Caregiver Burden Index Research Articles

Nurses' Awareness of and Current Approaches to Oral Care in a Community Hospital in Japan: A Longitudinal Study of Dental Specialists' Interventions.

Objective: This study aimed to increase nurses' interest and priority in oral care by implementing educational interventions, such as teaching oral care methods suitable for each patient in clinical settings, over a period of one year. Materials and Methods: This study included all 150 nurses working in Unnan City Hospital in Japan who answered a questionnaire comprising 19 questions regarding awareness, actual implementation status of oral care provided, burden, and involvement with oral and maxillofacial surgery department of the hospital, along with participants' characteristics. The rate of interest in learning, need for oral care, time spent in oral care, and oral health-related caregiver burden index (OHBI) score were compared between pre- and post-intervention groups. Results: The number and rate of valid questionnaires were 136 and 90.7%, respectively. The mean years of clinical experience were 19.3 ± 12.5 years; 93.4% of the nurses were women. After the interventions by dental specialists, the nurses' level of interest in and priority to oral care were significantly higher than those before the interventions (p < 0.001), regardless of nurses' background, such as age, gender, or years of experience. However, the "burden" did not statistically decrease. Conclusions: This study shows that dental specialists succeeded in significantly increasing nurses' interest in and priority to oral care by intervening in clinical practice but failed in decreasing nurses' burden of oral care. In the future, we would like to investigate the problems that hinder the reduction of the sense of burden, reduce the burden of nurses' oral care, and improve oral care.

Oral Care Awareness and Factors Related to the Burden of Nurses at a Community Hospital in Japan.

Objective: This cross-sectional study investigated the oral care knowledge, awareness, and challenges of 159 nurses and identified the factors related to the burden of oral care in Unnan City Hospital, Japan. Materials and Methods: This study included outpatient, ward, and operating room nurses who answered a questionnaire comprising 19 questions regarding awareness, actual implementation status of oral care provided, burden and learning experiences of oral care, and participants’ characteristics. A univariate regression model was used to assess whether catheterization was associated with the independent variables. Results: The number and rate of valid questionnaires were 134 and 87.6%, respectively. The mean years of clinical experience were 18.71 ± 12.02 years; 95.5% of the nurses were women. There were significant differences in the Oral Health-related Caregiver Burden Index among “interest in oral care” (p = 0.006), “priority of oral care” (p = 0.005), and “burden of oral care”. Conclusions: This study shows that nurses who are highly interested in oral care, prioritize oral care, and do not perceive oral care as a burden. Educational interventions, such as training sessions and direct guidance to solve challenges, are needed and can lead to improvements in the quality of life and advancement of health.

Care needs level in long-term care insurance system and family caregivers’ self-perceived time-dependent burden in patients with home palliative care for cancer: a cross-sectional study

Although home care improves patients' quality of life (QOL), several studies have suggested that home care lowers the QOL of family caregivers and decreases their mortality. To alleviate the deleterious impact of home care on caregivers, the major burdens on caregivers and the clinical characteristics of the caregivers vulnerable to the major burden needs to be clarified. A survey questionnaire was distributed to 710 family caregivers of patients with cancer in Japan, and 342 valid responses were obtained (valid response rate: 48.2%). The Burden Index of Caregivers was used to identify the major burden on caregivers. To assess the associations of the patients' care needs level and other clinically relevant factors with the major burden, a multivariable-adjusted logistic regression model was used. The time-dependent burden was identified as a major burden. An adjusted model showed a nonlinear association between the care needs level and the time-dependent burden, in which the caregivers of the patients who required moderate care needs level had the highest time-dependent burden [adjusted odds ratio of none, mild, moderate, and severe care needs levels: 0.50 (95% confidence interval 0.07-2.12), 1.08 (0.43-2.57), 1.87 (1.01-3.52), and 1.00 (reference), respectively]. Additionally, older patients and younger caregivers were significantly associated with a time-dependent burden. The time-dependent burden was highest in caregivers at the moderate care needs level and younger caregivers. An imbalance between the demand and supply of care services may be improved by considering the clinical characteristics of both patients and caregivers.

