Breaking the cycle of frailty: The impact of health promotion training on older family caregivers

Background Family caregivers may experience financial vulnerabilities due to their caregiving role, affecting their ability to afford appropriate food and ensure optimal nutrient intake. Therefore, this cross-sectional study aimed to assess the extent to which there are diet-related disparities among older family caregivers. Methods We included 125 family caregivers from Eastern Finland (mean age 74 y). Data on family caregivers’ health, nutritional status, and sociodemographic factors were collected at their households between June 2019 and December 2019. First, we assessed the sociodemographic factors associated with family caregivers’ inadequate diet. Then, we evaluated diet-related health disparities. The associations and predictors of diet-related disparities were assessed using the independent samples t-test, χ2-test, and binary logistic regression. Results The preliminary results show that family caregivers experiencing subjective poverty were less likely to consume two or more portions of fruit and vegetables per day (odds ratio = 0.11; 95% confidence interval 0.02-0.72; p = 0.021) and were more likely to be overweight. Furthermore, family caregivers’ inadequate diet (i.e., lack of daily fruit and vegetables and risk of malnutrition) was further associated with several health conditions, including comorbidity, depression, diabetes (type I and II), and osteoporosis. Conclusions Family caregivers have diet-related disparities, which may further lead to health inequalities. Family caregivers’ diet-related disparities require increasing attention in healthcare. Thus, addressing family caregivers’ food insecurity risk could enhance their health equity. Key messages • Older family caregivers’ inadequate diet is associated with social and health inequalities. • We must assess the root causes of diet-related disparities among older family caregivers and the broad consequences to find solutions to narrow the inequalities.

The purpose of this study was to describe adherence to recommended preventive health practices among middle-aged and older male and female family caregivers of individuals receiving home health services. Perceptions of the burden and benefit of caregiving, wellness orientation, social participation, and community resource use by the caregiving dyad (caregiver and carereceiver) were also explored using the t test and the chi2 test to detect gender differences. A sample of 319 participants 50 and older was recruited from a home health agency in southwestern Pennsylvania to participate in a telephone survey. Results revealed that caregivers had performed 86% of age- and gender-appropriate preventive health practices, but they currently adhered to guidelines for 63% of such behaviors, regardless of gender. Men experienced less burden than women, and were more likely to acknowledge that caregiving made them feel useful and appreciated and gave more meaning to their lives. The study suggests that family caregivers may be as vigilant in their preventive health behavior as the general population, despite their responsibilities. Nurses in contact with middle-aged and older family caregivers are well positioned to encourage health promotion and disease prevention behaviors in this accessible population.

Some older family caregivers experience financial vulnerabilities due to their caregiving role, which may affect their ability to afford appropriate food. This study aimed to assess the extent to which there are diet-related disparities among older family caregivers in Eastern Finland. This study is based on the multidisciplinary LifEstyle, NutriTion and Oral health in caregivers (LENTO) study. In total, 125 family caregivers were included. Data were collected between June and December 2019. Participants were assessed on health, nutritional status and sociodemographic factors. The associations and predictors of diet-related disparities were assessed using the independent samples t-test, ANOVA-test, χ2 -tests and binary logistic regression. The mean age of family caregivers was 74 years (SD = 8). Most were female (72%), 20% had malnutrition risk and 30% reported having 'moderately enough money' or less, which was identified as 'subjective poverty'. Family caregivers experiencing subjective poverty were less likely to consume two or more portions of fruit and vegetables daily and were more likely overweight. Study participants' diet-related disparities were further associated with several health inequalities, including comorbidity, depression, diabetes (Type I or II) and osteoporosis. Older family caregivers have diet-related disparities, further associated with health inequalities. Family caregivers' diet-related disparities require increasing attention in healthcare. Addressing family caregivers' food insecurity risk would enhance their health equity. Lack of assessment of diet-related disparities will only deepen health inequalities.

Associations between psychological functioning and natural killer cell activity (NKA) were examined in 23 older (62.2 ± 7.5 years) family caregivers randomized to a moderate intensity four-month exercise program or to a wait-list control condition. At baseline, although NKA was related to anger-control (r = -.42; trend p < .06) and anger-out (r = .50; p < .03), it was not related to depression, anxiety, perceived stress, or caregiver burden. After controlling for baseline NKA, changes in anger-control explained 14 percent of the variance in NKA four months later. Decreases in anger-control predicted increases in NKA. Group assignment (exercise vs control) was unrelated to changes in NKA over the four-month period; however, the study was not powered to detect this effect. These results are consistent with reported relationships of anger expression with other physiological measures, and extend the importance of anger expression to immune functioning in older family caregivers.

