor in providing care at home. Aims To explore what motivates people to provide care at home until death. Methods Qualitative interviews with 43 family carers of deceased patients about factors enabling death at home. Interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis. Results Participants who rated their end-of-life experience positively reported that they particularly benefited from encouraging feedback and gratitude from their dying loved ones, as well as appraisal support. It takes courage to care for someone at home and to feel responsible for them. These themes made the participants' home care efforts meaningful, gave them confidence in what they were doing and helped maintain their motivation to care. Conclusion Encouraging feedback and appraisal support are both minimally invasive techniques with maximum impact for continuing care at home.
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Affiliation(s)
- Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Alina Kasdorf
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Jonas Karneboge
- Department of Psychology, Psychological Aging Research (PAR), Faculty V: School of Life Sciences, University of Siegen, Siegen, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Health Services Research, University of Cologne, Cologne, Germany
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3
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Sun PC, Shen HW. The Effect of Home- and Community-Based Services on Social Engagement. J Appl Gerontol 2024; 43:242-250. [PMID: 37914279 DOI: 10.1177/07334648231205386] [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: 11/03/2023] Open
Abstract
Objectives: Home- and community-based services (HCBS) help older adults to remain active in community settings. However, it is not known if there is a causal relationship between HCBS and social engagement. Methods: We used data from the 2010 and 2012 Health and Retirement Study and measured the effect of HCBS on social engagement via nearest-neighbor Mahalanobis matching, optimal pair matching, genetic matching, and optimal full matching. Results: Genetic matching showed that the odds of social engagement for participants who received at least one HCBS (congregate meal, home-delivered meal, transportation service, case management, homemaker or housekeeping services, or caregiver services) in the prior two years was 1.07 times more likely than participants who have not received any HCBS (robust SE = .030, p = .040). Discussion: HCBS may remove barriers to social engagement through increasing older adults' personal resources and personal networks.
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Affiliation(s)
- Peter C Sun
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Huei-Wern Shen
- Department of Social Work, College of Health and Public Service, University of North Texas, Denton, TX, USA
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4
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Shin JY, Pohlig R, Habermann B. Impacts of Perceived Choice on Physical Strain, Emotional Stress and Health among Caregivers. West J Nurs Res 2023; 45:826-832. [PMID: 37431090 DOI: 10.1177/01939459231186900] [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] [Indexed: 07/12/2023]
Abstract
BACKGROUND Having no choice in becoming a caregiver has been associated with higher levels of emotional stress and physical strain. This secondary analysis examined associations between caregivers' perceived choice and health outcomes. METHODS This study utilized data from caregivers who answered a question about whether they felt they had a choice to take on caring for a care recipient in the Caregiving in the U.S. in 2020 survey. Variables of caregivers' and recipients' characteristics, caregiving activities, and health outcomes were extracted. Data were analyzed using descriptive statistics, t-tests, Chi-squared tests, and regression models. RESULTS More than half of the 1,642 caregivers (54.4%) perceived no choice in becoming a caregiver. Having no choice was associated with higher levels of physical strain and emotional stress, and greater negative impact on caregiver's health. Other predictive variables of higher physical strain included being a primary caregiver, recipients having more comorbidities, and a higher level of care intensity. Higher education level, household income, number of recipient's conditions, level of care intensity, and being a primary caregiver were associated with higher levels of emotional stress. Taking care of a spouse and non-relative compared to taking care of a grandparent or parent was associated with lower emotional stress. Recipients with more comorbidities and higher care intensity were associated with worse caregiver health. CONCLUSIONS There is a need to screen and identify caregivers who have no choice in caregiving and assist them in providing care for their recipient to prevent them from being invisible patients.