Factors Affecting the Care Burden of Nurses Caring Elderly Patients with Dementia

Purpose: In Korea, the prevalence of dementia patients has increased, which makes the care burden of nurses important. The purpose of this study is to identify factors affecting the care burden of nurses caring elderly patients with dementia. Methods: A cross-sectional design was conducted using a convenience sample of 127 nurses from two hospitals and a nursing home in Korea. Participants completed questionnaires on knowledge of and attitudes toward dementia, social support, self-esteem, dementia problematic behavior (DPB), and professional caregiver burden index. The data were analyzed by using the t-test, ANOVA, Pearson correlation, and multiple regression with the SPSS/windows version 21.0 program. Results: The influencing factors for nurse burden include day shift, DPB, self-esteem, social support, which explain 28.0% of care burden of nurses. Conclusion: To reduce the burden of the nurses, there needs to be an administrative system that focuses on enhancing their self-esteem and social support. Active institutional support may be necessary for the nurses taking care of elderly patients with dementia.

Prospective study of the relationship between patient falls and caregiver burden in home health care: A pilot study.

AimTo investigate the relationship between caregiver burden and patient falls, and the incidence of falls in patients receiving home health care.MethodsA prospective cohort study was conducted on patients receiving home health care provided by 3 home‐care support clinics and their primary caregivers from November 2015 to February 2016. Cox proportional hazards analysis was performed on the Burden Index of Caregivers (BIC) and the presence of falls.ResultsOf the eligible 114 subjects, 47 were included in the final analysis. Nineteen subjects (40.4%) reported falls in the 3‐month observation period. The incidence of falls was 1120 per 1000 person‐years. The unadjusted hazard ratios for BIC score, patient gender (female), fall assessment score, and lack of physical barriers within the home were 1.46, 1.39, 0.52, and 0.52, respectively, and differences were not statistically significant. Adjusted hazard ratios were 1.56, 1.44, 0.65, and 0.62, respectively, and were also not statistically significant.ConclusionThe incidence of falls was found to be roughly 5 times more than that in the general community elderly population. No causal relationship was found between caregiver burden and patient falls.

The impact of different anti-vascular endothelial growth factor treatment regimens on reducing burden for caregivers and patients with wet age-related macular degeneration in a single-center real-world Japanese setting.

ObjectiveTo describe the burden associated with different anti-vascular endothelial growth factor (VEGF) treatment strategies for wet age-related macular degeneration (wAMD) in a real-word setting in Japan.MethodsSingle-center, cross-sectional survey of caregivers of patients with wAMD performed in a hospital in Mito-City, a rural area in Japan. Caregiver burden was evaluated using the Burden Index of Caregivers (BIC-11), and depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale. Retrospective medical chart review was conducted to monitor resource use and visual acuity outcomes in patients. The productivity loss of caregivers accompanying patients on hospital visits was estimated using the human capital method.ResultsSeventy-one patient-caregiver pairs were included. Most caregivers were female (74.6%), spouse/partner (54.9%), employed (46.5%), and the primary caregiver (85.9%). Patients received anti-VEGF treatment as follows: treat-and-extend (T&E; n = 42), switch (from as-needed [PRN] to T&E; n = 18), PRN (n = 10), and other (n = 1). Caregiver-related burden (total BIC-11 scores) were 4.29 (T&E) 4.60 (PRN), and 5.33 (switch) (p = NS).The mean number of hospital visits was lower with T&E than PRN (7.88 vs. 14.0 [p = 0.00674] in year 1 and 5.68 vs. 9.0 in year 2). For patients who switched from PRN to T&E, the mean number of hospital visits decreased from 13.21 to 7.43 (p<0.0001) in the first year after switch. The productivity loss associated with accompanying patients to the hospital was lower for caregivers of patients receiving T&E than PRN (mean differences: 74,456.04 JPY [p = 0.00284] in year 1 and 40843.14 JPY in year 2), and was also reduced for caregivers of patients who switched from PRN to T&E.ConclusionwAMD treatment with anti-VEGF agents via T&E reduced hospital visits compared with PRN, where associated monitoring visits are necessary to provide good patient outcomes. T&E was associated with a reduction trend in caregiver burden, including time and costs.

Validity and reliability of the oral health-related caregiver burden index.

