Caregiving Load Research Articles

Effects of home disease management strategies based on the dyadic illness management theory on elderly patients with chronic heart failure and informal caregivers’ physical and psychological outcomes: protocol of a randomized controlled trial

BackgroundCurrently, most elderly chronic heart failure (CHF) patients go home for rehabilitation after certain treatment in hospitals. However, the results of their rehabilitation at home are not satisfactory. According to studies, dyadic treatments can increase the efficiency of home rehabilitation, enhance both partners' quality of life, lessen the caregiver's load of care, and alleviate the strain of medical resources. Thus, the aim of our research is to design a study protocol that included elderly CHF patients and their informal caregivers as an intervention unit and to explore the impact of the protocol on their health and physical outcomes.MethodsThis is a prospective randomized controlled trial conducted in a triple-A hospital. In total, 80 elderly CHF patients and informal caregivers (80 dyads) will be recruited with informed consent. Based on the randomized numbers, they are divided into a control group (40 dyads) and an intervention group (40 dyads), subjects in the control group will receive usual care, and subjects in the intervention group will receive a home-based disease management program based on the Theory of Dyadic Illness Management on the basis of the control group. The duration of the intervention is 3 months, and the follow-up is 6 months. Data is collected at enrolment, 3 months after the intervention, and 3 months after the end of the intervention. The primary outcome is patients’ quality of life and readmission. Secondary outcomes include patients’ self-management behaviors, anxiety, and depression and caregivers’ quality of life and care burden.DiscussionThis study focuses on whether this home-based disease management program can improve the quality of life of elderly patients with CHF, reduce the readmission rate, enhance their self-management capacity, reduce negative emotions, and reduce the burden of informal caregivers. It can provide a new perspective on home management and cardiac rehabilitation of heart failure disease in the elderly, as well as alleviate problems such as the burden of healthcare resources.Trial registrationChinese Clinical Trials Registry ChiCRT2300068026. Registered on 3 February 2023, manuscript Version: 1.0, https://www.chictr.org.cn/.

Predictive value of somatic and functional variables for cognitive deterioration for early-stage patients with Alzheimer's Disease: Evidence from a prospective registry on dementia.

Alzheimer's disease (AD) imposes a major burden on affected individuals, their caregivers and health-care systems alike. Though quite many risk factors for disease progression have been identified, there is a lack of prospective studies investigating the interplay and predictive value of a wide variety of patient variables associated with cognitive deterioration (defined as key feature of AD progression). Study participants were patients with probable and possible AD, that were assessed at four time points over a period of two years (T1-T4). The main results were threefold: (i) over time, significant changes were observed regarding patients' cognitive functioning, activities of daily living and caregiver load (but not depression, pain, neuropsychiatric symptoms); (ii) intercorrelations between caregiver load and patients' cognitive and functional variables were high, correlation patterns remaining rather stable across time; (iii) cognitive functioning at T4 was best predicted by patients' age, sex, atrial fibrillation and activities of daily living at T1; and (iv) across all four assessment points, cognitive functioning was best predicted by time (i.e., disease duration), age, sex, activities of daily living and depression. Overall, even in early stages of AD and during a short two-year period, functional changes were significant and tightly intertwined with caregiver load, thus stressing the need to consider caregiver load when diagnosing and treating patients with AD. A novel and clinically relevant finding is that even in early stages of AD, cognitive deterioration was best predicted by a combination of patients' demographic, somatic and functional variables.

Mental health outcomes of family carers after admission to aged care: A cross-sectional survey study.

This study investigated the predictors of poor mental health outcomes among family carers of residents after transitioning into residential aged care. Using a cross-sectional design, five groups of variables were evaluated as predictors: caregiver demographics; caregiving load; resident-related variables; loneliness and visiting frequency; and the impact of the COVID-19 context. A total of 309 primary family contacts of all residents of two residential aged care organisations in the state of Victoria (Australia) participated in the study (response rate 19%). The K-10 and the Burden Scale for Family Caregivers were used to measure the primary outcomes. We compared psychological distress and burden outcomes between carers whose relative was admitted within the last 12 months, or longer than 12 months ago. Time since admission (<12 months or >12 months) did not affect the level of psychological distress (t (238) = -.08, p = .94) or subjective burden (t (245) = -.89, p = .38). Being a woman, a spouse, speaking a language other than English at home, being less satisfied with the support offered by the facility, not feeling supported in the decision to admit their relative, being lonely and providing higher levels of care preadmission were predictors of poor mental health outcomes. Older women with low-English proficiency who were primary carers and are socially isolated, are more likely to experience poor mental health outcomes and need additional support. These findings may inform the development of screening tools and tailored interventions to support this population during and after the transition process.