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Affiliation(s)
- Ju Young Shin
- Associate Professor, School of Nursing, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Ryan Pohlig
- Director of the Biostatistics Core, Assistant Professor of Epidemiology, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Barbara Habermann
- Dean and Professor of Nursing, School of Nursing, Pacific Lutheran University, Tacoma, WA, USA
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5
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Ferraris G, Zarzycki M, Gérain P, Elayan S, Morrison V, Sanderman R, Hagedoorn M. Does willingness to care fluctuate over time? A weekly diary study among informal caregivers. Psychol Health 2023:1-19. [PMID: 37608731 DOI: 10.1080/08870446.2023.2249538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 07/21/2023] [Accepted: 08/12/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Informal caregivers are expected to be willing to care for relatives with care needs. Little is known about whether and how willingness to care changes over time. Using a weekly diary study, we examined changes in the willingness of 955 caregivers from nine countries. Caregivers provided information on their caregiving context, relationship type, and relationship satisfaction with the care recipient. METHODS AND MEASURES For 24 consecutive weeks, caregivers evaluated willingness to care as it was 'right now'. RESULTS Willingness differs from one caregiver to another (68% between-level variability) but also fluctuates in the same caregiver from week to week (32% within-level variability), with a decrease over 6 months (intercept = 8.55; slope = -0.93; p < .001). Regardless of individual differences in average willingness to care based on caregiving context and relationship satisfaction, caregivers reported decreases in willingness. Caregivers who presented one or more health conditions themselves reported higher weekly fluctuations in willingness than caregivers with no health conditions. CONCLUSION Willingness is not a stable attitude because it decreases and caregivers experience fluctuations from week to week. A clearer understanding of weekly processes is optimal for monitoring the caregivers' well-being and tailoring interventions in line with weekly individual variations.
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Affiliation(s)
- Giulia Ferraris
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mikołaj Zarzycki
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Pierre Gérain
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Saif Elayan
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Val Morrison
- School of Human and Behavioural Science, Bangor University, Bangor, UK
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Osborne T, Lowe TA, Meijering L. Care and rhythmanalysis: Using metastability to understand the routines of dementia care. Soc Sci Med 2023; 331:116099. [PMID: 37478663 DOI: 10.1016/j.socscimed.2023.116099] [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: 02/06/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
An increasing number of people living with dementia worldwide receive informal care from their family members. A key element of dementia care is maintaining a daily routine and familiarity, making caring an extremely rhythmic practice. To explore the rhythmic nature of informal care, we apply and advance Lefebvre's unfinished rhythmanalysis by developing an original typology of eurhythmia as a metastable equilibrium. Metastability, although appearing macroscopically stable, is a vulnerable state where a slight disturbance can result in deviation to another state (i.e., stable or unstable). Drawing upon interviews with informal caregivers, we discuss the rhythms and (dis)harmonies of caring practice, including the substantial rhythms of caring practice, the relational balance of rhythms between the caregiver and care recipient, and the various rhythmic disruptions that occur. We demonstrate how metastability provides an understanding of the ever-changing rhythms of every day and allows us to move beyond the immediacy of arrhythmic breaks and explore the subtle changes that occur in (poly)rhythms. Thus, eurhythmia as a metastable equilibrium allows us to explore the gradual and subtle development of, and changes to, dementia care and other routine practices in health geography.
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Affiliation(s)
- Tess Osborne
- School of Geography, Geology and the Environment, University of Leicester, UK; Population Research Centre, Faculty of Spatial Sciences, University of Groningen, the Netherlands.
| | - Thomas A Lowe
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, the Netherlands
| | - Louise Meijering
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, the Netherlands
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7
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Larocque S, Rietze L, Heale R. Helping the helpers: Understanding information and support needs of caregivers in underserved communities. DEATH STUDIES 2023; 48:361-370. [PMID: 37427573 DOI: 10.1080/07481187.2023.2230551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Informal caregivers caring for patients at the end of life in rural geographic areas may have inadequate support due to insufficient community-based palliative care services. We conducted a parallel mixed-methods study to understand informal caregivers' unmet supportive, educational, and informational needs living in rural areas with limited community-based palliative care services. Forty-four caregivers of loved ones that died at home between December 2017 and September 2020 completed the Carer Support Needs Assessment Tool (CSNAT) and 14 caregivers were interviewed. Using a parallel mixed analysis, results showed that caregiver distress was associated with unmet information needs about how to accurately assess and manage pain levels and identify signs and symptoms of end-of-life. Caregivers needed more support related to available, knowledgeable, and well-trained home health care providers, accessible equipment, 24-hour respite care, accessible grief counseling, and a central triage contact number for community support.
