Benefits For Caregivers Research Articles

Access to Leave Benefits for Primary Caregivers of Children with Special Health Care Needs: A Double Bind

ObjectiveFamily leave benefits are a key tool that allow parents to miss work to care for their ill children. We examined whether access to benefits varies by level of childcare responsibilities among employed parents of children with special health care needs (CSHCN). MethodsWe conducted telephone interviews with 3 successive cohorts of employed parents of CSHCN, randomly sampled from a California children's hospital. At Wave 1 (November 2003 to January 2004), we conducted 372 parent interviews. At Wave 2 (November 2005 to January 2006), we conducted 396 parent interviews. At Wave 3 (November 2007 to January 2008), we conducted 393 parent interviews. We pooled these samples for bivariate and multivariate regression analyses by using wave indicators and sample weights. ResultsParents with more childcare responsibilities (primary caregivers) reported less access to sick leave/vacation (65% vs 82%, P < .001), access to paid leave outside of sick leave/vacation (41% vs 51%, P < .05), and eligibility for Family and Medical Leave Act benefits (28% vs 44%, P < .001) than secondary caregivers. Part-time employment and female gender largely explained 2 of the 3 associations between more childcare responsibilities and less access to leave benefits. Even in the context of part-time employment, however, primary caregivers were just as likely as secondary caregivers both to miss work due to their child's illness and to report being unable to miss work when they needed to. ConclusionsDue in part to employment and gender differences, leave benefits among parents of CSHCN are skewed away from primary caregivers and toward secondary caregivers. Thus, primary caregivers may face particularly difficult choices between employment and childcare responsibilities. Reducing this disparity in access to benefits may improve the circumstances of CSHCN and their families.

Physical Health, Mental Health, and Life Changes Among Family Caregivers of Patients With Lung Cancer

To describe physical health, mental health, and life changes among family caregivers of patients with lung cancer. Cross-sectional quantitative study. A university outpatient oncology center, two Veterans Affairs outpatient clinics, and a private outpatient oncology practice in Indianapolis, IN. 91 family caregivers of patients with lung cancer. Data were collected using standardized instruments and analyzed using descriptive statistics and hierarchical multiple regression. Demographic and medical factors, physical health, mental health, and life changes from caregiving. Caregivers' physical health and mental health were below population norms, whereas social functioning did not differ from norms. More than 50% of caregivers reported negative emotional effects of caregiving, and more than 33% reported negative physical health effects of caregiving. About 40% of caregivers, however, reported positive changes in their relationships with the patients with lung cancer and other family members as a result of caregiving. Caregivers' mental health was more strongly associated with life changes than physical health. Findings suggest that many family caregivers of patients with lung cancer experience negative physical and mental health effects of caregiving, whereas relations with family members improve for a substantial minority of caregivers. These positive and negative consequences of caregiving should be jointly considered when developing self-report measures and interventions for this population. Nurses can conduct brief screening assessments to identify caregivers with probable distress and can provide practical and psychosocial support, as well as referrals to support services. Findings suggest that interventions are needed to address the negative physical and emotional health consequences of caring for family members with lung cancer. Such interventions could build on the relational benefits of caregiving to improve the patient-caregiver relationship and expand caregivers' support system.

Attitudes of the German General Population toward Early Diagnosis of Dementia – Results of a Representative Telephone Survey

BackgroundEarly detection of dementia has clearly improved. Even though none of the currently available treatments for the most common form of dementia, Alzheimer’s dementia, promises a cure, early diagnosis provides several benefits for patients, caregivers, and health care systems. This study aimed to describe attitudes toward early diagnosis of dementia in the German general population.MethodsA representative telephone survey of the German population aged 18+ years (n = 1,002) was conducted in 2011.ResultsThe majority of respondents (69%) would be willing to be examined for early diagnosis of dementia. Almost two thirds reported that they would prefer their general practitioner (GP) as the first source of professional help. More than half of the respondents (55%) stated their belief that dementia could be prevented. Respondents mostly indicated psychosocial prevention options.ConclusionsOur findings suggest that the general population in Germany is very open to early diagnosis of dementia; however, this seems connected with large expectations on the effectiveness of prevention options. Dementia awareness campaigns may be employed to carefully inform the public about the prevention options currently available and their efficacy. To exploit GPs’ potential as a gatekeeper for early detection of dementia, their ability to identify patients with antecedent and mild stages of the disease must be improved.

