Patient Caregiver Burden Research Articles

Assessment of burden in caregivers of patients with chronic schizophrenia: Who attend the tertiary care center

Assessment of burden in caregivers of patients with chronic schizophrenia: Who attend the tertiary care center

Physical Frailty Correlates With Behavioral and Psychological Symptoms of Dementia and Caregiver Burden in Alzheimer's Disease.

The aim of this study was to clarify the association of physical frailty with behavioral and psychological symptoms of dementia (BPSD) and caregiver burden in patients with Alzheimer's disease (AD). The subjects were 1,193 AD patients who presented to the Memory Clinic at the National Center for Geriatrics and Gerontology of Japan during the period from October 2010 to February 2015 (mean ± SD age = 78.8 ± 6.3 years; female, 68.6%). AD was diagnosed based on the criteria of the National Institute on Aging and Alzheimer's Association workgroups. The Frailty Index (FI) was calculated as the ratio of actual to 38 potential deficits. BPSD and caregiver burden were assessed by using the Dementia Behavior Disturbance Scale (DBD) and the Japanese version of Zarit Burden Interview (J-ZBI). Multiple linear regression analyses and structural equation modeling (SEM) were performed to examine the relationship between the FI, DBD, and J-ZBI. The subjects' mean FI score was 0.16 ± 0.10, with 663 (55.6%) and 198 (16.6%) subjects shown to be pre-frail (0.08 ≤ FI < 0.25) and frail (FI ≥ 0.25), respectively. Multiple linear regression analyses and SEM showed that the FI was independently associated with both DBD (β = 0.30, P < .001) and J-ZBI (β = 0.13, P < .001). Moreover, when the FI was considered as a categorical variable, even pre-frailty was associated with increased DBD score (β = 0.16, P < .001) and J-ZBI score (β = 0.09, P = .003). The presence of not only physical frailty but also pre-frailty, as determined by the FI, could increase BPSD and caregiver burden in patients with AD.

Burden of caregivers of patients with Alzheimer's disease

Alzheimer's disease is a progressive, degenerative brain disease of unknown aetiology. It is characterised by a gradual deterioration of cognitive processes, especially memory, orientation and thinking. With the deepening of Alzheimer's disease, the independence of patients is increasingly limited, what results in an increased involvement of caregivers in care. Excessive duties contribute to the development of caregiver burnout. The aim of the study was to examine the level of feeling of burden in caregivers of patients with Alzheimer's disease and to determine the relationship between selected parameters and the feeling of burden. The study included 55 people with Alzheimer's disease and their caregivers. In order to test the level of the burden, the Polish version of Caregiver Burden Scale was used. The level of self-esteem was assessed using the Polish version of the Rosenberg Self-Esteem Scale. The total result of the level of burden of caregivers of people with Alzheimer's disease, according to the Caregiver Burden Scale, was 2.6 points. There was a significant relationship between the feeling of burden and the caregiver's gender, the lack of free time, the number of hours devoted to day care, the number of years of patient care, the degree of a caregiver's self-assessment and the progression of the patient's disease. In the examined group of caregivers of people with Alzheimer's disease and according to the Rosenberg Self-Esteem Scale, the medium level of care burden and the average level of self-esteem were prevailing.

A Meta-analytic Study of Predictors for Informal Caregiver Burden in Patients With Stroke

BackgroundSeveral studies have reported on predictors for caregiver burden in patients with stroke, but the magnitude of the impact of these variables remains unclear. The aim of the study was to determine the magnitude of relationship between each predictor and caregiver burden. MethodsArticles related to this filed were search in PUBMED, MEDLINE and Cochrane Library electronic database from the upset to May 2018. Of the 812 articles identified, 22 were included in the final analysis (3025 patients and 2887 caregivers). Weighted correlation coefficient (r-index) was computed as effect size for each predictor. ResultsOf predictor variables of patients, the activity of daily living and anxiety had moderate to large effect sizes; gender, neurological function and depression had the small to moderate effect sizes. Of caregivers’ predictors, depression, anxiety, and sense of coherence had large effect sizes; gender, daughter in law, physical health and employment status had small to moderate effect sizes. ConclusionsThe most powerful predictors of caregiver burden using meta-analysis were identified to direct future research and evidence-based practice.

