Institutionalization in Taiwan. The role of caregiver gender

The role of caregiver gender in the likelihood of institutionalization of Taiwanese older adults was explored in this study. A sample of 78 male and 69 female primary caregivers of elderly patients who had experienced a stroke at least 6 months prior to the study were interviewed. Logistic regression analyses were applied to examine direct and interaction effects of the elderly adult's functioning the caregiver's available resources, the degree of caregiver burden, perceived public opinion toward institutionalization, and precipitating events on the likelihood of institutionalization among Taiwanese male and female caregivers. Women were more likely to institutionalize the older adult for whom they cared. The proposed model correctly predicted the likelihood of institutionalization of an elderly adult based on male versus female caregivers at the 92% level. Perceived public opinion toward institutionalization was the most significant predictor of institutionalization for both genders. Perceived public opinion toward institutionalization has a strong influence on whether or not caregivers institutionalize an elderly relative. This is consistent with Chinese culture in which public opinion has a much stronger effect on individual behavior than in the United States. American concepts of "minding one's own business" do not exist in Taiwan. It is logical that the older adults' level of functioning would predict the likelihood of institutionalization regardless of caregiver gender. In terms of caregiver characteristics, working hours in male caregivers is more predictive, and the quality of the relationship with the older adult was more predictive of institutionalization for female caregivers.     

Depression and caregiver burden experienced by caregivers of Jordanian patients with stroke

Many stroke survivors will be cared for at home, primarily by their relatives. Providing care to a family member with a chronic disabling disease can be both emotionally and physically distressing for the caregivers. The purpose of this study was to investigate the relationship between patients' characteristics, duration of caregiving, daily caregiving time, caregiver's characteristics, caregiver depression and burden in caregivers of patients with stroke. A cross-sectional design was used with a convenience sample of 116 subjects. The Center of Epidemiologic Studies of Depression and the Caregiver Strain Index were used to identify caregiver depression and burden, respectively. Logistic regression analysis identified the influence of independent variables on caregiver depression and caregiver burden. Caregivers had high scores for depression and burden indices. Caregivers' health, receiving professional home health care and caregivers' burden were related to caregiver depression. Functional disabilities of patients with stroke and depression of caregivers were related to caregiver burden. To decrease caregiver depression and burden, nurses must provide caregivers with instructions for home management of patients with stroke. Development of specialized stroke home health services in Jordan that targets patients with stroke and their caregivers are recommended.     

Family carers of ICU survivors: a survey of the burden they experience

Intensive care unit (ICU) survivors may experience deterioration in their quality of life for months following their return home, with families assuming a caregiving role. The aim of this study was to measure the burden associated with caring for a family member who had been critically ill. The study also sought to describe the relationship between three factors (filial obligation, social support, self-efficacy) and caregiver burden. Seventy-one family carers, 51 females (72%) and 20 (28%) males of long-term intensive care patients completed a mailed survey, after signing an informed consent form. Although the vast majority of the caregivers were providing substantial number of hours of care each week, they scored lower than the midpoint on all caregiver burden inventory subscales. Filial obligation was found to be positively associated with caregiver burden; however, there was no association between social support, self-efficacy and caregiver burden. Male caregivers experienced significantly more burden than female caregivers. The findings suggest that an understanding of the factors that impact on caregiver burden of families of ICU survivors is only beginning to emerge.     

Factors predicting the health status of caregivers of stroke survivors: A cross‐sectional study

In this cross‐sectional study, we aimed to determine factors influencing the health status of caregivers of stroke survivors. A total of 126 caregivers of stroke survivors were recruited from three outpatient clinics in Thai Nguyen National General Hospital, Vietnam, from November 2016 to March 2017. Data were collected through six instruments: a demographic questionnaire, the Modified Barthel Index, the Zarit Burden Interview Scale, the Multidimensional Scale of Perceived Social Support, the Family Caregiver Conflict Scale, and the Short Form‐36 Health Survey. Stepwise multiple regression was employed to analyze the data. Caregiver burden, patient's functional status, caregiver's age, and social support together explained 80.3% of the variations in health status of caregivers of stroke survivors. Caregiver burden was the strongest predictor of health status of these caregivers. Based on the findings, nurses should take caregiver's age, functional status of stroke survivors, caregiver burden, and social support into consideration when preparing family caregivers to provide care for stroke survivors. To reduce perceived caregiver burden, family support interventions should be embraced to enhance health status of the caregivers of stroke survivors.     

