Correlates of caregiving satisfaction: prerequisites to elder home care

In this comparative study, a path analytic model was used to identify variables predictive of satisfaction in providing care to elderly family members, and to determine differences in the predictor variables between past and present caregivers as potential precipitators of institutionalization. Nineteen current caregivers and 29 past caregivers were recruited from health agencies in a rural area. Demographic predictors of caregiving satisfaction included age and sex of the client and age of the caregiver; psychological problems of the client influenced caregiver satisfaction. Measures of situational stress (medical, psychological, environmental) revealed that the past caregivers had higher psychological and environmental stress and less life satisfaction than current caregivers. Additional analysis revealed that the most common pattern of nursing home admission was hospitalization of the client for physical illness, with subsequent physician-recommended nursing home placement. Areas of identified need for preventing premature relinquishing of the caregiving role are discussed.     

Caregiver Reactions to Dementia Symptoms: Effects on Coping Repertoire and Mental Health

ABSTRACT

Currently, 15 million informal caregivers, most of whom are women, provide care for older adults with dementia (Alzheimer's Disease Association, 2016). Caregiving for these individuals often creates distress and may adversely affect female caregivers' psychosocial and spiritual well-being. Approximately 35% of dementia caregivers complain of health deterioration after initiating caregiving responsibilities as compared to 19% of caregivers of older adults who do not have dementia (Alzheimer's Disease Association, 2016). Persons with dementia exhibit symptoms and behaviors that often are challenging for their caregivers. The way that caregivers react to these symptoms and behaviors may affect their coping repertoire and their mental health. Adequate evaluation of caregiver reactions to symptoms of dementia will provide information useful for developing targeted interventions to promote optimal health of female dementia caregivers and to potentially postpone the need for nursing home or long-term placement of the care recipient.     

Family caregivers' adjustment to nursing home placement of older relatives

The literature on the impact of nursing home placement of older parents on family caregivers is still incomplete. Family caregivers experience stress, shock, anxiety, fear, resistance, and guilt in the process of decision making. The literature has demonstrated that family caregivers continue to experience stress and problems after placing older relatives into a long term care facility. Cultural values impact on people's attitudes, values and expectations. Culture will therefore affect the care-giving experience. Relatively little information is available from Asian and multicultural societies. Identifying family caregiver experiences after nursing home placement can alert professionals to the need for family guidance prior to nursing home placement and assist in early identification of potential problems. This article reviews the literature and discusses the impact on family caregivers of making a decision for nursing home placement and dealing with the stress and challenges that persist after nursing home admission.     

Caregiving stress among community caregivers for the elderly: does institutionalization make a difference?

Nurses in community settings are frequently exposed to elderly persons who receive a significant amount of physical and/or psychosocial support from one or more informal caregivers. Although numerous investigations exist examining stress and coping in persons who provide such care for elderly persons, little is known about the caregiver's status once full-time caregiving ceases. This study describes emotional and physical components of caregiving stress in a convenience sample of 124 caregivers. Of these, 31 had placed their charge in a nursing home, while 93 had not. A multivariate analysis of variance (MANOVA) between placed-nonplaced groups revealed no significant differences in the total score or Role and Personal Strain subscales of the Burden Interview (J. Zarit & S. Zarit, 1983). Implications for community health nursing practice involve providing ongoing counseling and support of the caregiver and his or her charge, preparing both for the placement experience should it be indicated, and continued follow-up care post-placement. Greater collaboration between community-based and institutionally based nurses can facilitate implementation of these strategies.     

Giving voice to informal caregivers of older adults.

This study focused on the experiences of informal caregivers of older adults and explored whether employment, use of home-care services, or other factors influence the health of caregivers and their ability to manage their caregiving and other responsibilities. Focus groups conducted with 26 caregivers and personal interviews with 4 caregivers identified 12 themes under 5 conceptual areas: caregiver health, relationships, independence, employment, and use of home-care services. The findings reveal that caregiving coupled with other responsibilities can have serious health effects. Participants spoke of the tenuous balance of decision-making control between caregiver and care recipient. Many caregivers expressed a desire to be included as part of the formal health-care team. Implications for nursing are discussed.     