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Affiliation(s)
- Sylvie Larocque
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
| | - Lori Rietze
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
| | - Roberta Heale
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
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Charenkova J. " Parenting my parents": Perspectives of adult children on assuming and remaining in the caregiver's role. Front Public Health 2023; 11:1059006. [PMID: 36875393 PMCID: PMC9982148 DOI: 10.3389/fpubh.2023.1059006] [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: 09/30/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Background Family caregivers are essential when responding to the long-term care needs of aging societies. The complex and multifaceted caregiver's role encompasses a unique set of challenges and strains, however, it can be a rewarding experience with many benefits and positive outcomes. Moreover, there is a link between the caregiver's wellbeing, quality of care, and the quality of life of the care recipient. Thus, the current study aimed to explore why adult children are assuming and remaining in the caregiver's role despite its challenges. Methods Research data was collected through the use of qualitative semi-structured interviews from September 2021 to July 2022. In total 16 Lithuanian and Italian caregivers were recruited through convenience/snowball sampling. The study utilized the constructivist grounded theory for data analysis and self-determination theory for data interpretation. Results Adult children's caregiving experiences revealed three themes related to the motivation to assume and continue with family care: (1) believing in the inherent value of family care; (2) making sense of the changing nature of caregiving; and (3) "making the best of it". Key motivational drivers of these decisions were associated with the satisfaction of the three basic psychological needs - autonomy, competence, and relatedness. Results show that finding meaning and making sense of the caregiving role when responding to a parent's increased care needs may result in positive caregiving experiences and outcomes even at rather low levels of the care recipient's autonomy. Conclusion Caregivers were able to experience family care as a meaningful and rewarding experience while acknowledging its challenges and limitations. Implications for family caregiving decisions and experiences, social policy, and future research are discussed in more depth in the paper.
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Affiliation(s)
- Jūratė Charenkova
- Faculty of Philosophy, Institute of Sociology and Social Work, Vilnius University, Vilnius, Lithuania
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9
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Harris ML, Errickson J, Ha J, Hoffman GJ. Depressive Symptoms and Caregiving Intensity Before and After Onset of Dementia in Partners: A Retrospective, Observational Study. Med Care 2022; 60:844-851. [PMID: 36038513 PMCID: PMC9588760 DOI: 10.1097/mlr.0000000000001771] [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: 11/26/2022]
Abstract
BACKGROUND Caring for a partner with dementia poses significant emotional burden and high care demands, but changes in impacts before and after dementia onset is unclear. OBJECTIVE Examine changes in depressive symptoms and hours of care provided by caregivers through the course of their partners' cognitive decline. METHODS Retrospective, observational study using household survey data from 2000-2016 Health and Retirement Study and count models to evaluate older individuals' (ages ≥51 y) depressive symptoms (measured using the shortened Center for Epidemiologic Studies Depression Scale) and weekly caregiving in the 10 years before and after their partners' dementia onset (identified using Telephone Interview Cognitive Status screening). Relationships were examined overall and by sex and race. RESULTS We identified 8298 observations for 1836 older caregivers whose partners developed dementia. From before to after partners' dementia onset, caregivers' mean (SD) depressive symptoms increased from 1.4 (1.9) to 1.9 (2.1) ( P <0.001) and weekly caregiving increased from 4.4 (19.7) to 20.8 (44.1) ( P <0.001) hours. Depressive symptoms and caregiving hours were higher for women compared with men. Depressive symptoms were higher for Blacks compared with Whites, while caregiving hours were higher for Whites. The expected count of caregivers' depressive symptoms and caregiving hours increased by 3% ( P <0.001) and 9% ( P =0.001) before partners' dementia onset and decreased by 2% ( P <0.001) and 1% ( P =0.63) following partners' dementia onset. No differences observed by sex or race. DISCUSSION Depressive symptoms and instrumental burdens for caregivers increase substantially before the onset of dementia in partners. Early referral to specialty services is critical.