This study developed the Oral Health-related Caregiver Burden Index (OHBI), which contains nine questions with five response options each. As a secondary objective, we aimed to clarify the relationship between oral health-related caregiver burden and general caregiver burden. There are a few reports of the oral health-related caregiver burden. Between January 2016 and February 2016, 155 participants enrolled in the study. We conducted the survey to examine the validity and reliability of OHBI. Additionally, the cut-off score for this scale was calculated, and the relationship between OHBI and general caregiver burden (BIC-11) was examined by binomial logistic regression. Survey 1 was completed by 102 caregivers, of whom 58 (56.9%) were female. Survey 2 was completed by 40 caregivers, of whom 22 (55.0%) were female. Factor analysis revealed four factors in OHBI. Cronbach's α was .691-.866. OHBI scores were significantly associated with scores for each factor of the BIC-11. OHBI had a cut-off score of 10 (AUC=.881, sensitivity=.828, specificity=.744). A good-poor analysis revealed significant differences for discriminant validity. ICC, an indicator of reliability, was .449-.842. There was a significant relationship between caregiver burden and oral health-related caregiver burden according to binomial logistic regression analysis (P<.05). We developed the OHBI as a multidimensional care burden scale, which comprises nine items covering five domains. Further, we verified the relationship between general caregiver burden and oral health-related caregiver burden.

Psychometric Properties of the Turkish Version of Caregiver Burden Index (CBI) for Parents of Children with Allergies

Childhood chronic diseases have a great impact, including physiological, social and financial burdens, on parents. The concept of “caregiver burden” is gaining importance to understand the effects of allergic diseases and plan family-centered strategies. PurposeThe purpose of this study was to examine the psychometric properties of the Caregiver Burden Index (CBI) in Turkish mothers of children with allergies. MethodThe participants of this methodological study were 213 mothers of children with allergies between 6 and 12years. Construct validity was evaluated through factor analysis and reliability was evaluated through internal consistency and item-total correlation. ResultsIn reliability analysis, the overall Cronbach's alpha value (0.85) demonstrated a high level of reliability. The corrected item-total correlation varied between 0.63 and 0.84. In exploratory factor analysis, it was detected that 3 factors structure explained 73.6% of the total variance. ConclusionThis study indicated that the CBI is a valid and reliable tool to assess the caregiver burden of mothers of Turkish children with allergies. Implication for PracticesThe results of this study contribute to the development and implementation of evidence based models of care that address the caregiver burden needs of parents whose children have allergies.

Effects of a Health and Social Collaborative Case Management Model on Health Outcomes of Family Caregivers of Frail Older Adults: Preliminary Data from a Pilot Randomized Controlled Trial.

Family caregiving is an important form of informal care provided to frail, community-dwelling older adults. This article describes a health and social collaborative case management (HSC-CM) model that aims to optimize the support given to caregivers of frail elderly adults. The model was characterized by a comprehensive assessment to identify the caregiver's needs; a case management approach to provide integrated, coordinated, continued care; and multidisciplinary group-based education customized to the caregiver's individualized needs. A pilot study using a randomized controlled trial study design was conducted to evaluate the effects of the HSC-CM on caregiver burden and health-related quality of life of family caregivers of frail elderly adults. Sixty family caregivers (mean age 61.3 ± 15.5) of frail older adults recruited from a community center for elderly adults in Hong Kong were randomly assigned to receive a 16-week HSC-CM intervention or usual care. Case managers who conducted a comprehensive assessment of the care dyads to identify caregiver needs using a case management approach to optimize care coordination and continuity led the HSC-CM. These case managers served as liaisons for multidisciplinary efforts to provide group-based education according to caregiver needs. Family caregivers who participated in the HSC-CM had significantly greater improvement on the Caregiver Burden Index (p = .03) and on the Medical Outcomes Study 36-item Short-Form Survey subscales, including vitality (p = .049), social role functioning (p = .047), and general well-being (p = .049). This study provides preliminary evidence indicating that client-centered care, a case management approach, and multidisciplinary support are crucial to an effective caregiving support initiative. A full-scale study is required to validate these findings.

Influence of family dynamics on burden among family caregivers in aging Japan.

