Cultural and noncultural predictors of health outcomes in Korean daughter and daughter-in-law caregivers

In Western cultures, adverse health effects resulting from providing care for impaired elders is well documented for family caregivers, but little is known about the health of Korean caregivers. This study examined the level of depression and physical health of 120 daughter and daughter-in-law caregivers who cared for cognitively or functionally impaired elderly in Korea. It was hypothesized that cultural factors would have a greater effect on caregivers' health outcomes than noncultural factors, but, contrary to this expectation, the effects of noncultural factors were found to outweigh those of cultural factors. Moreover, the caregivers in this study reported a relatively high level of depression, and more caregivers rated their own health as "poor" than did Western caregivers in previous studies. Family caregiving for the impaired elderly is stressful and negatively affects Korean caregivers' health outcomes regardless of societal values such as filial piety and familism regarding parent care in Korea. Culturally acceptable and sensible support programs may be useful in sustaining long-term care at home by Korean daughter and daughter-in-law caregivers. Further family caregiving studies in the Korean sociocultural context are recommended.     

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.     

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.     

香港脑损伤患者的出院后服务

目的:建立针对脑损伤患者及其看护者的可负担、易获取的出院后电话跟进服务,并为发展区域内有成本效益的连续监护体制提供实证基础。方法:本研究从香港大学玛丽医院脑外科招募35名成年脑损伤患者和26名看护者。参与者在出院后第4周和第12周各接受一次结构化的电话访谈。有调整能力不足风险的患者与看护者将被送交进一步的医疗咨询或心理干预。患者的生理和认知功能,以及患者与看护者的情感功能、知觉到的社会支持和对当前所提供的服务的满意程度都被列入调查。结果:大部分患者报告他们的生理状况有明显改善。相当多的患者在出院后经历过认知困难并报告所接受到的社会心理支持不足。大多数看护者报告在看护期间健康、情感功能和社会生活受损。患者与看护者都对服务表示满意,看护者的满意程度更高。结论:脑损伤患者及其看护者都受益于出院后电话跟进服务。两者都同意该项服务有助于识别有调整能力不足风险的个体,并提供及时的建议和情感支持。看护工作会明显损害看护者的生理、情感功能和社会生活,提示需要为他们提供关于看护技巧、生活调整和压力管理的意见与建议。     

Social Networks of Women Caregivers

Abstract Social networks and the support that network members provide are important resources for family caregivers in sustaining their caregiving role. Caregivers' perceptions of support from family and friends have been linked to their health status (R. Kahn & T. Antonucci, 1980; I. Sandler & M. Barrera, 1984). The purpose of this study was to explore the social networks and types of perceived support described by women who are caregivers of cognitively impaired older adults. Content analysis was used to examine interview data from a longitudinal qualitative study of 20 women caregivers of cognitively impaired older persons. An important finding of this study was the identification of a typology of social networks of the women caregivers. The caregivers' perceptions of satisfaction with support received and experience of conflict with network members varied according to the characteristics of their social network. Those caregivers who belonged to diverse social networks reported high satisfaction with the support that they received and little or no conflict. Those caregivers with kin-dominated social networks reported little satisfaction with support received and a high degree of conflict.     

The emotional needs of care recipients and the psychological well-being of informal caregivers: implications for home care clinicians

In this exploratory study, 77 informal caregivers of older persons in Ohio completed telephone interviews that included questions regarding their perceived difficulty providing emotional and physical care, perceived quality of care, demographic items including caregivers' health status, and a measure of their psychological well-being. Findings suggest that psychological well-being of informal caregivers is diminished when they experience greater difficulty meeting the care recipients' emotional care needs, are in poorer health, or are older. Suggestions for clinical implications and future research based on these findings are discussed.     