Do Caregivers Benefit More From Educational and Volunteer Activities Than Their Noncaregiving Peers?

Informal caregivers are a critical component of the US long-term care system, but caregivers often experience poor physical and mental health as a result of strain from the caregiving role. Engagement in community-based educational and volunteer activities contributes to older adult well-being, but previous studies have not assessed whether the effects of these types of engagement are different for older adults who are also caregivers. Using a sample of participants in educational and volunteer activities sponsored by a national nonprofit organization, we find that participants who are caregivers report more benefit from these community-based activities than their noncaregiving counterparts. Connecting caregivers to existing community-based activities may be an efficient strategy for improving caregiver well-being.

Cancer caregivers’ perceptions of an exercise and nutrition program

Little research has addressed exercise and nutrition-based interventions for cancer caregivers. This study explored cancer caregivers' perceptions of participating in a structured exercise and nutrition program alongside cancer survivors for whom they provided care. In-depth, semi-structured interviews were conducted by one interviewer with 12 cancer caregivers about their experiences participating in a structured, 12-week exercise and nutrition program designed for cancer survivors and caregivers to complete concurrently. Interviews were conducted until data saturation was reached. Inductive content analysis from individual interviews indicated three separate, but interrelated, themes: (1) the program was a positive mechanism through which caregivers shared and supported the cancer journey concurrently with survivors, (2) the program led to perceived physical and psychological benefits for both caregivers and survivors, and (3) participants perceived that participation in the program led to feeling increased social support in their caregiving duties. Findings from this study suggest that participating in an exercise- and nutrition-based intervention is viewed positively by caregivers and that the outcomes are seen as beneficial to both caregivers and survivors. Interventions that address the health needs of both members of the caregiver-survivor dyad should continue to be encouraged by allied health professionals.

1470P - Family Caregiver Burden: Results of A Moroccan Prospective Study of Cancer in The Elderly and their Caregivers

ABSTRACT Introduction The support of older patients affected with cancer by their natural caregivers is not a simple task. It could be a painful experience with a major emotional, physical and economic impact on relatives. Usually family members do that task and they may not be prepared for the challenges. The needs of older patients are diverse and may include assistance with medication, transportation for treatment, and emotional support. Methods This is a prospective descriptive study, conducted in the National Institute of Oncology in Rabat during a ten month period from December 2010 to September 2011.We included relatives of patients aged 70 or older with histologically proven cancer and also their relatives. A questionnaire was given to participants. For all participants, demographics, disease characteristics, social, economical and psychological features were recorded. Psychological impact was assessed using DSM-IV. Findings A total of 150 patients' relative caregivers responded to the questionnaire. Mean age was 44.7 years old. More than two thirds live in urban areas and educated in 62.7%. They were 56.7% sons or daughters, living with their relatives in 54% of cases. Most of participants were married and have familial responsibilities. In relatives, anxiety was found in 79.3%. It was related to fear of losing the patient in 57% and led to the use of anxiolytics in 10%. Guilty feelings toward patients regarding neglecting early symptoms was reported in 38% of the relatives. Depression and anxiety were more frequent among female relatives and in those of urban origin. Obsession with dying from cancer was present in about 30% and fear of contagion was more common among those from rural backgrounds and the illiterate. Economic resources were exceeded in 78.7%, and 56% have used credit, sale of properties and work lay-off was recorded in 54%. Relatives participated in treatment making decisions in 86%. Conclusion Even where there was a great impact on older cancer patients' relatives, the benefits of caregiving was observed in 80% in our study, these included greater self-esteem, personal growth, meaning and purpose in one's life, and gratitude for being able to reciprocate care. Assistance and information from healthcare professionals remains the key to improving the ability of caregivers to cope with caring for older patients with cancer. Disclosure All authors have declared no conflicts of interest.

