Factors influencing the employed caregiver burden for patients with dementia residing in nursing homes:A cross-sectional study from China

Objective:The institutionalization of care for patients with dementia is becoming a trend.Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice.Therefore,this study aimed to examine the relationship between basic attributes,caring ability,and caregiver burden in employed caregivers practicing in nursing homes.Methods:This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December 2022.Caregiver burden was assessed using the Zarit Burden Interview(ZBI).Demographic characteristics of participants,characteristics of the older patients with dementia,caring characteristics,training in dementia care,and caring abilities were collected for analysis of influencing factors.A hierarchical multiple regression analysis was conducted to explore the factors influencing the burden on employed caregivers in nursing homes.Results:The ZBI score of employed caregivers in nursing homes was 40.42±10.18,representing a moderate caregiver burden.Factors such as age(U=27.82,P<0.001),residence(U=7.89,P<0.001),educational level(H=55.81,P<0.001),self-care of older patients with dementia(H=85.21,P<0.001),daily care hours(H=73.25,P<0.001),number of older people with dementia cared for(H=14.56,P<0.012)and training in dementia care(U=-9.43,P<0.001)were significantly associated with caregiver burden.Caring ability was negatively associated with caregiver burden(r=-0.22,P<0.01).Furthermore,after controlling for demographic characteristics,the characteristics of older people with dementia,caring characteristics,training in dementia care,and caring ability explained 8.5%,5.8%,and 4.8%of the caregiver burden,respectively.Conclusion:The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various factors.We recommend tailored interventions,such as dementia care training and reviewing the number and duration of hours worked to reduce the burden experienced by caregivers.

Psychiatric disorders and caregiver burden in children with transfusion dependentβ-thalassaemia and their caregivers

BACKGROUND Children with thalassemia need care from the first years of life owing to the physical and psychological effects of their disorder.Thalassemia is a concern not only for the children’s physical health but also the mental health of themselves and their caregivers.AIM To screen the psychosocial problems and assessment of psychiatric morbidities among thalassaemic children and their caretakers,along with an assessment of caregiver burden in them.METHODS In this observational cross-sectional study,children with transfusion-dependent thalassemia,were included and were assessed for psychiatric morbidity and global functioning.Their parents were assessed for psychiatric morbidity and the caregiver burden they faced.All the parents completed two different questionnaires to assess their knowledge about the psycho-social functioning[using Pediatric Symptom Checklist-35(PSC-35)]of their children and the level of the burden faced by them by Caregiver Burden Scale(CBS).RESULTS A total of 46 children(28 boys and 18 girls)with transfusion-dependent thalassemia with a mean age of 8.83±2.70 years and 46 parents(12 fathers and 34 mothers)were included in this study.More than 32 children had some psychosocial problems on screening by PSC-35.On assessment by CBS moderate caregiver burden was perceived in domains of general strain,isolation,disappointment,emotional involvement,and environment.A total of 65.3%of children and 62.7%of parents were diagnosed with psychiatric problems.CONCLUSION Thalassemia affects not only the persons with the disorder but also their caregivers in several aspects,including their psychosocial well-being.This study emphasizes the role of a supportive group in the psychological well-being of caregivers,which could be used to prevent the pathological effects of caregiver burden and enhance their psychological well-being through counselling.

The status of caregiver burden and influencing factors among family caregivers in maintenance hemodialysis patients

Objective: To investigate the status of caregiver burden and influencing factors among family caregivers in maintenance hemodialysis (MHD) patients under the background of coronavirus disease 2019, and to provide references for nursing intervention. Methods: From May to August 2020, 237 convenient samples were recruited from the Hemodialysis Centers of The Renmin Hospital of Wuhan University and Zhongnan Hospital of Wuhan University. Questionnaires were conducted with the General Information Questionnaire, Zarit Burden Interview (ZBI), Sense of Coherence-13 (SOC-13) and Perceived Social Support Scale (PSSS). Multiple linear regression was used to analyze the influencing factors of caregiver burden. Results: The score of ZBI among the caregivers was (36.05 ± 14.09). The ZBI of family caregivers was negatively correlated with SOC-13 and PSSS (P < 0.01). Multiple regression results showed that professional status of MHD patients, activity of MHD patients, comprehensibility, manageability and other support were the main influencing factors of their caregiver burden (P < 0.01), which explained 44.4% of the variance. Conclusion: The caregiver burden among family caregivers of MHD patients was above average under the background of COVID-19, which indicated that they felt more burden in the process of caring. Medical staff could give targeted support and guidance in combination with their influencing factors to reduce their caregiver burden further.

