Subjective responses to caregiving for a spouse with dementia

Mental states in caregivers toward people with Alzheimer's disease at different stages

Introduction

Caring for people with Alzheimer's disease (AD) is burdensome, especially when family members act as caregivers. This multicenter survey first aimed to investigate caregivers' mental states as well as its influencing factors in caring for people with different severities of AD in China.

Methods

People with AD and their caregivers from 30 provincial regions in mainland China were enrolled from October 2020 to December 2020 to be surveyed for caregivers' mental states and living conditions, as well as caregivers' attitudes toward treatment and caring. Logistic regression was used to explore the factors that influence the positive and negative states of caregivers who care for people with different stages of AD.

Results

A total of 1,966 valid questionnaires were analyzed (mild AD: 795, moderate AD: 521, severe AD: 650). A total of 73.6% of caregivers maintained normal states (mild group: 71.9%, moderate group: 73.9%, severe group: 75.2%; X2 = 2.023, p = 0.364), and the proportions of caregivers with positive and negative states were 26.3% (mild group: 38.4%, moderate group: 24.6%, severe group: 13.1%; X2 = 119.000, p < 0.001) and 36.5% (mild group: 25.2%, moderate group: 36.9%, severe group: 50.2%; X2 = 96.417, p < 0.001), respectively. The major factors that both influenced caregivers' positive and negative states were the severity of AD, perceived efficacy of treatment, safety issues after AD dementia diagnosis and perceived social support (p < 0.005), while neuropsychiatric symptoms causing stress in caregivers (p < 0.001) only affected the negative states of caregivers. The results of further analysis according to disease severity showed that safety issues after AD dementia diagnosis (p < 0.005) only made significant differences in the mild-to-moderate group.

Conclusion

To reduce negative states and promote positive states among caregivers, flexible and sensitive caregiving support could be built on caregivers' demands in caring for people with different stages of AD. The support of emotion, social functioning and nursing skills is one of the significant ways for health workers to enhance caregivers' competency.

Focused Attention on Positive Aspects of Dementia Care in Culturally and Linguistically Diverse Communities: Qualitative Insights from Australia

OBJECTIVES

Dementia care scholarship focuses on care challenges and less on positive aspects of care, especially among culturally and linguistically diverse (CALD) carers outside the United States. This article investigates positive aspects of dementia care across eight CALD groups in Australia.

METHODS

We analyzed interviews of 112 family carers using a four-domain framework covering: a sense of personal growth, feelings of mutuality, increases in family cohesion, and a sense of personal accomplishment.

RESULTS

Positive associations with care are derived from past relationships, feelings of mutual obligation, valuing changed relationships and enjoying spending time with the person with dementia. Positive aspects of care were not associated with increased family cohesion except in Vietnamese and Arab families; neither was use of ethno-specific residential aged care, except for Greek and Italian families. Religion and spirituality as a coping and comforting mechanism was inconsistently expressed.

CONCLUSIONS

The study reveals the multi-dimensional nature of care, what resonates, and diverges across CALD populations. Knowing which parts of the framework apply and which do not is useful for interventions seeking to enhance positive aspects of care.

CLINICAL IMPLICATIONS

Migrant populations are varied and dynamic, and practitioners should be mindful of differences within and between ethnic minority groups.

Positive experiences in dementia care-giving: findings from the IDEAL programme

There is a growing evidence base that identifying positive experiences in providing care can have a beneficial influence on carer wellbeing. However, there is a need to better understand what carers identify as the positive aspects of care-giving. The aim of this study is to explore the satisfying aspects of providing care to people with dementia. This study utilised Time 1 data from 1,277 carers of people in the mild-to-moderate stages of dementia taking part in the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort study. Responses from 900 carers who answered the open-ended question ‘What is your greatest satisfaction in caring for your relative/friend?’ were analysed using thematic analysis. From the responses, 839 carers detailed satisfactions. Eight themes were identified, pertaining to three groups of beneficiaries: carers, people with dementia and the dyad. Perceived benefits for carers included identifying aspects of personal growth, seeing glimpses of the person, feeling they were making a difference and doing their duty. For the person with dementia, these included retaining independence, receiving good quality care and being happy. Dyadic benefits concerned the continuation of the relationship between carer and person with dementia. The findings highlight the need to take a dyadic approach when conceptualising positive experiences in providing care. Further research is needed to understand the role these positive experiences play and to develop interventions. Professionals working with carers should identify and validate these experiences.

