Problem-solving counseling for caregivers of the cognitively impaired: effective for whom?

BACKGROUND: Individualized problem-solving counseling for caregivers of cognitively impaired relatives is thought to help caregivers cope with the stress and burden of caregiving. Few studies have shown the effectiveness of counseling for these caregivers. OBJECTIVES: To determine the effectiveness of individualized problem-solving counseling by nurses for caregivers and the expenditures of health care utilization. METHOD: Caregivers (n = 77) of the cognitively impaired living at home were randomized to receive nurse counseling or not. Psychosocial adjustment to their relative's illness, psychological distress, burden, coping skills, and expenditures were measured after 6 months and 1 year. RESULTS: Although on average, all caregivers receiving nurse counseling indicated no improvement in psychosocial adjustment to their relative's illness, psychological distress, or caregiver burden, they found counseling very helpful and it was effective for a subgroup of caregivers. Those with poor logical analysis coping skills at baseline had decreased psychological distress (F(1,53) = 9.7, p = .003) and improved psychosocial adjustment (F(1,53) = 4.7, p = .035) after 1 year. Caregivers in control and counseling groups whose relatives entered a nursing home improved their psychosocial adjustment 23% on average whereas those continuing to live in the community decreased by 8%. Almost half as many relatives entered nursing homes in the counseling group (n = 9 vs. n = 5) but these compared to control group relatives had greater annualized per person expenditures for health and social services (Cdn$23,437 vs. Cdn$15,151). CONCLUSIONS: Caregivers found nurse counseling most helpful. Those indicating infrequent use of logical analysis coping skills showed benefits.     

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.     

Concept analysis: abuse of ageing caregivers by elderly care recipients

PURPOSE: The purpose of this article is to clarify the concept of abuse within the context of ageing women who are at risk for or experiencing physical or emotional injury inflicted by elderly family members for whom they provide care. BACKGROUND: The study of abuse of ageing individuals in family caregiving situations has traditionally focused on abuse of the dependent care receiver. However, evidence supports the health risks related to abuse of ageing caregivers as well. Women, usually spouses, daughters, or daughters-in-law, most frequently assume the caregiver role. METHODS: A modification of the strategies for concept analysis proposed by Walker and Avant (1995) is used to clarify the concept of caregiver abuse. Searches of the professional literature reveal that caregiver abuse is rarely addressed; therefore, the broader concept of elder abuse is reviewed and then placed within the general context of family caregiving. Audiotapes of the first session of a community based intervention research study entitled Intervention for the Abuse of Ageing Caregivers (Phillips et al., NIH Grant No. R01 DA-AG11155-01, 1996), in which ageing women caregivers described abusive caregiving situations, were analysed qualitatively using the principles of concept analysis. The audiotapes serve as a second source of data for the concept analysis process. FINDINGS: Antecedents, defining characteristics, and consequences of abuse of ageing caregivers were identified through the process of concept analysis. Model, contrary, and borderline cases are presented to illustrate the findings. CONCLUSIONS: Findings supported the need for awareness that ageing caregivers can be placed at risk by verbally and physically abusive behaviours of the elders for whom they provide care. Use of the term 'abuse' by health care professionals has potentially negative consequences for identification and intervention in cases of potential or actual caregiver abuse.     

Exploring the roles of men. Caring for demented relatives

1. Men are under-represented among family members providing care to a demented relative. 2. Few differences were noted among the male caregivers: men with demented relatives at home spent more time daily on caregiving tasks although both groups of men tended to rely on others for the "hands-on" care needed; institutionalized demented relatives were rated as being more impaired than those at home; and men caring for relatives at home seemed determined to continue in their role. 3. It is possible that men find it more difficult to become caregivers because of lack of support from other family members, the impairment of the relative and the need for direct care, and men's lack of involvement in providing direct care. 4. Nurses involved in dementia care should offer instructional sessions aimed at men, provide assistance in working through emotional problems, and encourage their participation in future research on the male caregiving experience.     

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.     

Outcomes of family involvement in care intervention for caregivers of individuals with dementia