Family caregiving of persons living with HIV/AIDS in Thailand: caregiver burden, an outcome measure

The present paper provides an initial picture of HIV/AIDS-affected families. It is evident that families play a major role of support for HIV/AIDS patients in Thai society. Caregiver burden is one of the patient-related outcomes, which is the most common outcome measure in caregiver research. The demands on the family caregivers of these patients are enormous and need to be addressed. The determinants that are associated with caregiver burden such as caregiver characteristics, patient characteristics and social stigma are important for nurses to minimize the burden of care so that appropriate interventions can be developed for persons with HIV/AIDS and family members who share the work of managing their care at home.     

1型糖尿病患者主要照顾者负担水平与其社会支持状况的相关性研究

目的：调查1型糖尿病（T1DM）患者照顾者负担水平与社会支持状况及两者相关性。方法：采用一般资料问卷、照顾者负担量表及社会支持评定量表对65例T1DM患者照顾者进行问卷调查。结果：T1DM患者照顾者负担总分为（33.0±14.9）分,仅13.8%的照顾者无照顾负担;社会支持总分为（35.6±6.6）分,绝大多数（95.4%）照顾者社会支持尚未达到高水平。总社会支持水平与总负担及负担各维度呈显著负相关（P〈0.05）;主观支持维度与总负担及负担各维度呈显著负相关（P〈0.05）;客观支持维度与总负担及角色负担维度呈显著负相关（P〈0.05）。结论：T1DM患者照顾者普遍存在不同程度的照顾负担,社会支持多处于中低水平;所获社会支持程度越高,感知的照顾者负担越轻。护理人员应给予照顾者恰当的社会家庭支持及相关知识的指导,减轻其身心负担,使其能更有效地承担照顾患者的责任,优化患者疾病控制情况。     

Keeping vulnerable elderly patients free from pressure ulcer is associated with high caregiver burden in informal caregivers

Rationale and objectives The effect of the presence of pressure ulcers on burden of caregivers is unknown. We investigated the relationship between the state of pressure ulcers in vulnerable elderly patients and the burden on their informal caregivers. Methods This cross‐sectional study enrolled 137 patients aged ≥40 years with limited activity and mobility at 10 home care service facilities in Japan. We assessed pressure ulcer status from medical records and caregiver burden using scores from both the Burden Index of Caregivers (BIC) and the Japanese short version of the Zarit Burden Interview (ZBI). Results Among patients, mean age was 80.9 years, 31.4% were men, and 83.9% were free from pressure ulcers. Multivariable analysis showed that caregivers whose patients were free from pressure ulcers had significantly higher caregiver burden as assessed by both the BIC [β‐coefficient = 3.18, 95% confidence interval (CI): 1.42–4.95, P = 0.003] and ZBI scores (β‐coefficient = 1.94; 95%CI = 0.30–3.58; P = 0.03). Conclusions Our results suggest that the continuous effort involved in keeping patients free from pressure ulcers may be associated with high caregiver burden in informal caregivers.     

Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: a cross-sectional community-based study

BACKGROUND: Family caregivers of relatives with dementia report higher level of psychological distress than other caregivers and report their self-related health as poorer than that of comparison groups. AIMS AND OBJECTIVES: The purpose of the study was to examine characteristics of family caregivers and to assess whether income, subjective health, age and relationship were associated with the burden of care they experienced. SETTING: Group living units in southern Sweden. PARTICIPANTS: Fifty caregivers who served as informal caregivers of relatives with dementia in group living care. DESIGN: Interviews regarding economic and social conditions and well-evaluated scales for health and caregiver burden (CB) were used. RESULTS: The majority of the family caregivers were adult children, and twice as many were female than were males. The investigation showed that total burden, strain and disappointment, adjusted for health and age, were related to income. Disappointment showed a relation to subjective health. The adult children showed a significantly higher degree of total burden, irrespective of age, compared to other family caregivers. Low income was associated with a higher degree of burden among adult children. However, elderly participants experienced less of burden than younger ones. CONCLUSION: Our findings indicate that caregivers with low health profile and low income, especially adult children, are associated with higher CB. RELEVANCE TO CLINICAL PRACTICE: People with coexisting risk factors (low income, low perceived health) are the ones who may benefit most from health-oriented interventions.     