Greek Adaptation of the Positive Aspects of Caregiving (PAC) Scale in Dementia Caregivers

Objectives: The aim of the present study is to validate the Positive Aspects of Caregiving (PAC) scale in Greek informal family caregivers of patients with dementia, in order to assess its psychometric properties.Methods: Two hundred and forty-seven dementia caregivers completed the Greek version of the PAC (G-PAC) scale in correlation with the following psychometric tools, the Beck Depression Scale, the Zarit Burden Interview (ZBI), the Beck Anxiety Inventory (BAI), the Quality of Life-AD (QoL-AD), the Perceived Stress Scale (PSS), and the Neuropsychiatric Inventory (NPI). Caregivers were included in the study after they had been initially informed of its purpose and completed the informed consent.Results: The Principal Component Analysis (PCA) extracted two factors for the G-PAC, which is also in agreement with the original version, which is Enriching Life and Affirming Self. Concurrent validity suggested significant correlations between G-PAC and behavioral and psychological symptoms of dementia and with perceived stress. In regard to the reliability measures, the results showed that the G-PAC scale has very good internal reliability and high levels of test-retest reliability.Conclusions: The scale is a both valid and reliable tool, and therefore it can be used to assess the positive aspects of caregiving in dementia caregivers.Clinical implications: The development of positive psychology measures in dementia care can be regarded as the cornerstone of the psychotherapeutic interventions addressed to caregivers, and therefore helping them to adapt better in their caregiving role.

Positive Aspects of Family Caregiving for Older Adults at End-of-Life: A Qualitative Examination

Family caregivers of older adults with dementia have significant challenges across many domains. While this role has been found to be burdensome on the caregiver, increasingly, though, there are also significant positive aspects reported by caregivers (known as the positive aspects of caregiving-PAC). This participatory qualitative study of 30 United States caregivers of family members age 65 and older who died with a dementia-related diagnoses used in-depth qualitative interviews and directed content analysis to understand the data. The study addressed a gap in the research literature and asked about caregiver's positive experiences during their family members' last weeks of life and investigated what this meant for the caregiver. Three primary themes were identified: (1) The Importance and Impact of Family Traditions/Celebrations, (2) Use of Humor in Living and the Difficult Experiences at End-of-Life, and (3) "The Gift of Caregiving." These findings are explored and reviewed in light of other research looking at the positive aspects of caregiving for caregivers taking care of persons living with dementia, finding concurrence and some uniqueness across the results. Implications of the findings for families and social work professionals are reviewed.

Developing and testing of an integrative theoretical model to predict positive aspects of caregiving among family caregivers of persons with dementia: A study protocol

AIMS

The aim is to develop and test an integrative model based on the stress and coping paradigm and the existential paradigm, to explain positive aspects of caregiving among family caregivers of persons with dementia.

DESIGN

A mixed method research, comprises a longitudinal exploratory study and a descriptive qualitative study.

METHODS

A total of 370 family caregivers will be recruited from community elderly centres. Questionnaires on positive aspects of caregiving and its predictors (including active dementia management strategies, meaning-focused coping, and self-efficacy) and contextual factors (including social support, religiosity, continuous good dyadic relationship quality, and intrinsic motivation towards caregiving) will be administered. Positive aspects of caregiving will be reassessed six months later. Path analysis will be used to test the hypothesized model. A subsample of 30 family caregivers will be interviewed individually to explore how positive aspects of caregiving develop from the caregiving experience. Inductive thematic analysis will be used to for the qualitative data analysis. The funding was approved in January 2018.

DISCUSSION

Positive aspects of caregiving represents the extent to which the caregiving experience is seen as enriching an individual's life space and resulted in health protective effects. With the increasing evidence to indicate its associating factors, it is imperative to identify the theoretical model to comprehensively elucidate the process for its development.

IMPACT

Theoretically, this study will advance the knowledge of dementia caregiving by generating a comprehensive theory-driven predictive model to explain how positive aspects of caregiving is developed among the family caregivers. In terms of nursing practice, the findings can inform the development of intervention to improve positive aspects of caregiving and thereby acts as a catalyst to promote the paradigm shift from 'reducing limitations' to 'optimizing strengths' in family caregivers support services.

The types of caregiving reactions experienced by the older spouse caregivers

AIMS

To examine factors associated with the four types of caregiver reactions according to the modified Caregiver Reaction Assessment (mCRA) and assess the differences in the narrative assessment from spouse caregivers between the high-positive and high-negative caregiver reactions.

BACKGROUND

There is a limited understanding of the factors contributing to positive and negative reactions among older spouse caregivers with chronic illnesses. Narrative assessment from spouse caregivers has not been studied before.

DESIGN

The study design was a paired-sample, mixed-method survey design. Data were collected from spouse caregivers (≥55 years old) and care-recipients in one medical institute from February 2017-December 2017. This manuscript used STROBE checklist to ensure complete reporting.