The meaning of daily activity in family caregiving for the elderly

Sixty ethnographic interviews with 15 family caregivers for frail older people living in the community were analyzed to understand the meaning of activity in caregiving. Sch?n's (1983) reflection-in-action framework was used to organize the data. Three goals of caregiving activity were derived: (a) getting things done, (b) achieving a sense of health and well-being for the care receiver, and (c) achieving a sense of health and well-being for the caregiver. The family caregiver was conceptualized as a lay practitioner involved in the clinical reasoning and ethical dilemmas integral to the provision of health care for the care receiver. The caregivers' judgments regarding the prioritization and attainment of goals determined the forms of caregiving activities. Implications for occupational therapy practice and the relationship between the caregiver and the professional are discussed.     

Caregiving Experience of Dementia among Korean American Family Caregivers

Dementia is a major public health problem affecting 5.5 million people in USA. This qualitative study explored the caregiving experience of Korean American (KA) families of persons with dementia (PWD). Adult KA caregivers of PWD (n?=?18) were recruited for semi-structured interviews. Thematic analysis yielded four themes: challenges in finding resources, struggling with mental health issues, traveling the path of acceptance, and finding ways to survive. Due to the language barrier, most KA caregivers reported using Korean Internet for information on dementia and caregiving. Some traveled to South Korea seeking medical assistance for dementia (medical tourism). Importantly, some KA caregivers expressed suicidal thoughts and depression. Unexpectedly, familism prevented help seeking and possible relief from their difficulties. There is an urgent need to improve access to dementia care services and education for the KA community. Building a trusting relationship with healthcare providers is even more important for KA caregivers to address their mental health concerns.     

Modeling the effects of past relationship and obligation on changes in the health and health promotion of women caregivers of family members with dementia

Wuest's (1998, 2001) caregiving theory was tested with 282 women self-identified as caregivers of family members with dementia to examine how quality of past relationship within caregiving dyads and sense of obligation to care affected their health outcomes and health promotion over 9 months, using latent growth curve analysis. The model explained 62% of the variance in women's health (Time 4). Health was affected positively by past relationship and negatively by obligation. Health promotion was positively affected by health (Time 1) and by obligation. Change observed in health promotion was nonlinear and positively affected health (Time 4). Findings suggest past relationship and obligation to care predict health outcomes for caregivers and that interventions to increase caregivers' health promotion may improve health outcomes.     

Responses of elderly spouse caregivers

In this paper three categories of variables were identified to predict spouses' reactions to caregiving roles: patient characteristics, the caregiving environment, and characteristics of the caregiver. Measures of these variables were administered to 159 spouse caregivers. Four domains of caregivers' responses were identified: negative emotional reactions, feelings of responsibility for the patient, feelings of abandonment by family, and impact of caregiving on daily schedules. These domains were influenced most by patient negative behaviors, physical health, and age, and by caregiver age, employment, and emotional status. Amount of assistance, affective support, and hours of care also were predictive of spouse responses.     

Korean version of the Revised Caregiving Appraisal Scale: a translation and validation study

AIM: This paper is a report of a study to examine the reliability and validity of a Korean version of the Revised Caregiving Appraisal Scale with Korean caregivers of older stroke survivors. BACKGROUND: The Revised Caregiving Appraisal Scale was developed in the United States of America for an American English-speaking population to measure primary caregivers' appraisals of potential stressors and the efficacy of their coping efforts related to caregiving experiences. METHODS: Using the back-translation method, the instrument was translated into Korean. The Korean version of the Revised Caregiving Appraisal Scale was self-administered by 147 primary family caregivers recruited from three outpatient clinics and two home health agencies in Korea. The study was conducted in 2005. RESULTS: In this sample, Cronbach's alpha for the total scale was 0.86. Reliability coefficients for each of the five subscales ranged from 0.40 to 0.85. Two subscales, burden and satisfaction, showed good reliability; one subscale, impact, showed marginally acceptable reliability; two subscales, mastery and demand, had low reliability. Principal components factor analysis of the Korean version of the Revised Caregiving Appraisal Scale yielded six factors. Except for the mastery domain, which was divided into two factors, the other factors were similar to those in the original scale. CONCLUSION: The Korean version of the Revised Caregiving Appraisal Scale had adequate reliability and validity in a sample of Korean caregivers of stroke survivors. It can be used to assess the impact of caregiving and interventions on Korean caregiver attitudes. Further studies are needed with different categories of caregiver.     

