Family caregiver experiences and needs across health conditions, relationships, and the lifespan: a Qualitative analysis

PURPOSE

The purpose of this study was to understand the lived experiences of family caregivers who provide care to individuals across a broad range of ages, caregiving relationships, and health conditions and/or disabilities. Family caregiver research is typically siloed by health condition or by caregiving relationship, leaving gaps in understanding similarities and differences among caregivers.

METHODS

We hosted three virtual focus groups with diverse family caregivers (n = 26) caring for an individual with a long-term disability and/or health condition(s). We conducted a qualitative thematic analysis using an iterative, inductive process.

RESULTS

Participants primarily expressed shared experiences, despite having unique caregiving situations. We identified themes among a) caregiver experiences: Trying to Do It All, Balancing Complex Emotions, Managing Expectations, and Adjusting to Changes Over Time and b) caregiver needs: Longing for Breaks and Self-Care; Lacking Help, Support and Resources; and Desiring Understanding and Recognition.

CONCLUSIONS

These findings emphasize that many elements of the caregiving experience transcend care recipient age, condition, and relationship and are applicable to clinicians, researchers, and policy makers. The evidence of shared caregiver experiences can guide efficiencies in policy and practice (e.g., pooling of existing resources, expansion of interventions) to meet the needs of a broader population of caregivers.

Nonkin Carers' Roles and Contributions to the Support of Older People Living Alone: An Analysis of Qualitative Data

OBJECTIVES

In the Global North, the number of older people living alone who have little or no support from family members is increasing. However, little is known about older people living alone who have basic needs for support but do not have kin living nearby or a sustainable relationship to a relative they can rely on. Thus, this paper focuses on the role of nonkin carers and their contribution to the support arrangements of older people living alone.

METHODS

We conducted semistructured interviews with 32 older people living alone aged between 67 and 99 (Ø 84.2 years) in Austria, 23 women, and 9 men. The interviews were analyzed by applying a coding strategy based on grounded theory. In addition, sociograms were created to illustrate relevant relations in each support arrangement.

RESULTS

We identified and characterized 3 groups of nonkins involved in the support arrangements of older people living alone based on the origins of the relationships: (1) friends, (2) neighbors, and (3) acquaintances like members of various communities. The arrangements were classified according to the amount and quality of involvement of nonkin carers, namely manifold, scattered, and little nonkin involvement.

DISCUSSION

Our study highlights the diversity of nonkin support in the support arrangements of older people living alone. This heterogeneity should be considered by policy-makers when promoting informal care and designing policy measures.

Associations Between Family Caregiving and Romantic Relationships: An Exploratory Study With Nondistressed Couples Caring for an Outside Family Member

BACKGROUND AND OBJECTIVES

Family caregiving-providing emotional and physical health care for a family member or friend with an illness or disability-can result in many outcomes, including stress and beneficial experiences. Both romantic and caregiving relationships are complex and varied. Nevertheless, little research has examined how caregiving and romantic relationships influence one another. The purpose of this study was to understand ways romantic partners who care for a family member outside of their romantic relationship perceive that their romantic relationship and caregiving experiences influence one another.

RESEARCH DESIGN AND METHODS

A qualitative study using thematic analysis was conducted. A sample of 5 couples where one or both partners were caring for a relative with dementia participated in interviews about their experiences in family caregiving and in their romantic relationship, as well as how the 2 roles interacted with each other. Couple members were interviewed separately and together.

RESULTS

From these interviews, themes reflecting ways that caregiving influences romantic relationships, as well as ways romantic relationships influence caregiving emerged. Themes about caregiving influencing romantic relationships were caregiver stress interacting in the romantic relationship, the romantic relationship becoming less of a priority, and benefits experienced in the romantic relationship due to caregiving. Themes about romantic relationships influencing caregiving were partners improving the caregiving experience, and workload inequality.

DISCUSSION AND IMPLICATIONS

These findings broaden our understanding of how dyadic coping affects family caregiving and may suggest ways that the mutual influences caregivers experience between romantic relationships and caregiving benefits and challenges.

Impact of caregiving on mental, self-rated, and physical health: evidence from the China health and retirement longitudinal study

OBJECTIVES

Given the escalating demand for care services, understanding the impact of informal caregiving, providing unpaid care for family members, on own health is essential. This study longitudinally analyzed the association of caregiving (and different caregiver types) with mental, physical, and self-rated health. Urban-rural, gender, and employment heterogeneity were further investigated.

METHOD

Based on three-wave data (2011, 2013, and 2018) from the China Health and Retirement Longitudinal Study, we used growth curve models to assess the impact of informal caregiving (providing care to family members) and caregiver types (caregivers to grandchildren, parents, spouses, or multiple family members) on three health outcomes (depressive symptoms, self-rated health, and activities of daily living limitations).

RESULTS

Our study included 13,377 individuals. Results showed a negative correlation of caregiving with mental, physical, and self-rated health. Compared to noncaregivers, spousal caregivers and multiple caregivers were both associated with worsening mental, self-rated, and physical health. In contrast, adult child caregivers were only negatively associated with mental health, and grandparent caregiving did not significantly affect any health outcomes. Further heterogeneity analysis showed that gender did not moderate the relationship between caregiving and health, whereas the negative association between caregiving and health was more pronounced among the rural population and those employed in agriculture.

DISCUSSION

Findings from the present study suggest that caregiving is detrimental to health, and recommend considering caregiver type when examining caregiving and health. These findings have vital implications for policymakers in addressing the challenges of structuring and implementing a sustainable informal care system.

Exploring the lived experiences of family caregivers of patients with stroke in Africa: a scoping review of qualitative evidence

OBJECTIVE

The burden of stroke is immense in African countries, with post-stroke care usually becoming the responsibility of family. This review sought to determine the current breadth and depth of qualitative evidence regarding the lived experiences of family caregivers of patients with stroke in Africa.

METHODS

Informed by Joanna Briggs Institute (JBI) methodology for scoping reviews, six databases were searched. Included articles were appraised for quality using the JBI checklist. A priori themes developed using the study objectives were used to synthesize study findings.

RESULTS

The review included 22 articles, which outlined key patterns in stroke outcomes with most articles focused on rehabilitation and the experiences, outcomes, burdens, and coping mechanisms of caregiving. The intersectionality of socio-economic status, socio-political structures, and religious or traditional beliefs, attitudes, and practices characterized etiology beliefs, treatment trajectories of stroke, and caregiving role assignment. Whereas burdens were driven by limited resources, adopted coping strategies involved spiritual or religious beliefs, optimism, resilience, and social support networks.

CONCLUSIONS

Family caregivers' values must be acknowledged, supported, and integrated into the traditional healthcare system to provide comprehensive stroke care. Caregivers' health and well-being should be given more attention given their necessary contribution to stroke survivorship in Africa.

Trends in private caregiving cost after implementing a comprehensive nursing service covered by national health insurance: Interrupted time series

BACKGROUND

The Korean government has implemented a comprehensive nursing care service system (CNS) to mitigate the stress faced by caregivers.

OBJECTIVE

This study aimed to assess trends in the estimated average costs of private caregiving and determine the difference in costs between those using CNS and those not using it.

DESIGN

A comparative interrupted time series analysis with a 2-year lag period verified total private caregiving cost trends; biannual differences in costs were evaluated based on using CNS.

PARTICIPANTS

The main unit of analysis was episode. We extracted a total of 6418 episodes of hospitalization in acute care settings that included the use of caregiving services (formal, informal caregiving and CNS).

METHODS

We conducted segmented regression to assess the impact of CNS on total private caregiving costs using data from 2012 to 2018, excluding the years 2015 and 2016 of the Korean Health Panel dataset.

RESULTS

We presented that the immediate mean difference in total private caregiving costs between CNS users and non-users was -444.7 USD two years after the implementation of the CNS policy (95 % CI -714.5 to -174.5, p-value 0.001). Among individuals living in rural areas, two years after the implementation of the CNS policy, there was a significant immediate mean cost difference of -476.9 USD in total private caregiving costs between CNS users and non-users (p-value 0.011). Similarly, for episodes with a Charlson Comorbidity Index (CCI) score of 0 to 1, there was a substantial immediate mean cost difference in total private caregiving costs between CNS users and non-users, amounting to -399.9 USD two years after the CNS policy (p-value 0.008).

CONCLUSIONS

This study evaluated the trend of total private caregiving costs between groups using and not using CNS. After two years of being covered by CNS health insurance, those who utilized CNS paid $433 less for their total private caregiving cost over a 6-month period, compared to those who did not use CNS. The adoption of CNS may be an effective system for relieving the financial burden on inpatients in need of private caregiving services.