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Affiliation(s)
- Melissa L. Harris
- Clinical & Translational Science Institute, National Clinician Scholars Program, Duke University
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Josh Errickson
- Consulting for Statistics, Computing and Analytics Research, University of Michigan
| | - Jinkyung Ha
- Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan
| | - Geoffrey J. Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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Barbosa FCS, Delerue Matos AM, Voss GDS, Eiras AFS. The importance of social participation for life satisfaction among spouse caregivers aged 65 and over. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3096-e3105. [PMID: 35170122 PMCID: PMC9578721 DOI: 10.1111/hsc.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/23/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Spouse caregivers report lower levels of life satisfaction. However, social participation generates life satisfaction. The main goal of this study is to analyse the contribution of social participation to the life satisfaction of European and Israeli spouse caregivers aged 65 plus. The study uses cross-sectional data from 17 European countries, plus Israel, which are part of wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The sample was limited to individuals aged 65+, who were classified as non-caregivers (N = 25,313) or spouse caregivers (N = 1977). The mean scores of life satisfaction by country and caregiver status were calculated and tests for a two-group comparison and multilevel logistic regressions were performed. The spouse caregiver group reported lower levels of satisfaction with life. Tests for a two-group comparison show that the group of spouse caregivers reports fewer social activities than the non-caregivers group. Moreover, multilevel linear regressions allowed us to conclude that providing spousal care at older ages (65+) is related to lower life satisfaction but that providing spousal care and reporting having social participation is related to higher life satisfaction than in the group of spouse caregivers who are not involved in social activities, and non-caregivers. Social participation is a key issue in the life satisfaction of spouse caregivers aged 65 years and older. The social participation of spouse caregivers should be a concern to relatives, communities, social and health professionals, as well as public policymakers.
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Affiliation(s)
| | - Alice Maria Delerue Matos
- Communication and Society Research CentreInstitute of Social SciencesUniversity of MinhoBragaPortugal
- Department of SociologyInstitute of Social SciencesUniversity of MinhoBragaPortugal
| | - Gina da Silva Voss
- Communication and Society Research CentreInstitute of Social SciencesUniversity of MinhoBragaPortugal
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11
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McManus K, Tao H, Jennelle PJ, Wheeler JC, Anderson GA. The effect of a performing arts intervention on caregivers of people with mild to moderately severe dementia. Aging Ment Health 2022; 26:735-744. [PMID: 33769137 DOI: 10.1080/13607863.2021.1891200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aimed to determine the feasibility and acceptability of a multi-modal performing arts intervention (MPAI) for caregivers of people with mild to moderately severe dementia. The secondary objective was to examine how MPAI might change caregiver burden, caregiver resiliency, and perceived quality of life (QoL) for care recipients. METHOD The study features a mixed-methods design. Caregivers (N = 32) completed the Zarit Burden Interview (caregiver burden) Brief Resilience Scale (resiliency) and Quality of Life-Alzheimer's disease measure (care recipient QoL) at five study timepoints. Semi-structured interviews (N = 15) documented the intervention's acceptability and caregivers' subjective experiences. Feasibility was indexed through withdrawal and attendance analysis. Braun and Clarke (2006) thematic analysis guided the qualitative analysis. RESULTS Caregiver burden significantly declined from baseline through final follow-up. Caregiver resiliency and care recipient QoL were not significantly changed but trended up during the intervention until it dropped at the end of the program. Qualitative data suggests the reversal in resiliency and QoL may be explained by caregivers' increased anxiety as the program ended. Acceptability data indicated caregivers were unanimously highly satisfied with the intervention, desiring to continue participation. Feasibility findings provide recommendations for intervention improvements. CONCLUSION MPAI could reduce caregiver burden and increase resilience for informal caregivers of a person with dementia. Effects drop off quickly at the end of the program, indicating the need for ongoing interventions that provide social support, a respite from the pressures of care recipients' dependency, and the relief that caregivers experience when they perceive benefits to their care recipient's well-being.
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Affiliation(s)
- Kim McManus
- AdventHealth Research Institute, Orlando, FL, USA
| | - Hong Tao
- AdventHealth Research Institute, Orlando, FL, USA
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12
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Wu-Chung EL, Leal SL, Denny BT, Cheng SL, Fagundes CP. Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood. Neurosci Biobehav Rev 2022; 134:104487. [PMID: 34971701 PMCID: PMC8925984 DOI: 10.1016/j.neubiorev.2021.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/18/2023]
Abstract
Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.
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Affiliation(s)
| | | | - Bryan T. Denny
- Department of Psychological Sciences, Rice University, Houston, TX
| | | | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
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13
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Johansson MF, McKee KJ, Dahlberg L, Summer Meranius M, Williams CL, Marmstål Hammar L. Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031788. [PMID: 35162811 PMCID: PMC8835239 DOI: 10.3390/ijerph19031788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer–care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.
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Affiliation(s)
- Marcus F. Johansson
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
- Correspondence:
| | - Kevin J. McKee
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
| | - Lena Dahlberg
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
- Aging Research Center, Karolinska Institutet & Stockholm University, Tomtebodavägen 18A, 171 65 Solna, Sweden
| | | | - Christine L. Williams
- Christine E Lynn College of Nursing, Florida Atlantic University Boca Raton, FL 334 31, USA;
| | - Lena Marmstål Hammar
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; (K.J.M.); (L.D.); (L.M.H.)