Caregiver Burden for Patients With Severe Osteoarthritis Significantly Decreases by One Year After Total Knee Arthroplasty

BackgroundThe impact of total knee arthroplasty (TKA) on patients’ informal caregivers (eg, family members, friends) has gone largely ignored. The goals of this study are to measure the impact of TKA on the caregiver and identify factors contributing to higher burden. MethodsOne hundred fifty primary TKA patients and their designated caregivers were prospectively enrolled. The Caregiver Strain Index (CSI) was completed by caregivers preoperatively, at 4 weeks, and at 1 year after surgery. Additional outcomes included the Knee injury and Osteoarthritis Outcome Score for patients only and the Veterans Rand 12 Item Health Survey for both patients and caregivers. Univariate analysis and multivariate regression modeling were performed. ResultsMean CSI scores at 1 year were significantly lower than preoperative values (P < .01), where lower scores indicate better results. Higher mean CSI values for younger caregivers were identified preoperatively (r = −0.21, P < .01) and at 4 weeks (r = −0.26, P < .01). There were higher mean CSI values for employed caregivers preoperatively (P = .01) and at 4 weeks (P < .01). A negative correlation was identified between CSI and the caregiver’s Veterans Rand 12 Item Health Survey Mental Component Score preoperatively (r = −0.15, P = .03) and at 4 weeks (r = −1.5, P = .03). ConclusionCaregiver burden nearly doubled in the early postoperative period, which was related to several caregiver and patient factors. However, the burden was close to zero by 1 year postoperatively. Thus, TKA is a beneficial intervention for both patient and caregiver.

Caregivers' education decreases depression symptoms and burden in caregivers of patients with dementia.

To determine whether providing education to caregivers of patients with dementia decreases their depression symptoms and burden. Eighty-three outpatients with dementia being treated at the Memory Clinic of Tokyo Medical University Hospital and their caregivers were enrolled. Forty-seven caregivers were enrolled in the caregivers' education (EDU) group and 36 were enrolled in the control (CTL) group. Caregivers were assessed for depression, burden, and quality of life (QoL). Patients were assessed for cognition, psychological symptoms, and QoL. Assessments were carried out at baseline and at 3 months (3M). Caregivers in the EDU group received lectures on symptoms and progression of dementia, management of symptoms, use of social resources etc. RESULTS: At 3M, prevalence of depression symptoms in the EDU group significantly decreased from 36% to 17%, whereas it significantly increased from 22% to 50% in the CTL group. Depression and burden were significantly improved at 3M in the EDU group, whereas they significantly worsened in the CTL group. Psychological symptoms showed a lower tendency at 3M for the EDU group. No significant changes in QoL of caregivers and patients were found in either group. Providing education to caregivers of patients with dementia improves their depression symptoms and sense of burden, and tends to improve the behaviour and psychological symptoms of dementia in the patients. Providing education to caregivers of dementia patients may hence result in beneficial effects for both the patients and their caregivers, and should be widely used in dementia care.

The caregiver burden and related factors on quality of life among caregivers for patients with lung cancer