TWEETABLE ABSTRACT

Korean Comprehensive Nursing Service reduces private caregiving costs.

Filling In: Family Member Support for Nonrelative Residents in Long-Term Care Homes

BACKGROUND AND OBJECTIVES

Past research about family involvement in long-term care (LTC) homes mainly focuses on family members' involvement with their own relative, interactions with staff, and collective activities such as Family Councils. Our research provides novel insights into family member's involvement in the care of residents who are not their relatives, an area that has not previously been explored.

RESEARCH DESIGN AND METHODS

This critical ethnographic study examined ways that family members negotiate and navigate their roles within LTC homes. Data collection and analysis took place at 3 LTC homes in British Columbia, Canada, between 2014 and 2018. Data were collected through participant observation and semistructured interviews. Eleven family member participants shared experiences of caring for residents who were not their relatives.

RESULTS

The umbrella theme was "filling in," which takes place in a care environment that is understaffed and underresourced. The subthemes reflect the various ways that families are "filling in": responding to resident's needs, supporting staff to respond to resident needs, and filling in for residents' families.

DISCUSSION AND IMPLICATIONS

Caring for residents who are not their relatives is facet of family involvement in LTC homes that has not been previously explored. Many family members have expertise in providing person-centered care and they extend this expertise to residents who are not their relatives. Policies and legislation are needed to formalize family involvement in caring for nonrelative residents as it is a component of quality of care for all residents.

Cross-country variations in the caregiver role: evidence from the ENTWINE-iCohort study

BACKGROUND

Globally, economically developed countries face similar ageing demographics and the challenge of a 'care gap', yet they vary due to different care and formal support systems, and different cultural and societal norms around illness and care. The aim of this exploratory study was to examine cross-country variations in caregiver motivations, willingness, values, meaning in life, illness beliefs, and experiences of wellbeing, gain, health-related quality of life, burden and depression, across 6 European countries and Israel. Cross-country differences in the above-mentioned informal caregiver experiences are rarely described.

METHODS

An online survey (ENTWINE-iCohort) was conducted using validated measures wherever possible. This paper utilises data from 879 caregivers and seven countries (Greece, Italy, the Netherlands, Poland, Sweden, the UK, and Israel).

RESULTS

No consistent finding supporting the concurrent relationship between caregiver support policies/country culture and caregiver motivations/willingness was found. Caregivers in countries typically characterised by individualist cultures reported lower familism, higher self-enhancement values, and greater perceived illness threat compared to more collectivist countries. Search for meaning was higher in poorer countries than in wealthier countries. Higher negative caregiver experiences (e.g., burden) and lower positive experiences (e.g., wellbeing) were generally observed in countries with underdeveloped caregiver support as compared to countries with more developed formal support systems.

CONCLUSIONS

Cross-country variations can be explained to varying degrees by national policies around care (or their absence) and country cultural contexts. The results emphasise the importance of formal support services for achieving positive caregiver experiences, and help inform the development of policies and measures to support caregivers in Europe and Israel.

Telecaregiving for Dementia: A Mapping Review of Technological and Nontechnological Interventions

BACKGROUND AND OBJECTIVES

Informal (or family) caregivers to older adults with Alzheimer's disease or other related dementias (ADRD) could greatly benefit from innovative telecaregiving systems that support caregiving from a distance. The objective of this review is to better understand (a) who is involved in telecaregiving and their experiences; (b) the interventions currently available to support ADRD telecaregiving; and (c) the outcomes measured to assess the effects of ADRD telecaregiving interventions.

RESEARCH DESIGN AND METHODS

A mapping review was conducted by systematically searching MEDLINE, CINAHL, Embase, and PsycINFO for all works published in English from 2002 to 2022. References of included publications were searched to identify additional empirical publications for inclusion.

RESULTS

Sixty-one publications (describing 48 studies and 5 nonstudy sources) were included in the review. Currently available information on the demographics, experiences, challenges, and benefits of ADRD telecaregivers is summarized. We found that interventions to support telecaregiving could be classified into 7 categories of technological interventions and 3 categories of nontechnological interventions. Empirical studies on ADRD telecaregiving interventions investigated a variety of outcomes, the most prevalent being user experience.

DISCUSSION AND IMPLICATIONS

We conclude that (a) the paucity of literature on telecaregiving does not allow for a comprehensive understanding of the needs and day-to-day activities of ADRD telecaregivers; (b) interventions developed to support ADRD telecaregiving may not fully meet the needs of caregivers or care recipients; and (c) there is insufficient rigorous research establishing the effects of telecaregiving interventions on key ADRD-related outcomes.

Impact of informal caregiving on caregivers' subjective well-being in China: a longitudinal study

BACKGROUND

While informal caregiving is crucial for improving and maintaining health of the elderly, there is limited evidence of its potential effect on caregivers' wellbeing. Understanding this effect is important for policy makers to design effective long-term care policies. This longitudinal study aims to investigate the impact of informal caregiving on caregivers' subjective wellbeing in China.

METHODS

Three waves (2016, 2018, 2020) of data from the China Family Panel Studies (CFPS) are constructed for empirical analysis. Ordered logit model is first used to estimate the effect. Fixed effects ordered logit model and mixed effects ordered logit model are further employed to control for the possible bias from unobserved individual heterogeneity.

RESULTS

Informal caregiving significantly reduces caregivers' subjective wellbeing and the negative effect is stronger for high-frequency caregivers. Subgroup analysis reveals that informal caregiving imposed greater negative impacts on women, those living in rural areas, being married, working, and living separately from parents. Further analysis of mechanism indicates that decrease in wage income, leisure and sleep time were channels through which informal caregiving affects caregivers' well-being.

CONCLUSION

When policy makers formulate sustainable long-term care policies and home support services, interventions to improve caregivers' stress-coping skills and ensure their engagement in leisure and social activities could be adopted to mitigate the negative effects on caregivers' subjective well-being.

The intersection of social determinants of health and family care of people living with Alzheimer's disease and related dementias: A public health opportunity

In this Perspective article, we highlight current research to illustrate the intersection of social determinants of health (SDOHs) and Alzheimer's disease and related dementia (ADRD) caregiving. We then outline how public health can support ADRD family caregivers in the United States. Emerging research suggests that family care for persons with ADRD is influenced by SDOHs. Public health actions that address these intersections such as improved surveillance and identification of ADRD caregivers; building and enhancing community partnerships; advancing dementia-capable health care and related payment incentives; and reducing the stigma of dementia and ADRD caregiving can potentially enhance the health and well-being of dementia caregivers. By engaging in one or all of these actions, public health practitioners could more effectively address the myriad of challenges facing ADRD caregivers most at risk for emotional, social, financial, psychological, and health disruption.

Physical and mental health of informal caregivers before and during the COVID-19 pandemic in the United States

BACKGROUND

Informal caregiving, a common form of social support, can be a chronic stressor with health consequences for caregivers. It is unclear how varying restrictions during the COVID-19 pandemic affected caregivers' physical and mental health. This study explores pre-post March 2020 differences in reported days of poor physical and mental health among informal caregivers.

METHODS

Data from the 2019/2020 Behavioral Risk Factor Surveillance System survey were used to match, via propensity scores, informal caregivers who provided care during COVID-19 restrictions to those who provided care before the pandemic. Negative binomial weighted regression models estimated incidence rate ratios (IRRs) and differences by demographics of reporting days of poor physical and mental health. A sensitivity analysis including multiple imputation was also performed.

RESULTS

The sample included 9,240 informal caregivers, of whom 861 provided care during the COVID-19 pandemic. The incidence rate for days of poor physical health was 26% lower (p = 0.001) for those who provided care during the COVID-19 pandemic, though the incidence rates for days of poor mental health were not statistically different between groups. Informal caregivers with low educational attainment experienced significantly higher IRRs for days of poor physical and mental health. Younger informal caregivers had a significantly lower IRR for days of poor physical health, but higher IRR for days of poor mental health.

CONCLUSIONS

This study contends that the physical and mental health burden associated with informal caregiving in a period of great uncertainty may be heightened among certain populations. Policymakers should consider expanding access to resources through institutional mechanisms for informal caregivers, who may be likely to incur a higher physical and mental health burden during public health emergencies, especially those identified as higher risk.