- School of Health, Care and Social Welfare, Mälardalen University, 721 23 Västerås, Sweden;
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden
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14
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Crittenden JA, Coleman RL, Butler SS. "It helps me find balance": older adult perspectives on the intersection of caregiving and volunteering. Home Health Care Serv Q 2022; 41:291-309. [PMID: 35098900 DOI: 10.1080/01621424.2022.2034700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Caregiving is an increasingly prevalent experience that can negatively impact health and well-being. Volunteerism, long associated with positive benefits for older adults, is one potential strategy that can be used to counteract caregiver stress. A national cohort of existing older adult volunteers was engaged to explore the intersection of volunteering and caregiving through qualitative analysis of respondent comments using the lens of role theory. Survey responses from 533 older volunteers were analyzed. Role conflict and role enhancement themes were examined, with time constraints and reduced energy emerging as the perceived causes of conflict between the caregiver and volunteer roles. Caregivers discussed benefits to their caregiving role, including respite, learning, access to information and resources relevant to caregiving, increased socialization and improved physical and cognitive health. Findings indicate that volunteering can be framed as a health and well-being intervention for caregivers.
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Affiliation(s)
| | | | - Sandra S Butler
- School of Social Work, University of Maine, Orono, Maine, USA
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Barbosa F, Delerue Matos A, Voss G, Costa P. Spousal Care and Pain Among the Population Aged 65 Years and Older: A European Analysis. Front Med (Lausanne) 2021; 8:602276. [PMID: 34046416 PMCID: PMC8144647 DOI: 10.3389/fmed.2021.602276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/29/2021] [Indexed: 01/17/2023] Open
Abstract
Background: Spousal care is the most important source of informal care in old age. Nevertheless, despite the growing importance of this issue, the association between providing spousal care inside the household and pain remains unexplored in Europe. Objective and Methods: This study aims to estimate the prevalence of pain reported by spouse caregivers aged 65 plus that provide care inside the household and to investigate the association between providing spousal care and pain. Data from 17 European countries that participated in wave 6 of the Survey of Health, Aging and Retirement in Europe (SHARE) is used. The analyses are based on 26,301 respondents aged 65 years and older who provide informal care inside the household to their spouse/partner exclusively (N = 1,895) or do not provide any informal care (inside or outside the household) (24,406). Descriptive statistics and multilevel logistic regressions (individual-level as level 1, and country as level 2) were performed. Results: Overall, spouse caregivers report pain more often (63.4%) than their non-caregiver‘s counterparts (50.3%). Important differences in the prevalence of pain among spouse caregivers were found between countries, with Portugal (80.3%), Spain (74.6%), France (73%), Italy (72.4%), and Slovenia (72.1) showing the highest prevalence of pain, and Denmark (36%), Switzerland (41.5) and Sweden (42.3%), the lowest. Results from multilevel logistic regressions show that European individuals aged 65+ who provide spousal care have an increased likelihood of reporting pain (OR 1.30; CI = 1.13–1.48). Conclusion: Our results suggest that in Europe, spouse caregivers aged 65+ are at greater risk of experiencing pain. Therefore, European policymakers should consider spouse caregivers as a health priority group, and take measures to ensure they receive comprehensive health and socio-economic support.