A comparison of African American & Caucasian American female caregivers of rural, post-stroke, bedbound older adults

As changes in health care take place, the care of older adults in the home becomes a greater responsibility of informal caregivers. The purpose of this study was to compare African American and Caucasian American female caregivers of post-stroke, bedbound older adults in rural Mississippi. A purposive sample of 74 caregivers reported bedbound older adults' functional impairments, along with caregivers' stress and self-efficacy, social support, coping, depression, and life satisfaction. Significant differences were determined for self-efficacy between the African American and Caucasian American caregivers. Disordinal interactions existed between race and caregiving self-efficacy on the variables of stress and life satisfaction. Nurses must be cognizant of the many stressors influenced by cultural factors, such as race, faced by these caregivers. This is important to include in the curricula of nursing programs for the 21st century.     

Caregivers of frail rural older adults. Effects of an advanced practice nursing intervention

Informal caregivers are responsible for providing the majority of post-discharge care for many frail older adults in rural settings. The purpose of this study was to investigate whether an advanced practice nurse (APN) intervention would promote more positive physical and emotional outcomes in caregivers of rural older adults who are frail and were recently discharged from urban-based hospitals. Thirty-two caregivers of frail rural elderly individuals were randomly assigned to treatment (APN intervention) and control groups (no APN intervention). Assessments of caregiver outcomes were collected via telephone interviews at 48-hour, 2-week, and 4-week intervals after hospital discharge of the frail rural older adults. Outcomes were operationalized as caregiver physical health and well being, and stress and burden. The former was measured using the Health and Daily Living form (HDL) and the latter by the Thoughts and Feeling and Time and Energy subscales of the Caregiver Burden Inventory (CBI). Additional information on caregiver problems and APN visit time was collected by the APN using the Omaha Classification System. Caregivers in the treatment group experienced significantly more positive physical and emotional health outcomes. The caregivers who received the APN intervention had higher self-rated emotional health scores, fewer emotional symptoms at Week 4, fewer depressive symptoms at Week 2 and 4, and lower Thoughts and Feelings stress scores at 48 hours than the control group. Findings support the importance of addressing the needs of caregivers post-discharge and the ability of APNs to improve post-discharge outcomes for home health care recipients and their caregivers.     

Caregiver burden among dementia patient caregivers: a review of the literature

Purpose: To identify current evidence of factors influencing dementia-related caregiver burden (CB), describe patient and caregiver characteristics associated with CB, and describe evidence-based interventions designed to lessen the burden of caregiving.
Data sources: Comprehensive literature review of Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Psych Info was performed for the years 1996–2006 of peer-reviewed journals using keywords CB and dementia.
Conclusion: Dementia caregiving has been associated with negative effects on caregiver health and early nursing home placement for dementia patients. Many factors influence the impact of the caregiving experience such as gender, relationship to the patient, culture, and personal characteristics. Although various interventions have been developed with the goal of alleviating CB, evidence suggests that individually developed multicomponent interventions including a diversity of services will decrease burden, improve quality of life, and enable caregivers to provide at-home care for longer periods prior to institutionalization.
Implications for practice: The ability to properly assess the dementia patient–caregiver dyad related to CB is critical to decreasing its negative physical and psychological health outcomes. Appropriately tailored interventions can improve the health and well-being of both caregiver and patient.     

Factors determining the attitudes of family caregivers of dementia patients toward nursing home placement in Taiwan: comparisons between urban and semiurban areas

This study sought to determine the factors that influence the attitudes of family caregivers of dementia patients toward nursing home placement. A telephone survey of primary caregivers was conducted in two metropolitan areas of Taiwan. Caregivers of dementia patients were recruited from the neurology and psychiatry outpatient departments of two medical centers in Taipei (a highly urbanized area, n=144) and two medical centers in Kaohsiung (an area of mixed farm and nonfarm sectors, n=134). Family caregivers were asked if they would place patients in a nursing home if their dementia progressed. The mental status of dementia patients was the most significant variable affecting caregivers attitudes toward nursing home placement. Family manpower available for caregiving at home was especially emphasized as a determining factor affecting the decision to use nursing home care by primary caregivers in highly urbanized areas.     

