Physical and psychosocial health in family caregiving: a comparison of AIDS and cancer caregivers

The objectives of this study were to compare cancer and AIDS family caregivers in regard to their physical and emotional health. The sample consisted of 26 caregivers of persons with cancer or AIDS. Study participants completed a questionnaire that included measures of depression, grief, symptoms of stress, caregiving demands, interpersonal relationships, health status, and quality of life. The data revealed that both AIDS and cancer caregivers reported high levels of stress and depression as compared to community norms. No significant differences were found between AIDS and cancer caregivers for any of the scale scores; however, the two groups differed on several individual subscales. Cancer caregivers demonstrated higher social functioning and were more likely to report that the work of caregiving itself disrupted their ability to socially engage with others. In contrast, AIDS caregivers were more likely to report that their own health limited their ability to socialize. Even though AIDS caregivers experienced less family support than cancer caregivers, they reported more rewards from caregiving. Results suggest that support delivered to caregivers emphasize a more inclusive approach to program delivery, versus a disease-specific perspective, in order to increase the depth and breath of services provided to families undertaking these challenges.     

Effects of formal supports on stress outcomes in family caregivers of Alzheimer's patients

The aim of this study was to examine whether formal support and coping would mediate the effects of primary stressors and caregiver characteristics on three stress outcomes: yielding of role, anxiety, and physical health. Secondary analysis of longitudinal data from a convenience sample of 452 spouse and adult child caregivers of Alzheimer's patients was used for model testing. Path analysis suggested that decreased physical health of the caregiver was best explained by caregiver overload. Caregiver anxiety was explained by lower levels of care receiver dependency, higher levels of caregiver overload, and higher levels of caregiver anxiety measured 1 year earlier. Yielding of the caregiver role was explained by the direct effect of higher levels of care receiver problem behaviors as well as more use of formal supports. Spouse relationship had a negative effect and care receiver dependency had a positive effect on yielding of the role through the mediating influence of formal support. Neither coping nor formal support mediated primary stressors and caregiver characteristics in the directions hypothesized. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 27–37, 1997     

Emotional and physical health of spouse caregivers of persons with Alzheimer''s disease and stroke

Providing care for a cognitively impaired spouse can adversely affect caregivers' health. It is not known how early in the caregiver's 'career' emotional and physical health deteriorates. The progressive deterioration associated with Alzheimer's disease (AD) may have different effects on caregivers' health when compared with the potential recovery following a stroke. An exploratory study was conducted with 42 couples, equally divided among early phase AD, ischaemic stroke after hospital discharge, and well controls. Couples were evaluated at baseline (time 1), 6 months (time 2) and 1 year (time 3). At time 1, depression was significantly higher in AD and stroke caregivers when compared to controls. Over time, depression increased significantly for AD caregivers with 21% evidencing moderate to severe depression at time 1 and 50% at time 3. For stroke caregivers there was a significant interaction effect with race: white stroke caregivers' depression increased over time while African American stroke caregivers' depression decreased. Physical health was not significantly different for the three groups and remained stable over time. Cognitive and functional impairment levels of care recipients were significantly related to stroke caregivers' but not AD caregivers' depression. Long-term counselling and support to family caregivers is advocated.     

Patterns of caregiving when family caregivers face competing needs

'Finding a balance point' is a process used by caregivers to achieve or preserve equilibrium in caregiving while facing competing needs. This paper describes different patterns of 'finding a balance point'. Interviews with 15 family caregivers receiving home nursing services and 14 family caregivers of hospitalized and discharged frail elders were analysed using constant comparison. Sources of competing needs and the strategies used to find a balance point were identified by participants. Findings suggest that caregivers in a stable situation maintain a balance point, caregivers experiencing major family change try to regain a balance point, and caregivers experiencing the transition from hospital to home work at establishing a balance point. These findings can sensitize nurses to family caregivers' needs and conditions.     

社区护理干预对减轻长期卧床老年居家患者照顾者抑郁、焦虑的效果评价

总结30例长期卧床老年居家患者照顾者在接受1年的社区护理团队支持干预后抑郁、焦虑情绪的变化。结果显示,干预后照顾者抑郁、焦虑评分低于干预前,差异有统计学意义（P〈0.05）。说明通过社区医护团队对居家照顾者照顾技能的宣教、疾病相关知识的培训和心理辅导,可以缓解照顾者的抑郁及焦虑情绪,增加其主观幸福感。     

Using family history and health risk behaviors to determine predictors of depressive symptoms in Central American immigrant mothers

In this study, depressive symptomatology in Central American immigrant mothers with adolescent daughters living in the USA was explored. Using the Center for Epidemiologic Studies Depression Short Scale, the Family History Scale, an Acculturation Scale, and the core section of the Youth Conduct Disorder scale from the National Health and Nutrition Examination Survey, 101 Central American mothers were analyzed to identify predictors of depressive symptoms. Over one‐third of the participants had depressive symptoms. There were no significant findings for acculturation as a predictor of depressive symptoms. Predictors that related to depressive symptomatology were a positive family history of depression, marital status (divorced), and having a daughter engaged in health risk behaviors. Clinicians working with mothers from Central America should consider risk of depression, whether there is a family history of depression; and additional stresses, such as the health risk behaviors of adolescents. Unprecedented levels of immigration around the world underscore the importance of meeting the healthcare needs of culturally‐diverse groups.     