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Affiliation(s)
- Fátima Barbosa
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Braga, Portugal
| | - Alice Delerue Matos
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Braga, Portugal.,Department of Sociology, Institute of Social Sciences, University of Minho, Braga, Portugal
| | - Gina Voss
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Braga, Portugal
| | - Patrício Costa
- School of Medicine, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.,ICVS (Life and Health Sciences Research Institute)/3B's (Biomaterials, Biodegradables and Biomimetics) Associate Laboratory, Guimarães, Portugal.,Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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16
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Yehene E, Manevich A, Rubin SS. Caregivers' Grief in Acquired Non-death Interpersonal Loss (NoDIL): A Process Based Model With Implications for Theory, Research, and Intervention. Front Psychol 2021; 12:676536. [PMID: 33995234 PMCID: PMC8119762 DOI: 10.3389/fpsyg.2021.676536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/07/2021] [Indexed: 12/31/2022] Open
Abstract
The number of family members caring and caregiving for a loved one undergoing physical and mental changes continues to increase dramatically. For many, this ongoing experience not only involves the “burden of caregiving” but also the “burden of grief” as their loved-one’s newfound medical condition can result in the loss of the person they previously knew. Dramatic cognitive, behavioral, and personality changes, often leave caregivers bereft of the significant relationship they shared with the affected person prior to the illness or injury. This results in what we term conditions of acquired “non-death interpersonal loss” (NoDIL). Current approaches to these losses use an amalgam of models drawn from both death and non-death loss. Despite their utility, these frameworks have not adequately addressed the unique processes occurring in the interpersonal sphere where the grieving caregiver needs to reach some modus vivendi regarding the triad of “who the person was,” “who they are now,” and “who they will yet become.” In this paper we propose a process-based model which addresses cognitive-emotional-behavioral challenges caregivers meet in the face of their new reality. These require a revision of the interpersonal schemas and the relationships that takes into account the ongoing interactions with the affected family member. The model and its utility to identify adaptive and maladaptive responses to NoDIL is elaborated upon with clinical material obtained from caregivers of people diagnosed with major neuro-cognitive disorder and pediatric traumatic brain injury. The article concludes with implications for theory, research and clinical intervention.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Alexander Manevich
- The School of Psychological Sciences and the International Laboratory for the Study of Loss, Bereavement and Human Resilience, University of Haifa, Haifa, Israel
| | - Simon Shimshon Rubin
- The School of Psychological Sciences and the International Laboratory for the Study of Loss, Bereavement and Human Resilience, University of Haifa, Haifa, Israel.,Department of Psychology, Max Stern Academic College of Emek Yezreel, Jezreel Valley, Israel
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17
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The challenges characterizing the lived experience of caregiving. A qualitative study in the field of spinal cord injury. Spinal Cord 2021; 59:493-503. [PMID: 33742117 PMCID: PMC8110474 DOI: 10.1038/s41393-021-00618-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/08/2022]
Abstract
Study design Qualitative exploratory study. Objectives To explore the lived experience of SCI caregivers, with a focus on the challenges of their role. Setting Caregivers of people with SCI living in the community in Switzerland. Methods Data were collected through semi-structured interviews. Thematic analysis was performed. Results The sample included 22 participants (16 women, 15 life partners) with a mean age of 61 years who had been caregivers for an average of 18 years. Caregiving in SCI seemed to be characterized by two phases. The first phase was relatively short and was central to becoming a caregiver; it was marked by challenges related to adjusting to the role of caregiver (e.g., dealing with shock, feeling unprepared). The second phase is lifelong and is characterized by a number of recurrent challenges related to balancing caregiving and personal life (e.g., having to prioritize caregiving over personal wishes, negotiating tasks and workload). Challenges related to lacking appropriate housing, facing financial uncertainty and dealing with bureaucracy were noted during both phases. Caregivers had to deal with these challenges to stay in step with life changes and newly emerging needs. Conclusions Informal caregivers have a major role in supporting people with SCI. But their needs are not static. Any strategy to empower them has to adapt to an evolving role characterized by multiple tasks and challenges. A functional relationship between caregivers and care recipients is based on the recognition of their individualities and the different phases of adaptation, which is also an enriching process.
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18
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Teahan Á, Carney P, Cahill S, O'Shea E. Establishing priorities for psychosocial supports and services among family carers of people with dementia in Ireland. DEMENTIA 2021; 20:2109-2132. [PMID: 33423536 DOI: 10.1177/1471301220984907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Many family carers, particularly those caring for people with dementia, report significant personal and social challenges associated with caring. The aim of this article is to identify the range of challenges experienced by family carers of people with dementia and to ascertain their preferences for various supports and services that address those challenges. METHOD Three modified nominal group technique (NGT) focus groups were conducted with family carers of people with dementia. The NGT groups were conducted with 17 participants in two stages, focusing separately on personal and social domains. Family carers identified challenges and individually ranked preferences for both existing and new services and supports. Data analysis consisted of qualitative content analysis and summative scoring of individual rankings. FINDINGS Family carers identified the following personal-level challenges: needing a break, social isolation and relationship changes. Family carers' combined preferences for personal-level supports and services to overcome these challenges were day care, family care support groups, short-term respite, long-break respite and social activities. Social challenges referenced by family carers included finances, rights and entitlements and stigma and awareness. Preferences for supports and services to address these social challenges were non-means-tested carer's allowance, legal recognition, carer's support grant, monthly wage and community awareness programmes. CONCLUSION Participants ranked day care and non-means-tested carer's allowance as their top priorities under personal and social headings. Increased government investment in these two areas would not only help to maintain family carers' contributions to community-based care in dementia but would also facilitate social inclusion, social connectedness and economic sustainability.