The Impact of Caregiving History on Later-Life Self-Perceptions of Aging

OBJECTIVES

Theories suggest that self-perceptions of aging (SPA) reflect structural and cultural ageism together with an individual's personal life experiences. We examine the impact of an individual's history of informal caregiving on their SPA.

METHODS

Using data from the Health and Retirement Study (HRS, N = 8,372, age range 50-102 years), we investigated caregiving history as a determinant of later-life SPA. HRS participants provided reports of up to 5 episodes of caregiving, the life-course timing of each episode (start/end year), and their relationship with the care recipients. SPA was measured by the HRS Attitudes Toward Own Aging Scale. We conducted linear regressions to examine associations between specific caregiving histories and later-life SPA. Models included controls for current sociodemographic and health status.

RESULTS

Individuals who were ever a caregiver reported more negative SPA than noncaregivers. Variations in the impact of histories of caregiving were also revealed. Specifically, compared to people who had cared for adult(s) only, HRS participants who cared for both a child with special needs and an adult reported more negative SPA later in life.

DISCUSSION

The study provides insight into potential life-course precursors of SPA and highlights the importance of conceptualizing caregiving history as a complex life experience that might affect an individual's SPA later in life.

Mental health, social integration and support of informal caregivers during the second wave of the COVID-19 pandemic: A population-based representative study from Germany

INTRODUCTION

The study analyzed mental health, social integration and social support of informal caregivers of individuals aged ≥60 years compared to non-caregivers during the second wave of the COVID-19 pandemic.

METHODS

A quantitative, cross-sectional study was conducted with a sample drawn randomly from the nationally representative online panel forsa.omninet in Germany between March 4th and 19th 2021. In total, 3022 adults aged ≥40 years from Germany were questioned, including 489 adults providing informal care for adults aged ≥60 years between December 2020 and March 2021. Depressive (PHQ-9) and anxiety symptoms (GAD-7), loneliness (De Jong Gierveld Scale), social exclusion (Bude & Lantermann Scale) and social network support (Lubben's Social Network Scale) were measured. Adjusted OLS regression analyses and additional moderator analyses (moderators: perceived restrictions and danger of infection due to the COVID-19 pandemic) were conducted.

RESULTS

Significant higher levels of depressive and anxiety symptoms and more social support were found among informal caregivers compared to non-caregivers. Loneliness and social exclusion did not differ between both groups. Perceived restrictions by the pandemic significantly moderated the association between informal caregiving and social support - social support was stronger among caregivers with higher levels of perceived restrictions by the pandemic.

CONCLUSION

Informal caregivers are faced with worse mental health than non-caregivers during the pandemic, although their social support was stronger, in particular in dependence of higher levels of perceived restrictions by the pandemic. Thus, results indicate a need for an informal-care-specific policy and more professional support for informal caregivers during a health crisis.

Informal Caregiving Among Faculty at a Large Academic Health Sciences University in the United States: an Opportunity for Policy Changes

OBJECTIVE

This article aims to determine the prevalence of caregiving among faculty at a large academic health sciences institution, to examine the effect of gender and other demographic and professional covariates on caregiving status, and to explore caregiver-generated policy recommendations.

METHOD

A cross-sectional, mixed-methods survey was collected from June through August 2018. Participants were faculty within one of the institution's health professional schools (dentistry, medicine, nursing, or pharmacy) receiving at least 50% salary from the institution. In addition to demographic information, we collected academic series and rank, and assessed association between covariates on caregiving status using logistic regression. We analyzed open-ended responses using thematic analysis to identify themes in caregiver barriers and policy suggestions.

RESULTS

Among 657 eligible respondents, 11.4% were informal caregivers. Women were more likely to be caregivers than men (aOR 2.53, 95% CI: 1.40, 4.78), as were older faculty. Caregivers identified unsupportive climate or unrealistic work expectations, concern about career advancement, insufficient information about policies, and concern about colleague burden as barriers to support. Suggestions for workplace support included improved leave policies, increased flexibility, caregiver resource support, improved clarity and dissemination of policy information, and financial support.

CONCLUSIONS

Women faculty are more likely to be informal caregivers, exacerbating disparities within academic medicine for promotion and retention among women faculty. Institutions might include caregiving status in annual burnout surveys to guide the development of structural support and policies for extension of family leave beyond childbearing (or catastrophic leave), flexibility in work hours, and subsidized eldercare services.

Reconciling Paid Work and Informal Caregiving Among Older Adults: Implications for Work Interference With Family

Background and Objectives

Many older adults who combine paid work and informal caregiving responsibilities are often in work arrangements that differ from their preference. There is reason to believe that such work status incongruence may lead to work interference with family (WIF). In response, many governments have policies that support flexible work arrangements (FWA) to help individuals manage work and family commitments. This paper examines whether work status preferences contribute to WIF for older adults who combine work and care and whether the use of flexible work arrangements moderates this relationship.

Research Design and Methods

The study included 610 informal caregivers (aged 55-70 years) in paid employment who participated in either the 2018 or 2020 waves of the New Zealand Health, Work and Retirement study. Using a simple moderation analysis with demographic controls, the effects of work status preferences and FWAs on WIF were estimated.

Results

After controlling for confounds, significant main effects were found for both work status preferences and flexible work arrangements on WIF. The moderation analysis revealed that involuntary part-timers using flexible time-off arrangements reported lower levels of WIF. However, other types of flexible work arrangements did not moderate the relationship between work status preferences and WIF.

Discussion and Implications

These findings suggest that work status preferences can contribute to WIF, but not all types of flexible work arrangements alleviate it. Policy initiatives designed to reduce WIF for those combining work and care should consider accounting for differences in the work status preferences of older workers.

Caregiver Experience of Tele-dementia Care for Older Veterans

BACKGROUND

For the 5 million persons living with dementia (PLWD) in the USA, telemedicine may improve access to specialty care from their homes.

OBJECTIVE

To elicit informal caregiver perceptions of tele-dementia care provided during COVID-19.

DESIGN

Qualitative, observational study using grounded theory.

PARTICIPANTS

Informal caregivers aged 18 + who cared for an older adult who received tele-dementia services at two major VA healthcare systems participated in 30-60-min semi-structured telephone interviews.

INTERVENTIONS

Interviews were designed using Fortney's Access to Care model.

MAIN MEASURES

Thirty caregivers (mean age = 67, SD = 12, 87% women) were interviewed.

KEY RESULTS

Five major themes were (1) Tele-dementia care avoids routine disruption and pre-visit stress; (2) Transportation barriers to in-person visits include not only travel logistics but navigating the sequelae of dementia and comorbid medical conditions. These include cognitive, behavioral, physical, and emotional challenges such as balance issues, incontinence, and agitation in traffic; (3) Tele-dementia care saves time and money and improves access to specialists; (4) Tele-dementia facilitated communication between caregiver and provider without hindering communication between PLWD and provider; and (5) Caregivers described ideal future dementia care as a combination of virtual and in-person modalities with in-home help, financial and medical support, and dementia-sensitive caregiver access. Caregivers interviewed saved 2.6 h ± 1.5 h (range: 0.5 to 6 h) of travel time. Multiple caregivers described disruption of routines as difficult in PLWD and appreciated the limited preparation and immediate return to routine post telemedicine visit as positives.

CONCLUSIONS

Caregivers found tele-dementia care convenient, comfortable, stress reducing, timesaving, and highly satisfactory. Caregivers would prefer a combination of in-person and telemedicine visits, with an opportunity to communicate with providers privately. This intervention prioritizes care for older Veterans with dementia who have high care needs and are at higher risk for hospitalization than their same age counterparts without dementia.

Does becoming an informal caregiver make your health worse? A longitudinal analysis across Europe

OBJECTIVE

To determine whether becoming an informal caregiver in Europe has a significant effect on health status, compared with non-informal caregivers, distinguishing by place of residence (in or outside the home of the care receivers) and country. And to determine whether there is an adaptation effect after the passage of time.

METHODS

The Survey of Health, Aging and Retirement in Europe (2004-2017) was used. Propensity score matching was applied to analyse the differences in the health status of people who became informal carers between different periods and those who did not. We considered short-term (2-3 years after the shock) and medium-term effects (4-5 years).

RESULTS

In the short term, the probability of those who became informal caregivers being depressed was 3.7% points (p.p.) higher than among their counterparts, being higher among those who lived in the care recipients' homes (12.8 p.p.) and those providing care outside and at home (12.9 p.p.). Significant differences in the probability of being depressed were also observed by country (Southern and Eastern Europe), and in countries with low expenditure on long-term care (LTC). Those effects remained in the medium term. No significant effects were found in cancer, stroke, heart attack and diabetes.