Objective: To explore the influence of caregiver burden on quality of life among caregivers for patients with lung cancer in Beijing. Methods: From August to October in 2017, 336 caregivers for patients with primary lung cancer from a large tertiary hospital were recruited to this survey by convenient sampling method. The Caregiver Reaction Assessment (CRA) and the WHO Quality of Life-BREF (WHOQOL-BREF) Instruments were used to evaluate the caregiver burden and quality of life. The demographic characteristics were evaluated using Pearson chi-square or Fisher's exact tests. In addition, using the 4 dimensions of quality of life scale as the dependent variables while the 5 dimensions of caregiver burden and demographic variables as the explanatory variables, we conducted the multiple linear stepwise regression analysis (the defaults were 0.15 for FORWARD and BACKWARD). Results: The scores of family caregivers' esteem, impact on schedule, impact on finances, impact on health and lack of family support were 4.30±0.47、3.55±0.74、3.10±0.91、2.60±0.78、2.32±0.73, respectively. Regression results showed that demographic factors, including marriage, occupation and relationship with patients and impact on health, caregivers' esteem and impact on finances dimensions of caregiver burden were the factors which influenced the quality of life of caregivers. Conclusions: The caregiver burden in patients with lung cancer is mainly focused on impact on schedule and finances. Impact on health, finances and caregivers' esteem (seven items were reverse-scored) are significantly negatively correlated with quality of life of caregivers.

Assessing Caregiver Burden in Caregivers of Patients with Schizophrenia and Bipolar Affective Disorder in Kathmandu Medical College.

Schizophrenia and bipolar affective disorder are chronic psychiatric illness that requires long term care. This study tends to measure psychological burden and factors associated with it among caregivers of these two illnesses. This is a cross- sectional study that included participants by purposive sampling method. Self designed performa was used to collect the socio-demographic details of the caregivers. Modified caregiver strain index was used to assess the overall stress. Beck`s depression inventory and Beck`s anxiety inventory was used to assess depression and anxiety respectively. Hundred caregivers, 50 each of schizophrenia and bipolar affective disorder were enrolled. Seventy-two percent of caregivers were found to have higher level of stress. Twenty-five percent had depression and 29% anxiety related problems. Stress was found to be significantly associated with being in debt, longer duration of illness, education level, marital status, subjective feeling of psychological stress and self- acknowledgement of need of professional help. Caregivers of both group experienced similar level of stress. Psychological burden is seen to be high in caregivers of patients of Schizophrenia and Bipolar Affective Disorder.

Assessing Caregiver Burden in Caregivers of Patients with Schizophrenia and Bipolar Affective Disorder in Kathmandu Medical College

Assessing Caregiver Burden in Caregivers of Patients with Schizophrenia and Bipolar Affective Disorder in Kathmandu Medical College

Role of 3-monthly long-acting injectable paliperidone in the maintenance of schizophrenia.

AimsPaliperidone palmitate 3-month (PP3M) represents a new long-acting injectable antipsychotic therapeutic option. This review aims: 1) to summarize available data relating to efficacy, safety, tolerability and costs of PP3M; 2) to describe hospitalization rate, occupational status, treatment preference, satisfaction, adherence and caregiver burden of patients with schizophrenia who participate in PP3M clinical trials; 3) to examine ethical implications, pros and cons of PP3M use and 4) to propose study designs to further assess PP3M.MethodsOn August 21, 2017, a search on PubMed about PPM3, without any filter restriction, was conducted and all available records were analyzed. Records written in a language other than English were excluded.ResultsTwenty-two records were included in this review: 6 reviews, 1 report, 4 pharmacokinetic studies, 2 cost-effectiveness analyses, 1 open-label clinical trial, 2 randomized controlled trials (RCTs), 5 studies based on these 2 RCTs and 1 observational study.DiscussionAccording to these last 9 studies, when compared with placebo, PP3M showed a longer time to relapse and good safety and tolerability profiles. Furthermore, when compared with paliperidone palmitate 1 month (PP1M), PP3M treatment showed: 1) non-inferiority in terms of efficacy, safety, tolerability, rate of hospitalization, symptomatic and functional remission, treatment preference and variations of the occupational status; 2) a longer time to relapse after treatment discontinuation and 3) a similar reduction of the caregiver burden.ConclusionPP3M is the only 3-monthly long-acting injectable antipsychotic available on the market. This makes it a unique option of treatment, which could be chosen both in early and advanced phases of illness. Nonetheless, longer naturalistic follow-up studies, two-arm head-to-head superiority trials and mirror studies, based on real-world samples of patients, are needed to further assess long-term safety and advantages of this new option of treatment and to define patients’ sub-populations that would most beneficiate from it.

