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Oh E, Moon S, Chung D, Choi R, Hong GRS. The moderating effect of care time on care-related characteristics and caregiver burden: differences between formal and informal caregivers of dependent older adults. Front Public Health 2024; 12:1354263. [PMID: 38638476 PMCID: PMC11024244 DOI: 10.3389/fpubh.2024.1354263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024] Open
Abstract
Objective This study examined differences in care burden between formal and informal caregivers of dependent older adults according to care-related characteristics, and whether care time had a moderating effect on the relationship between care-related characteristics and caregiver burden. Methods Participants were formal (n = 520) and informal caregivers (n = 142) of dependent older adults in South Korea. Caregiver burden was measured using the Korean version of the Zarit Burden Interview. Data were analyzed using hierarchical regression with interaction terms and moderation analysis. Results Caregiver burden was higher for informal caregivers than formal caregivers. Factors associated with an increased risk of caregiver burden in both formal and informal caregiver of dependent older adults were caregivers' stress, physical strain, and care time. Care time significantly moderated the relationship between care attitude and care burden only among formal caregivers. When formal caregivers' care time was 1 standard deviation higher than the mean value, care attitude was significantly associated with care burden (bsimple = -0.903, SE = 0.106, p < 0.001). Conclusion The caregiver burden of dependent older adults can be reduced by providing interventions to attenuate the effects of modifiable risk factors that were identified in this study. And to weaken the relationship between care attitude and burden of formal caregivers who have long care hours, a positive social atmosphere for care should be provided in addition to education. To realize sustainable care, policy considerations that reflect the results of this study will help solve the problem of formal and informal caregiver burden of dependent older adults.
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Affiliation(s)
- Eunmi Oh
- Research Institute of Nursing Science, Hanyang University, Seoul, Republic of Korea
| | - SeolHwa Moon
- Department of Nursing, Hoseo University, Cheonan-si, Republic of Korea
| | - Daum Chung
- College of Nursing, Hanyang University, Seoul, Republic of Korea
| | - Rina Choi
- College of Nursing, Hanyang University, Seoul, Republic of Korea
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Mohamad MA, Leong Bin Abdullah MFI, Shari NI. Similarities and differences in the prevalence and risk factors of suicidal behavior between caregivers and people with dementia: a systematic review. BMC Geriatr 2024; 24:254. [PMID: 38486186 PMCID: PMC10941364 DOI: 10.1186/s12877-024-04753-4] [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] [Received: 05/13/2023] [Accepted: 01/27/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND People with dementia and their caregivers are prone to suicidal behaviors due to difficulty adjusting to their initial caregiving role and due to emotional disturbances resulting from deterioration of functioning. The present systematic review (1) explored the prevalence of and risk factors for suicidal behavior and (2) assessed the similarities and differences in the prevalence and risk factors for suicidal behavior between people with dementia and their caregivers. METHODS A comprehensive literature search for research articles published between 1950 and 2023 was carried out using major databases, such as Google Scholar, Web of Science, PubMed, Scopus, PsycINFO, EMBASE, the Cochrane Library, and Medline. RESULTS A total of 40 research articles were selected for review. A total of 12 research articles revealed that the prevalence of suicidal behavior among caregivers ranged from 4.7% to 26%. However, the risk of suicidal behavior among people with dementia was inconsistent, as only 17 out of 28 selected studies reported the risk of suicidal behavior among people with dementia. The risk factors associated with suicidal behavior among caregivers of people with dementia could be both self-related and care receiver-related factors, whereas risk factors in people with dementia were self-related factors. Notably, greater cognitive decline, which impairs individuals' ability to carry out complex acts and planning, may lower their suicidal risk. Finally, assessment of the risk of bias indicated that 95% of the selected studies had unclear risk. CONCLUSION Self-related and care receiver-related factors should be assessed among caregivers of people with dementia to evaluate the risk of suicidal behavior. In addition, we recommend evaluating suicidal risk in people with dementia in the early phase of dementia when cognitive decline is less severe. However, as the majority of the selected studies had unclear risk of bias, future studies with improved methodologies are warranted to confirm our study findings.