Coping strategies and burden stress in caregivers of patients with schizophrenia and patients with bipolar disorder

BackgroundMental illness has a great impact not only on patients but also on their carers as it makes them more prone to stress, interferes with their daily life activities, and can negatively affect their social, psychological, and physical health quality of life. They neglect seeking medical help that may negatively affect clinical outcome of patients and quality of their life. Therefore, it is important to evaluate the magnitude of burden on such caregivers and to investigate the coping strategies used by them in order to develop tailored biopsychosocial interventions to reduce their stress.ObjectiveTo assess the magnitude of burden and patterns of coping with stress in caregivers of patients with schizophrenia. To assess the magnitude of burden and patterns of coping with stress in caregivers of patients with bipolar affective disorder. To compare both the coping strategies and burden stress scores among carers of patients diagnosed with schizophrenia and bipolar patients.Patients and methodsThis cross-sectional study was done on 100 caregivers to assess burden in caregivers of schizophrenia patients and caregivers of bipolar patients, the coping style used by the caregivers of both groups and comparing between two groups.ResultsThere was statistically significant difference found between bipolar group and schizophrenia group regarding coping inventory scores make fun and behavioral withdrawal, which showed higher median score in schizophrenia group than bipolar group. Burden of caring and coping with this burden, affect each other mutually. As, according to the results of our study, rural residence of caregiver, positive reassessment ≤ 12 and denial > 8 were found significantly associated with high burden in bipolar group. While employed caregivers were associated with high burden among schizophrenia group. Burden is higher in bipolar group than schizophrenia group.ConclusionThe burden placed on caregivers has a significant impact on their capacity to offer service and care to patients. It also has an impact on how service providers adjust to and deal with their families' illnesses. Reduced caregiver load and increased awareness of the condition may help caregivers to use more flexible coping techniques.

Emerging costs in a "hidden" workforce: The longitudinal psychosocial effects of caregiving during the COVID-19 pandemic among Norwegian adults.

During COVID-19 many informal caregivers experienced increased caregiving load while access to formal and informal support systems and coping resources decreased. Little is known about the psychosocial costs of these challenges for an essential yet vulnerable and "hidden" frontline workforce. This study explores and compares changes in psychosocial well-being (psychological well-being, psychological ill-being, and loneliness) before and across up to three stages of the COVID-19 pandemic among caregivers and non-caregivers. We also examine predictors of psychosocial well-being among caregivers during the peak of the pandemic. We use longitudinal data collected online in the Norwegian Counties Public Health Survey (age: 18-92) in four counties and up to four data points (n = 14,881). Caregivers are those who provide care unpaid, continuous (≥ monthly across all time points) help to someone with health problems. Findings show that levels of psychosocial well-being first remained stable but later, during the peak stages of the pandemic, dropped markedly. Caregivers (13-15% of the samples) report lower psychosocial well-being than non-caregivers both before and during the pandemic. Caregivers seem especially vulnerable in terms of ill-being, and during the peak of the pandemic caregivers report higher net levels of worry (OR = 1.22, p < 0.01) and anxiety (OR = 1.23, p < 0.01) than non-caregivers. As expected, impacts are graver for caregivers who provide more intensive care and those reporting health problems or poor access to social support. Our study findings are valuable information for interventions to support caregivers during this and future pandemics.

Effects of the discharge plan on the caregiving load of people with chronic disease: Quasi-experimental study.