Optimism,Social Support,and Caregiving Burden among the Long-Term Caregivers:The Mediating Effect of Psychological Resilience

Background:As the elderly population grows,the demand for long-term care services is increasing.Despite significant investments in care quality and workforce training,long-term care workers often face challenges such as work fatigue,heavy workloads,and inadequate support.These issues can impact job satisfaction,mental health,and care quality,leading to staff turnover.This study examines how optimism,social support,and psychological resilience relate to caregiving burden,aiming to understand their effects on caregivers’well-being and performance to enhance the quality of long-term care services.Methods:The participants were 542 long-term care workers.Descriptive statistics,t-tests,one-way ANOVA,and hierarchical regression were used for data analysis.Results:(1)Optimism and social support were significantly and positively correlated with psychological resilience and significantly and negatively associated with caregiving burden.(2)Regarding differences in optimism,social support,psychological resilience,and caregiving burden among long-term care workers,females scored significantly higher than males in“social support;”married workers scored significantly higher than unmarried workers in“optimism,”“social support,”and“psychological resilience”;workers aged 45–65 scored significantly higher than those aged 25–45 in“optimism”;workers aged 25–45 scored significantly higher than those aged 45–65 in“caregiving burden”;social workers scored significantly higher than nursing staff in“optimism.”(3)Psychological resilience partially mediated the relationship between social support and caregiving burden concerning explanatory and predictive power.Conclusions:These findings suggest that optimism,social support,and psychological resilience are essential factors in reducing the caregiving burden among long-term care workers.The study highlights the importance of promoting psychological resilience and providing social support to alleviate the burden of caregiving.

Caregiver burden is increased in Parkinson’s disease with mild cognitive impairment (PD-MCI)

Background:There is limited evidence on caregiver outcomes associated with mild cognitive impairment in patients with Parkinson’s disease(PD-MCI)and the coping strategies used by these caregivers.Methods:To investigate this relationship,we examined levels of burden,depression,anxiety,coping strategies and positive aspects of caregiving in the informal caregivers of 96 PD patients.The PD patients were classified using MDS-Task Force Level II criteria as showing either normal cognition(PD-N;n=51),PD-MCI(n=30)or with dementia(PDD;n=15).Results:Mean Zarit Burden Interview(ZBI)score increased significantly between carers of PD-N(M=13.39,SD=12.22)compared to those of PD-MCI patients(M=22.00,SD=10.8),and between carers of PD-MCI and PDD patients(M=29.33,SD=9.59).Moreover,the proportion of carers showing clinically significant levels of burden(ZBI score≥21)also increased as the patients’cognitive status declined(18% for PD-N;60% for PD-MCI;and 80%for PDD)and was mirrored by an increasing amount of time spent providing care by the caregivers.Caregiver ZBI score was independent of patient neuropsychiatric symptoms,motor function,disease duration and time that caregivers spent caregiving.Caregiver use of different coping strategies increased with worsening cognition.However,we found only equivocal evidence that the use of problem-focused,emotion-focused and dysfunctional coping mediated the association between patient cognitive status and caregiver burden,because the inverse models that used caregiver burden as the mediator were also significant.Conclusions:The study highlights the impact of Parkinson’s disease on those providing care when the patient’s cognition is poor,including those with MCI.Caregiver well-being has important implications for caregiver support,nursing home placement and disease course.