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Affiliation(s)
- Mohd Afifuddin Mohamad
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, 13200, Malaysia
| | | | - Nurul Izzah Shari
- School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities (FSSH), Universiti Teknologi Malaysia, Skudai, Johor, 81310, Malaysia
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Yuk JS, Lee JS, Park JH. Menopausal hormone therapy and risk of dementia: health insurance database in South Korea-based retrospective cohort study. Front Aging Neurosci 2023; 15:1213481. [PMID: 37744387 PMCID: PMC10512830 DOI: 10.3389/fnagi.2023.1213481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Menopausal hormone therapy (MHT) is used to alleviate the symptoms associated with menopause, despite the lack of recommendations for MHT in preventing dementia. Recent nationwide studies have explored the association between MHT and dementia risk, but the findings remain limited. This study aims to investigate the association between MHT and the incidence of Alzheimer's disease (AD) and non-AD dementia using national population data from Korea. Methods We conducted a retrospective study using data from the National Health Insurance Service in Korea between January 1, 2002, and December 31, 2019. Women over 40 years were eligible for this study and classified into the MHT or non-MHT groups. The MHT group consisted of women who used Tibolone (TIB), combined estrogen plus progestin by the manufacturer (CEPM), estrogen, combined estrogen plus progestin by a physician (CEPP), and transdermal estrogen during menopause. We compared the risk of dementia between the MHT and non-MHT groups. Results The study included 1,399,256 patients, of whom 387,477 were in the MHT group, and 1,011,779 were in the non-MHT group. The median duration of MHT was 23 months (range: 10-55 months). After adjusting for available confounders, we found that different types of MHT had varying effects on the occurrence of dementia. TIB (HR 1.041, 95% confidence interval (CI) 1.01-1.072) and oral estrogen alone (HR 1.081, 95% CI 1.03-1.134) were associated with a higher risk of AD dementia. In contrast, there was no difference in the risk of AD dementia by CEPM (HR 0.975, 95% CI 0.93-1.019), CEPP (HR 1.131, 95% CI 0.997-1.283), and transdermal estrogen (HR 0.989, 95% CI 0.757-1.292) use. The use of TIB, CEPM, and oral estrogen alone increased the risk of non-AD dementia (HR 1.335, 95% CI 1.303-1.368; HR 1.25, 95% CI 1.21-1.292; and HR 1.128, 95% CI 1.079-1.179; respectively), but there was no risk of non-AD dementia in the other MHT groups (CEPP and topical estrogen). Conclusion Our findings indicate that MHT has varying effects on the incidence of AD and non-AD dementia. Specifically, TIB, CEPM, and oral estrogen alone increase the risk of non-AD dementia, while transdermal estrogen is not associated with dementia risk. It is essential to consider the type of MHT used when assessing the risk of dementia in women.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Joong Hyun Park
- Department of Neurology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
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Kuramoto Y, Nabeshima H, Khan MSR, Kadoya Y. The Association of Caregivers' Socio-Economic Conditions with Family Caregiving Norms: Evidence from China. Behav Sci (Basel) 2023; 13:bs13050362. [PMID: 37232599 DOI: 10.3390/bs13050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Similar to her neighboring country, Japan, China faces significant difficulties in providing long-term care to the elderly. Female household members who traditionally provided necessary caregiving are no longer available as much as in the past due to the demographic and socioeconomic changes over the past few decades. Against this backdrop, we investigated how socioeconomic factors affect the perception of family caregiving norms in China, using an international comparative household dataset that allowed us to compare China with Japan, the latter being extensively investigated. We used ordered probit regression to estimate the model equation. Our results show that rural residency, household assets, and government dependency are positively associated with the perception of care. A notable difference from the Japanese results is that rural residents have a rather positive perception of family caregiving norms. Furthermore, urban-rural subsample analyses revealed that women in rural areas perceive caregiving negatively.