Background.Long-term care for the elderly is largely shouldered by their family, representing a serious burden in a hyper-aging society. However, although family dynamics are known to play an important role in such care, the influence of caring for the elderly on burden among caregiving family members is poorly understood.Objective.To examine the influence of family dynamics on burden experienced by family caregivers.Methods.We conducted a cross-sectional study at six primary care clinics, involving 199 caregivers of adult care receivers who need long-term care. Participants were divided into three groups based on tertile of Index of Family Dynamics for Long-term Care (IF-Long score), where higher scores imply poorer relationships between care receivers and caregiving family: best, <2; intermediate, 2 to <5; worst, ≥5. The mean differences in burden index of caregivers (BIC-11) between the three groups were estimated by linear regression model with adjustment for care receiver’s activity of daily living and cognitive function.Results.Mean age of caregivers was 63.2 years (with 40.7% aged ≥ 65 years). BIC-11 scores were higher in the worst IF-Long group (adjusted mean difference: 4.4, 95% confidence interval: 1.2 to 7.5) than in the best IF-Long group. We also detected a positive trend between IF-Long score and BIC-11 score (P-value for trend <0.01).Conclusion.Our findings indicate that family dynamics strongly influences burden experienced by caregiving family members, regardless of the care receiver’s degree of cognitive impairment. These results underscore the importance of evaluating relationships between care receivers and their caregivers when discussing a care regimen for care receivers.

Burden and Depression in Caregivers of Blind Patients in New York State

ABSTRACTPurpose: To describe the degree of burden of care and the proportion at risk of depression among individuals caring for legally blind patients.Methods: We performed a cross-sectional study of 486 individuals providing care to their family members who were legally blind. Best-corrected visual acuity of the better-seeing eye in patients determined group placement: Group 1, 20/200–10/200; group 2, 10/200 to light perception (LP); group 3, no light perception (NLP); group VF, visual field loss to <20 central degrees. Burden was evaluated using the Burden Index of Caregivers (BIC-11) and the prevalence at risk of depression was determined by the Center for Epidemiologic Studies Depression (CES-D) scale.Results: Total mean BIC-11 scores ranged from 8.78 ± 4.82 (group 1) to 12.03 ± 5.22 (group 3; p = 0.04). Daily hours spent on close supervision, intensity of caregiving and presence of multiple chronic illnesses in caregivers were the significant covariates affecting BIC-11 scores (p < 0.05). The prevalence of caregivers at risk of depression increased with vision loss from 6.9% (group 1) to 17.9% (group 3; p < 0.05). Female caregivers had an odds ratio (OR) of 2.89 for depression (95% confidence interval, CI, 1.07–3.97; p = 0.04). Caregivers with ≥2 comorbidities had OR 4.24 (95% CI 2.41–6.11) for risk of depression (p < 0.01).Conclusion: Burden of care was highest among caregivers who provided greater hours of supervision. Patients with more limitations in their activities of daily living had caregivers who reported higher burden. Female caregivers and caregivers with multiple chronic illnesses were at higher risk of depression.

Burden and Depression among Caregivers of Visually Impaired Patients in a Canadian Population.

Purpose/Background. This study reports the degree of burden and the proportion at risk for depression among individuals who provide care to visually impaired patients. Study Design. This is clinic-based, cross-sectional survey in a tertiary care hospital. Methods. Caregivers were considered unpaid family members for patients whose sole impairment was visual. Patients were stratified by vision in their better seeing eye into two groups: Group 1 had visual acuity between 6/18 and 6/60 and Group 2 were those who had 6/60 or worse. Burden was evaluated by the Burden Index of Caregivers and the prevalence of being at risk for depression was determined by the Center for Epidemiologic Studies Depression scale. Results. 236 caregivers of 236 patients were included. Total mean BIC scores were higher in Group 2. Female caregivers, caregivers providing greater hours of care, and caregivers of patients who have not completed vision rehabilitation programs are at higher risk for depression.

Development and Psychometric Testing of a Chinese Version of the Caregiver Burden Index for Parents of Children With Allergies

BACKGROUNG: No specific instrument has thus far been developed for measuring the caregiver burden perceived by parents of children with allergies (CWA). To determine the psychometric properties of the Caregiver Burden Index (CBI). A mixed-methods design was adopted to evaluate the psychometric properties of the scale. The content validity index was 0.89, and the internal consistency was high with a coefficient alpha of 0.98. Three factors were extracted after exploratory factor analysis. The study findings suggest that the CBI has sufficient reliability and validity to evaluate the caregiver burden of parents of CWA.