Eiehavioral Symptoms in Motor Neuron Disease and Their Negative Impact on Caregiver Burden

Background： The spectrum of abnormal behaviors in amyotrophic lateral sclerosis/motor neuron disease （ALS/MND） has been described, but its practical meaning, namely its impact on caregiver burden, has not been clearly documented in Chinese population. This study aimed to assess the distribution of abnormal behaviors in Chinese population, and to analyze the relationship between behavior changes and caregivcr burden. Methods： Sixty-five patients with ALS/MND have been consecutively enrolled into registry platform of Peking Union Medical College Hospital. An investigation was performed to these patients and their caregivers using the revised ALS function rating scale, Frontal Behavioral Inventory-ALS version, the Frontal Assessment Battery, and the Caregiver Burden Inventory. Results： Twenty-eight （43.1%） patients displayed abnormal behaviors of varying degrees, with one fulfilling the diagnostic criteria of frontotemporal lobe degeneration. Irritability, logopenia, and inflexibility ranked top 3 of abnormal behavior list. Correlation analysis revealed that the degree of behavioral change and frontal cognitive status were significantly associated with caregiver burden, with more extensive impact from disinhibitive behaviors. Analysis of covariance analysis showed that after associated factors were corrected, caregivers of patients with moderate to severe behavior change reported significantly heavier developmental burden, physical burden, and total burden than those with no behavioral change. Conclusions： Nettrobehavioral symptoms could present in around 40% of Chinese patients with ALS/MND, and the distribution of these behaviors was also unique. Besides, abnormal behaviors were highly related to caregivers＇ burden.

Burden among caregivers for children with asthma:A mixed-method study in Guangzhou,China

Objective:Research suggests that caregivers of children with asthma experience a substantial amount of stress,though no comprehensive study examines this problem.Here we both quantitatively and qualitatively examined the burden on caregivers of children with asthma.Methods:Surveys were administered to 138 caregivers of asthmatic children by convenience sampling.The Zarit Caregiver Burden Interview(ZBI)was used to assess the degree of caregiver burden.In addition,13 qualitative semi-structured interviews were carried out via purposive sampling and were used to explore the perception of caregivers.SPSS and content analysis were used to analyze quantitative and qualitative data,respectively.Results:We found that caregiver burden(mean=31.56±14.19)ranged from 24%with no or mild burden,52%with mild to moderate burden,22%with moderate to severe burden and 2%with very severe burden.Caregiver burden was also assessed as 5 different dimensions.Selfcriticism ranked most burdensome(2.09±1.05),followed by sacrifice(1.57±0.94),embarrassment/anger(1.30±0.80),dependency(1.21±0.77),and lastly,loss of control(1.20±0.84).The highest individually scored item on the ZBI was“fear of the future of the relative”(mean=3.04).Interviews of caregiver burden were summarized into three main themes,namely:1)life is too chaotic;2)negative emotions;and 3)gaps in themedical support system.Conclusions:These findings expand our understanding about the burden caregivers of children with asthma face,and may help to propose targeted strategies to help caregivers adapt to their roles,and maintain and promote the health of themselves and their families.

Exploring the Experiences of Personal Recovery among Mental Health Consumers and Their Caregivers Receiving Strength- Based Family Interventions

Background:This study explored the personal recovery of consumers and their caregivers receiving the strength-based family intervention.Method:A three-year project was implemented with 43 dyads from 5 community psychiatric rehabilitation agencies in northern,central,and Southern Taiwan.This paper presents qualitative analysis with a focus on describing the experiences of personal recovery.To gain a deeper understanding of the participants’personal experiences and perspectives,semi-structured in-depth interviews were conducted on three occasions(six months after the inception of the experiment,18 months after,and when the participants left the services of this study).Over the three occasions,a total of 27 consumers and 28 caregivers were interviewed.Data analysis was conducted based on grounded theory.Results:Consumers expressed positive experiences in the domain of the recovery process(positive sense of self,taking responsibility,and better coping)and on the objective indicators of recovery(functioning,interpersonal interaction,and family relationship).Caregivers experienced lessened psychological burdens.They also revealed improvements to their sense of self(recovery process)and subjective indicators of recovery outcomes,including feeling empowered and having a better quality of life.Moreover,they had better interaction with consumers(objective domain of recovery).Conclusion:These findings suggest that the strength-based perspective is an acceptable,culturally-compatible approach among Chinese mental health consumers and their caregivers.The investigators suggest that additional resources would be necessary to support a change in the service system in Taiwan so that family-based services can be provided to promote the recovery of mental health consumers and their family caregivers.

