Effect of background factors concerning both elderly persons and their families with regard to the caregiver burnout in the home]

A cross sectional survey was performed to quantify factors that exhaust caregivers. We report that the degree of difficulty for caregivers correlated well with the burnout score (r = -0.517; p < 0.001), but the correlation between caregivers' burnout score and the level of their patient's basic ADL was lower (r = -0.317; p = 0.014). In this paper, we investigated other factors related to exhaustion. Caregivers' burnout score correlated with their age. The level of disease that caregivers complained increased burnout score. The need for nocturnal care and continuous observation, as well as rejection of aid burned out caregivers. Multiple regression analysis clarified that significant independent contributing factors for burnout score were help with toilet use, nocturnal aid and diseases suffered by caregivers.     

Quantitative evaluation of the burden of those giving home care for senile dementia of Alzheimer type subjects using the burnout scale of pines]

We quantitatively measured the physical and psychological burden of caregivers of 25 patients with senile dementia of Alzheimer type (SDAT). The Barthel Index (BADL, full score: 20 points) and the caregiver burden in terms of physical symptoms correlated well (r = -0.964, p < 0.001), as did the degree of abnormal behavior and caregiver burden in terms of psychological symptoms (r = 0.946, p < 0.001). The correlation with the burnout scale (BOS) of Pines was best when both factors of psychological and physical symptoms were included. The correlation between BOS and the caregiver burden in terms of both physical and psychological symptoms was r = 0.874, p < 0.001, and the correlation between BOS and "the degree of abnormal behavior" +(20- "BADL") was r = 0.853, p < 0.001. The burden in terms of physical symptoms increased as the BADL score decreased, but the burden in terms of psychological symptoms increased initially and decreased in the last phase of the disease. We conclude that the BOS score of SDAT caregivers was stable in the initial phase, then increased rapidly, thereafter preserved high, and dropped rapidly as the BADL score decreased.     

A comparison of caregivers for elderly stroke and dementia victims.

OBJECTIVE: To compare elderly co-resident caregivers of stroke and dementia patients on measures of burden and psychological morbidity. DESIGN: Cohort study. SETTING: Caregivers interviewed at home. SUBJECTS: Convenience sample, 99 co-resident caregivers of dementia and stroke patients registered with a community rehabilitation and geriatric service and who were 60 years or over. MAIN OUTCOME MEASURES: Caregiver burden as measured by self-administered questionnaire and subsequent interview, using the Relatives Stress Scale (RSS) and psychological morbidity as measured on the General Health Questionnaire (GHQ). RESULTS: Forty-six percent of caregivers had significant psychological morbidity (GHQ greater than 4). Mean RSS score was 12.2 (SD 5.4). No significant differences were found between stroke and dementia caregivers on these measures. Caregiver burden was significantly correlated with psychological morbidity in both caregiver groups. Behavior and mood disturbance in the patient was significantly correlated with burden (dementia caregivers r = 0.66; stroke caregivers r = 0.49, P less than 0.0001) and psychological morbidity (dementia caregivers r = 0.44, P less than 0.01; stroke caregivers r = 0.30, P less than 0.05). Caregiver's dissatisfaction with participation in life activities was correlated with burden (dementia caregivers r = 0.58; stroke caregivers r = 0.63, P less than 0.0001) and psychological morbidity (dementia caregivers r = 0.67, stroke caregivers r = 0.56, P, 0.0001). CONCLUSION: Elderly co-resident caregivers for stroke and dementia patients experience similar degrees of burden and high levels of psychological morbidity. Psychiatric aspects of chronic disability, rather than physical aspects, were found to be more stressful to caregivers. All assessments of the disabled elderly should include measures of caregiver burden and psychological distress.     