CONCLUSIONS

The results might help to concentrate a major effort of any policy in the field of mental health on the period immediately after the negative shock, especially for those caregivers who live with the care receiver, for those in Southern and Eastern Europe and in countries with low expenditure on LTC.

Designing a Persuasive E-Coaching Application for Informal Caregivers

Being an informal caregiver is not easy, and might cause physical and psychosocial burden, especially in the long run. However, the formal health care system has little support for informal caregivers who experience abandonment and lack information. Mobile health can potentially be an efficient and cost-effective way of supporting informal caregivers. However, research has shown that mHealth systems often have problems with usability, and people do not use the systems for more than a short period. Therefore, this paper explores the design of an mHealth app using Persuasive Design, an established design framework. This paper presents the design of the first version of the e-coaching application using the persuasive design framework and unmet needs of informal caregivers from the literature. This prototype version will be updated based on interview data from informal caregivers in Sweden.

Will your child take care of you in your old age? Unequal caregiving received by older parents from adult children in Sweden

Intergenerational family care provided to older parents by adult children is growing and differs based on gender and socioeconomic status. Few studies consider these elements in relation to both the parent and their adult child, and little is known about the number of care tasks received even though those providing intensive levels of care are at risk of experiencing adverse consequences in their lives. This study uses data from the nationally representative 2011 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and includes child-specific information from parents aged 76 years and above. Analyses used ordinal logistic regression and are presented as average marginal effects and predictive margins. Results show that parents in need of care report that one-third of all adult children in the sample provide care to three out of five of them. The care is most often non-intensive, yet nearly one in ten of all children provide more intensive care of two or more tasks. When adjusting for dyad characteristics as well as geographic proximity, results show adult-child gender differences where parents receive more care from manual-working-class daughters than manual-working-class sons. Overall, manual-working-class daughters are most commonly reported as carers among adult children, and they are particularly overrepresented in providing intensive care. We conclude that gender and socioeconomic inequalities exist among care receivers' adult children, even in a strong welfare state such as Sweden. Knowledge about levels and patterns of intergenerational care have important implications for how to reduce unequal caregiving.

Mandated Caregiver Training in the Veterans Health Administration: Caregiver Inquiry Informs National Dissemination

BACKGROUND AND OBJECTIVES

A minority of family caregivers receive training, with implications for their own and their recipient's outcomes. Federal policy has supported the implementation and expansion of caregiver training and support. The Department of Veterans Affairs (VA) has developed a national Caregiver Support Program and collaborated with VA health services researchers to explore caregivers' acceptance of an evidence-based training program in preparation for system-wide dissemination.

RESEARCH DESIGN AND METHODS

This approach entailed a convergent mixed-methods design, which involved separate analyses of quantitative and qualitative data. Survey questions based on the Kirkpatrick model for training evaluation measured caregivers' reaction and learning, and interview questions elicited caregivers' reports about the value of the program for them.

RESULTS

Most caregivers reported satisfaction with the training when responding to survey questions, although qualitative interviews revealed caveats suggesting need to hone the best timing and specific group of caregivers for maximal benefit.

DISCUSSION AND IMPLICATIONS

Our findings indicate that understanding program-user fit may be particularly critical when implementing training for caregivers as they come to the program at different points along their caregiving journey, needing differing types and intensities of support. While a general program may appeal to policymakers aiming to scale caregiver training within a large, heterogeneous system, there may be shortcomings in terms of end-user acceptance and subsequent downstream outcomes such as reach and ultimately program effectiveness. Good, iterative communication flow between program developers and policymakers facilitates this understanding and, in turn, decisions about scaling.

Personal human values, informal caregiving and the relevance of gender and age: Findings from the population-based German Aging Survey

OBJECTIVES

This study analyzed if personal human values and provision of informal care were associated and if this differed as a function of gender or age.

METHOD

Data from the German Aging Survey were used (wave 2008, N=6,089), which included 748 informal caregivers. Human values were measured with the Human Values Scale from Schwartz (self-enhancement, self-transcendence, conservation, openness to change). Adjusted logistic regression analyses (with gender and age as additional moderators) were conducted.

RESULTS

Placing higher importance on conservation and self-enhancement values was associated with lower odds for caregiving, while a higher appreciation of self-transcendence was associated with higher odds of caregiving. With older age, a higher score in conservation values was associated with even lower odds for caregiving. Gender did not moderate these associations, still, lower odds of caregiving were found only among men with higher scores in openness to change, and only among women with higher scores in conservation values. Self-transcendence was associated with higher odds of caregiving among both, men and women.

DISCUSSION

In brief, personal values were significantly associated with informal caregiving and may act as motivators or barriers. The same motivators were found among men and women but different values were associated with lower odds of providing care. When aiming to foster informal care and a gender-equal distribution of caregiving, it could be helpful to take these values into account.

Positive aspects of caregiving among informal caregivers of persons with dementia in the Asian context: a qualitative study

BACKGROUND

Positive aspects of caregiving are important coping resources for informal caregivers of persons with dementia (PWD). However, existing studies mostly focused on caregivers from western societies and less attention was paid to the potential cultural differences. This study aims to explore positive aspects of caregiving in the Asian context.

METHODS

A qualitative methodology with semi-structured interviews was adopted. A total of 29 informal caregivers of PWD in Singapore were interviewed from Apr 2019 to Dec 2020. All the interviews were audio-recorded and transcribed verbatim for the analysis. Inductive thematic analysis was conducted.

RESULTS

The results revealed a total of three major themes with 11 sub-themes including: 1) positive aspects within self (i.e., better understanding of dementia and caregiving, personal growth, role satisfaction, and improved awareness of self-care); 2) positive aspects between caregiver and PWD (i.e., chance to demonstrate filial piety towards PWD, happiness and positive attitudes of PWD, positive interactions with PWD, and closer relationships with PWD); and 3) positive aspects between caregiver and others (i.e., empathy towards other caregivers, befriending peers, and sharing dementia and caregiving knowledge with others).

DISCUSSION

Findings from this study improved our understanding on positive aspects of caregiving among informal caregivers of PWD in the Asian context. In addition to similar themes across cultures such as personal growth, our study identified a few unique themes like improved awareness of self-care and chances to demonstrate filial piety. For future studies targeting Asian caregivers, it is necessary to include these cultural-specific positive aspects of caregiving.

Does retirement (really) increase informal caregiving? Quasi-experimental evidence from Australia

This paper analyzes the impact of retirement on informal care provision using nationally representative panel data from Australia. To establish causality, we exploit the gender and cohort specific eligibility age for the Australian Age Pension. We find no evidence of an impact of retirement (status or duration) on co-residential or extra-residential unpaid care provided by older individuals. The null effect of retirement on informal caregiving does not differ by the type of care recipient. Furthermore, we demonstrate that older people who postpone retirement reduce the amount of time they spend on other non-market activities to resolve the time conflict between unpaid care and extended employment. Our analysis indicates that the Australian Age Pension reform aimed at working career prolongation has not crowded out the supply of informal care.

Gender differences in access to community-based care: a longitudinal analysis of widowhood and living arrangements

Persistent inequalities in access to community-based support limit opportunities for independent living for older people with care needs in Europe. Our study focuses on investigating how gender, widowhood and living arrangement associate with the probability of receiving home and community-based care, while accounting for the shorter-term associations of transitions into widowhood (bereavement) and living alone, as well as the longer-term associations of being widowed and living alone. We use comparative, longitudinal data from the Survey of Health, Ageing and Retirement in Europe (collected between 2004 and 2015 in 15 countries) specifying sex-disaggregated random-effects within-between models, which allow us to examine both cross-sectional and longitudinal associations among widowhood, living arrangements and community-based care use. We find widowhood and living alone are independently associated with care use for both older women and men, while bereavement is associated with higher probability of care use only for women. Socio-economic status was associated with care use for older women, but not for men in our sample. The gender-specific associations we identify have important implications for fairness in European long-term care systems. They can inform improved care targeting towards individuals with limited informal care resources (e.g. bereaved older men) and lower socio-economic status, who are particularly vulnerable to experiencing unmet care needs. Gender differences are attenuated in countries that support formal care provision, suggesting gender equity can be promoted by decoupling access to care from household and family circumstances.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00717-y.