METHODS

Demographic, socioeconomic, Frailty Index, perceived stress, and quality of life data were gathered from caregiver dyads. mCRA, relationship, and life satisfaction data were collected from caregivers. mCRA identified the four types of caregiver reactions: (a) high-positive, low-negative; (b) high-positive, high-negative; (c) low-positive, high-negative; and (d) low-positive, low-negative. A qualitative interview was conducted to understand the differences in the narrative and choice of words used to describe caregiving experience.

RESULTS

Seventy-five caregiver dyads were recruited. Total perceived stress was found to be negatively associated with high-positive, low-negative caregiver reaction (baseline category: low-positive, high-negative) by multinomial logistic regression. Content analyses showed that low-positive and high-negative caregivers used words that implied a lack of volition. Caregivers with positive experience viewed caregiving as a responsibility; the opposite viewed it as having 'no choice'.

CONCLUSIONS

Perceived stress is an important indicator of caregiver reactions. Words used when describing caregiving experiences can potentially depict the spouse caregivers' current state of being as a caregiver.

RELEVANCE TO CLINICAL PRACTICE

Spouse caregiver's narrative of their caregiving experience may provide easy and quick insights if interventions are needed. Early identification of negative reactions will allow for prompt interventions in mitigating caregivers' stress.

Factors related to sense of competence in family caregivers of people living with dementia in the community: a narrative synthesis

ABSTRACTObjectives:Sense of competence defines a caregiver's feeling of being capable to manage the caregiving task and is an important clinical concept in the caregiving literature. The aim of this review was to identify the factors, both positive and negative, associated with a caregiver's perception of their sense of competence.

DESIGN

A systematic review of the literature was conducted, retrieving both quantitative and qualitative papers from databases PsycINFO, CINAHL, EMBASE, and Medline. A quality assessment was conducted using the STROBE and CASP checklists, and the quality rating informed the inclusion of papers ensuring the evidence was robust. Narrative synthesis was employed to synthesize the findings and to generate an updated conceptual model of sense of competence.

RESULTS

Seventeen papers were included in the review, all of which were moderate to high quality. These included 13 quantitative, three mixed-methods and one qualitative study. Factors associated with sense of competence included: behavioral and psychological symptoms of dementia (BPSD), caregiver depression, gratitude, and the ability to find meaning in caregiving.

CONCLUSIONS

The results of this review demonstrate that both positive and negative aspects of caring are associated with caregiver sense of competence. Positive and negative aspects of caregiving act in tandem to influence caregiver perception of their competence. The proposed model of sense of competence aims to guide future research and clinical interventions aimed at improving this domain but requires further testing, as due to the observational nature of the include papers, the direction of causality could not be inferred.

Determining a cutoff score for the family burden interview schedule using three statistical methods

Background

While it is widely acknowledged that family burden can be ameliorated with effective psycho-social interventions, how to measure family burden and define a valid cutoff to identify family caregivers in need of such interventions remains a key question. The purpose of the present study was to determine a statistically valid cutoff score for the Family Burden Interview Schedule (FBIS), using the cutoff scores of the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) as the reference.

Methods

The FBIS, PHQ-9, and GAD-7 were administered to a representative community sample of 327 family caregivers of schizophrenia patients. A FBIS cutoff score was determined using three different statistical methods: tree-based modeling, K-means clustering technique and linear regression. Contingency analysis was conducted to compare the FBIS cutoff with depression and anxiety scale scores.

Results

Findings proposed a cutoff score of 23 for the FBIS, with sensitivity being 76% for PHQ-9 and 74% for GAD-7, specificity being 68% for PHQ-9 and 67% for GAD-7.

Conclusion

This cutoff score would enable health care providers to assess family caregivers at risk and provide necessary interventions to improve their quality of life.

Electronic supplementary material

The online version of this article (10.1186/s12874-019-0734-8) contains supplementary material, which is available to authorized users.

Association of physical functioning of persons with dementia with caregiver burden and depression in dementia caregivers: an integrative data analysis

OBJECTIVES

To determine whether caregiver relationship and race modify associations between physical functioning of persons with dementia (PWD) and their caregiver's burden and general depressive symptoms.

METHOD

We pooled data from four behavioral intervention trials (N = 1,211). Using latent growth modeling, we evaluated associations of PWD physical functioning with the level and rate of change in caregiver burden and caregivers' general depressive symptoms and stratified these associations by caregiver relationship and race.

RESULTS

PWD were, on average, 81 years old (68% female) with mean follow-up of 0.5 years. More baseline PWD physical impairment was associated with less worsening in caregiver burden over time (β = -0.23, 95% CI: -0.29, -0.14), but this relationship was not modified by caregiver characteristics. More impaired baseline PWD physical functioning was not associated with changes in depressive symptoms (β = -0.08, 95% CI: -0.17, 0.00), but was associated with less worsening in depressive symptoms among spousal (β = -0.08, 95% CI: -0.17, 0.00) and non-white (β = -0.08, 95% CI: -0.17, 0.00) caregivers.