Burden among caregivers of the frail elderly and its correlation with the introduction of a long-term care insurance system for the elderly in fourth year

The present study was conducted in October 2003 to investigate the factors related to psychological stress and the heavy burden of caregivers taking care of frail elderly persons in the northern part of the Onga district, Fukuoka Prefecture, Kyushu, Japan. A total of 40 caregivers were assessed using a self-administered questionnaire involving the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI) and thus described their own caregiving situation. J-ZBI research had been done on a yearly basis for the previous 5 years and the results of each investigation regarding Center for Epidemiologic Studies Depression Scale (CES-D), and incidence of depression, ADL and dementia were compared prior to and after initiation of public long term care insurance for the elderly (LTCI). Compared to caregivers with a middle or light burden, heavily burdened caregivers were more likely to have a higher J-ZBI, and CES-D. Compared to caregivers with a light burden, heavily burdened caregivers were more likely to 1) be in poor condition, 2) complain of their economical situation, 3) spend a longer time with care talker. Compared to caregivers with a middle burden, heavily burdened caregivers more frequently used short-stay services (i.e., temporary nursing home assistance). J-ZBI and ADL were compared to before LTCI, and 4 years after LTCI had been started. Scores for both were lower after 4 years. Compared to before LTCI, day-care and day service were used less frequently 3 and 4 years after LTCI. After LTCI, caregivers showed a lower J-ZBI score, but the incidence of depression among caregivers was higher, compared to the general public. It is suggested that a government agency should be created to support not only the frail elderly but also their caregivers.     

Emotional support from family members and subjective health in caregivers of the frail elderly at home in Japan

This study sought to determine the factors associated with subjective health in caregivers of the frail elderly living at home, using multivariate regression analysis. Data were collected from 130 caregivers of frail elderly persons listed on a roster for utilization of day service or short stay service from two Home Visit Nursing Care Stations, using self-administered questionnaire from January to February of 2005. Family caregivers were defined as co-residents family members who provided a minimum of 1 h of daily care for at least 3 months. Multiple logistic regression analysis was performed to examine the factors associated with subjective health in caregivers of the frail elderly at home. Subjects with good health had less depressive symptom (p=0.001), much emotional support (p=0.003) and low caregiver burden (p=0.03). Multivariate logistic regression analysis showed good health had a significantly positive association with only much emotional support after adjustment for confounders. Of the total effect of emotional support on subjective health, the direct effect (84.7%) was much greater than the indirect effect (15.3%). Results indicate that much emotional support from family member for caregiver is essential for better subjective health in caregivers.     

阿尔茨海默病患者精神行为症状与照料者负担的相关性分析

目的分析阿尔茨海默病(AD)患者精神行为症状(BPS)的临床特点与照料者负担的关系。方法连续纳入江苏省苏北人民医院2015年11月~2017年11月确诊的AD患者43例及其照料者,采用简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)和认知障碍简明评价量表(Cog-12)评估AD患者的认知功能;采用神经精神量表问卷(NPI-Q)评估AD患者BPS;采用照料者负担量表(CBI)评估照料者负担,并进行Pearson相关性分析。结果入选的AD患者MMSE总分(17.3±5.9)分,MoCA总分(13.1±6.4)分,Cog-12总分(24.3±10.6)分,NPI-Q评估患者BPS总严重程度为(2.51±2.26)分;照料者总苦恼程度为(3.23±3.07)分,AD患者照料者的CBI总分为(24.70±13.34)分。NPI-Q评估AD患者BPS严重程度和照料者苦恼程度总分与MMSE评分和MoCA及Cog-12总分不相关(P>0.05)。NPI-Q评估AD患者BPS严重程度总分与时间依赖负担、社交负担、情感负担、CBI总分呈正相关(r=0.439,0.330,0.319和0.386,P<0.05);NPI-Q评估BPS照料者苦恼程度总分与时间依赖负担和CBI总分呈正相关(r=0.417和0.306,P<0.05)。结论AD患者BPS增加照料者的时间依赖负担、社交负担及情感负担。     

Activities of daily living function and neuropsychiatric symptoms of people with dementia and caregiver burden: The mediating role of caregiving hours