Factor analysis of the Zarit Burden Interview in family caregivers of patients with amyotrophic lateral sclerosis

Objective: The Zarit Burden Interview has been used in many studies to assess caregiver burden in family caregivers of patients with amyotrophic lateral sclerosis, but the factor structure of the Zarit Burden Interview in the caregivers of amyotrophic lateral sclerosis patients is unknown. The aim of this study was to explore the factor structure of the Zarit Burden Interview in family caregivers of amyotrophic lateral sclerosis patients using exploratory factor analysis.Methods: The exploratory factor analysis was performed using generalized least squares with oblique rotation in a sample of 202 family caregivers.Results: Three factors had an eigenvalue greater than 1 and accounted for 60.33% of the total variance. The three factors were named as follows: (factor 1) “Social restrictions” (items 2, 3, and 10–15); (factor 2) “Self-criticism” (items 20–21); and (factor 3) “Anger and frustration” (items 1, 4–6, 9, and 16–19). The correlation between factors 1 and 3 was much higher (r = 0.79) than that between factors 1 and 2 (r = 0.14) or factors 2 and 3 (r = 0.15).Conclusion: The findings of this study enriched our understanding of several meaningful dimensions of the caregiving burden in caregivers of an amyotrophic lateral sclerosis population and provided opportunities for future intervention.

Caregivers’ education decreases depressive symptoms and burden in caregivers of patients with dementia

We have been holding the caregiver classes performing “Caregivers’Education”. Doctors, nurses and social workers are managing caregivers’ education.

Prevalence of mild behavioral impairment in mild cognitive impairment and subjective cognitive decline, and its association with caregiver burden.

Mild behavioral impairment (MBI) describes later life acquired, sustained neuropsychiatric symptoms (NPS) in cognitively normal individuals or those with mild cognitive impairment (MCI), as an at-risk state for incident cognitive decline and dementia. We developed an operational definition of MBI and tested whether the presence of MBI was related to caregiver burden in patients with subjective cognitive decline (SCD) or MCI assessed at a memory clinic. MBI was assessed in 282 consecutive memory clinic patients with SCD (n = 119) or MCI (n = 163) in accordance with the International Society to Advance Alzheimer's Research and Treatment - Alzheimer's Association (ISTAART-AA) research diagnostic criteria. We operationalized a definition of MBI using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Caregiver burden was assessed using the Zarit caregiver burden scale. Generalized linear regression was used to model the effect of MBI domains on caregiver burden. While MBI was more prevalent in MCI (85.3%) than in SCD (76.5%), this difference was not statistically significant (p = 0.06). Prevalence estimates across MBI domains were affective dysregulation (77.8%); impulse control (64.4%); decreased motivation (51.7%); social inappropriateness (27.8%); and abnormal perception or thought content (8.7%). Affective dysregulation (p = 0.03) and decreased motivation (p=0.01) were more prevalent in MCI than SCD patients. Caregiver burden was 3.35 times higher when MBI was present after controlling for age, education, sex, and MCI (p < 0.0001). MBI was common in memory clinic patients without dementia and was associated with greater caregiver burden. These data show that MBI is a common and clinically relevant syndrome.

Anxiety and Depression Associated With Burden in Caregivers of Patients With Brain Metastases.

To describe and examine the relationship between caregiver burden and the affective disorders anxiety and depression in caregivers of patients with brain metastases. . Cross-sectional, descriptive, correlational. . Moores Cancer Center at the University of California, San Diego. . 56 family caregivers of patients with brain metastases from solid tumors at other primary sites. . Self-administered survey. . Caregiver burden, anxiety, and depression. . With the exception of caregiver esteem, no statistically significant relationships were noted between impact on schedule, a dimension of caregiver burden, and screening positive for affective disorders. . Findings from this study support previous reports indicating that the odds of having anxiety and depressive symptoms are greater in family caregivers who report higher levels of caregiver burden. . The identification and management of caregiver burden are important considerations for a comprehensive cancer care program. Addressing the needs of the cancer caregiver, who is at heightened risk for various psychological, physical, financial, and social problems, is increasingly vital.