Potential explanations for control group benefit

Estimating effectiveness of clinical interventions depends on detecting differences between the responses of intervention and control groups. The outcome, intervention, and moderating factors all may influence the between group change. The absence of a clinically or statistically meaningful difference may also result from control group improvement due to nonspecific factors such as participants' perception of attention, positive regard, expectations, desire to please, and therapeutic alliance with the care provider. We examined perceived benefit and sources of benefit for control caregivers who participated in the CONNECT randomized controlled trial of a dementia caregiving intervention. After the final scheduled data collection in CONNECT, control group participants were asked whether they believed they benefited from study participation. Those who reported benefit were asked to describe the benefit received. Data were analyzed qualitatively. Of 60 available control caregivers, 82% reported a perceived benefit from study participation in five areas: getting information about dementia and caregiving; having someone to talk to and feeling supported; receiving understanding and validation of feelings; knowledge that others were in similar situations; and perceived appreciation of own abilities. Control caregivers who reported benefit were less burdened and depressed and spent less time on duty at baseline than those who did not report benefit. From caregivers' responses, we have identified the assessment battery, both content and time spent in data collection, as a possible mechanism of action for benefit. Study limitations include the better baseline characteristics of the control caregivers who reported benefit, the sample size of benefit control caregivers, the possibility of perceptions of benefit being a function of social desirability, and the lack of a similar question about benefit being asked of intervention caregivers. These findings suggest that the outcome assessment questionnaires used in this and similar trials may be an intervention of sorts for caregiver participants in the control group. Caregivers who are less distressed may benefit more from the attention provided during assessment. These findings underscore the importance of asking caregivers how they are doing. For researchers, there is a need to develop innovative ways to assess outcomes to avoid unintended benefit of assessments.

Early Interventionists’ Perspectives on Teaching Caregivers

Relatively little is known about the role of early interventionists as teachers of caregivers. The current study was conducted to better understand interventionists’ perspectives about teaching caregivers. A national sample of 1,525 multidisciplinary interventionists completed an online questionnaire, which elicited information about interventionists’ preferences for use of caregiver teaching strategies, factors influencing decisions about teaching strategy use as well as comfort in, frequency of, and barriers to teaching caregivers. Use of a range of teaching strategies across contexts was reported. Differences emerged in teaching strategy preference based on experience in teaching specific skills and years of experience in early intervention. Ten themes emerged as rationales for teaching strategy selection. Interventionists reported moderate confidence in and frequency of caregiver teaching and few barriers to teaching. Results suggest a preference for use of multiple strategies and selection factors based on experience, perceived caregiver benefit, or other general factors such as interventionist preference.

Psycho-Educational Group Intervention for Family Caregivers of Hospitalized Palliative Care Patients: Pilot Study

Family caregivers of patients requiring palliative care commonly experience physical, social, and psychological burdens. Although family caregivers are acknowledged as valid service recipients of palliative care, many have unmet needs, and systematic reviews have shown there are limited evidence-based supportive interventions. This study aimed to develop and pilot test a psycho-educational group education program delivered in the inpatient specialist palliative care setting and designed to prepare primary family caregivers for the role of supporting a relative receiving hospital-based palliative care. (1) Development of education session and delivery protocol by the research team and expert panel; (2) pilot the intervention in three clinical sites (five sessions in total); (3) evaluate its accessibility and acceptability; and (4) preliminary testing of outcome measures used to access the intervention's effectiveness. The results revealed that the intervention was appropriate and acceptable to caregivers. The intervention needs to be tested in a larger sample to determine the potential benefits for caregivers' sense of preparedness and competence, and testing needs to ascertain if the intervention is accessible.

A multimodal, interdisciplinary programme for the management of cachexia and fatigue

Fatigue and cachexia are common symptoms of advanced disease that have a significant impact on quality of life for palliative care clients. Management of cachexia and fatigue is often overlooked, but growing understanding of the multidimensional nature of fatigue and muscle wasting has led to interest in a model of care based on multimodal therapy that has been successfully implemented in specialized multidisciplinary hospital-based clinics in the oncology/palliative care setting. This article reports on an innovative incorporation of features of this model into a client-centred, interdisciplinary programme that aims to manage the effects of cachexia and fatigue and to improve quality of life for palliative care clients in their home setting. This Cachexia and Fatigue Management Programme (CFMP) involves the use of an anti-inflammatory agent, high protein intake, and an individually tailored resistance exercise regimen to counteract muscle wasting and fatigue. The article provides an overview of the role of multimodal therapies in the management of cachexia and fatigue before moving on to discuss the development of the CFMP, its features, and potential benefits for palliative care clients, caregivers, and health services.