Longitudinal association between informal unpaid caregiving and mental health amongst working age adults in high-income OECD countries: A systematic review

BACKGROUND

Informal unpaid caregivers provide most of the world's care needs, experiencing numerous health and wealth penalties as a result. As the COVID-19 pandemic has highlighted, informal care is highly gendered. Longitudinal evidence is needed to assess the causal effect of caregiving on mental health. This review addresses a gap by summarising and appraising the longitudinal evidence examining the association between unpaid caregiving and mental health among working age adults in high-income Organisation for Economic Co-operation and Development (OECD) countries and examining gender differences.

METHODS

Six databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science, Econlit) from Jan 1, 2000 to April 1, 2022. Population-based, peer-reviewed quantitative studies using any observational design were included. Population of interest was working age adults. Exposure was any unpaid caregiving, and studies must have had a non-caregiving comparator for inclusion. Mental health outcomes (depression, anxiety, psychological distress/wellbeing) were measurable by validated self-report tools or professional diagnosis. Screening, data extraction and quality assessment (ROBINS-E) were conducted by two reviewers. The study was prospectively registered with PROSPERO (CRD42022312401).

FINDINGS

Of the 4536 records screened; 13 eligible studies (133,426 participants) were included. Overall quality of evidence was moderate. Significant between-study heterogeneity precluded meta-analysis, so albatross and effect-direction plots complement the narrative synthesis. Results indicate a negative association between informal unpaid care and mental health in adults of working age. Importantly, all included studies were longitudinal in design. Where studies were stratified by gender, caregiving had a consistently negative impact on the mental health of women. Few studies examined men but revealed a negative effect where an association was found.

INTERPRETATION

Our review highlights the need to mitigate the mental health risks of caregiving in working age adults. Whilst men need to be included in further scholarship, reducing the disproportionate caregiving load on women is a crucial requirement for policy development.

FUNDING

Melbourne School of Population and Global Health, Targeted Research Support Grant.

A human factors and ergonomics approach to conceptualizing care work among caregivers of people with dementia

Society relies upon informal (family, friend) caregivers to provide much of the care to the estimated 43.8 million individuals living with Alzheimer's disease and related dementias globally. Caregivers rarely receive sufficient training, resources, or support to meet the demands associated with dementia care, which is often associated with increased risk of suboptimal outcomes. Human factors and ergonomics (HFE) can address the call for new approaches to better understand caregiving and support caregiver performance through systematic attention to and design of systems that support the work of caregivers- their care work. Thus, our objective was to perform a work system analysis of care work. We conducted a qualitative study using a Critical Incident Technique interviewing approach and Grounded Dimensional Analysis analytic procedures. Our findings introduce a new conceptual framework for understanding the care work system of dementia caregivers and suggest that care work is influenced by interactions among distinct caregiver goals, the task demands of the care needs of the person with dementia, daily life needs of the caregiver and family, and contextual factors that shape caregivers' perceptions surrounding care. The initial work system model produced by this study provides a foundation from which future work can further elucidate the care work system, determine how the care work system intersects and coordinates with other work systems such as the patient work system, and design systems that address caregivers' individual caregiving context.

Social Support for Informal Caregivers of Spouses and Parents(-in-Law) Aged 60 Years and Older During the COVID-19 Pandemic: Findings From a Representative German Online Survey

OBJECTIVES

We analyzed whether spousal and adult child caregivers of older adults differed from each other and from noncaregivers in terms of the social support available to them during the coronavirus disease 2019 pandemic, whether available support differed by gender, and whether the perception of pandemic restrictions moderated these differences.

METHODS

Participants (≥40 years) were randomly drawn from the population-based German online panel forsa.omninet. Between March 4 and 19, 2021, 2,520 noncaregivers, 337 adult child caregivers, and 55 spousal caregivers were questioned about social support, perception of pandemic restrictions, health, and sociodemographic information. Adjusted regression analyses and moderator analyses were conducted.

RESULTS

Adult child caregivers had higher social support from family and friends than noncaregivers, and more support from friends than spousal caregivers. Spousal caregivers had less social support from friends compared to both groups. The perceived restrictions of the pandemic moderated the differences in support from family and friends between spousal caregivers and noncaregivers, and the differences between spousal and adult child caregivers in support from friends. Gender moderated the difference in support by friends between caregiving and noncaregiving wives and sons(-in-law).

DISCUSSION

Informal caregivers seemed to have a supportive informal network during the pandemic. However, spousal caregivers only had similar levels of support as adult child caregivers if they strongly perceived restrictions of the pandemic, and had the lowest support level of all 3 groups-in particular from friends. Thus, spousal caregivers may benefit most from support actions, and these should focus on their wider social network.

Piloting a Dementia Caregiver Intervention in a Primary Care Setting

OBJECTIVES

The purpose of this pilot study is to examine the efficacy of a theoretically based, 6-week dementia caregiver support group in a primary care setting.

METHODS

Using a quasi-experimental design, 22 participants completed the caregiver support group. Participants were mostly in their mid-60 s (M = 63 years old), female (n = 19), Caucasian (n = 14), and identified as either the care recipient's child or spouse (n = 19). At baseline and 6 weeks, participants completed self-report measures related to demographic information, caregiver preparedness, strain, and depressive symptoms, and care recipient's neuropsychiatric symptoms. Participants also completed a satisfaction survey. Within-subjects t-tests were run to determine if participants' scores changed over time.

RESULTS

Results revealed that participants demonstrated a significant increase in mean caregiver preparedness scores. No significant effects were found for caregiver strain, depressive symptoms, and distress related to neuropsychiatric symptoms. Participants rated being largely satisfied with the program.

CONCLUSIONS

Results suggest that this 6-week caregiver support group may be a promising caregiver intervention in primary care clinics.

CLINICAL IMPLICATIONS

Findings support the importance of caregiver support for persons with dementia in primary care.

Designing for Human Well-Being: A Case Study with Informal Caregivers of Individuals with Cancer

Informal Caregivers such as a spouse, other close relatives or friends of cancer patients can play an essential role in home-based treatment and care. However, the informal caregivers might not be prepared for this responsibility, and they might have several unmet requirements for taking care of patients in the home environment. The informal caregivers' physical, social and psychological health is also profoundly affected due to the health conditions of their relatives. We propose a User-centred Positive Design as a hybrid framework by merging the traditional User-cantered design and positive design frameworks to enhance the informal caregivers' subjective well-being. Our ongoing project (Carer-eSupport) will be used as a case study, and its main objective is to co-create and evaluate a web-based support system for informal caregivers of people with cancer. The proposed framework can be used for the design and development of health information systems with a special focus on users' wellbeing and positive emotions.

The impact of having foreign domestic workers on informal caregivers of persons with dementia - findings from a multi-method research in Singapore

Background

Informal caregivers of persons with dementia (PWDs) sometimes engage foreign domestic workers (FDWs) to support their caregiving journey. However, there has not been much research to establish if this is really beneficial. The current study aims to investigate whether engaging FDWs specifically for caregiving of PWDs truly moderates caregiver stress and to explore caregivers’ experiences of engaging FDWs.

Methods

A multi-method study design with a quantitative and qualitative sub-study was adopted. For the quantitative sub-study, 282 informal caregivers of PWDs were recruited. Propensity score matching analysis was used. For the qualitative sub-study, 15 informal caregivers with FDWs were interviewed. Inductive thematic analysis was conducted.

Results

The quantitative sub-study confirmed that engaging FDWs did moderate the depressive symptoms of informal dementia caregivers (marginal effect = -3.35, p = 0.0497). However, such support did not affect their caregiving burden, self-efficacy, and perceived positive aspects of caregiving. The qualitative sub-study suggested that engaging FDWs is an ambivalent experience, which entails both support and challenges.

Conclusions

The current study confirmed previous research findings, that engaging FDWs moderated depressive symptoms among caregivers of PWDs, and it could be through their physical support such as in daily caregiving activities. Policy-makers may consider providing more subsidies to caregivers caring for PWDs with mobility issues to hire FDWs. They may also consider providing training to FDWs on dementia caregiving skills and improving the intake of such training as this might be helpful for both FDWs and caregivers during this journey.

Can Informal Caregiving be Perceived as Rejuvenating? Changes in Perceptions of Ageing at Onset and End of Informal Caregiving during Different Stages of Life

INTRODUCTION

Perceptions of ageing are a central predictor of health, wellbeing, and longevity. This study analyses the association between the onset and end of informal caregiving and perceptions of ageing in different stages of life.