ObjectiveDue to the presence of neuropsychiatric behaviors and the decreased ability for activities of daily living (ADLs), family caregivers experience high burden levels in caring for people with dementia (PWD). This study sought to test the mediating role of caregiving hours in association with PWDs’ ability for basic activities of daily living (BADL) function or neuropsychiatric behaviors and caregiver burden.MethodsThis study used two waves of survey data, collected between 2013 and 2016, from 186 PWD–caregiver dyads in a dementia clinic at a teaching hospital in southern Taiwan. Two sets of multiple linear regression models were used to analyze the relationships between the changes in patients’ BADL function, patients’ neuropsychiatric behaviors, caregiving hours in ADL (including BADL and Instrumental ADL), and caregiver burden (measured using Zarit Burden Interview). Bootstrapping methods were used to detect the mediating effects of caregiving hours in ADL if the 95% confidence interval (CI) did not cover 0.ResultsCaregiving hours in BADL mediated the relationship of PWDs’ BADL function and caregiver burden (effect = −0.0137, 95% bootstrap CI = −0.0379, −0.0003). However, such mediating effects were not found in the relationship of PWDs’ neuropsychiatric behaviors and caregiver burden.ConclusionsIn order to relieve caregiver burden, respite care services for caregivers for PWD should target services that assist with PWD’s BADL.     

Abnormal behavior of residents in a long-term care facility and the associated stress of care staff members

To survey the factors associated with abnormal behavior in 99 elderly residing in a special nursing home, we investigated the relationships between abnormal behavior and depression as well as impairments in cognition and activities of daily living (ADL), and the stress level of 28 care staff members. The clinical criteria for grading of dementia (intellectual level), the Cornell scale for depression in dementia (CSDD), the dementia behavior disturbance (DBD) scale, and rating of performance of ADL were used to assess behavioral and psychiatric symptoms in the elderly patients. Stress levels of care staff members were assessed using the 'burnout' scale. The DBD scale score correlated with the intellectual level, CSDD score, and three categories of ADL (urinary continence, faecal continence, and comprehension of conversation). The DBD scale score correlated negatively with one category of ADL (eating) in men, but did not correlate with ADL in women. No correlation was found between the burnout scale scores of care staff and either their age or work schedules. Present results showed that abnormal behavior in special nursing home residents correlated with depression as well as cognitive impairment. It is believed that the treatment and management of depression will decrease abnormal behaviors and improve their quality of life in special nursing home residents.     

Predictor of increase in caregiver burden for disabled elderly at home

In order to classify the caregivers at high risk of increase in their burden early, linear discriminant analysis was performed to obtain an effective discriminant model for differentiation of the presence or absence of increase in caregiver burden. The data obtained by self-administered questionnaire from 193 caregivers of frail elderly from January to February of 2005 were used. The discriminant analysis yielded a statistically significant function explaining 35.0% (Rc=0.59; d.f.=6; p=0.0001). The configuration indicated that the psychological predictors of change in caregiver burden with much perceived stress (1.47), high caregiver burden at baseline (1.28), emotional control (0.75), effort to achieve (-0.28), symptomatic depression (0.20) and "ikigai" (purpose in life) (0.18) made statistically significant contributions to the differentiation between no increase and increase in caregiver burden. The discriminant function showed a sensitivity of 86% and specificity of 81%, and successfully classified 83% of the caregivers. The function at baseline is a simple and useful method for screening of an increase in caregiver burden among caregivers for the frail elderly at home.     

Factors affecting subjective satisfaction with verbal communication among the disabled elderly and their family caregivers

The aims of the present study were to investigate satisfaction with verbal communication among the disabled elderly and their family caregivers; and to find the significantly influential factors of satisfaction with verbal communication. The subjects were 85 disabled elderly and 85 family caregivers. For the disabled elderly, satisfaction with verbal communication, demographic, and physical factors were examined using an interview survey. For the caregivers, satisfaction with verbal communication, demographic factors, and some factors related caregiving were examined using a self-administered questionnaire. In the disabled elderly, 82.4% were satisfied with their verbal communication while 55.3% of family caregivers were satisfied. Satisfaction with verbal communication between the disabled elderly and their caregivers showed low agreement (kappa = 0.17). Bivariate analysis revealed that satisfaction with verbal communication of the disabled elderly was significantly related to ADL (p < 0.01), dysphagia risk (p < 0.05), and ability of comprehension (p < 0.05) while satisfaction with verbal communication of caregivers was significantly related to the gender of the disabled elderly and caregivers' burden. Furthermore, multiple regression analysis showed that the factor most related to satisfaction with verbal communication for the disabled elderly was ability of comprehension (p value = 0.032, odds ratio = 2.960), and the most related factor for their caregivers was the burden evaluated by J-ZBI_8 (p value = 0.004, odds ratio = 0.842). These results suggest that satisfaction with verbal communication of the disabled elderly disagrees with that of the family caregivers, and that some related factors for the disabled elderly are different from those in their family caregivers.     