Hospice Employee as Personal Caregiver of a Family Member Receiving Hospice Care (762)

1.Examine the dual role of hospice employees as personal caregivers.2.Identify prevalent caregiver characteristics of this population. Much is known about family caregiving characteristics including caregiver benefit and burden; however, no studies have been conducted to examine the phenomenon of the concurrent role of hospice employees serving as personal caregivers of family members (HEPCs) receiving hospice care. To identify the most prevalent HEPC characteristics and determine if specific support needs are warranted. A 30-item survey was developed based on the five dimensions of the Caregiver Reaction Assessment (CRA). Survey items were revised for content validity through peer review process and pilot tested. 900 surveys were distributed to paid employees of a large not- for- profit hospice. Participants must have been hospice employees while their family member received hospice services. Data were collected for 4 months using the Dillman Technique. Seventy-five surveys were returned and analyzed. Respondents were mostly female, middle aged (mean = 49; SD = 9.0), caring for an elderly parent (mean age 79; SD = 13.9), and working in hospice greater than five years (73%). Total mean score of the HEPC survey was 90.12 (range = 69-119; SD = 9.8). Individual item scores ranged from 1–4 (higher scores = greater benefit). Over half of the respondents (59%) provided care between 8–24 hours/week, endorsed all roles of caregiving- direct care, instrumental support, and emotional/spiritual support, and felt their privacy was respected. Only 10% of respondents participated in formal bereavement follow up. Overall, HEPCs were supported by their hospice team and coworkers and found benefit in the dual roles of the caregiving experience; however, qualitative data suggest bereavement leave (3 days) may need to be extended in order to re-enter the “same world just experienced.”

Impact of patient suffering on caregiver well-being: The case of amyotrophic lateral sclerosis patients and their caregivers

The impact of patient suffering on family caregivers is an understudied but important topic. This study of patients with amyotrophic lateral sclerosis (ALS) and their caregivers examined the associations of two components of patient suffering: patient physical symptoms, and mental distress, as well as the patient's support for the caregiver, with caregiver well-being. The sample consisted of 52 patients with ALS and their caregivers. Patients and caregivers each completed a structured survey assessing multiple domains including demographics, health, and well-being. Specifically, patients rated their own physical symptoms and mental distress. Caregivers rated their own daily affect, and the extent to which they perceived the patient as supportive. Caregivers also reported whether or not they had found any benefit in dealing with the patient's illness. Regression analyses yielded significant associations of patient distress with caregiver negative affect; patient support was associated with greater caregiver positive affect, and patient symptoms and support were associated with greater likelihood of caregiver benefit finding. There was a significant two-way interaction of patient symptoms by support, namely, benefit finding was not only more likely with greater physical suffering and patient support, but it was also the case that caregivers who perceived the care recipient as unsupportive could only find benefit when this person experienced intense physical suffering. Support interventions for ALS patients and their caregivers should devote particular attention to how caregivers may be affected by witnessing their loved one's sufferings, as well as identify and address challenges in support exchanges between caregivers and patients.