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Affiliation(s)
- Yu Kuramoto
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima 7398525, Japan
| | - Honoka Nabeshima
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima 7398525, Japan
| | | | - Yoshihiko Kadoya
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima 7398525, Japan
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Edwards AC, Gentry AE, Peterson RE, Webb BT, Mościcki EK. Multifaceted risk for non-suicidal self-injury only versus suicide attempt in a population-based cohort of adults. J Affect Disord 2023; 333:474-481. [PMID: 37084979 DOI: 10.1016/j.jad.2023.04.040] [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] [Received: 09/14/2022] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Non-suicidal self-injury and suicide attempt represent significant public health concerns. While these outcomes are related, there is prior evidence that their etiology does not entirely overlap. Efforts to directly differentiate risk across outcomes are uncommon, particularly among older, population-based cohorts. METHODS This research has been conducted using the UK Biobank. Data on individuals' self-reported history of non-suicidal self-injury only versus suicide attempt (maximum N = 6643) were analyzed. Applying LASSO and standard logistic regression, participants reporting one of these outcomes were assessed for differences across a range of sociodemographic, behavioral, and environmental features. RESULTS Sociodemographic features most strongly differentiated between the outcomes of non-suicidal self-injury only versus suicide attempt. Specifically, Black individuals were more likely to report a suicide attempt, as were those of mixed race, those endorsing higher levels of depressive symptoms or trauma history, and those who had experienced financial problems (odds ratios 1.02-3.92). Those more likely to engage in non-suicidal self-injury only were younger, female, had higher levels of education, those who resided with a partner, and those who had a recently injured relative. LIMITATIONS Differences in timing across correlates and outcomes preclude the ability to establish causal pathways. CONCLUSIONS The factors identified in the current study as differentially associated with non-suicidal self-injury only versus suicide attempt provide further evidence of at least partially distinct correlates, and warrant follow-up in independent samples to investigate causality.
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Affiliation(s)
- Alexis C Edwards
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond 23298, VA, United States of America; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond 23298, VA, United States of America.
| | - Amanda Elswick Gentry
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond 23298, VA, United States of America; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond 23298, VA, United States of America
| | - Roseann E Peterson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond 23298, VA, United States of America; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond 23298, VA, United States of America; Department of Psychiatry and Behavioral Health, Institute for Genomics in Health, SUNY Downstate Health Sciences University, Brooklyn 11205, NY, United States of America
| | - Bradley T Webb
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond 23298, VA, United States of America; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond 23298, VA, United States of America; GenOmics, Bioinformatics, and Translational Research Center, Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC, United States of America
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Zhang X, Clarke C, Ding R. Living with dementia: Why I am thinking of 'death'. DEMENTIA 2023; 22:807-819. [PMID: 36809154 PMCID: PMC10088338 DOI: 10.1177/14713012231158859] [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: 02/23/2023]
Abstract
BACKGROUND AND AIMS Dementia is recognized globally as a massive burden on public health and wider society. It is a major cause of disability and mortality amongst older people. China has the largest population of people with dementia worldwide, accounting for approximately 25% of the entire global population of people with dementia. The study investigated the perceived experiences of care giving and care receiving in China, with one area identified in the data concerning the extent to which the participants discussed death. The research also explored the meaning of living with dementia in modern China, where the economy, demography and culture are rapidly changing. METHOD The qualitative approach of interpretative phenomenological analysis was used for this study. Semi-structured interviews were used for data collection. FINDING The paper reports on one specific finding concerning death as a way out of the situation that participants found themselves in. CONCLUSION The study described and interpreted one of the specific issues, 'death', in the participants' narratives. This finding reflects how psychological and social factors, such as stress, social support, healthcare cost, caring burden and medical practice have created the participants' thoughts of 'wishing to die' and the reasons why they believe 'death is a way to reduce burden'. It calls for an understanding, supportive social environment and a reconsideration of a culturally and economically appropriate family-based care system.
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Affiliation(s)
- Xiubin Zhang
- National Heart and Lung Institute, 4615Imperial College London, London, UK
| | | | - Rong Ding
- School of Heath in Social Science, The University of Edinburgh, Edinburgh, UK
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Impact of Changing Socioeconomic Conditions on Family Caregiving Norms: Evidence from Japan. Behav Sci (Basel) 2022; 12:bs12120471. [PMID: 36546954 PMCID: PMC9774562 DOI: 10.3390/bs12120471] [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: 10/03/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
Eldercare is a major public health concern in many East Asian countries, including Japan, because of the ever-growing elderly population, and significant changes in family caregiving norms. The changes are due to global diffusion and the influence of socioeconomic and demographic shifts. Consequently, perceptions of the norm of family caregiving need investigation. We examined how demographic and socioeconomic factors influence the perception of family caregiving norms in Japan, using data from Osaka University's preference parameter study. According to the results of the probit regression, age, education, full-time employment, marital status, the number of sons and daughters, interactions between females and age and females and full-time employment, and parents' education are negatively related to the participants' perceptions of family caregiving norms. Our results suggest that people traditionally perceived as caregivers are less likely to have a positive attitude towards family caregiving, despite the government's efforts through Universal Long-Term Care Insurance, implemented in 2000. Therefore, authorities must reassess the role of families, explore alternative forms of community-based care, and provide more assistance to caregivers.
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