Bowel incontinence is related to improvement in basic activities of daily living in residents of long-term health care facilities for the elderly in Japan

Background:   The purpose of the present study is to clarify the target criteria for care in long-term health care facilities for the elderly in Japan and to investigate the relationship between changes in basic activities of daily living (BADL) over 1 year and the comprehensive geriatric assessment (CGA) scale.
Methods:   An observational study was conducted in a facility in Nagoya, Japan. The participants consisted of 54 residents. The following four scales of comprehensive geriatric assessment were administered to the residents in both 2000 and 2001: Barthel index (BI), Lawton scale, mini-mental state examination and geriatric depression scale 15.
Results:   The Barthel index was significantly improved in 2001 compared with 2000 ( P = 0.007). The Lawton scale was significantly lower in 2001 ( P = 0.029). Neither the mini-mental state examination nor geriatric depression scale 15 scores changed significantly. To determine the factors that influenced the change in BADL, logistic regression analyses were performed using the above four scales as independent variables and the BI change as a dependent variable. In multivariate analysis, a BI score of less than 75 approached significance for improvement in BADL ( P  = 0.094, odds ratio = 2.79). Other logistic regression analyses were also performed using each ADL task in BI as an independent variable and the change in BI as a dependent variable. In multivariate analysis, bowel incontinence was a significant independent variable ( P  = 0.006, odds ratio = 10.9).
Conclusion:   As bridging facilities between acute-care hospitals and home, long-term health care facilities are a reasonable choice for the elderly with bowel incontinence.     

Health-related quality of life assessed by EuroQol in caregivers of home care stroke patients

The purpose of this study was to identify significant factors influencing health-related quality of life (HRQOL) of caregivers for home care patients with stroke. Subjects were 150 caregivers and 167 stroke patients who required help in activities of daily living (ADL) after discharge. HRQOL of caregivers and patients was assessed using a EuroQol utility score obtained by mailed questionnaire. The questionnaire also included the following items; caregiver's relationship to the patient, age, nursing care hours, family support, patient's functional changes after discharge, stroke recurrence, ADL, public nursing care insurance, care levels, and number of services patients received. The mean QOL score of 0.82 +/- 0.18 for caregivers was significantly higher than that of 0.57 +/- 0.20 for patients. Multiple regression analysis revealed that the significant factors influencing caregiver's QOL were caregiver's age and family support for caregivers, and anxious/depressed state, pain/discomfort state, and failure of memory of the patients. In addition, a significant correlation of QOL score was observed between patients and caregivers in the pain/discomfort and anxious/depressed states. The results of our study suggested that the alleviation of the patient's depressive state after stroke and the family's active support to caregivers played an important role for improving caregiver's QOL.     

Burden on family caregivers of frail elderly persons one year after the introduction of public long-term care insurance service in the Onga District, Fukuoka Prefecture: evaluation with a Japanese version of the Zarit caregiver burden interview]

The present study was conducted to investigate the factors related to the feeling of psychological stress, called heavy burden, in caregivers who took care of frail elderly persons 1 year after the introduction of the public long-term care insurance system (i.e., kaigo hoken) in the northern part of Fukuoka Prefecture, Kyushu, Japan. Forty-seven caregivers answered a self-administered questionnaire involving the Japanese version of the Zarit Caregiver Burden Interview (ZBI) and thus described their own caregiving situation. Compared to caregivers with a light burden, heavily burdened caregivers were less likely to have time to go out without their frail elderly, but tended to spend a longer time with them in providing for their physical care. Compared with less burdened caregivers, heavily burdened caregivers tended to be concerned with what others thought or said and more likely to use a short-stay service (i.e., temporary nursing home assistance). More social services should be provided to let caregivers have their own time without caring for their patients. In addition, local governments and caremanagers should help caregivers to understand the benefits of services available for the elderly and their caregivers.     