BACKGROUND: Despite the increasing number of individuals with dementia relocated from caregiving at home to a nursing home, there is only a small body of literature examining the influence of institutional family-oriented practices on family member perceptions of care and family-staff relationships. OBJECTIVE: The study tested the effects of the Family Involvement in Care partnership intervention on family members' perceptions of their caregiving role, relationships with staff, and satisfaction with the care of relatives with dementia residing in special care units as well as the effects on staff attitudes toward families and staff satisfaction with a caregiving role. METHODS: A quasi-experimental design with nonequivalent groups and repeated pretest and posttest measures was used to examine the effects of the Family Involvement in Care intervention. The study recruited 14 Midwestern nursing home special dementia care units, matched by aegis and staff turnover, and randomized from matched pairs to experimental and control conditions. The samples included 185 family members and 895 staff. The Family Involvement in Care intervention is a protocol for family and staff negotiation of a written partnership agreement. Family caregiver outcomes were measured using instruments pretested for reliability and validity. Data were analyzed using hierarchical linear modeling. RESULTS: With adjustment for multiple tests, statistically significant beneficial intervention effects were found in three areas of family caregiver outcomes (emotional reactions to the caregiving role, perceptions of relationships with staff, and perceptions of care for relatives) and in one of three areas of staff outcomes (staff perceptions of the family caregiving role). For family members, effects were found for the measures assessing loss, captivity, staff disregard, resident activities, and physical care. Some of the intervention effects for family members were found only for caregivers of the same generation as the resident. For staff, effects were found for measures of dominion, disruption by family, and irrelevance of family. CONCLUSIONS: The results of the study indicate that the Family Involvement in Care intervention improves the caregiving experience of family members in nursing homes as well as nursing home staff attitudes toward family members. The intervention did not influence the perceived conflict with staff on the part of family caregivers or the perception of a partnership with family caregivers on the part of staff.     

Burden of responsibility experienced by family caregivers of elderly dementia sufferers

Eight family caregivers of elderly dementia sufferers participated in in-depth interviews regarding their experiences of giving care. They were selected according to strain, isolation, disappointment and emotional involvement, measured on a 'caregiver burden' scale. Structural analyses of the interviews identified six categories reflecting the feelings and experiences of the caregivers. The first symptom of dementia noted by caregiving husbands was a change in personality, whereas other relatives first observed impaired memory. The dementia sufferers were deemed to be helpless, vulnerable and anxious. The quality of the relationship preceding the onset of dementia had a bearing on the carer's situation. All caregivers felt a heavy burden, especially early in the dementia process. Husbands sustained the heaviest burden; they expressed anger, worry, weariness, guilt, distress and isolation. The caregivers used different problem- and emotion-focused strategies to cope with their situation. Visits to the homesof the elderly, for instance by the district nurse or home help, which should include interviews with close relatives, are recommended in order to disclose early signs of dementia and to prepare further individual support for the family caregivers and their relatives suffering from dementia.     

The meaning of caregiving.

The purpose of the research reported in this article was to describe the experiences of caregivers who were providing care to an individual who recently had been discharged from a physical rehabilitation program. The research was aimed at answering the question, “What is the meaning ascribed to the caregiver role?” A convenience sample of 10 caregivers was interviewed. Most of the caregivers (80%) were female; all were relatives of the individual requiring care. These family members believed that caregiving was their responsibility by virtue of relationship, or that no one else was available to assume the caregiving role. Many had no assistance from outside agencies, and most related that caregiving entailed full-time responsibility. Many also continued in other roles such as employee, homemaker, and parent.     

Caring for patients with Alzheimer's disease. Recommendations for nursing education

1. Most educational programs for healthcare professionals stress acute rather than chronic care and provide little education or training related to caregiving of persons with dementia. 2. Long-term care facilities employ a minimum of licensed staff with the bulk of direct caregiving done by nursing assistants. 3. Licensed nurses and nursing assistants who work with the cognitively impaired should have specialized training and education in caring for persons with AD or other dementias. 4. Annual ongoing training and education should be provided for all caregivers of persons with a dementing illness.     

Circumstances leading to placement: a difficult caregiving decision

Due to advances made in medicine and healthcare, older adults are living longer but enduring problems with physical functioning and health over longer periods of time. In addition, the percentage of older adults with cognitive impairments is increasing. Caregiving duties, which decades ago lasted for months, now last for years. This long-term strain of caring for an older adult who is physically and/or cognitively impaired may lead many caregivers to feel frustrated, angry, overwhelmed, and isolated. As a result of this stress many caregivers resort to nursing home placement. The Caregiver Options Program and Evaluation research project was undertaken to provide service options to participating caregivers to alleviate some of the debilitating stress associated with caregiving and postpone institutionalization. Results of logistic regression indicate the predictors of nursing home placement were whether the caregiver felt she/he had provided good care, and whether the elder had a problem with household tasks and/or woke the caregiver or other family members up during the night. Findings suggest that elderly care receivers who are predominately low-to-middle income have a physical and/or cognitive impairment, along with their caregivers, need to be especially targeted for help by case managers early in the caregiving process before placement becomes the only alternative.     