Development of interventional protocol for reducing perception of burden of caregivers of depressed patients having risk for suicide

This experimental study attempted to develop an Interventional Protocol for Managing Suicidality to reduce the perception of burden in the caregivers of patients with depression.An Interventional Protocol for Reducing Perception of Burden of Caregivers (IPMS) was developed and the programme was conducted for 30 family caregivers of depressed patients having risk for suicide. Results: half of the caregivers reported ‘Very Severe Burden’ before exposure to IPMS whereas there were no caregivers in this category after exposure to IPMS, meaning thereby that IPMS was definitely effective in bringing down the perception of burden among caregivers. There was significant difference in pre and post intervention perception of burden in caregivers of depressed patients having risk for suicide (p = 0.001). Conclusion: There will be decrease in number of admissions as the caregivers would be able to manage the patients having suicidal tendencies at home after undergoing training such as IPMS.

Effects of aromatherapy on agitation and related caregiver burden in patients with moderate to severe dementia: A pilot study

We examined the effects of aromatherapy on agitation in patients with dementia and evaluated related caregiver burden. Patients and their caregivers from two hospitals in Turkey were selected and divided into an intervention group (n = 14) and a control group (n = 14). Patients were stratified according to their dementia phase and intake of antipsychotic medication. The intervention group received aromatherapy via massage and inhalation at home for 4 weeks. The control group received no intervention. Data were collected using the Neuropsychiatric Inventory (NPI), the Cohen-Mansfield Agitation Inventory (CMAI) and the Zarit Burden Interview (ZBI). At 2 and 4 weeks, the NPI scores were significantly lower in the intervention group (p < 0.05). At 4 weeks, the CMAI and ZBI scores were significantly lower in the intervention group (p < 0.05). In conclusion, after aromatherapy, agitation, neuropsychiatric symptoms, and caregiver distress significantly reduced, and aromatherapy prevented caregiver burden increase.

Psychometrics of the Zarit Burden Interview in Caregivers of Patients With Heart Failure.

Identification of family caregivers who are burdened by the caregiving experience is vital to prevention of poor outcomes associated with caregiving. The Zarit Burden Interview (ZBI), a well-known measure of caregiving burden in caregivers of patients with dementia, has been used without being validated in caregivers of patients with heart failure (HF). The purpose of this study is to examine the reliability and validity of the ZBI in caregivers of patients with HF. A total of 124 primary caregivers of patients with HF completed survey questionnaires. Caregiving burden was measured by the ZBI. Reliability was examined using Cronbach's α and item-total/item-item correlations. Convergent validity was examined using correlations with the Oberst Caregiving Burden Scale. Construct validity was demonstrated by exploratory factor analysis and known hypothesis testing (ie, the hypothesis of the association between caregiving burden and depressive symptoms). Cronbach's α for the ZBI was .921. The ZBI had good item-total (r = 0.395-0.764) and item-item (mean r = 0.365) correlations. Significant correlations between the ZBI and the Oberst Caregiving Burden Scale (r = 0.466 for the caregiving time subscale and 0.583 for the caregiving task difficulty subscale; P < .001 for both) supported convergent validity. Four factors were identified (ie, consequences of caregiving, patient's dependence, exhaustion with caregiving and uncertainty, and guilt and fear for the patient's future) using factor analysis, which are consistent with previous studies. Caregivers with high burden scores had significantly higher depressive symptoms than did caregivers with lower burden scores (7.0 ± 6.8 vs 3.1 ± 4.3; P < .01). The findings provide evidence that the ZBI is a reliable and valid measure for assessing burden in caregivers of patients with HF.