CONCLUSIONS

Dementia caregivers may experience reduced caregiver-related burden because of adjustment to PWD functional status, while spousal and non-white caregivers may experience less depressive symptoms resultant of adjustment to functional status.

Informal Caregiving in a Medically Underserved Community: Challenges, Construction of Meaning, and the Caregiver-Recipient Dyad

Little is known about informal caregivers' challenges in medically underserved communities. This qualitative study explores their perceptions/experiences of caregiving in a medically underserved community in Midwest United States. Two focus groups (n = 12) were conducted and themes were extracted and analyzed. Theme 1 included perceived barriers/unmet needs; most prevalent of which were lack of informational resources and support groups. A second unsolicited and unanticipated theme highlighted how caregivers constructed meaning through reappraising challenges to create enriching experiences for themselves, reinforcing their evolving dyadic relationship with care-recipient. Challenging and enriching aspects of caregiving coexisted and were rooted in caregiver-care-recipient dyad. Caregivers used meaning-making as a coping strategy for challenges. Prior research corroborates caregivers' challenges and meaning-making; this study contributes by delineating how both become interrelated. Policy makers can (a) alleviate challenges by increasing informational resources and support groups and (b) provide training to optimize caregivers' meaning-making, thus enhancing their positive experiences.

Unravelling positive aspects of caregiving in dementia: An integrative review of research literature

BACKGROUND

Family caregiving is the crucial informal care resource to lessen the burdens associated with dementia. Research in this field has focused on reducing the caregiver's burden, but little attention has been given to promoting the positive aspects of caregiving.

OBJECTIVES

To conduct a systematic critical review of research on the nature of positive aspects of caregiving, and the factors predicting this phenomenon among family caregivers of dementia patients, with the ultimate purpose of gaining insights to explain how and why it emerges.

REVIEW METHODS

A systematic search of the literature was undertaken in the databases OvidMedline, CINAHL, PsycINFO, Web of Science and Scopus, using the keywords 'care* AND Alzheimer OR dementia AND 'positive aspect' OR 'positive experience' OR 'positive perceptions' OR reward OR gain OR 'satisfaction with care*' OR 'care* satisfaction' OR benefit OR uplift OR meaning OR enjoyment OR pleasure OR growth OR hope OR gratification. The Critical Appraisal Skills Programme checklists for qualitative and cohort studies were used to evaluate data quality. Narrative data synthesis was undertaken using the five-stage Whittermore and Knafl method.

RESULTS

A total of 3862 articles were identified, of which 41 were included in this review. The key findings are that positive aspects of caregiving among family caregivers of dementia patients form a multi-dimensional construct which covers four key domains: a sense of personal accomplishment and gratification, feelings of mutuality in a dyadic relationship, an increase of family cohesion and functionality, and a sense of personal growth and purpose in life. By integrating the findings about the nature and conditions predicting positive aspects of caregiving, the presence of three conditions was identified as promoting the emergence of such qualities i) personal and social affirmation of role fulfilment, ii) effective cognitive emotional regulation and iii) contexts which favour finding meaning in the caregiving process.

CONCLUSION

The findings of this review provide insight into catalysing the paradigm shift from 'reducing stress' to 'optimising positive experience' in developing caregiving support services for dementia, and may guide future empirical study to explain this unique dimension of caregiving experience.

Positive Aspects of Caregiving Questionnaire

OBJECTIVE

The potential role of positive aspects of caregiving in enhancing caregivers' health is an important issue. The aim of this study was to develop and validate Positive Aspects of Caregiving Questionnaire (PACQ) in caregivers of patients with dementia in Iran.

METHODS

Content validation process was used to content valid development. Cronbach α and intraclass correlation coefficient (ICC) were calculated as reliability indices. We used exploratory factor analysis to extract potential latent factors and evaluate the factor structure of PACQ. We assess correlation between PACQ and caregiver burden for divergent validity. For convergent validity, correlation between PACQ and self-rated health was specified.

RESULTS

Content validity indices (CVIs), internal consistency, and test-retest reliability were CVI > 0.80, α = 0.785, and ICC = 0.905, respectively. Moreover, item-total correlations confirmed good reliability of PACQ. Two factors were identified by factor analysis in this 10-item measure: patient and caregiver relationship and caregiver's psychological well-being. Divergent validity and convergent validity were established by high negative correlation between positive aspect of caregiving (PAC) and caregiver burden along with significant positive correlation between PAC and self-rated health, respectively. While Cronbach α for the entire scale was 0.785, Cronbach αs for both of the scale components were 0.71.

CONCLUSION

The PACQ demonstrated acceptable psychometric properties of reliability and performs well in preliminary tests of validity as a measure of positive aspects of caregiving. This measure can be used to determine the outcome of interventional programs on positive, not only negative, aspect of caregiving.