Family caregiving in dementia in Japan

Family caregivers were interviewed to describe their caregiving experience with their older relatives who were afflicted with Alzheimer's disease at home. Three elements were identified to contribute toward a caregiving career: (a) good prior relationships between caregivers and care recipients, (b) positive interpretations of the relative's condition, and (c) utilization of resources. Some caregivers were identified as high risk: husbands caring for their wives and daughters-in-law caring for their mothers-in-law. Specific interventions for these subgroup caregivers are in order.     

Mexican American intergenerational caregiving model

This study employed grounded theory to formulate a conceptual model of intergenerational caregiving among Mexican American families. The sample consisted of 10 Mexican American caregivers of various generations older than 21 who provided at least one intermittent service (without pay at least once a month) to an elder, related through consanguinal or acquired kinship ties. The inductively generated theory of role acceptance is composed of four phases: (a) introduction--early caregiving experiences, (b) role reconciliation, (c) role imprint, and (d) providing or projecting care. This model can be used to study varied generations of Mexican American caregivers. It also provides a framework for comparison with other groups of caregivers. The results can help in designing nursing interventions to support caregivers based on understanding the issues, to create and design systems that address the varying and ever-changing needs of informal caregivers, and to assist in the formulation of policy that supports Mexican American caregivers.     

Dyadic relational resources and role strain in family caregivers of persons living with dementia at home: A cross-sectional survey

Background

Family caregivers of older persons with dementia face negative impacts such as heightened role strain due to care receivers’ incremental loss of cognitive function. Dyadic relational resources were found to protect caregivers against negative caregiving outcomes while caring for cancer patients, but had not been explored in caregivers of patients with dementia.

Objective

To explore whether the impact of caregiving demand/care receivers’ cognitive functioning on caregiver role strain is moderated by dyadic relational resources.

Design

Cross-sectional correlational survey.

Setting

The neurological clinics of a 3700-bed medical centre, neurological ward, and day care centre affiliated with a regional hospital in northern Taiwan.

Participants

A convenience sample of 219 family caregivers and care receivers with dementia was enrolled, with 197 (90%) completing the study questionnaires.

Method

Data were collected from family caregivers’ self-completed questionnaires from December 2010 to November 2011. We examined the moderating effects of caregiving demand/care receiver dementia severity and dyadic relational resources (mutuality, preparedness and predictability) on caregiving outcome (role strain) using hierarchical multiple regression analyses. Moderating effects were examined according to two- and three-way interaction terms in the regressions. We also explored the simple effect of each independent variable on role strain.

Results

The dyadic relational resources of mutuality and preparedness moderated the effects of caregiving demand on caregivers’ role strain. That is, a high level of mutuality and preparedness protected caregivers from high levels of role strain, even when caregiving demand was high. Another important factor was a high level of predictability, which tended to decrease role strain. Finally, the association between care receiver cognitive functioning and caregiver role strain was influenced by the level of mutuality between caregiver and care receiver. More specifically, high levels of mutuality diminished role strain in caregivers of patients with mild dementia.

Conclusions

Dyadic relational resources may moderate the effects of role strain. These findings suggest that these dyadic relational resources should be enhanced for family caregivers of patients with dementia to ease their caregiving role strain.     

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.     

Role stress and job satisfaction for nurse specialists

AIM: This paper is a report of a study to illustrate the unique relationship between role stress and job satisfaction and provide recommendations for advanced nursing practice in Taiwan. BACKGROUND: International literature has shown that work role-related stress experienced by staff nurses predicts role strain, which in turn influences job satisfaction and intention to leave the job. In this study, the direct relationship between role stress and job satisfaction of nurse specialists was examined after controlling for personality trait and personal characteristics. METHOD: In 2004 a convenience sample of 129 nurse specialists from five acute care teaching hospitals in Taiwan participated. They completed a questionnaire (response rate 81%) focusing on personal characteristics, the Five Factor Model of personality traits, role stress (i.e. ambiguity, conflict, overload, incompetence) and job satisfaction (i.e. professionalism, interaction, demand/reward, control/recognition). Data were analysed using hierarchical regression models. RESULTS: After controlling for personality traits and personal characteristics, role stress variables predicted 24.8% of the variance in job satisfaction. Role ambiguity (P < 0.001) and role overload (P < 0.01) were the best predictors, but role conflict was not statistically significant. Role stress explained statistically significant proportions of the variance for each component of job satisfaction: professionalism (10.6%), interaction (16.7%), demand/reward (27.1%) and control/recognition (18.5%). Role ambiguity predicted all four satisfaction components, role overload predicted demand/reward and role incompetence predicted interaction. CONCLUSION: Organizational restructuring and administrative support are recommended to address the issues raised. Appropriate training, sufficient communications and supportive legislation are required. Future research should be conducted to evaluate the impact of these interventions.