Analysis of caregiver burden in palliative care: An integrated review

The inclusion of caregivers in a holistic care approach represents a basic principle in palliative care. However, many palliative care professionals have a lack of understanding of difficulties or unmet needs among caregivers. To enhance the quality of life of caregivers and the quality of care for patients, healthcare professionals should be better informed about the constructs of caregiver burden. The aim of this study is to synthesize the concept of caregiver burden in palliative care, providing implications for the caregivers and their support systems. This concept analysis study adopts the integrative review approach and the basic text analysis method (ie, word frequency). The PubMed, CINAHL, Embase, and PsycINFO databases are explored for eligible studies. From this literature search, 66 articles from 1998 to 2018 are located. After data collection is completed, the two authors independently evaluate the quality of studies published before 1 September 2018. The caregiver burden is then redefined with its attributes, antecedents, consequences, empirical referents, and facilitators. It is recommended that the multidimensional concept of caregiver burden in palliative care be measured by considering caregiver characteristics and the caregiving context.     

Caregiver strain and caregiver burden of primary caregivers of stroke survivors with and without aphasia.

Little is known about how the burden and strain of caring for stroke patients with or without aphasia affects primary caregivers. This article (a) critically examines the literature on the burden and strain of care experienced by caregivers of stroke patients and (b) examines the relationship between aphasia and caregiver burden and strain. Two literature reviews of three databases were conducted. Fourteen articles (12 quantitative articles, 1 mixed-design article, and 1 qualitative article) were found to comply with the study criteria for the first literature search. A second literature search focused on the effects of stroke survivors' aphasia on caregiving; none of the articles retrieved met the inclusion criteria. This article suggests that there is a lack of research in this area and that several key initiatives are needed, including the development of an instrument with psychometric properties appropriate for assessing the burden and strain on caregivers of stroke patients. Implications for future nursing practice and research are highlighted.     

Caring for a relative with dementia: family caregiver burden

AIM: This paper is a report of part of a study to investigate the burden experienced by families giving care to a relative with dementia, the consequences of care for the mental health of the primary caregiver and the strategies families use to cope with the care giving stressors. BACKGROUND: The cost of caring for people with dementia is enormous, both monetary and psychological. Partners, relatives and friends who take care of patients experience emotional, physical and financial stress, and care giving demands are central to decisions on patient institutionalization. METHOD: A volunteer sample of 172 caregiver/care recipient dyads participated in the study in Cyprus in 2004-2005. All patients were suffering from probable Alzheimer's type dementia and were recruited from neurology clinics. Data were collected using the Memory and Behaviour Problem Checklist, Burden Interview, Center for Epidemiological Studies-Depression scale and Ways of Coping Questionnaire. FINDINGS: The results showed that 68.02% of caregivers were highly burdened and 65% exhibited depressive symptoms. Burden was related to patient psychopathology and caregiver sex, income and level of education. There was no statistically significant difference in level of burden or depression when patients lived in the community or in institutions. High scores in the burden scale were associated with use of emotional-focused coping strategies, while less burdened relatives used more problem-solving approaches to care-giving demands. CONCLUSION: Caregivers, especially women, need individualized, specific training in how to understand and manage the behaviour of relatives with dementia and how to cope with their own feelings.     

胃癌术后患者家庭照顾者负担及其影响因素分析

目的探讨胃癌术后患者家庭照顾者所承受的负担及其影响因素。方法对102名胃癌术后患者家庭照顾者进行问卷调查。结果胃癌术后患者家庭照顾者心理、社会方面的负荷较大。多元线性回归分析显示,照顾者负荷状况与患者病程分期、照顾者与患者的社会关系有关。结论应重视胃癌术后患者家庭照顾者的负担,采取有效的信息支持,进行居家照顾专题培训,以减轻照顾者负担。     