Caregiver care

In 2009, nearly 66 million Americans (three in 10 U.S. households) reported at least one person providing unpaid care as a family caregiver. More adults with chronic conditions and disabilities are living at home than ever before, and family caregivers have an even higher level of responsibility. Caring for loved ones is associated with several benefits, including personal fulfillment. However, caregiving is also associated with physical, psychological, and financial burdens. Primary care physicians can aid in the identification, support, and treatment of caregivers by offering caregiver assessments-interviews directed at identifying high levels of burden-as soon as caregivers are identified. Repeat assessments may be considered when there is a change in the status of caregiver or care recipient. Caregivers should be directed to appropriate resources for support, including national caregiving organizations, local area agencies on aging, Web sites, and respite care. Psychoeducational, skills-training, and therapeutic counseling interventions for caregivers of patients with chronic conditions such as dementia, cancer, stroke, and heart failure have shown small to moderate success in decreasing caregiver burden and increasing caregiver quality of life. Further research is needed to further identify strategies to offset caregiver stress, depression, and poor health outcomes. Additional support and anticipatory guidance for the care recipient and caregiver are particularly helpful during care transitions and at the care recipient's end of life.     

Relationship of empathy to appraisal, depression, life satisfaction, and physical health in informal caregivers of older adults

The relationship between empathy and caregiving appraisal and outcomes was examined among 140 informal caregivers of older adults. Caregivers with high cognitive empathy appraised the caregiving situation as less stressful and less threatening, were less depressed, and reported higher life satisfaction than did caregivers with low cognitive empathy. The caregivers' appraisal, along with educational levels and total household income, significantly predicted individual differences in caregiver depression, life satisfaction, and perceived physical health. Emotional empathy was negatively related to life satisfaction. There appeared to be distinct roles for emotional and cognitive empathy in informal caregiving outcomes. The study supported the important role of caregiving appraisal and resources in caregiving outcomes.     

Men providing care to older adults in the home

Men are important providers of care to older adults who are functionally impaired in the home setting. Some results from research studies suggest that the male caregiver may provide different types of care and have different responses to caregiving than female caregivers. This article provides an overview of research related to the role of the male caregiver and discusses implications for supportive interventions. The need for more research related to the needs of the male caregivers and the value of traditional interventions for this group are addressed.     

Social support and strain of family caregivers of older adults

To assess the direct effects and interactive models of social support, caregivers to functionally impaired older adults were identified by hospital personnel. Within a week of referral, family caregivers were interviewed in the home about strain, depressive symptomatology, caregiving appraisal, informal social support, and coping. Caregiving appraisal significantly explained strain and depressive symptomatology. The interaction of social support with strain did not moderate or lessen depressive symptomatology. These findings suggest that nursing continue to examine the effect of home health care on strain and depressive symptomatology of caregivers of older adults.     

Perspectives from family caregivers receiving home nursing support: findings from a qualitative study of home care patients with heart failure

Many heart failure (HF) patients depend on a family caregiver and many families need additional home care nursing support. This qualitative study identified perspectives of being a HF caregiver for families receiving home care nursing. Eleven caregivers of homebound HF patients were interviewed on what helps them the most, their own health, obstacles in caregiving, and greatest needs overall. Eight themes emerged and will be discussed in this article. The findings articulate the positive influence nurses can have on HF families to guide future practice and research.     

The changes in caregiver burden following nursing home placement

This longitudinal study explored changes in perceived burden among Taiwanese family caregivers (n=77) from nursing home placement of an elder to four months postadmission. Higher burden at placement was related to the level of dependence of the care recipients (p=0.004), or caregiver's poor health (p<0.01). After nursing home placement for four months, global burden decreased (p<0.01) contributed primarily by lessened burden in three sub-scales: lack of family support, impact of schedule and impact of health. Burden scores on caregiver esteem and impact of finances were not decreased after placement. Duration of caregiving was the only demographic factor predicting change in global burden (p<0.001). Changes in impact on finances, and impact on health were, respectively, predicted by the perceived health (p=0.005), and religious preference (p=0.01). These results provide valuable information to healthcare providers for an understanding of the changes of caregiving burden after nursing home placement and the correlates of these changes, which may help devise an appropriate policy for alleviating the caregiver's burden.     

Family caregivers need support with heart failure patients

Millions of family members are serving as caregivers for patients with heart failure and the numbers will continue to rise. It appears that caregivers desire to be involved in the patient's care even when the caregiving tasks average 8 hours per day. Burden, stress, and depression have been found to be significantly associated with the caregiving role in this population. Decreasing any negative aspects of caregiving should be a priority. Alarmingly, caregivers have reported being ignored or made to feel like an outsider by health care providers. Nurses are in a pivotal position to improve patient and caregiver outcomes by including the family caregivers of heart failure patients in all aspects of care and in promoting the well being of the caregiver. This article will highlight the importance of social support on patient and caregiver outcomes, and second, review studies on family caregiving among heart failure patients. Recommendations for nursing practice and further research will be discussed.