Measuring appraisal during advanced cancer: psychometric testing of the appraisal of caregiving scale

OBJECTIVE

Examine the psychometric properties of the Appraisal of Caregiving Scale (ACS).

METHODS

Data were collected as part of the FOCUS Program trial in Michigan (N = 484 caregivers).

RESULTS

Exploratory factor analysis found the ACS measured Threat, General Stress, and Benefit appraisals. Cronbach's alphas for all subscales exceeded 0.70. Construct validity analyses indicated the Threat subscale correlated significantly with concepts of avoidant coping, burden, and dyadic support (r > 0.30). General Stress correlated significantly with burden (r = 0.348) and dyadic support (r = -0.373), and the Benefit subscale correlated significantly with active coping (r = 0.444). Known group analyses indicated that depressed caregivers had higher Threat and General Stress scores than non-depressed caregivers. Also, younger caregivers reported significantly higher scores on the General Stress subscale than older caregivers. Predictive validity analyses found appraisal scores at baseline accounted for 33.3% of the variance in hopelessness and 27.8% of the variance in depression at Time 2.

CONCLUSION AND PRACTICE IMPLICATIONS

The ACS is a reliable measure of Threat, General Stress, and Benefit appraisals, with some support for its validity. Health professionals may find the ACS useful for guiding intervention development. Future research should continue to examine the ACS' validity.

Self-efficacy and health-related quality of life in family carers of people with dementia: a systematic review

OBJECTIVES

This review aims to explore the role of self-efficacy (SE) in the health-related quality of life (QoL) of family carers of people with dementia.

METHODS

A systematic review of literature identified a range of qualitative and quantitative studies. Search terms related to caring, SE, and dementia. Narrative synthesis was adopted to synthesise the findings.

RESULTS

Twenty-two studies met the full inclusion criteria, these included 17 quantitative, four qualitative, and one mixed-method study. A model describing the role of task/domain-specific SE beliefs in family carer health-related QoL was constructed. This model was informed by review findings and discussed in the context of existing conceptual models of carer adaptation and empirical research. Review findings offer support for the application of the SE theory to caring and for the two-factor view of carer appraisals and well-being. Findings do not support the independence of the negative and positive pathways. The review was valuable in highlighting methodological challenges confronting this area of research, particularly the conceptualisation and measurement issues surrounding both SE and health-related QoL.

CONCLUSIONS

The model might have theoretical implications in guiding future research and advancing theoretical models of caring. It might also have clinical implications in facilitating the development of carer support services aimed at improving SE. The review highlights the need for future research, particularly longitudinal research, and further exploration of domain/task-specific SE beliefs, the influence of carer characteristics, and other mediating/moderating variables.

Positive aspects of caregiving (PAC): scale validation among Chinese dementia caregivers (CG)

OBJECTIVES

This study validates the psychometric properties of the PAC scale among Hong Kong Chinese informal dementia caregivers.

METHODS

Three hundred and seventy-four caregivers responded to questionnaires including the Chinese version of the PAC scale, Center for Epidemiologic Studies Depression Scale (CES-D), Zarit Burden Interview (ZBI), occurrence of problem behaviors, caregiver bother, caregiver confidence, and self-rated health (SRH). Translation and back translation were conducted in translating the PAC scale.

RESULTS

Results of an exploratory principal component analysis (PCA) suggest two components in the 11-item Chinese PAC (C-PAC) scale, namely enriching life and affirming self. C-PAC demonstrates satisfactory reliability. Criteria-related validity of C-PAC is suggested by significant correlations with CES-D, SRH, occurrence of problem behaviors, caregiver bother, and caregiver confidence.

CONCLUSION

Our results support the psychometric properties of C-PAC among Hong Kong Chinese caregivers. This brief measure may help interventionists identify psychological resources of caregivers and capitalize these resources during strength-based interventions.

Health literacy needs related to incontinence and skin damage among family and friend caregivers of individuals with dementia

PURPOSE

The purpose of this study was to describe health literacy needs related to incontinence and skin care among family or friend caregivers of individuals with Alzheimer disease (AD) and develop supportive and educational materials that address these needs.

DESIGN

Descriptive.

SUBJECTS AND SETTINGS

The sample included 48 family/friend adult caregivers of individuals who had advanced dementia. Caregivers were spouses (44%), daughters (31%), or extended family members/friends (25%) recruited from community-based agencies, with a mean age of 64 ± 14 years (mean ± SD), and 75% were female. Nearly half (48%) had a racially or ethnically diverse background.

METHODS

Focus groups, interviews, and written surveys were conducted to assess health literacy needs of AD caregivers related to incontinence and skin care; verbal responses were audiotaped, transcribed, and summarized. To address these needs, a set of educational and supportive materials was developed, whose content was directed by caregiver responses and supported by a literature review of current evidence and consultation with clinical and research experts. Study procedures were guided by an advisory committee of AD caregivers.