METHODS

Data from the German Aging Survey (2014, 2017) were used; a longitudinal dataset that is representative of community-dwelling individuals aged ≥40 years in Germany. Adjusted asymmetric fixed effects regression analyses were conducted to analyse the associations in three age groups (40 to <60, 60 to <80, and ≥80). Perceptions of ageing were measured in terms of attitude towards one's own ageing (Philadelphia Geriatric Centre Morale Scale), subjective age (felt age), and onset of old age (when someone is considered to be old).

RESULTS

Significant changes in the perceptions of ageing were found only among individuals aged ≥80 years. In this group, the onset of informal caregiving was significantly associated with improved attitude towards one's own ageing and the end of informal caregiving was significantly associated with increased subjective age and earlier onset of old age.

CONCLUSION

The perceptions of ageing improved with the onset and worsened with end of caregiving - but only among oldest old individuals. Thus, informal caregiving seems to be a significant predictor for perceptions of ageing in old age.

Gender Differences in Mental Health, Quality of Life, and Caregiver Burden among Informal Caregivers during the Second Wave of the COVID-19 Pandemic in Germany: A Representative, Population-Based Study

INTRODUCTION

This study aimed to compare the mental health, quality of life, and caregiving burden between male and female informal caregivers of older adults (≥60 years) during the second wave of the COVID-19 pandemic in Germany.

METHODS

The sample consisted of 301 female and 188 male informal caregivers of older adults in need of care (≥60 years). Data were used from a cross-sectional study in March 2021 that questioned a representative sample of adults aged 40 years and older from Germany. Information on informal care provision, mental health (depressive and anxiety symptoms), caregiving burden, and quality of life was assessed for the period between December 2020 and March 2021. Regression analyses, adjusted for (1) the sociodemographic background and health of the caregivers, (2) the caregiving time and caregiving tasks, and (3) the perception of impairment and danger posed by the pandemic, were conducted.

RESULTS

Findings of the fully adjusted model indicated a higher level of anxiety and lower quality of life among female caregivers, compared to male caregivers. Gender differences in depression and caregiver burden were not significant in analyses that controlled for care tasks and time. Moderator analyses indicated that gender differences in caregiver's anxiety levels were influenced by the danger perceived to be posed by the pandemic: among men the danger to the care recipient, and among women the danger to themselves, increased anxiety.

CONCLUSION

Female informal caregivers were more negatively affected than male informal caregivers during the pandemic, as indicated by higher levels of anxiety and lower quality of life. Gender differences in anxiety depended on the perceived danger posed by the pandemic. Thus, policy and pandemic measures should focus on gender-specific support of female caregivers who seem to be particularly vulnerable during the pandemic. More caregiver-specific support and information around protecting themselves and their care recipients are recommended. Also, further research on gender differences in care performance and their relation to psychosocial health outcomes is recommended.

Why do they care? A qualitative systematic review and meta-synthesis of personal and relational motivations for providing informal care

Informal caregiving is crucial to the sustainability of health and social care systems globally. With ageing populations and a rising prevalence of acute and chronic health conditions, the need for informal care is growing, making it important to understand what motivates individuals to care and to continue caring. This paper reports findings of a systematic review which examined determinants of motivations and willingness to provide informal care. A systematic search was conducted using six electronic databases and a wide range of additional sources. 105 qualitative studies published before August 2019 were included with 103 of them reporting on personal and relational motivations, and the contextual factors underpinning these. Grounded theory-based, thematic synthesis was applied to synthesise the literature. This meta-synthesis reports on findings from across the world spanning three decades, with data from over 2500 caregivers across a range of health conditions. This paper presents the relational, personal and contextual themes. It highlights the significance of reciprocity, affection, family values and caregiving obligations. Personal characteristics, finding meaning, illness perceptions, situational and temporal aspects of caregiving are also identified as important in shaping motivations and willingness to care and to continue caring. Implications for theory, research, policy and practice are discussed.

Levels of depression and anxiety among informal caregivers during the COVID-19 pandemic: A study based on the Canadian Longitudinal Study on Aging

Objectives

Studies on informal caregiving during the coronavirus disease 2019 (COVID-19) pandemic have mainly focused on subgroups of caregivers using cross-sectional or convenience samples, limiting the generalizability of findings. Conversely, this longitudinal study examines the effects of the pandemic and caregiving factors on depressive symptoms and anxiety over 9 months among informal caregivers in Canada.

Methods

This study uses data from the Baseline (2011–2015), Follow-up 1 (2015–2018), and COVID-19 Study Baseline survey (April to May 2020) and Exit surveys (September to December 2020) of the Canadian Longitudinal Study on Aging (CLSA). A total of 14,118 CLSA participants who were caregivers at Follow-up 1 and participated in the COVID-19 studies were selected. Linear mixed models were used to examine the effect of sex of caregiver, changes in caregiving (increase in caregiving hours and inability to care), and location of care (same household, another household, and health care institution) on depressive symptoms and anxiety from COVID-19 studies Baseline to Exit surveys (about 6–7 months apart).

Results

Informal caregivers reported more frequent depressive symptoms from the COVID-19 Baseline to Exit surveys, but not anxiety. Female caregivers reported greater depressive symptoms and anxiety, and male caregivers exhibited a greater increase in depressive symptoms and anxiety over time. More caregiving hours and inability to provide care were significantly positively associated with depressive symptoms and anxiety. Also, in-home caregivers reported more depressive symptoms and anxiety than those who cared for someone in health care institution, and more anxiety than those who cared for some in another household.

Discussion

The findings shed light on the change in mental health among informal caregivers during the outset of the pandemic. The demonstrated associations between studied variables and mental health among informal caregivers provide empirical evidence for intervention programs aiming to support caregivers, particularly those who are female, and providing intensive care at home.

[Sharing informal care: What are the considerations?]

Due to social, political, and demographic developments in Dutch healthcare, the pressure on informal carers of vulnerable, senior citizens living at home continues to increase. To relieve this pressure, people in the senior citizens' social network are looking for ways to share care tasks with others. However, many informal caregivers seem to experience a threshold in this respect. This pilot study focuses on understanding the considerations involved in sharing caregiving tasks with others. Therefore, semi-structured interviews were conducted with six informal caregivers of single, senior citizens living at home. This study shows that these considerations are characterised by a relationship between informal caregivers' workload, their shyness to ask others for help, and the perception of care recipients' demand, combined with informal caregivers' natural inclination to do it themselves. Feelings of being responsible for the care and behaviour of care recipients, and the choices that must be made for them seem to play an additional role. To develop adequate solutions that lead to sharing informal care with others, and relieving the pressure on informal caregivers, more insight into the (personal) mechanisms behind this sense of responsibility seems necessary.

Identifying solutions to meet unmet needs of family caregivers using human-centered design

Background

Given the rapidly aging society, shrinking workforce, and reducing dependency ratio, there is an increasing challenge for family members to provide care for older adults. While a broad understanding of caregiver burden and its consequences have been studied across various contexts, there is a need to better understand this challenge among family caregivers in Asian societies.

Methods

This study is a cross-sectional observational study. A total of 20 dyads of community-based older adults, who required assistance with at least one activities of daily living, and family caregivers in Thailand participated in the study. We used the first three stages out of five stages of human-centered design: empathize, define, and ideate.

Results

On average caregivers were 59.2 years old, with 43% still employed. Of the older adult participants, 10 were interviewed, the others had moderate-to-severe cognitive impairment. Based on the analysis, six caregiver personas (i.e. semi-fictional characters) are identified. Caregiver personas of “The 2-Jober” and “My Life Purpose” has the highest caregiver burden score whereas “The Spouse” has the lowest. Based on the specific needs of the caregiver persona “My Life Purpose”, the team brainstormed more than 80 potential solutions which were classified into three categories of solutions that satisfied the metrics of desirability, feasibility and viability: distributed medical care system, technology-charged care network, and community gathering for rest and recuperation.

Conclusions

These solutions are culturally sensitive given that they are built around established behavioral patterns. This is an illustration of a method of innovation that can be applied to bring a culturally specific understanding, and to develop products and services to enable further independent aging.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02790-5.

Psychotic experiences among informal caregivers: findings from 48 low- and middle-income countries

PURPOSE

Informal caregivers may be at high risk for psychotic experiences (PE) due to caregiving related stress, sleep issues, or other potential mechanisms, but this has not been previously investigated in the general adult population. Thus, we examined the association between caregiving and PE, and its mediators, in a large sample of adults from 48 low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data from the World Health Organization (WHO) World Health Survey were analyzed. Informal caregivers referred to those who provided help to a relative or friend (adult or child) in the past year, because this person has a long-term physical or mental illness or disability, or is getting old and weak. PE were assessed using the WHO Composite International Diagnostic Interview psychosis screen. Multivariable logistic regression and mediation analyses were conducted.