The relationships between depression and other outcomes of chronic illness caregiving

Background  

Many caregivers with chronically ill relatives suffer from depression. However, the relationship of depression to other outcomes of chronic caregiving remains unclear. This study tested a hypothesized model which proposed that hours of care, stressful life events, social support, age and gender would predict caregivers' outcomes through perceived caregiver stress. Depression was expected to mediate the relationship between perceived stress and outcomes of chronic caregiving (physical function, self-esteem, and marital satisfaction).     

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample This study explored the needs of family caregivers during the transition from hospital to home. Data from 37 face-to-face interviews with 16 caregivers before discharge and at 2 weeks and 1 month after discharge were subjected to constant comparative analysis. Findings revealed changes in family caregivers' needs during the discharge transition. While preparing to take caregiving responsibility, caregivers reported a need for various types of information. After the discharge, but before home caregiving settled into a pattern, they needed help with caregiving practices. After reaching a pattern for providing family care, caregivers frequently reported needs for continuous emotional support. These findings provide a basis for transitional care services such as discharge planning and home health care services.     

Loneliness as a predictor of quality of life among older caregivers

AIM: This paper reports a study investigating quality of life in relation to loneliness, caregiving, social network, gender, age and economic status among caregiving men and women in a population-based sample aged 75 years or older. BACKGROUND: Because of demographic changes, in the future more care for older people will be given by informal caregivers who are themselves older. Being old and caring for another older person may affect various aspects of life, such as physical and emotional health and decreased time for respite, which may affect social life and quality of life. METHOD: A postal questionnaire including the Short Form Health Survey was used. The sample consisted of 4278 people, aged 75 years and over, living in Sweden. Of these, 783 (18%) were caregivers. FINDINGS: Caregivers had a larger social network and reported feelings of loneliness less often than non-caregivers. Forty per cent of caregivers helped every day. There were gender differences in experiences of loneliness during the last year, with the frequency of intense feelings of loneliness being higher among women. Loneliness and a small or non-existent network were significantly associated with low quality of life among caregivers, as well as in the total sample. The results showed significant association between loneliness, weak social network and low mental quality of life. CONCLUSIONS: The fact that loneliness was the most important factor predicting low quality of life among caregivers, as well as older people in general, indicates that it is crucial in the care of older people. From a nursing perspective, the findings indicate the advantage of helping older people to keep up and develop their social networks. Nursing care should involve steps to maintain the social network before an older person becomes too weak, since decreased health status makes social contacts more difficult.     

Crisis in caregiving: when home-based end-of-life care is no longer possible

Understanding the factors that precipitate caregiving crises that cannot be resolved at home is central to improving options for care at life's end. The purpose of this study was to explore caregivers' perceptions of the crises that preceded and were resolved by relocation during end-of-life care. In-depth interviews were conducted with 36 caregivers of people who died in a hospice house. The results illuminate a conceptual model of the caregiving crisis, which has three stages: (a) precipitating factors--the interrelationship between illness trajectory and reciprocal suffering (physical, psychological, emotional and social distress), (b) crisis, and (c) resolution (settled or unsettled). Relocation presents an opportunity for families to relinquish the burden of end-stage care so that they can resume and complete a lifelong relationship. Careful recognition of and attention to the intimate dynamics that accompany suffering and dying are essential elements of palliative care, which aims to uphold the dignity of the dying person and the integrity of the family in both caregiving and bereavement.     

Easing the impact of the family caregiver's role

This article describes problems facing family caregivers of elderly, ill, or disabled people. The physical and emotional impact of caregiving is explored, and the concept of role fatigue is discussed to assist nurses in understanding caregivers' problems and needs. Motivational factors for becoming a caregiver and community sources of support are addressed. Rehabilitation nurses are challenged both to accept the responsibility of identifying caregiver role problems, and to help caregivers obtain assistance that will enable them to continue family members' care in a home environment.