Person-centered Planning and Participant Decision Making

It is a humbling experience to try to capture those critical elements in the Patient Protection and Affordable Care Act (P.L. 111-148) (now more commonly called the Affordable Care Act [ACA]) that have the most import for our profession of social work. I focus my remarks on one theme that is woven throughout health care reform: person-centered planning and participant direction. Whereas that theme appears in both the acute and long-term care portions of the legislation, here I zero in on the provisions dealing with long-term supports and services in the community. Participant-directed services are long-term care services that help people of all ages, across all types of disabilities, to maintain their independence and determine for themselves what mixture of personal care services and supports works best for them. Sometimes these are referred to as consumer-directed or self-directed services. Under the participant-directed model, individuals have control over who helps them with the basic, personal activities of daily living (ADLs) such as bathing, dressing, and getting out of bed (employer authority) and how their funds are used (budget authority). Within the constraints of their budget, they can purchase any combination of goods, services, and human assistance that meets their personal assistance needs and helps them stay independent in the community. If they need help in managing, they can appoint an unpaid family member or friend to be their representative; and they have readily available support services to help them handle bookkeeping, taxpaying, and check-writing responsibilities (financial management services) and to develop person-centered plans, find resources, develop backup plans, meet training needs, and so forth (support broker or counseling services). This approach not only meets present and future needs for flexibility and choice, but also (under the Cash & Counseling demonstration [see http://www. bc.edu/schools/gssw/nrcpds/cash_and_counseling. html]) has proven itself under rigorous comparative effectiveness testing. Here is a summary of what the research, conducted by Mathematica Policy Research, provides: * improved access; * improved quality of care: * increased satisfaction, * reduced unmet needs, and * same or better health outcomes; * caregiver benefits; * controllable costs; and * the potential for reduced nursing facility usage. Clearly, interest in participant direction is increasing. The National Survey of Participant Direction Programs, which Boston College's National Resource Center for Participant-Directed Services (NRCPDS) is completing, shows that all states have at least one program offering employer authority, and 41 states have at least one program with the budget authority option. This movement will only expand. In 2003, AARP's Public Policy Institute released a survey in which they asked a representative group of members (over the age of 50 years) how they would like to receive services if, in the future, they needed help in basic ADLs like bathing, dressing, or getting out of bed (Gibson, 2003). Seventy-five percent indicated that they would prefer managing for themselves over receiving care from agencies. Furthermore, no one needs to remind us of the increasing diversity of our nation's older population. Between 1990 and 2030, elders in four ethnic groups are expected to grow from 14 percent to 25 percent of the over-65 population. Our nation is diverse in terms of race, gender, ethnicity, sexual orientation, functional ability, and cognitive ability, to name but a few dimensions. We need a system that is flexible. Let me repeat, it is clear that one size does not fit all. Participant direction allows individuals and families to tailor supports to their unique needs and preferences. No wonder the 2008 Commonwealth Fund Survey of Long-Term Care Opinion Leaders (Miller, Mor, & Clark, 2008) found that 61 percent of 1,147 leaders responding favored expansion of participant direction efforts like Cash & Counseling as a potential strategy for reform of publically funded services. …

Does Caregiver Burden Mediate the Effects of Behavioral Disturbances on Nursing Home Admission?

The primary objective of this study was to determine whether caregiving burden mediated the relationship between specific behavior disturbances and time to nursing home admission (NHA) for persons with dementia (i.e., Alzheimer disease or a related disorder). The study used secondary longitudinal data from the Medicare Alzheimer's Disease Demonstration, a Medicare-covered home care benefit and case management program for family caregivers of persons with dementia. Primary caregivers of persons with dementia were assessed via in-person and telephone interviews every 6 months over a 3-year period. Dementia caregivers were recruited from eight catchment areas throughout the United States. The baseline sample included 5,831 dementia caregivers. Just more than 40% (43.9%; N = 2,556) of persons with dementia permanently entered a nursing home during the 3-year study period. Individual behavior problems were measured with the Memory and Behavior Problem Checklist. Caregiving burden was assessed with a short version of the Zarit Burden Inventory. Key covariates, including sociodemographic background, functional status, and service utilization, were also considered. Event history analyses revealed that time-varying measures of caregiver burden fully mediated the relationship between four behavioral disturbances (episodes of combativeness, property destruction, repetitive questions, and reliving the past) and NHA. The findings highlight the multifaceted, complex pathway to NHA for persons with dementia and their family caregivers. The results emphasize the need for comprehensive treatment approaches that incorporate the burden of caregivers and the behavioral/psychiatric symptoms of persons with dementia simultaneously.

Associations between symptom burdens (SB) and expectations of benefit (EB) for advanced cancer patients (ACP) and spousal caregivers (SC) participating in phase I trials.