RESULTS

Caregivers had numerous health literacy needs related to incontinence and skin care; areas of need were categorized into knowledge, skills, and attitudes. Caregivers expressed a need to validate the health literacy they possessed. Fourteen educational and supportive documents were developed to address these needs.

CONCLUSION

Materials developed in this study are suitable to incorporate into interventions that support caregivers of persons with AD. They offer the potential to raise health literacy and care capacity of caregivers, increase communication with health care providers, and improve health outcomes of care recipients.

Positieve ervaringen door mantelzorg: constructie van een schaal

POSITIVE EXPERIENCE THROUGH INFORMAL CARE: CONSTRUCTION OF A SCALE: An 8-item scale has been developed to measure positive experiences by informal caregivers, the Positive Experiences Scale (PES). The PES is a unidimensional hierarchical Mokkenscale which varies from intrinsic satisfaction and relational enhancement to improvement of competence and social enhancement. The scale has a satisfactory Loevinger's H-value (0.37) and reliability (0.74). Furthermore, satisfying H-values are found for large groups of informal caregivers, such as carers for the elderly, the chronically ill, partners, parents and people who live in a care facility. For informal caregivers of people with dementia or mental impairments, two items do not uphold ('I received appreciation for the care I've been giving' and 'the help brought me and my family and friends closer together'. For these groups a 6-item scale is advised. Solely for informal caregivers of people with psychological impairments, the scale as a whole does not uphold. Further research will have to determine how these caregivers derive positive experiences from caregiving. The PES is recommended because of its psychometric qualities and its usefulness in different populations of informal caregivers.

Experiences and concerns of family caregivers providing support to people with dementia: A cross-cultural perspective

Abstract:

We examined experiences and concerns among caregivers of community-dwelling people with dementia from two ethnic groups. We conducted a thematic analysis of responses to the question, ‘What is your life like as a caregiver?’ in nine focus groups ( n = 75) with Filipino and non–Hispanic White caregivers. Constant comparison methods identified themes by ethnicity. Experiences and concerns expressed across groups were related to care recipient symptoms commonly associated with dementia, including severe memory loss and behavioral changes. Participants in both ethnic groups described strategies that help them cope, such as receiving help from family and friends, receiving respite support, and participating in support groups. Filipino caregivers more often emphasized positive aspects of caregiving, whereas Whites often expressed that others do not understand the daily experiences of caregiving. Filipinos more commonly described caregivers as a ‘good person’ or ‘saint’ and emphasized that caregiving made them stronger.

The involvement of multiple caregivers in cognitive-behavior therapy for anxiety in persons with dementia

OBJECTIVES

Peaceful Mind, a cognitive-behavioral therapy for treating anxiety in persons with dementia, is a promising new treatment currently under investigation. This article reports results of our examination of a modification of the treatment protocol in two cases that included multiple caregivers in treating two persons with dementia.

METHOD

Two case presentations of the benefits and challenges of including multiple caregivers in treatment are discussed. Treatment outcome data for these cases were collected as part of a larger investigation of Peaceful Mind.

RESULTS

The involvement of multiple collaterals resulted in several benefits, including increased family communication, as well as increased opportunities for the practice of new skills. These cases have also presented unique challenges requiring alterations in therapy structure and attention to issues of family conflict.

CONCLUSIONS

Including multiple collaterals in cognitive-behavioral therapy for treating anxiety in persons with dementia is feasible and may be beneficial in maximizing treatment gains and increasing the family's investment in therapy.

Toward a better understanding of psychological well-being in dementia caregivers: the link between marital communication and depression

Dementia research has frequently documented high rates of caregiver depression and distress in spouses providing care for a partner suffering from dementia. However, the role of marital communication in understanding caregiver distress has not been examined sufficiently. Studies with healthy couples demonstrated an association between marital communication and the partners' psychological well-being, depressiveness, respectively (e.g., Heene, Buysee, & Van Oost, 2005). The current study investigates the relationship between caregiver depression and communication in 37 couples in which the wives care for their partners with dementia. Nonsequential and sequential analyses revealed significant correlations between caregiver depression and marital communication quality. Caregivers whose husbands used more positive communication reported less depression and distress. Additionally, caregiver depression was negatively correlated with rates of positive reciprocal communication indicating dependence between the couples' interaction patterns. This study is one of the first to illustrate the relevance of spousal communication in understanding caregiver distress and depression.