Severe Caregiver Distress Precipitating Dissociative Seizures in a Patient with Intellectual Disability and Epilepsy: Diagnostic and Therapeutic Hardships

Comorbid psychiatric diagnoses increase the caregiver burden in patients with intellectual disability (ID). There is scarce literature on the dynamics between caregiver distress and psychopathology in persons with ID, especially regarding the dissociative disorders. We present the case of a young female with cerebral palsy, ID, epilepsy and psychosis where conflict with caregivers due to their emotional over-involvement precipitated dissociative seizures. We performed Antecedent-Behavior-Consequence (ABC) analysis which helped in identifying negative expressed emotions in the caregivers. An integrated psychosocial intervention brought significant reduction in the dissociation which facilitated the overall therapeutic process. Adverse emotional turmoil due to expressed emotions from caregivers can precipitate dissociative events in patients with ID. Dissociative seizures in a patient with ID and epilepsy may pose diagnostic challenges and can hamper therapeutic response which can be overcome by behavior analyses and integrated psychosocial interventions.

Comparison of Caregiver Burden in First Episode Versus Chronic Psychosis

The aim of this study was to compare burden on caregivers of patients with first episode psychosis and caregivers of those with chronic psychosis. The study sample consisted of 39 caregivers of patients with first episode psychosis and 40 caregivers of patients with chronic psychosis. The Caregiver Burden Inventory (CBI) was used for data collection. The average caregiver burden in caregivers of patients with chronic psychosis was significantly higher than that in caregivers of patients with first episode psychosis. With regard to the subscales of CBI, there was a significantly higher level of burden in terms of time dependence, development, physical burden, and social burden in caregivers of patients with chronic psychosis than in caregivers of patients with first episode psychosis, while no such difference could be detected for the emotional burden. The absence of a difference in emotional burden suggests that caregivers of first episode psychosis may be going through an intense emotional experience, placing them in a high-risk status, despite an average caregiving experience duration of 11 months. Family interventions targeting the caregivers of patients with chronic psychosis or patients with first episode psychosis should be planned in accordance with the specific needs of these caregiver groups. It is also recommended to conduct programs involving the concurrent participation of the caregivers of patients with first episode psychosis and caregivers of patients with chronic psychosis and interventional programs such as “early psychosis support” for the caregivers of patients with first episode psychosis.

Factors associated with caregiver burden: comparative study between Brazilian and Spanish caregivers of patients with Alzheimer's disease (AD).

Transcultural studies regarding the comparison of levels of burden in caregivers of patients with Alzheimer's disease (AD) from Europe and Latin America are rare. We designed this study to investigate the differentiating factors associated with burden in Brazilian and Spanish caregivers of patients with AD. This is a cross-sectional study composed by samples of outpatients with AD and their caregivers from Brazil (n = 128) and Spain (n = 146). Caregivers answered the Zarit Burden Interview (ZBI) and a Sociodemographic Questionnaire. Patients were assessed with the Mini-Mental State Examination (MMSE), Functional Activities Questionnaire (FAQ), Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI), and Clinical Dementia Rating (CDR) Scale. In the multivariate regression analysis, high burden levels were reported in Brazil, when caregivers were female (p = 0.025) and when patients did not attend Day Care Center (p = 0.025). In Spain, high burden levels were associated with living with the patient (p = 0.014), younger caregivers (p = 0.003), and participation of patients at Day Care Center (p = 0.046). Also, different neuropsychiatric symptoms explained high burden levels: in Brazil, depression (p < 0.001) and anxiety (p = 0.024) and, in Spain, apathy/indifference (p < 0.001), agitation/aggression (p = 0.019) and irritability/lability (p = 0.027). Caregivers' gender, patients who attended Day Care Center and neuropsychiatric symptoms were differentiating factors in the burden of Brazilian and Spanish caregivers.