RESULTS

Data on 224,842 individuals were analyzed. The mean (SD) age was 38.3 (16.0) years (range 18-120 years) and 50.7% were females. After adjustment for age, sex, and country, in the overall sample, caregiving was associated with 1.67 (95%CI = 1.56-1.79) times higher odds for PE. Sleep/energy explained the largest proportion of the association between caregiving and PE (13.9%), followed by pain/discomfort (11.5%), perceived stress (7.6%), depression (6.2%), and cognition (3.5%).

CONCLUSION

Caregivers in LMICs are at higher risk of PE. Future studies are warranted to gain a further understanding of the underlying mechanisms, and to assess whether addressing the identified mediators can lead to lower risk for PE among caregivers.

Ethical and Methodological Challenges in Research with Hard-to-Reach Groups: Examples from Research on Family Caregivers for Migrant Older Adults Living with Dementia

Family caregivers of migrants with dementia constitute a population group that is hard to reach for research participation due to factors such as shame about the disease and past experiences of discrimination. In this article, research-ethical challenges associated with participant recruitment and qualitative data collection among relatives of migrants with dementia are discussed. Over a period of 8 years, 3 studies were conducted to investigate the experiences of family caregivers for persons with dementia of Turkish descent in Germany. Across these studies, a total of 32 family caregivers were interviewed. In this article, based on the “Principles of Biomedical Ethics” according to Beauchamp and Childress (2009), research-ethical conflicts associated with sampling methods and the presence of third parties during qualitative interviews are discussed. The potential risks emanating from sampling strategies and the presence of third parties during interviews regarding the voluntary nature of study participation are examined. Additionally, this article formulates recommendations for ensuring truly voluntary participation and protecting both the participants (family caregivers) and relatives with dementia from harm. These practical recommendations aim to help future researchers to avoid ethical pitfalls and represent a roadmap for making necessary methodological decisions.

Family caregiving and changes in mental health status in Japan during the COVID-19 pandemic

Background

The coronavirus disease 2019 (COVID-19) pandemic has had a widespread significant impact on mental health. However, the effect of providing care to family members (informal caregiving) on changes in mental health status during the pandemic remains unclear.

Methods

Using cross-sectional data from a large internet survey conducted between August and September 2020, we investigated the association of informal caregiving status with the incidence of mental health deterioration (increased loneliness, self-reported deterioration in mental health, and new suicidal ideation) in Japan during the COVID-19 pandemic.

Results

Among 25,482 participants (mean age 48.8 [standard deviation 17.3]; 50.3% women), 2,500 (9.8%) were providing informal care during the pandemic. After adjusting for potential confounders, informal caregivers were more likely than non-caregivers to experience increased loneliness (adjusted odds ratio [aOR] 2.16; 95% confidence interval [CI] 1.70–2.76), self-reported deterioration in mental health (aOR 1.54; 95% CI 1.14–2.08), and new incidence of suicidal ideation (aOR 3.65; 95% CI 1.92–6.92). The degree of mental health deterioration depended on the intensity of care. For example, the incidence rates of new suicidal ideation were 15.0%, 5.2%, and 3.6% for individuals who provided high-intensity caregiving, those who provided low-intensity caregiving, and non-caregivers, respectively (p-for-trend<0.001). The stratified analysis by gender showed that informal caregiving was associated with self-reported deterioration in mental health status among women (aOR 2.19; 95% CI 1.49–3.21) but not men (aOR 1.08; 95% CI 0.75–1.56).

Conclusion

Informal caregivers were more likely to experience mental health deterioration than non-caregivers during the COVID-19 pandemic.

Effects of a Modified Mindfulness-Based Cognitive Therapy for Family Caregivers of People With Dementia: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVES

Family caregivers of people with dementia (PWD) experience high levels of stress resulting from caregiving. This study aimed to investigate the effects of a modified of Mindfulness-Based Cognitive Therapy (MBCT) for dementia caregiving.

RESEARCH DESIGN AND METHODS

113 family caregivers of PWD were randomized to either the intervention group, receiving the 7-session modified MBCT for a period of 10 weeks with telephone follow-up or the control group, receiving the brief education on dementia care and usual care. The caregiving stress (primary outcome) and various psychological outcomes of caregivers and the behavioral and psychological symptoms of dementia (BPSD) in the care recipients were assessed and compared at baseline (T0), postintervention (T1), and at the 6-month follow-up (T2).

RESULTS

At both T1 and T2, the intervention group had a statistically greater improvement in stress (p = .02 and .03), depression (p = .001 and .04), anxiety (p = .007 and .03), and BPSD-related caregivers' distress (p = .003 and p = .04). A significant greater improvement was also demonstrated in mental health-related quality of life at T2 (p = .001) and BPSD of the care recipients at T1 (p = .04). The increased caregivers' level of mindfulness was significantly correlated with the improvement of various psychological outcomes at T1 and T2 with a correlation coefficient -0.64 to 0.43.

DISCUSSION AND IMPLICATIONS

The modified MBCT enhanced the level of mindfulness in the caregivers and was effective to reduce the caregivers' stress and promote their psychological well-being during a 6-month follow-up. Future research is recommended to further examine its effects on the varieties of psychological and behavioral outcomes of both caregivers and care recipients and their dyadic relationships, as well as explore its mechanism of action in facilitating dementia caregiving.

CLINICAL TRIALS REGISTRATION NUMBER

NCT03354819.

Coping Patterns Among Primary Informal Dementia Caregivers in Singapore and Its Impact on Caregivers-Implications of a Latent Class Analysis

BACKGROUND AND OBJECTIVES

Existing studies typically explore the factor structure of coping strategies among dementia caregivers. However, this approach overlooks the fact that caregivers often use different coping strategies simultaneously. This study aims to explore the coping patterns of primary informal dementia caregivers in Singapore, examine their significant correlates, and investigate whether different patterns would affect the depressive symptoms of caregivers.

RESEARCH DESIGN AND METHODS

Two hundred eighty-one primary informal caregivers of persons with dementia (PWD) were assessed. Coping strategies were measured by the Brief Coping Orientation to Problem Experienced inventory. A latent class analysis was performed to explore caregivers' coping patterns, followed by logistic regressions to identify the significant correlates and the relationships between coping patterns and caregiver depression.

RESULTS

The latent class analysis suggested a three-class solution that was featured by the frequency and variety of coping strategies used by caregivers-high coping (36.3%), medium coping (37.7%), and low coping (26.0%). Factors influencing the coping patterns of our sample were mainly related to caregivers' individual resources such as personal characteristics and caregiving stressors like PWD's problematic behaviors and caregiving burden. Compared to caregivers in the low coping group, those in the medium coping group had significantly higher risks of potential depression.

DISCUSSION AND IMPLICATIONS

The current study confirmed that there are distinct coping patterns among primary informal dementia caregivers, and caregivers with the low coping pattern had fewer depressive symptoms. Future research is needed to explore if coping patterns from our sample are generalizable to dementia caregivers elsewhere.

Family Caregiving During the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has negatively affected persons with existing chronic health conditions. The pandemic also has the potential to exacerbate the stresses of family caregiving. We compare family caregivers with noncaregivers on physical, psychosocial, and financial well-being outcomes during the pandemic and determine family caregivers most at risk for adverse outcomes.

RESEARCH DESIGN AND METHODS

We conducted a cross-sectional online survey of 576 family caregivers and 2,933 noncaregivers from April to May 2020 in Pittsburgh, PA region with a national supplement. Outcome measures included concurrent anxiety, depression, fatigue, sleep disturbance, social participation, and financial well-being and perceived changes due to COVID-19 (loneliness, financial well-being, food security). We also measured sociodemographic, caregiving contextual variables, and COVID-19-related caregiver stressors (COVID Caregiver Risk Index).

RESULTS

Controlling for sociodemographics, family caregivers reported higher anxiety, depression, fatigue, sleep disturbance, lower social participation, lower financial well-being, increased food insecurity (all p < .01), and increased financial worries (p = .01). Caregivers who reported more COVID-19-related caregiver stressors and disruptions reported more adverse outcomes (all p < .01). In addition, caregivers who were female, younger, lower income, providing both personal/medical care, and providing care for cognitive/behavioral/emotional problems reported more adverse outcomes.