[Caregiver burden with dementia patients. A validation study of the German language version of the Zarit Burden Interview]

Despite the large number of studies dealing with dementia caregivers in Europe, a valid German version of the most widely used measurement of caregiver burden, the Zarit Burden Interview, has not been published. The purpose of this study was to evaluate the psychometric properties of the German Zarit Burden Interview (G-ZBI). A sample of community-dwelling older couples (n=37) with the husband suffering from dementia and the wife being the primary caregiver participated in this study. The G-ZBI and related constructs were assessed in order to test for reliability and construct validity. The G-ZBI revealed psychometric properties comparable with those of the original instrument and empirically validated translations. Results indicate high internal consistency (Cronbach's alpha=0.91) and good validity due to strong correlations with caregiver life satisfaction and depression, as well as patients' dependency, neuropsychiatric symptoms, and dementia severity. The psychometric qualities of the G-ZBI indicate that it is both a reliable and valid instrument to assess caregiver burden and to detect highly stressed individuals.

The 3-phase-model of dyadic adaptation to dementia: why it might sometimes be better to be worse

In the next years and decades, the number of old spousal dyads having to deal with the onset and progression of dementia in one partner will increase significantly. Existing research indicates that caregiving for an ill spouse is related to decreased caregiver well-being and high levels of caregiver stress. In this theoretical paper, we argue that three aspects deserve additional theoretical and empirical attention: (a) Some spousal caregivers seem to exhibit stable pattern of individual well-being, (b) dyads may be able to adapt their ways of supporting each other to maintain a maximum of dyadic autonomy, and (c) the progression of the dementia increasingly compromising the individual autonomy is likely to require different behaviors and skills of the dyad to achieve high levels of dyadic well-being. We suggest a 3-phase-model of dyadic adaptation to dementia-related losses of patients' individual autonomy and discuss adaptive processes in three phases of dementia that may allow stable levels of well-being in caregivers over time. Thereby, our model can integrate existing findings and theories and allows deriving areas of future research.

Dementia caregiving in spousal relationships: a dyadic perspective

OBJECTIVES

The number of couples facing a dementia diagnosis for one partner of the spousal dyad increases. Spousal caregiving can be a highly stressful experience associated with negative caregiver outcomes such as depression and poorer immune function. However, surprisingly little is known about how the illness and the required care effects patient's well-being and relational changes experienced by afflicted couples. The aim of this study was to provide a literature review on how the dyadic perspective is taken into account and on how dementia effects both parts of the dyad.

METHODS

In order to outline findings about individual and dyadic well-being of affected couples, we conducted a literature search to review the three types of studies. First, studies focusing on one partner's perspective, usually the perspective of the caregiver; second, studies including the caregiver's and partially the care receiver's view; third, studies directly referring to both partners' perspectives.

RESULTS

The majority of studies neglect the individual with dementia by exclusively assessing caregiver variables or only indirectly including patients' characteristics. Very few studies embrace dyadic and relational variables to execute how both partners experience the illness, spousal caregiving, and changes in the relationship. Despite the arguable validity of self reports of individuals with dementia, some studies demonstrated the usefulness of including both partners' perspectives.

DISCUSSION

Results indicate the urgent need of integrating the perspective of the individual with dementia to improve the understanding of the effects of dementia caregiving. Directly assessing the dyadic perspective of affected couples provides essential information for interventions.

Development and initial validation of a family appraisal of caregiving questionnaire for palliative care

This article describes the derivation and initial psychometric validation of a multi-dimensional Family Appraisal of Caregiving Questionnaire for Palliative Care (FACQ-PC). The 25-item measure consists of four theoretically derived subscales: (i) caregiver strain, (ii) positive caregiving appraisals, (iii) caregiver distress, and (iv) family well-being. Based on a sample of 160 family caregivers of a relative with cancer receiving palliative care, reliability analyses demonstrated the subscale scores to be internally consistent and factor analysis revealed evidence of factorial validity. Correlations of the four subscales with measures of family functioning, positive and negative affect, and subjective burden provided evidence of convergent and discriminant validity. The FACQ-PC provides a measure of the family's appraisal of caregiving that can be used in clinical assessment, and has potential utility for evaluating the effectiveness of palliative care interventions.

Assessing family caregiver's mental health using a statistically derived cut-off score for the Zarit Burden Interview

Decades of research have confirmed that being a family caregiver is a stressful role. However, the point at which these stressors constitute a real risk for decreased mental health has not been established. The purpose of the present study was to determine a statistically valid cut-off score for the Zarit Burden Interview (ZBI) in order to identify family caregivers at risk for depression and in need of further assessment and intervention. The ZBI and the Geriatric Depression Scale or the CES-D were administered to three different populations of family caregivers of older adults: stroke caregivers (n=80), chronic obstructive pulmonary disease (COPD) caregivers (n=48), and general disability caregivers (n=70). Using three different statistical methods, a ZBI cut-off score was determined. Next, contingency analysis was used to compare depression scale scores and ZBI cut-offs for the three groups of caregivers. Findings suggest that a cut-off score ranging from 24-26 has significant predictive validity for identifying caregivers at risk for depression. A ZBI cut-off of 24 correctly identified 72% of caregivers with probable depression. The validity of ZBI cut-offs scores warrants further confirmation with larger samples. Valid cut-off scores would enable health care providers to assess family caregivers at risk and provide necessary interventions to improve their quality of life in this important role.