e19595 Background: Terminally-ill ACP have been shown to have EB from experimental agents beyond what might be reasonably expected. The influence of disease severity and psychological factors, as measured by SB, on such EB is unknown. Methods: A convenience sample of ACP enrolling in phase I trials and SC were evaluated at baseline (T1) and one month later(T2) using a battery of standardized and/or validated assessments of SB including: cognition (MMSE); depression (CES-D); state-trait anxiety (STAI-S/T); posttraumatic growth (PTGI); quality of life/qol (FACIT-Pal); global health (SF-36); and martial adjustment (DAS). Data re participant EB were obtained utilizing Likert scores (1-10) measuring the likelihood of chemotherapy in: “stabilizing” (ST), “halting/shrinking” (HL), producing “remission”(PR), and “curing” (C) ACP’s cancer. Results: 104 participants (52 Phase I ACPs and 52 SC) were separately interviewed at T1 and T2. For the population as a whole, median age was 61y (28-78y); 50% male; 100% married; 87% Ca; 67% >HS educ; 51% GI dx. No associations were found between ACP SB (MMSE, CES-D, STAI-T, PTGI, FACIT-Pal, SF-36, DAS) and EB reported by ACPs. Regression analyses at T2 revealed negative associations between ACP SB state anxiety scores and the following ACP EB: ST, F (1, 51) = 6.52, p=.01; HL, F (1, 51) = 8.44, p< .01; and to PR of disease, F (1, 51) = 4.30, p=.04. At T2, for SC, negative associations were found between SC state anxiety and SC EB for: ST cancer, F (1, 51) = 6.52, p=.01, and HL, F (1, 51) = 3.02, p<.01. SC trait anxiety was also negatively associated with SC EB for ST the ACP’s cancer, F (1, 51) = 5.46, p=.02. Regression analyses revealed positive associations between SC martial satisfaction scores and the following SC EB: ST, F (1, 51) = 4.14, p=.04; HL, F (1, 51) = 4.46 p=.04; PR, F (1, 51) = 4.39, p=.04; C, F(1, 51) = 4.22, p=.03. Further positive associations were found between SC EB HL cancer and SC SF36 scores, F(1, 51) = 3.97, p=.03. No additional associations were found between SC SB (MMSE, CES-D) and SC EB. Conclusions: Our data indicate that several significant associations exist between ACP and SC SB and EB from Phase I trial participation.

The development and testing of a scale of Taiwanese caregiver meaning

The purpose of this study was to develop and test a scale of Taiwanese caregiver meaning. The meaning of care-giving is defined as the beliefs one holds about oneself and the care-giving experiences that affect adjustment to the care-giving role. An existing tool, the Meaning in Care-giving Scale, has been tested in Taiwan, but it showed that the construct validity was unreliable. The study was a cross-sectional study with purposive sampling. The instrument was developed through 20 semi-structured interviews of caregivers of mentally ill patients. A comparative method was used to analyse the text and field notes. According to the results, 29 items were designed and 318 caregivers of mentally ill patients were recruited from a psychiatric outpatient department in central Taiwan. Content and back direct content validity tests were conducted. Internal consistency, Chronbach's alpha, was used to examine the reliability, and exploratory factor analysis was used to examine the construct validity. Twenty items were kept after exploratory factor analysis. They represent four factors: the benefits of care-giving, a belief in Karma, personal responsibility and a reflection on life. Cronbach's alpha value for a subscale increased from 0·68-0·84, and the total scale was 0·84. A sixty per cent (59·55%) cumulative variance can be explained by four factors. A Taiwanese caregiver meaning can be considered a useful scale for assessing the meaning of care-giving for Taiwanese caregivers of mentally ill patients. A good scale and instrument take years to develop. This study takes the first step to examine the structure of the scale, and it is worth continued testing, modification and improvements. The scale of Taiwanese caregiver meaning was developed based on certain aspects of contemporary Taiwanese culture. It can be used to provide mental health professionals new counselling knowledge to assist caregivers of mentally ill patients to adjust to their circumstances.

Quality of life and psychosocial functioning of spouse/partner caregivers before and after liver transplantation

Spouse/partner caregivers of liver transplant (LTx) patients play an important role both before and after transplantation. However, very little research has examined the quality of life (QOL), caregiving strain, and psychological functioning of these caregivers. In this study, we examined these outcomes and their correlates in 86 (49 pre-LTx, 38 post-LTx) spouse/partner caregivers. The physical QOL of caregivers was not impaired, and numerous caregiving benefits were identified (e.g., realizing what is important in life, discovering one's own inner strength, giving emotional support to the patient). However, a relatively high proportion of both pre-LTx and post-LTx caregivers had clinically low mental QOL (29% and 35%, respectively), low life satisfaction (45% and 32%, respectively), and high caregiving strain (59% and 81%, respectively). Both pre- and post-LTx caregivers, particularly women, had more total mood disturbance than a normative sample. Higher caregiving strain was significantly correlated with lower mental QOL, lower life satisfaction, and more mood disturbance. Overall, findings suggest that caregiving strain is prominent through the LTx spectrum. There is a need for prospective research to identify the patterns of caregiver outcomes over time and to examine the benefits of clinical interventions for caregivers.