截瘫患者家庭照顾者负担及其影响因素分析

目的探讨截瘫患者主要照顾者的负担及其影响因素：方法采用照顾者负担问卷、特质应对问卷、家庭关怀指数、生活质量自评及Karnofsky活动指数对80例居家治疗截瘫患者的主要照顾者进行调查.结果截瘫患者家庭照顾者身体、心理、社会方面的负担较大,其中社交负担最重.与常模相比,照顾者更多采用消极应对方式,这种消极应对方式与照顾者负担呈正相关。照顾者负担与患者的活动指数、自理情况、主观生活质量、瘫痪时间、家庭关怀度指数,以及家庭经济负担相关：结论应重视截瘫患者家庭照顾者的负担,指导其采用积极的应对方式,加强家庭支持系统,积极鼓励患者自理,以减轻照顾者负担.     

Family and paid caregivers of hospitalized patients in Korea

Aim. To examine patient need for family and paid caregivers during hospitalization and determine factors related to caregiver use and the economic burden for paid caregivers. Background. Provision of nursing care is influenced by the characteristics of the society and its health care system. An influencing factor in Korea is the involvement of family caregivers in inpatient care. Korean society has preserved the strong tradition of family bonds and filial responsibility for caregiving. However, the ability of Korean families to assist hospitalized family members has decreased as the society becomes more industrialized. Design. A cross‐sectional study design was used, employing data from the Seoul Citizens’ Health Survey, a community‐based interview survey with 3203 inpatients in Seoul, conducted in 2001. Methods. Distributions of caregivers and related factors were explored by employing univariate comparisons and multivariate logistic regression analyses. Results. During hospitalization, 87% of patients needed caregivers. A greater need for caregivers was found in children, women giving birth and patients with disability, longer length of stay and discharge from general hospitals. Family members were the primary caregivers while 3% of inpatients used private paid caregivers. Having paid caregivers was associated with being female, older, high household income, disability, longer stay and discharge from general hospitals. The average daily expense for paid caregiver was 38·5 US dollars (USD) and 73% of patients perceived it as burdensome. Conclusions. The demonstrated need for caregivers may suggest that patients rely on family and paid caregivers in receiving assistance and care during hospitalization. Therefore, implementation of policies to relieve the burden of caregivers is necessary at both institutional and national levels. Relevance to clinical practice. Nursing services need to be redesigned in response to changing needs and expectations of patients and their family members.     

肺癌晚期患者照顾者负担状况及其影响因素分析

目的探讨肺癌晚期患者家庭照顾者负担状况及其影响因素。方法采用一般资料问卷和Zarit照顾者负担量表,对2009年12月至2010年10月住院治疗的肺癌晚期患者家庭照顾者227例进行调查。结果肺癌晚期患者家庭照顾者负担总分为(29.79±13.89)分,184例(76.7%)照顾者存在照顾负担,其中轻度负担者占53.7%。女性照顾者负担高于男性,家庭经济状况好者负担低于经济状况不好者,身体健康状况好者负担低于身体健康状况不好者,文化水平高的照顾者负担高于文化水平低者。结论肺癌晚期患者家庭照顾者普遍存在照顾负担,负担程度以轻度为主;照顾者性别、家庭经济状况、身体状况、文化水平等因素影响照顾者负担水平。     

老年人家庭照顾者身体健康状况与照顾负担的关系分析

目的：探讨老年人家庭照顾者自身的身体健康状况及与照顾负担的关系。方法采用Zarit照顾者负担量表调查1517名老年人家庭照顾者负担情况,同时调查人口学资料及健康状况,分析不同健康状况的老年人家庭照顾者的照顾负担情况。结果本次调查的老年人家庭照顾者中有61．0％（926/1517）有明确诊断的疾病,77．5％有自我感觉不适症状,10．8％自我健康评价水平低。926名有疾病的老年人家庭照顾者中轻、中、重度照顾负担的比例分别为35．3％,18．5％,4．4％,高于无明确诊断疾病者（分别为31．5％,10．7％,2．7％）,差异有统计学意义（Z＝-5．632,P＜0．01）。有自我感觉不适症状的老年人家庭照顾者轻、中、重度照顾负担分别为35．7％,16．7％,4．4％,高于无症状者（分别为27.5％,11．1％,1．5％）,差异有统计学意义（Z＝-5．573,P＜0．01）。不同自我健康评价水平的老年人家庭照顾者间差异无统计学意义（P＞0．05）。结论身体健康状况差的老年人家庭照顾者照顾负担重,护理人员应重视其身体健康状况,提供照顾相关知识和技能,缓解照顾压力。     

High perceived caregiver burden for relatives of patients following hip fracture surgery

Purpose: To determine the profile of the main informal caregivers, the evolution of the caregiver burden, and the influencing factors of caregiver burden at 1-year after hip fracture surgery.