Relationship matters in dementia caregiving

This study examined the relationship between four framing categories of caregiving (Relational, Instrumental, Reactive, Role Acquiring), derived from interviews with spouse caregivers, and scores on standardized measures of responses to and outcomes of caregiving. Participants were 132 spouses recruited into a larger intervention study of family caregivers of community-dwelling persons with dementia. Qualitative data were analyzed using constant comparative method; quantitative data were analyzed using one-way analysis of variance (ANOVA). Findings demonstrated that relational spouses scored better than spouses in the other three categories, indicating greater positive well-being. Relational spouses also scored significantly lower than instrumental and reactive spouses on a composite caregiver distress measure (p = 0. 003). These results suggest that interventions may need to be tailored to spouses with different caregiving perspectives.

Final transitions: family caregiving at the end of life

BACKGROUND

This study aimed to understand how caregivers make the transition to end-stage caregiving and to illuminate its unique aspects using a stress process model.

METHODS

Qualitative in-depth interviews were conducted with 74 caregivers of a family member who had been receiving hospice care for at least 2 weeks. Interviews were tape recorded, transcribed, and coded for emergent themes using constant comparative analysis.

RESULTS

End-stage caregiving was characterized in the sample as (1) comprehension of terminality (the interrelationship of information, physical and cognitive decline, and personality change and role losses), (2) near-acute care, (3) executive functions, and (4) final decision making. The comprehension of terminality emerged from three interrelated experiences: receiving and assimilating concrete information about the illness, observing the progression of the disease, and observing the personality change and role loss. The primary stressors (unique end-stage caregiving tasks) were providing near-acute care, assuming an executive function, and beginning and final decision making. The secondary stressors were family role conflict, work conflict, and financial strain. Resources, such as intrinsic and extrinsic religious and faith practices and social support, were identified. Negative outcomes included intense emotional responses, and positive outcomes included heightened development of meaning making.

CONCLUSION

The findings suggest that palliative care professionals have important opportunities to provide information and support to family caregivers during the final stages of the patient's terminal illness.

What evidence underlies our practice with alzheimer families?

Registered nurses who base their practice on scientific evidence can justify their decisions and the care they provide to the families of people with Alzheimer disease (AD). The health care literature should provide an evidence base for nurses to draw on. Families care for older members with AD, regardless of whether the setting is a family home, long-term care facility, or day-support program. Sometimes families say they need information to enable them to provide quality care. Their questions may include "What happens next?" "Where do we go from here?" or "How do I stop the wandering?" This study reviewed AD education articles in five journals used by gerontologic health care workers-primarily registered nurses. Findings identified a serious lack of education-specific articles. The implication is whether registered nurses are meeting the education needs of families.

Alzheimer disease support group characteristics: A comparison of caregivers

Although family members are known to continue to be involved in care after admitting a loved one with Alzheimer disease into a long-term care (LTC) facility, little research has been done regarding the psychosocial support requirements of these caregivers. Of the 55 caregivers surveyed in this study, 13 had care recipients living in LTC, and 42 had recipients living at home. Results were studied to see if differences arose in the needs of these two groups and if current support groups met those needs. Data indicated that caregivers with relatives in LTC facilities were older and had less interest in receiving information on a variety of subjects. However, both groups indicated having feelings of reassurance after attending support group meetings.

Discourse-derived perspectives: differentiating among spouses' experiences of caregiving

A method of constant comparative analysis was used to code open-ended interviews with 132 spouse caregivers regarding their experiences in caregiving. Results of this analysis yielded 69 qualitative code categories. We used these categories to compare the caregivers on several groupings that the literature has identified as providing meaningful ways to differentiate among caregivers. We used the qualitative responses to compare the caregivers by caregiver gender care-recipient dementia severity, and duration of caregiving. Results partly confirmed previous findings that wife caregivers are more distressed than husbands, but the results also indicated these caregivers were more similar than dissimilar The other analyses likewise indicated greater similarities than dissimilarities in the caregiving experience. We next continued the analysis and, using the coding categories as a springboard, identified four distinct patterns for construction of the meaning of the caregiving experience in the caregivers' discourse. These discourse-derived framing categories, applicable in about three-quarters of the caregivers, offered other ways to distinguish among caregivers. Further analysis of these robust groupings' showed important differences among the groups. These framing categories suggest ways to differentiate among caregivers, based on their perception of their role in the caregiving situation, ways that might point the way to intervention strategies for each of the groupings.