The aim of this study was to investigate the prevalence of frailty and identify the demographical and clinical factors associated with frailty among older family caregivers. The participants of this cross-sectional study were older family caregivers (n = 125) living in Eastern Finland. Data on functional and cognitive status, depressive symptoms, nutritional status, medication, chronic diseases, stroke, and oral health were obtained. The Mini Nutritional Assessment (MNA) was used to evaluate nutritional status. Frailty status was evaluated using the abbreviated comprehensive geriatric assessment (aCGA) scale. Seventy-three percent of caregivers were identified as frail. According to multivariable logistic regression, cataract, glaucoma, or macular degeneration and the MNA score were predictors of frailty. After adjusting for age, gender, and number of own teeth, the MNA score remained a significant predictor of frailty (adjusted OR = 1.22, 95% CI = 1.06, 1.41). As the MNA scores decreased (meaning poorer nutritional status), the risk of frailty increased. The present study showed that frailty is prevalent among older family caregivers. Recognising older family caregivers with frailty or at risk of frailty is vital. It is essential to acknowledge vision problems' role in frailty and to monitor and support the nutritional status of family caregivers regularly to prevent frailty development.

Pilot test of a learned resourcefulness program for older family caregivers in Taiwan

We aimed to assess the social inequalities in older family caregivers' frailty conditions, comorbidity, and cognitive functioning. A cross-sectional study was conducted. Study participants were recruited in 2019 in Finland. First, cognitive functioning was assessed with a Mini-Mental State Examination, comorbidity with the modified Functional Comorbidity Index, and frailty conditions were evaluated using the abbreviated Comprehensive Geriatric Assessment. Study participants were also interviewed on socioeconomic factors. The social inequalities in these health outcomes were assessed using the Independent Samples t-test, Pearson Chi-square test, and Binary Logistic Regression Analysis. Family caregivers' (n = 125) mean age was 74, and 73% had frailty conditions. Family caregivers' social inequalities in frailty conditions were linked to their older age and the lowest caregiving cash benefit. Family caregivers' low educational attainment was also the main factor predicting their minor cognitive impairment. Family caregivers' social determinants of health should be fully assessed in their health assessment, policies, and programs to ensure healthy aging for both family caregivers and care recipients in the future.

This study aimed to identify differences among body mass index (BMI) categories of older family caregivers (≥60years) and their care recipients (≥65years). Secondly, this study aimed to examine group differences and factors associated with weight change during a nutrition and oral health intervention. This secondary analysis of a randomized controlled trial (ClinicalTrial.gov (NCT04003493)) involved individually tailored nutritional guidance from a clinical nutritionist and oral health guidance from a dental hygienist. Baseline BMI differences were analyzed, followed by further analyses of group differences and associated factors of weight change over a 6-month period using generalized estimating equations. Among the participants (113 family caregivers and 107 care recipients), 36.3% and 35.1% were overweight (BMI >29kg/m2), while 18.6% and 21.6% were underweight (BMI <24kg/m2) at baseline, respectively. For family caregivers differences in BMI categories included age, mid-arm and calf circumferences, and plasma prealbumin concentration. For care recipients differences were observed in medication use, mid-arm and calf circumferences, Mini Nutritional Assessment scores, physical function, and number of teeth. During the 6-month intervention, there were no differences in weight change between intervention and control groups for both caregivers and care recipients. Factors significantly associated (p < 0.05) with weight loss included female sex for both caregivers and care recipients, and frailty for caregivers. Family caregivers' characteristics were not significantly associated with weight change in their care recipients. In conclusion, being overweight is a prevalent among older family caregivers and care recipients. Factors such as age, medication use, physical function, number of teeth, and Mini Nutritional Assessment scores varied across BMI categories. Female sex was associated with weight loss in both older family caregivers and care recipients, and frailty was associated with weight loss in caregivers. However, the characteristics of family caregivers did not explain the weight loss of their care recipients. Clinical Trial Registration: [https://www.ClinicalTrial.gov/], identifier [NCT04003493].

The demand for family caregiving in the United States is significant, with millions providing unpaid care for individuals with dementia, often encountering substantial emotional, financial, and physical challenges. Expanding home and community-based support services is essential to reducing family caregiver burden, improving the quality of life for individuals with dementia, facilitating aging in place, and decreasing dependence on long term institutional care. A systematic review and meta-synthesis of qualitative research was conducted to examine unmet needs among older adult family caregivers of individuals with dementia. A comprehensive search strategy was implemented across multiple electronic databases spanning medical, psychological, social, and nursing sciences from 2014 to 2025. A total of 33 studies met inclusion criteria, representing perspectives from 879 family caregivers aggregated across all studies included. Key themes identified include: (1) the influence of cultural and social factors on coping strategies and access to support; (2) the evolving dyadic nature of caregiving as dementia progresses; and (3) the prevalence of unmet emotional and mental health needs. These findings provide a robust evidence base for informing the development of targeted home and community-based support programs, as well as future research initiatives aimed at addressing the diverse needs of older adult family caregivers of individuals with dementia.