Association between the caregiver's burden and physical activity in community-dwelling caregivers of dementia patients

Physical activity in the elderly has a significant influence on their health status. Studies have shown that elderly caregivers have fewer physical activities relative to non-caregivers. The present study aimed to identify factors associated with lower physical activity in elderly caregivers of demented patients. A cross-sectional survey of 50 elderly caregivers living with patients diagnosed with Alzheimer's-type dementia showed that the Zarit caregiver burden interview (ZBI) scores were significant predictors of physical activity measured by the questionnaire score (QS) of physical activities. Among the three subscales of the QS, it was only leisure time activity scores (LS) that the ZBI scores significantly predicted. The numbers of chronic diseases were associated with lower household activity scores (HS) and sport activities scores (SS). Physical activities, in particular leisure activities, were found to be inversely associated with care burden assessed by the ZBI. Interventions to increase the physical activity levels of older caregivers may improve their health status and quality of life.     

脑卒中急性期自我感受负担对老年患者康复早期自我管理行为的影响

目的 探讨脑卒中急性期老年患者自我感受负担的状况,分析自我感受负担对卒中后1个月自我管理行为的影响.方法 采用一般资料调查表、自我感受负担量表、脑卒中自我管理行为评定量表对2017年1月至9月于西安市3所三级甲等医院住院的216例脑卒中老年患者进行问卷调查(有效问卷209份),分析患者急性期自我感受负担状况及其与恢复期...     

Interactions of household composition and required care level with functional and cognitive status among disabled Japanese elderly living in a suburban apartment complex

Aim: In the forthcoming super‐aging society, the appropriate assessment of functional and cognitive conditions of disabled elderly people will become increasingly significant in providing care services. Care level and household composition would be key factors to assess function. There might also be an interaction between the two factors with the function. The present study examined the associations of household composition and care level with functional and cognitive status among the disabled elderly living in a suburban apartment complex with a high rate of aged residents (39% in 2009). Methods: Participants were 190 disabled elderly persons aged 65 years and over who lived in the apartment complex. Cross‐sectional data were collected between May 2009 and August 2010, including care level, household composition, basic activities of daily living (BADL), instrumental activities of daily living (IADL) and the independence level in relation to cognitive status. Lower scores meant less independence in BADL and IADL, and as determined by the cognitive/independence scale. Results: Approximately half of the participants lived alone. Generalized linear model procedure showed significant interactions with the BADL score and cognitive/independence scale between household composition and care level. Scores for BADL and the cognitive/independence scale in groups receiving a higher care level were lower; however, the slope of the trend for the elderly living alone was more gradual than for the elderly living with others. Conclusion: It is important for health‐care providers to assess in detail the status of the disabled elderly considering both their household composition and care level in planning and providing assistance for them. Geriatr Gerontol Int 2012; 12: 538–546.     

The evaluation of perceived stress and associated factors in elderly caregivers

ObjectiveFactors associated with perceived stress in older people have been studied previously, but this investigation in elderly caregivers is still scarce in the literature. Our aim was to assess factors that are associated with perceived stress in a sample of elderly caregivers.MethodsThis cross-sectional investigation assessed 341 elderly caregivers who cared for a dependent older person at home. They answered questionnaires including the Perceived Stress Scale (PSS-14), a sociodemographic and care characterization, health and cognitive status, and burden related to care.ResultsThe mean score in PSS-14 was 18.5 ± 9.9. Self-reported pain, difficult to sleep, “very poor/poor” self-rated health, impaired cognitive status, more people living in the house and higher levels of burden related to care were associated with higher levels of perceived stress.DiscussionThe results highlight the importance of the development of stress-reduced interventions directed to elderly caregivers focusing on the associated variables in this study. Attention should be given to cognitive decline prevention and strategies to avoid or reduce burden in the elderly caregivers.     