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Affiliation(s)
- Áine Teahan
- Centre for Economic and Social Research on Dementia (CESRD), 8799NUI Galway, Galway, Ireland
| | - Patricia Carney
- Department of Public Health Midlands, 8004Health Service Executive, Tullamore, Ireland
| | - Suzanne Cahill
- Centre for Economic and Social Research on Dementia (CESRD), 8799NUI Galway, Galway, Ireland
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia (CESRD), 8799NUI Galway, Galway, Ireland
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Morrison V, Williams K. Gaining Longitudinal Accounts of Carers' Experiences Using IPA and Photograph Elicitation. Front Psychol 2020; 11:521382. [PMID: 33343434 PMCID: PMC7746611 DOI: 10.3389/fpsyg.2020.521382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/26/2020] [Indexed: 01/19/2023] Open
Abstract
Fluctuations in positive and negative caregiving experiences remain only partially explained as the significant variability over time of potential predictive factors themselves is understudied. The current study aims to gain considerable insight into caregiving experiences and perceptions over time by using photovoice methodology to support semi-structured interviews. A case study, longitudinal design is taken with three female caregivers who provide detailed insight into their caregivers' experiences over a 12 month period. The interview transcripts were analyzed using IPA- Interpretative Phenomenological Analysis. This innovative combination of methods resulted in the emergence of three related themes which included consuming the role, feeling consumed by the role, and letting go of the role. The idiographic approach taken allowed both within case differences to be examined over time, and also between carer differences to be highlighted. Implications of illness type and its characteristics, and of attachment and relationship quality with the care recipient were seen in terms of how and when the caregivers moved between the themes identified. The use of others' support or respite care is examined vis-a vis caregiver's own beliefs, emotions, relationship attachment and motivations to care. Caregivers self-efficacy beliefs also shifted over time and were influential in caregiver experience as the care recipient condition or needs changed. No previous studies have found that negative caregiving consequences are, in part, under volitional control and yet our data on the underlying reasons for consuming caregiving or allowing themselves to consume, would suggest this may in part be true. This is important because it suggests that interventions to support caregivers should address relational and motivational factors more fully.
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Affiliation(s)
- Val Morrison
- School of Psychology, Bangor University, Bangor, United Kingdom
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20
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Rasmus A, Orłowska E. Marriage and Post-stroke Aphasia: The Long-Time Effects of Group Therapy of Fluent and Non-fluent Aphasic Patients and Their Spouses. Front Psychol 2020; 11:1574. [PMID: 32733342 PMCID: PMC7358429 DOI: 10.3389/fpsyg.2020.01574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies of therapy influence on after-aphasia marital relations are lacking. Much needs to be learned about the range of factors associated with couples benefiting from therapy. Understanding these issues is key to facilitating optimal post-aphasia outcomes from the perspective of the patient and his caretaking spouse. This paper reports an evaluation of a group therapy intervention conducted with aphasic people and their life partners. METHODS The intervention comprised of 10 sessions of approximately 90 min duration and included two groups of couples, with fluent and non-fluent aphasic partner. The therapy program consisted of basic communication activities within the group which encouraged sharing of personal experience but mostly relied on psychoeducation, gaining knowledge about after-stroke aphasia. The respondents were interviewed and completed neuropsychological assessment. Quality of marriage was determined using Dyadic Adjustment Scale. Marital adjustment was measured twice, before intervention and after 6 months. Long-time effects of therapy included a significant mean difference in quality of marriage between therapy attendants and controls. Marital relationship decline seems to be worse amongst control subjects, who were not involved in any kind of psychological support. In spite of initial non-distressed relationship they report deterioration of their bond in half a year's time. We also showed changes in dynamics of quality of marriage during this time in all investigated groups. The implications of these findings for counseling services are discussed.
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Affiliation(s)
- Anna Rasmus
- Instytut Psychologii, Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Bydgoszcz, Poland
| | - Edyta Orłowska
- Instytut Psychologii, Uniwersytet Gdański, Gdańsk, Poland
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