Caregiver burden in dementia is an important issue, but few studies have examined the mental health of younger and older family caregivers by comparing them with age- and gender-matched community residents. We aimed to compare the mental health of dementia caregivers with that of community residents and to clarify factors related to mental health problems in younger and older caregivers. We studied 104 dementia caregivers; 46 were younger (<65 years) and 58 were older (≥65 years). A total of 104 community residents who were matched for age and gender were selected. We compared depression (Center for Epidemiologic Studies Depression Scale for younger participants; Geriatric Depression Scale for older participants), health-related quality of life (QOL) short-form health survey (SF-8), sleep problems, and suicidal ideation between the caregivers and community residents by age. Behavioural and psychological symptoms of dementia, activities of daily living (ADL), and instrumental ADL were assessed among patients with dementia using the Neuropsychiatric Inventory, Physical Self-Maintenance Scale, and Lawton Instrumental ADL Scale, respectively. According to SF-8 results, both younger and older caregivers had significantly worse mental QOL than community residents (younger caregivers: 46.3 vs community residents: 49.7, P = 0.017; older caregivers: 48.2 vs community residents: 51.1, P = 0.024) but were not more depressive. Sleep problems were significantly more frequent in younger caregivers (39.1%) than in community residents (17.0%) (P = 0.017). Multiple regression analysis revealed that caregivers' deteriorated mental QOL was associated with patients' behavioural and psychological symptoms of dementia in younger caregivers and with dementia patients' instrumental ADL and female gender in older caregivers. Dementia caregivers had a lower mental QOL than community residents. To maintain caregivers' mental QOL, it is necessary to provide younger caregivers with skills or professional interventions for dealing with behavioural and psychological symptoms of dementia, and older caregivers must be offered adequate care support.

BackgroundIn today’s healthcare systems, older family caregivers who care for their spouses at home are indispensable providers of healthcare. However, many of these caregivers are at risk of becoming ill themselves. To prevent this and to guide the development of targeted healthcare services, home-care personnel need knowledge on how to promote the health of older family caregivers. The purpose of this study was to understand the health-promoting experiences of older family caregivers who care for their home-dwelling spouses receiving home-care services.MethodsThe experiences of older family caregivers were explored using a narrative design that involved narrative interviews and a narrative thematic and structural analytical approach. The sample consisted of four husbands and six wives aged 79–91 years. In the analysis, two storylines of narratives were constructed: one by husbands and one by wives.FindingsIn the husbands’ narrative, continuation of everyday life and social support in everyday life were highlighted as being health-promoting. In the wives’ narrative, the importance of having time for oneself and being seen, heard and included by the home-care personnel were emphasized as promoting their health. The husbands’ narrative contained stories of the past and the present, while the wives’ narrative mainly comprised stories of the present.ConclusionThis study has provided insights into the narratives of older husbands and wives acting as family caregivers regarding what promotes their health caring for their spouses at home. Their stories show variations in care style, coping style and experiences of the caregiver burden. These findings suggest that home-care services should consider providing customized health-promoting services to older family caregivers who are providing care to their home-dwelling spouses receiving home-care services. Given the sample size of only ten participants, further qualitative and quantitative research is needed.

The aim of this study was to investigate the effect of individually tailored dietary counseling on frailty status among older family caregivers (FC). This study is part of the LifEstyle, NutriTion, and Oral health in caregivers (LENTO) intervention study. There were a total of 113 participants, with a mean age of 74 years (SD 8.0). This randomized intervention included individually tailored nutritional guidance given by the clinical nutritionist at the baseline and at the 2-month visit and the intervention period was 6 months. At the baseline frailty prevalence was 68% (n = 43 out of 63) in the intervention group and 78% (n = 39 out of 50) in the control group. At the end of the 6-month intervention the prevalence in the intervention group had decreased to 41% (n = 24 out of 59) but remained stable in the control group with 79% (n = 37 out of 47). There was a significant difference in the change of the prevalence of frailty between the groups (P < 0.001). The intervention resulted in increased protein intake in the intervention group from 0.95 g/kg/d (SD 0.34) to 1.05 g/kg/d (SD 0.37) (P = 0.003). The results suggest that frailty among older caregivers can be decreased with personalized nutritional guidance.

Creating a conceptual model for family caregivers of older adults intervention research: A narrative review of learned resourcefulness, resourcefulness, and the transtheoretical model

There is little research on the relationship between digital health technology use and health services, self-efficacy, health status, and health information seeking behavior among older family caregivers. We conducted a secondary analysis of the US Health Information National Data and found that older family caregivers with a regular healthcare provider are more likely to use digital health technology, which increases their confidence in obtaining health information (β=0.075, z=2.015, p<0.044).

Research on caregiver burden and related psychological distress has been widely studied. However, little research has focused on perspectives and experiences of older family caregivers of persons with heart failure on engaging in physical exercise to improve their health and wellness. We investigated barriers and facilitators influencing physical activity engagement for older family caregivers of persons with heart failure through a qualitative descriptive study design utilizing participant interviews. The social cognitive theory framework guided the thematic analysis. Identified themes and subthemes that emerged were centered around the framework's interrelated personal, environmental, and behavioral factors. Self-efficacy emerged as a central construct facilitating engagement in physical activity. The older family caregivers embraced technology for physical activity interventions more readily since the COVID-19 pandemic encouraged increased technology use. The age-related and caregiving barriers to physical activity found in this study highlight considerations for an older family caregiver and guide interventions for future family caregivers' engagement.