Psychotropic drug use among caregivers of patients with dementia

The majority of research on "caregiver burden" focuses on mental health consequences. These stresses are associated with psychotropic drug use among some caregivers. The purposes of this paper are to identify the correlates of psychotropic drug use among caregivers of demented older adults and to determine whether or not certain types of psychotropics (ie, antianxiety, antidepressant, and sedative/hypnotic agents) have common or unique correlates. The prevalence of psychotropic drug use among caregivers in the sample (n = 510) is substantially higher than previously reported prevalence rates in the general population and among community-dwelling elderly. Using logistic regression techniques, caregiver characteristics (eg, gender, health, relationship to the patient) rather than severity of the patient's condition emerge as predictors of antianxiety, antidepressant, and sedative/hypnotic use. The caregiver's perception of how well he or she is supported in the caregiving role emerges as an important correlate of psychotropic drug use in general and especially of antidepressant consumption. Results suggest that caregivers are a high-risk group for the development of emotional symptoms such as nervousness, exhaustion, decreased appetite, and difficulty sleeping, symptoms that may or may not constitute a psychiatric disorder. Characteristics of the caregiver, especially aspects of the support system, should be important considerations in decisions to prescribe psychotropic drugs.     

Burden, anxiety and depression in caregivers of veterans with dementia in Beijing

Dementia is the most common neurodegenerative disease in the elderly. The number of Chinese dementia patients reached 5 million in 2001 and will grow rapidly by 314-336% in 2040. Caring for patients with dementia is a stressful experience, which can cause the physical and mental problems in caregivers. According to the protocol, we evaluated the burden, depression and anxiety of caregivers by Clinical Dementia Rating (CDR) Scale, Caregiver Burden Inventory (CBI), Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS). 90 caregivers of dementia patients and 90 caregivers of nondementia patients with other chronic diseases from 24 military communities in Beijing were enrolled in this investigation. The scores of burden, depression and anxiety increased from nondementia to severe dementia groups. There were associations between patient's CDR score and CBI score, as well as the average daily care time and CBI score. In addition, the scores of SDS and SAS were both positive correlated to CBI score. Comparing to general community, the caregivers of dementia veterans had lower scores in SDS and SAS. Therefore, we should pay more attentions to the caregivers of severe dementia patients. Reduction of daily care time is a possible way to releasing the burden of caregivers. Better general supports are beneficial to reducing depression and anxiety when caregivers confront the heavy burden.     

A short comprehensive assessment to predict outcome of elderly patients after hip fracture

BACKGROUND AND AIMS: Hip fractures result in significant functional impairment and a high rate of institutionalization. The aim of our study was to evaluate in patients with a recent hip fracture the contribution of a short (15-min) comprehensive assessment to predict the length of stay and the risk of discharge to a nursing home. METHODS: Prospective clinical study conducted in a rehabilitation ward of the Geriatric Hospital. Functional assessment included basic activities of daily living (BADL), cognitive status (MMSE) and a 4-item geriatric depression scale (Mini-GDS). Information on demographic data, living situation, diagnosis and illness burden was also collected. RESULTS: The mean age of the 86 patients (67W/19M) was 84.2 +/- 6.8 years. In a multiple regression analysis, the length of stay in a geriatric hospital was significantly associated with both marital status (living alone) (p = 0.035) and the intervention of a caregiver on a regular basis (p = 0.036), but not with Charlson's comorbidity score. In a logistic regression model, adjusted for age, gender, marital status, intervention of a caregiver on a regular basis, BADL, Mini-GDS and Charlson's comorbidity score, the only independent predictor of nursing home admission was a MMSE < 24, which increased by 10.7-fold (2.2-50.9) the risk of being admitted to a nursing home (p = 0.003). CONCLUSIONS: A short comprehensive assessment completed a few days after a hip fracture is useful in predicting length of stay and risk of nursing home admission.