Effect of hospital case‐manager nurses on the level of dependence, satisfaction and caregiver burden in patients with complex chronic disease

To determine the medium-term effects of nurse case management on the dependence and satisfaction of patients with complex chronic disease and on caregiver burden. Caregiver exhaustion increases the readmission rate of highly dependent patients with complex chronic disease and their consumption of primary care resources. An observational and analytical cohort study was undertaken in multimorbid patients. Data were gathered on Barthel Index and Caregiver Burden Index scores, primary care resource consumption, readmission and mortality rates, and patient satisfaction with care and care continuity. Results were compared between nurse case-managed (n = 62) and control (n = 193) multimorbid patients using univariate and bivariate analyses. The study included 255 patients with complex chronic disease (24·32% in management cohort vs. 75·68% in control cohort). The nurse case-managed group had significantly lower Barthel Index and higher Caregiver Burden Index scores and a significantly longer hospital stay. At 90 days postdischarge, no significant intergroup differences were observed in Barthel Index or Caregiver Burden Index scores, primary care resource consumption, readmission rate or mortality rate; the case-managed patients showed a significantly higher satisfaction level with their care and its continuity. Nurse case management prevents a postdischarge increase in the dependence of multimorbid patients and the burden of their caregivers. Application of nurse case management can reduce the readmission rate and primary care consumption of patients with chronic complex disease after their hospital stay and prevent an exacerbation of caregiver exhaustion.

Parenting Children with Conduct Disorder in Israel: Caregiver Burden and the Sense of Coherence

The study examines the caregiver burden and sense of coherence among parents of 300 children with conduct disorder, as compared to parents of 100 children without the disorder in Israel. Parents completed the Caregiver Burden Index and the Sense of Coherence Scale. The research findings showed significant differences between the two groups, with the parents of children with conduct disorder reporting a higher caregiver burden and lower sense of coherence than the parents of children with no disorder. The study highlights the need to provide professional support for parents of children with conduct disorder and to develop appropriate intervention programs for enhancing the parents' coping abilities.

Burden and Depression in the Caregivers of Blind Patients in India

Several studies have examined the rates of depression in caregivers of patients with debilitating neurologic diseases. This study describes the degree of burden and the prevalence of depression among individuals caring for legally blind patients. To the best of our knowledge, no prior studies in the ophthalmic literature have reported this relationship. Clinic-based, cross-sectional study. We included 522 individuals in Rampur, India, providing care to their close family relatives who were legally blind. Visual acuities varied from 20/200 in the best eye, to no light perception (NLP) in each eye. Several surveys were completed by the caregivers of patients whose sole impairment was visual, allowing us to quantitatively and selectively assess burden and depression among caregivers of blind patients. The Burden Index of Caregivers (BIC) was used to measure care burden and the Center for Epidemiologic Studies Depression scale was applied to determine depression. Caregivers of patients with NLP experience higher burden than caregivers of patients with lesser degrees of blindness. Daily hours spent on close supervision and the intensity of care-giving were the definitive factors linked to high BIC scores (P<0.01). The prevalence of caregiver depression increased with degree of visual impairment from 16% in the 20/200 group to 48% in the NLP cohort (P<0.01). Independently related variables for depression in caregivers were daily hours required for close supervision of the patient, intensity of care-giving, low household income, and the caregiver being the parent of a blind adult child (P<0.01). Severity of blindness in patients directly correlated with burden in caregivers. More severe forms of blindness meant patients require more help with their activities of daily living and additional hours of close supervision per day, both of which increase care burden. The same 2 factors also increase risk of caregiver depression along with low household income and the caregiver being the parent of a blind adult child. Awareness of the extent of burden and depression among caregivers of blind individuals is required by vision health personnel to identify at risk caregivers and implement effective interventions and support strategies.