Assessment of burden and coping strategies among caregivers of cancer patients in sub-Saharan Africa

BACKGROUND Cancer is a devastating and debilitating chronic disease that affects both patients and family members.Available evidence has confirmed that the care of chronically ill relatives by family members can be very challenging.This is because caregiving of cancer patients often presents a high level of burden on the caregivers.Consequently,this leads to a necessity to adopt coping mechanisms to cushion the effect of the burden experienced during caregiving.AIM To determine the burden experienced and coping strategies among caregivers of advanced cancer patients attending University of Calabar Teaching Hospital(UCTH),Cross River State,Nigeria.METHODS The study adopted a descriptive cross-sectional study design and the study population included informal family caregivers providing services to histologically diagnosed advanced cancer patients receiving treatment at the UCTH at the time of this survey.A researcher-developed structured questionnaire,a 22-item standardized validated Zarit Burden Interview(ZBI)and a modified 17-item Coping Orientation to Problems Experienced(COPE)Inventory were used to collect data from 250 eligible informal caregivers who were selected with regard to caregiver’s characteristics,caregivers’level of burden and caregiver’s coping strategies,respectively.Data gathered from the respondents were collated,coded and analyzed using Statistical Package for Social Sciences(SPSS version 24.0)software and Predictive Analytical Software(PAS version 19.0).Chi-square was used to test for association between categorical variables at the 0.05 level of significance.The results are presented in tables and charts.RESULTS The respondents consisted of more females 132(62.86%)than males 78(37.14%).The majority of respondents(46.2%)were aged between 31-50 years with a mean age of 35.9±18.1 years.The assessment of burden level revealed that 97 caregivers(46.19%)experienced severe burden,37(17.62%)experienced trivial or no burden,while 76(36.2%)perceived moderate burden.The coping strategies used by caregivers to ease the level of burden experienced during caregiving included;acceptance,reprioritization,appreciation,family,positive self-view and empathy.Also,it was documented that there was a strong association between caregivers’level of burden and coping strategies(P=0.030).Findings also showed that age(P=0.000),sex(P=0.000),educational status(P=0.000),functional ability(P=0.000),duration of care(P=0.000),desire to continue caregiving(P=0.000)and type of cancer(P=0.000)were statistically significantly associated with caregivers’coping strategies.CONCLUSION There is great recognition of the role of informal caregivers in improving the health of their relatives and family members who are chronically ill.It was recommended that support groups in collaboration with health care providers should organize a symposium for informal caregivers on the intricacies of caregiving in chronically ill patients.This would create a platform for experience sharing,information dissemination and health care professional-caregiver interaction to enhance positive caregiving outcomes.

Depression among caregivers of patients with dementia:Associative factors and management approaches

As elderly people increasingly come to represent a higher proportion of the world’s population,various forms of dementia are becoming a significant chronic disease burden.The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant,central role in dementia care.Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers.Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient.This review article explores depression in dementia caregivers and summarizes proposed mechanisms,associated factors,management and research findings,and proposes future research directions.

Factors Affecting Catecholamines in Caregivers of Patients with De­mentia

Background:Caregivers of dementia patients have significantly higher levels of serum IL-6 and CRP compared to non-caregivers,and the ac­cumulation of everyday stressors reportedly promotes the induction of inflammatory markers.However,few studies have identified factors that affect catecholamine levels in caregivers who experience a combination of physical and mental stress from caregiving.Purpose:This study aimed to identify physical factors that impact catecholamine levels in caregivers of dementia patients.Methods:Participants were elderly caregivers living together with elderly Alzhei­mer’s-type dementia patients.We performed logistic regression analysis,with levels of adrenaline,noradrenaline,and dopamine(indicators of catecholamine)as dependent variables.Results:Caregiver BMI had a significant impact on adrenaline levels(OR:0.792;95%CI:0.654-0.960)and noradrenaline levels(OR:1.210;95%CI:1.009-1.451),whereas age had a significant impact on dopamine levels(OR:1.162;95%CI:1.019-1.324).Discussion:While caregiver BMI significantly impacted adrenaline and noradrenaline levels,the mechanism underlying these relationships is unclear.One possibility is that obesity(BMI)and a rise in sympathetic nerve activity contributed to hypertension.Our findings suggest that chronic stress in elderly caregivers may potentially impair the dopaminergic activation system in the brain.Conclusion:There is a need to identify factors which increase BMI in caregivers.Future studies aimed at gaining a better understanding of the lifestyle habits of caregiv­ers and intervention studies aimed at reducing their BMI are warranted.