DISCUSSION AND IMPLICATIONS

Challenges of caregiving are exacerbated by the COVID-19 pandemic. Family caregivers reported increased duties, burdens, and resulting adverse health, psychosocial, and financial outcomes. Results were generally consistent with caregiver stress-health process models. Family caregivers should receive increased support during this serious public health crisis.

Getting back or giving back: understanding caregiver motivations and willingness to provide informal care

Background: Informal caregivers are those providing care, which exceeds that which is typically provided, to a relative or friend with care needs. Informal caregiving constitutes the backbone of a society’s care supply and with ageing populations the need for informal care is growing. We know little as to why caregivers start caring and continue doing so, yet understanding of motivations and willingness to provide care is important if informal caregivers are to be supported. However, both motivations and willingness are inconsistently defined making it difficult to compare the empirical findings that do exist.

Methods: This paper reviews and synthesises thinking about the theoretical constructs of motivations to provide care and willingness to perform informal care, and presents those in relation to existing theoretical and empirical literature.

Results and Conclusions: Theoretical reflections based on various motivational frameworks and available empirical data are presented to illustrate that: caregiving motivations should be conceptualised as multifaceted and multiply determined; intrinsic and extrinsic motivations should not be treated as antagonistic and can occur simultaneously; the commonly applied model of extrinsic/intrinsic motivations is oversimplified and omits consideration of the diversity of caregiver motives; other motivational models can be discerned in the context of the empirical research; there are differences between motivations and willingness to provide care with the latter being more consequent to the motives; both should be considered dynamic in nature; and finally, that the two constructs may not inevitably lead to actual caregiver behaviour. The implications of these theoretical reflections for methodology and research as well as their relevance for practice and policy are indicated.

Informal care and the impact on depression and anxiety among Swedish adults: a population-based cohort study

Background

As the population is ageing, the need for informal caregivers increases, and thus we need to know more about the effects on caregivers. This study aims to determine both cross-sectional and longitudinal associations between perceived limitation of informal caregiving and mental health of caregivers.

Methods

This population-based cohort study was based on the Swedish Psykisk hälsa, Arbete och RelaTioner (PART) study, and 9346 individuals aged 18–65 were included. Data were collected through questionnaires, interviews and Swedish registers. Informal care was defined as care given to a family member. Self-reported and diagnosed depression and anxiety were included as outcomes. Covariates included sex, age, social support and socio-economic position. Ordinal logistic regression and Cox regression were performed to determine the associations between caregiving and anxiety or depression.

Results

Self-reported depression and anxiety was only increased among those experiencing limitations (adjusted odds ratios [aOR] 2.00, 95% confidence intervals [CI] 1.63–2.47 for depression; aOR 2.07, 95% CI 1.57–2.74 for anxiety) compared to those not giving care, respectively. The adjusted hazard ratio (aHR) were increased for diagnosed depression (aHR 1.97, 95% CI 1.27–3.05) and for diagnosed anxiety (aHR 1.86, 95% CI 1.06–3.25) among those giving care and experiencing limitations, compared to those not giving care. No significant associations were found in caregivers without limitations.

Conclusion

Caregivers experiencing limitations showed a significant association with short- and long-term anxiety and depression. This study implies the importance of exploring the degree to which informal caregiving can be provided without adding burden to caregivers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11246-1.

The effect of subsidized childcare on the supply of informal care: Evidence from public kindergarten provision in the US

For informal caregivers in certain demographic groups, the tradeoff between childcare and informal care may be as significant as the tradeoff between informal care and labor supply. We shed light on this tradeoff empirically, by combining detailed time use data with a natural experiment created by differential access to publicly funded kindergarten across households and states. We find a substantial elasticity between informal care supply and kindergarten access, especially for female carers. In fact, for women, kindergarten access appears to largely increase their care supply rather than labor supply.

Association between primary caregiver type and mortality among Chinese older adults with disability: a prospective cohort study

Background

Socio-demographic transitions have dramatically changed the traditional family care settings in China, caused unmet care needs among older adults. However, whether different primary caregiver types have different influences on disabled older adults’ health outcomes remain poorly understood. We aimed to examine the association between the type of primary caregiver (e.g., spouse and children) and death among community-dwelling Chinese older adults disabled in activities of daily living.

Methods

We used data from Chinese Longitudinal Healthy Longevity Survey. The analytic sample comprised 4278 eligible adults aged ≥ 80 years. We classified primary caregiver type into five categories: spouse, son/daughter-in-law, daughter/son-in-law, grandchildren, and domestic helper. We used Cox regression model to examine the association between primary caregiver type and all-cause mortality. Covariates included age, sex, residence, years of education, co-residence status, financial independence, whether living with children, number of ADL disability, number of chronic conditions, and self-reported health, cognitive impairment, and caregiving quality.

Results

Married older adults whose primary caregivers were son/daughter-in-law had a 38% higher hazard of death than those who had spouse as the primary caregiver. Married men who received care primarily from son/daughter-in-law or daughter/son-in-law had a 64 and 68% higher hazard of death, respectively, than those whose primary caregiver was spouse. The association between primary caregiver type and mortality among widowed older adults differed between urban and rural areas. Urban residents who had domestic helpers as the primary caregiver had an 16% lower hazard of death, while those living in rural areas had a 50% higher hazard of death, than those having son/daughter-in-law as the primary caregiver.

Conclusions

The quality of care of the primary caregiver may be a risk factor for mortality of disabled older adults in China. Interventions are necessary for reducing unmet needs and managing care burden.

Patterns of Dyadic Appraisal of Decision-Making Involvement of African American Persons Living With Dementia

BACKGROUND AND OBJECTIVES

Greater everyday decision-making involvement by persons living with dementia (PLWD) and congruent appraisal between PLWDs and their caregivers have been associated with a better quality of life (QOL) for both members of the dyad. However, no study has examined the association between the appraisals of everyday decision-making involvement of PLWDs and their QOL among African Americans.

RESEARCH DESIGN AND METHODS

A secondary analysis of cross-sectional data from 62 African American dementia dyads was conducted. Multilevel and latent class mixture modeling was used to characterize dyadic appraisal of the decision-making involvement of African American PLWDs and identify distinct patterns thereof.

RESULTS

Three distinct patterns were observed. "Incongruent, PLWD Low Involvement" labeled 19.4% of the sample, 53.2% were labeled "Incongruent, PLWD Moderate Involvement," and 27.4% were labeled "Congruent, PLWD High Involvement." The Congruent, PLWD High Involvement pattern consisted of PLWDs who were significantly younger and had significantly less cognitive impairment than PLWDs in the other patterns. In the Incongruent, PLWD Moderate Involvement pattern, PLWDs had significantly better QOL than PLWDs in the Incongruent, PLWD Low Involvement pattern, but QOL did not significantly differ from PLWDs in the Congruent, PLWD High Involvement pattern.

DISCUSSION AND IMPLICATIONS

There is a need to tailor strategies to optimize QOL in African American dementia dyads. While increasing everyday decision-making involvement for PLWDs in the Incongruent, PLWD Low Involvement pattern is an important goal, other strategies may be needed to improve the QOL of PLWDs in the remaining patterns.

Predictors of Unmet Need Among Informal Caregivers

OBJECTIVES

This study investigates the relationship of caregiver demographics, caregiving intensity, caregiver support use, and aspects of the caregiving situation to a self-reported measure of unmet need among U.S. informal caregivers of older adults living at home with various conditions.

METHODS

Response data from 1,558 caregiver participants interviewed by telephone during the December 2016 baseline period of the Outcome Evaluation of the National Family Caregiver Support Program were used. Caregivers who responded "Definitely No" to the question "Are you receiving all the help you need?" were classified as reporting unmet need. Logistic regression was used to find significant factors associated with unmet need among the full sample and among caregivers tiered by three levels of burden.

RESULTS

Unmet need was reported by 22% of the caregivers. In a fully adjusted model, unmet need was predicted by higher levels of caregiving intensity, non-White race of the caregiver, and the caregiver not feeling appreciated by their care recipient. Other predictors associated with unmet need were no use of caregiver educational services, fewer respite hours, not living in a rural area, and caregiver having an education past high school.

DISCUSSION

Caregivers who do not feel appreciated by their care recipient and non-White caregivers should be identified as potential targets for intervention to address unmet need, especially if they are also reporting higher levels of caregiver burden. Understanding the factors associated with self-reported unmet need can assist caregiver support programs in measuring and addressing the needs of informal caregivers to support their continued caregiving.