Mothers of Children with Developmental Disorders in the Bedouin Community in Israel: Family Functioning, Caregiver Burden, and Coping Abilities

This preliminary study compares the family functioning, caregiver burden, and coping abilities between mothers of 300 children with developmental disorders and mothers of 100 children with no such disorders in the Bedouin community in Israel. The mothers completed the McMaster Family Assessment Device Scale, the Caregiver Burden Index, and the Sense of Coherence Scale. Mothers of children with developmental disorders reported lower family functioning, a higher caregiver burden, and a lower sense of coherence and thus lower coping abilities than mothers of children with no disorders. The study highlights the need to provide professional support for mothers of children with developmental disorders and to develop awareness and culturally appropriate intervention programs to enhance these mothers' coping abilities.

Keeping vulnerable elderly patients free from pressure ulcer is associated with high caregiver burden in informal caregivers

The effect of the presence of pressure ulcers on burden of caregivers is unknown. We investigated the relationship between the state of pressure ulcers in vulnerable elderly patients and the burden on their informal caregivers. This cross-sectional study enrolled 137 patients aged > or = 40 years with limited activity and mobility at 10 home care service facilities in Japan. We assessed pressure ulcer status from medical records and caregiver burden using scores from both the Burden Index of Caregivers (BIC) and the Japanese short version of the Zarit Burden Interview (ZBI). Among patients, mean age was 80.9 years, 31.4% were men, and 83.9% were free from pressure ulcers. Multivariable analysis showed that caregivers whose patients were free from pressure ulcers had significantly higher caregiver burden as assessed by both the BIC [beta-coefficient = 3.18, 95% confidence interval (CI): 1.42-4.95, P = 0.003] and ZBI scores (beta-coefficient = 1.94; 95%CI = 0.30-3.58; P = 0.03). Our results suggest that the continuous effort involved in keeping patients free from pressure ulcers may be associated with high caregiver burden in informal caregivers.

Validity and Reliability of the Japanese Version of the Caregiver Reaction Assessment Scale (CRA-J) for Community-Dwelling Cancer Patients

The aim of this study was to validate the Caregiver Reaction Assessment (CRA) among caregivers of community-dwelling advanced cancer patients in Japan. A cross-sectional questionnaire was administered to advanced cancer patients and their caregivers who were cared for at day hospices and home palliative care services. We translated the CRA into Japanese, and then verified factor validity, reliability, construct validity, concurrent validity, and known groups' validity. To address construct and concurrent validity, we calculated Pearson's correlation coefficient between the Japanese version of the CRA and the Burden Index of Caregivers (BIC). To address known groups' validity, we used the t test or analysis of variance (ANOVA). A total of 57 caregivers participated in the study. Five factors were extracted (''impact on schedule,'' ''caregiver's self-esteem,'' ''lack of family support,'' ''impact on health,'' and ''impact on finances'') and reliability was good. Construct and concurrent validity among the subscales of the BIC were good. Regarding known groups validity, the subscale score of ''impact on schedule'' for the groups that cared 6 hours or more per day was higher than the other group (P = .04). The CRA-J is valid and reliable. This scale is useful for caregivers of cancer patients in Japan.

Violent Patient Behavior Is Associated with Bodily Pain and a High Burden on Informal Caregivers

There have been no studies of the relationship between violent behavior by older patients and the physical and mental health of caregivers. To evaluate the influence of violent behavior in vulnerable elderly patients on bodily pain and caregiver burden in their informal caregivers. Cross-sectional study. One hundred thirty-seven patients aged > or =40 years old with limited activity and mobility in ten facilities providing home-care services in Japan. Degree of caregiver-perceived violent patient behavior and caregivers' bodily pain derived from a self-administered questionnaire, and caregiver burden assessed using scores from both the Burden Index of Caregivers and the Zarit Burden Interview. The mean age of the 137 patients enrolled in this study was 80.9 years. Of these patients, 31.4% were men, and 34.3% had violent behavior. The mean caregiver age was 65.0 years, and 29.2% were men. Caregivers who looked after violent patients experienced significantly higher odds of having bodily pain [AOR = 3.51; 95% confidence interval (CI): 1.81 to 6.85]. Caregivers of violent patients also reported significant caregiver burden as assessed by the Burden Index of Caregivers (beta-coefficient = 4.92; 95% CI: 1.95 to 7.88) and the Zarit Burden Interview (beta-coefficient = 5.81; 95% CI: 2.92 to 8.70). Violent behavior among older patients is associated with significant increases in both physical and psychological burden in their informal caregivers.