Methods: In this prospective cohort study, a total of 172 informal caregivers of patients were interviewed at four points during 1 year following hip fracture surgery in a regional hospital in southern Spain. The perceived caregiver burden was assessed using the Caregiver Strain Index (0–13 points).

Results: The mean (Standard Deviation) age of the 172 caregivers was 56 (13) years, of which 133 (77%) were woman and 94 (55%) were daughters of the patient. Seventy-nine of the 172 (46%) caregivers perceived a high level of burden (≥?7 points on the Caregiver Strain Index) at the hospital. The corresponding numbers with perceived high level of burden at 1-month, 3-months, and 1-year were 87 (50%), 61 (36%), and 45 (26%) caregivers. A low pre-fracture functional status, post-operative complications, older age of patients, and younger age of caregivers negatively influence caregiver burden at 1-year.

Conclusions: The main caregiver is predominantly female and is most often the daughter of the patient. New treatment strategies such as the support and training of the caregivers in patient handling during hospital stay could be carried out to reduce caregiver burden.

• Implications for rehabilitation

• The main caregiver of a hip fracture patient is usually a woman who is the daughter of the patient, and reducing her burden of care should be included as one of the objectives of rehabilitation treatment.

• The caregivers of hip fracture patients must be considered as part of the treatment during the patient’s recovery period, and patient handling training should be provided to the caregivers of hip fracture patients during the hospital stay to prepare the process of going back home.

• The caregivers of older patients, those with a low pre-fracture functional level, and of those who suffered post-operative complications, should receive more attention prior to hospital discharge and receive more assistance at home to reduce caregiver burden.

     

Influence of stroke survivor characteristics and family conflict surrounding recovery on caregivers' mental and physical health

BACKGROUND: Stroke recovery is a dynamic process for stroke survivors, and shorter lengths of stay in healthcare settings shift the care of the survivors to family caregivers. The physical and mental sequelae after stroke and the family's response to this catastrophic event may have deleterious effects on caregivers. OBJECTIVE: To examine the influence of stroke survivors' motor function, their memory and behavior changes, and the family conflict surrounding stroke recovery on the mental and physical health of caregivers during the subacute recovery period. METHODS: This cross-sectional, correlational study used baseline data from family caregivers (n = 132) and first-time stroke survivors enrolled in a larger multisite study. RESULTS: The caregivers were primarily White (71%), female (74%), college-educated (73%) spouses (80%) of survivors. Most of the caregivers (66%) reported family conflict. The caregivers from families with lower family functioning scores reported worse mental health.The caregivers reported lower mental health when they were caring for stroke survivors with a combination of high memory/behavior changes and low motor function (R =.30). Family conflict appears to exacerbate the impact of memory and behavior changes on caregiver mental health. Higher caregiver education and no major health problems were associated with better caregiver physical health (R =.36). Caregiver physical health was not associated with family functioning or stroke survivor memory and behavior changes. CONCLUSIONS: These results indicate that memory and behavior changes of stroke survivors and family conflict surrounding stroke recovery are important considerations for assessment during the poststroke recovery period.     

脑卒中患者家庭主要照顾者负荷及其影响因素分析

目的 研究脑卒中患者家庭主要照顾者负荷及其影响因素,并探讨相应的护理对策.方法 采用问卷调查法.采用照顾者负荷量表(Caregiver Burden Inventory,CBI)对56例脑卒中患者家庭主要照顾者进行调查.结果 脑卒中患者家庭主要照顾者负荷的总体水平为中等水平(1.55±0.35)分;影响照顾者负荷的因素有ADL指数、参与照顾人数、患者住院次数.结论 护理人员应通过对患者系统的康复指导和教育,减轻卒中后遗症的严重程度和减少再入院次数,增强患者的家庭支持,从而减轻照顾者的负荷,提高其身心健康水平.