肝硬化患者家属心理健康状况调查与分析

目的 了解肝硬化患者家属的心理健康状况及其影响因素。方法 采用一般情况凋查表、焦虑自评量表（SAS）、抑郁自评量表（SDS）对57例肝硬化患者家属进行问卷凋查。结果 肝硬化患者家属的焦虑、抑郁得分明显高于国内常模（P〈0．01），且受性别、文化程度、职业、在职情况、家庭平均月收人等因素影响。结论 肝硬化患者家属的心理健康状况较正常人群为差，采取多种护理干预措施，可以提高他们的心理健康水平和生活质量。     

健康教育在老年患者家庭护理中的应用

目的探讨健康教育在老年患者家庭护理中的实施效果。方法对65例老年患者家庭护理中实施健康教育,比较实施前后健康教育效果的差异,包括患者对疾病知识知晓程度、健康行为、治疗依从性、情绪管理等。结果实施后健康教育效果优于实施前,实施前后比较,χ2=28.770,P0.01,差异具有统计学意义。结论老年患者家庭护理中实施健康教育,有效改善患者对疾病知识知晓程度、健康行为,提高治疗依从性及自我管理能力,提高患者的生活质量。     

Role integration and perceived health in Asian American women caregivers

In this study, role involvement, role integration (including role stress and role satisfaction), and perceived health were examined in 50 Asian American women who were caregivers of aging parents in addition to being wives, mothers, and employees. Their mean age was 47.8 years. Twenty-nine of the participants were Chinese and 21 Filipino, with an average length of caregiving for each group of 11 years. All participants were born outside the United States. Instruments used in the study were translated and back-translated into Chinese and Tagalog and tested for validity and reliability. The association of role involvement, role integration, role stress, and role satisfaction with perceived physical and psychological health in the combined and separate groups was examined. Role involvement was not associated with health in the combined group of caregivers but was associated with overall health in the sample of Chinese women. Role integration was positively associated with all three perceived health measures in the Filipino group but not in the Chinese group. Role satisfaction was consistently high in both groups. Role satisfaction and psychological well-being were significantly correlated for the combined group and for the Filipino caregivers. Total role stress was significantly correlated with overall health and current health only in the combined group. Thus, support that helps to decrease role stress and to increase role satisfaction may be more effective than efforts to decrease the extent of role involvement.     

Creating avenues for relative empowerment (CARE): a pilot test of an intervention to improve outcomes of hospitalized elders and family caregivers

The purpose of this pilot study was to evaluate the effectiveness of a family caregiver-focused intervention program (CARE) on the outcomes of hospitalized elders and their family caregivers. A randomized clinical trial was conducted with 49 family caregivers of hospitalized elders in a university medical center in upstate New York. Driven by self-regulation and role theories, the two-phase CARE program consisted of: (a). a mutual agreement consisting of family caregiving activities during hospitalization; and (b). audiotaped information regarding emotional responses and possible complications associated with an elderly patient's hospitalization as well as instructions for effectively participating in the elder's hospital care. The comparison program consisted of information about hospital services and policies. CARE elders had fewer incidents of acute confusion reported by family caregivers during hospitalization and fewer depressive symptoms at 2 weeks and 2 months posthospitalization than did the comparison group. CARE family caregivers participated more in the care of their hospitalized elders and had higher scores on role rewards prior to hospital discharge. Findings from this study support the need for further testing of the CARE intervention with family caregivers to determine its effectiveness on outcomes of hospitalized elders and their family caregivers.     

对口腔门诊老年患者与家属同步实施健康教育的效果

目的探讨口腔门诊老年患者与家属同步接受健康教育对患者的影响。方法将76例老年患者分为两组,每组各38例,两组患者均接受常规口腔治疗和健康教育,观察组在此基础上对患者和家属实施同步健康教育,采用社会支持评定量表在健康教育前、后进行评分比较。结果健康教育后,观察组与对照组的社会支持差异具有统计学意义（P〈0．01）,观察组健康教育前后社会支持差异具有统计学意义（P〈0．01）。结论通过对老年患者及家属同步实施健康教育,提高了患者的社会支持水平,促进口腔疾病的治疗,     

Managing caregiver tasks among family caregivers of cancer patients in Hong Kong

Twenty-nine family caregivers of terminally ill cancer patients in Hong Kong were asked about their perceived difficulty in managing caregiver tasks. Results showed that the level of difficulty in handling the three main aspects of tasks, that is the direct care, intrapersonal tasks, and interpersonal ties, were similar (chi2 = 0.71, P > 0.05). The individual tasks identified as extremely difficult included compensation for personal time (31%), updating knowledge of reimbursement mechanism (20.7%), and emotionally accepting the likelihood of a progressive downward course of illness (17.2%). Mann-Whitney tests indicated that caregivers who had a shorter duration of caregiving experience perceived significantly greater difficulty in direct care (P < 0.05), intrapersonal tasks (P < 0.05), and overall tasks (P < 0.05). These findings indicate the need for the provision of counselling and educational support for these caregivers.