Translation of a Dementia Caregiver Support Program in a Health Care System—REACH VA

Based on the National Institute on Aging/National Institute of Nursing Research Resources for Enhancing Alzheimer's Caregiver Health (REACH) randomized controlled trial (REACH II), REACH VA (Department of Veterans Affairs) was the first national clinical translation of a proven behavioral intervention for dementia caregivers, running from September 2007 through August 2009. This article describes the population and outcomes of the REACH VA translation of REACH II into the VA. Clinical staff members from 24 VA Medical Center Home-Based Primary Care programs in 15 states delivered the intervention to stressed caregivers of patients with dementia. Like REACH II, the 6-month REACH VA intervention, structured through a protocol and individualized through a risk assessment, targeted education, support, and skills training to address caregiving risk areas of safety, social support, problem behaviors, depression, and health through 12 individual in-home and telephone sessions and 5 telephone support group sessions. Staff members of the Memphis VA Medical Center, Memphis, Tennessee, collected data on burden, depression, health and healthy behaviors, caregiving frustrations, social support, dementia-related behaviors, and time spent providing care and on duty. From baseline to 6 months, caregivers reported significantly decreased burden, depression, impact of depression on daily life, caregiving frustrations, and number of troubling dementia-related behaviors. A 2-hour decrease in hours per day on duty approached significance. Caregivers (96%) believed that the program should be provided by the VA to caregivers. This clinical translation achieved outcomes similar to the REACH II randomized controlled trial, providing clinically significant benefits for caregivers of a veteran with a progressive dementing disease. This model of caregiver support can inform public policy in providing assistance to caregivers.

A Pilot Investigation of Mindfulness-Based Stress Reduction for Caregivers of Frail Elderly

Family caregivers may experience psychiatric symptoms associated with the chronic stress of caring for frail elderly. Mindfulness training may mitigate some of the negative health effects related to caregiving, but the relevant literature is sparse. We present data from a small pilot study of mindfulness training for caregivers of frail elderly. Nine women caregivers between the ages of 48 to 73 participated. Eight weekly classes of mindfulness-based stress reduction were minimally adapted to enhance the potential benefits for caregivers. Measures of depressive symptoms, burden, perceived stress, anxiety, general health, and mindfulness were assessed at baseline, at completion of the intervention, and at a 1-month follow-up. Self-reported depression, perceived stress, and burden decreased during the 8-week intervention with further reduction demonstrated after a 1-month follow-up regarding stress and burden while depressive symptoms returned to baseline level. Mindful attention and calmness increased over the course of the study. Qualitatively, participants reported continued use of acquired skills and personal benefits from the training. These preliminary results are supportive of the development of larger controlled trials of mindfulness training for caregivers. Future studies may consider identifying subpopulations of caregivers most likely to benefit from mindfulness, and the potential need for a continuation phase of active group participation following the 8-week training.

Spouse Caregivers of Kidney Transplant Patients: Quality of Life and Psychosocial Outcomes

Most kidney transplant programs require patients to identify a primary caregiver who can assist them throughout the transplant process. Little is known about the quality of life, caregiving strain, and psychosocial functioning of these caregivers. To characterize the psychosocial functioning of spouse/partner caregivers. Cross-sectional survey administered to spouse/partner caregivers of patients before (n=33) and after (n=46) kidney transplantation at a transplant center in New England. Quality of life, life satisfaction, caregiving strain and benefit, mood, and social intimacy. Relative to normative samples and published data involving other transplant caregivers, caregivers of kidney transplant patients had favorable quality of life, life satisfaction, psychological, and social intimacy outcomes. Life satisfaction scores were significantly lower for caregivers before than after kidney transplantation, but otherwise the 2 cohorts did not differ significantly from each other. Most caregivers both before and after kidney transplantation reported clinically high levels of caregiving strain, as well as several caregiving benefits. Our data are consistent with results of other studies in showing that spouses experience considerable caregiving strain both before and after transplantation. However, caregivers of kidney transplant patients overall have good quality of life, life satisfaction, mood, and social intimacy. More prospective research is necessary to characterize better how these outcomes change over time throughout the transplant process.