To determine the effect of an anticipated care plan, structured around hospital discharge (PC-AH-US), regarding the caregiving load of people with NTCD residing in Colombia, 2019-2021. This is a quasi-experimental study with pre- and post-intervention measurements. It includes 1170 participants who represented 585 chronic disease patient-caregiver pairs. We compared the PC-AH-US intervention, to the regular intervention. The PC-AH-US intervention group showed better results in all dimensions when compared to the regular intervention group: Awareness 8.7 (SD: 0.7) and 6.8 (SD: 1.7); Acknowledgement of their unique conditions 11.3 (SD: 1.0) and 9.4 (SD: 1.8); Capacity to fulfill care tasks 8.8 (SD: 0.7) and 7.5 (SD: 1.5); Wellbeing 11.4 (SD: 0.90) and 8.87 (SD: 2.3); Anticipation 5.88 (SD: 0.4) and 4.7 (SD: 1.1) and Support Network 11.4 (SD: 0.8) and 9.9 (SD: 2.5). The PC-AH-US intervention group showed a statistically significant decrease in the caregiving load for people with NTCD (p < 00). There were no significant institutional differences in readmissions or deaths. The PC-AH-US intervention backs institutional policies meant to care for people with NTCD.

Difference Between Social Capital Caregivers of Schizophrenic Patients Who Have the Highest and Lowest Burden

Mental disorders cause economic, social, physical, and even psychological burdens on the sufferer and the family. The role of the family as an informal nurse (caregiver) greatly influences the patient’s healing. Long treatment and inhumanity of schizophrenic patients is a heavy burden and cause stress on the caregiver, so proper social capital is needed. This study aims to determine the difference between social capital in caregivers of schizophrenic patients with the highest load and caregivers of schizophrenic patients with the lowest gear at RSJD Surakarta. This study is a retrospective study with a case-control approach, conducted on 100 caregivers of schizophrenic patients where 25 caregivers with the highest caregiver load as cases and 25 caregivers with the lowest social load as a control, using social capital questionnaire instruments and validated caregiver load questionnaires. Based on the study's data, normal and homogeneous social capital data distribution was obtained in cases and controls. For the normality test results, the sig level value was obtained &gt; 0.05, namely 0.084 and 0.200, and the homogeneity test obtained a sig level value of &gt; 0.05, namely 0.066. From the results of the T-test, a Sig (2-tailed) value of &lt; 0.005 was obtained, which is 0.000. There is a significant difference between social capital in caregivers of schizophrenic patients with the highest burden (cases) and in caregivers of schizophrenic patients with the lowest load (control).

Longitudinal association between informal unpaid caregiving and mental health amongst working age adults in high-income OECD countries: A systematic review.

Informal unpaid caregivers provide most of the world's care needs, experiencing numerous health and wealth penalties as a result. As the COVID-19 pandemic has highlighted, informal care is highly gendered. Longitudinal evidence is needed to assess the causal effect of caregiving on mental health. This review addresses a gap by summarising and appraising the longitudinal evidence examining the association between unpaid caregiving and mental health among working age adults in high-income Organisation for Economic Co-operation and Development (OECD) countries and examining gender differences. Six databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science, Econlit) from Jan 1, 2000 to April 1, 2022. Population-based, peer-reviewed quantitative studies using any observational design were included. Population of interest was working age adults. Exposure was any unpaid caregiving, and studies must have had a non-caregiving comparator for inclusion. Mental health outcomes (depression, anxiety, psychological distress/wellbeing) were measurable by validated self-report tools or professional diagnosis. Screening, data extraction and quality assessment (ROBINS-E) were conducted by two reviewers. The study was prospectively registered with PROSPERO (CRD42022312401). Of the 4536 records screened; 13 eligible studies (133,426 participants) were included. Overall quality of evidence was moderate. Significant between-study heterogeneity precluded meta-analysis, so albatross and effect-direction plots complement the narrative synthesis. Results indicate a negative association between informal unpaid care and mental health in adults of working age. Importantly, all included studies were longitudinal in design. Where studies were stratified by gender, caregiving had a consistently negative impact on the mental health of women. Few studies examined men but revealed a negative effect where an association was found. Our review highlights the need to mitigate the mental health risks of caregiving in working age adults. Whilst men need to be included in further scholarship, reducing the disproportionate caregiving load on women is a crucial requirement for policy development. Melbourne School of Population and Global Health, Targeted Research Support Grant.

Transcultural adaptation of the revised caregiving appraisal scale (RCAS) in the Spanish population.

To develop a transcultural adaptation of the Revised Caregiving Appraisal Scale among Spanish caregivers of dependent older people and to test the psychometric properties of the scale. Cross-sectional study. The Revised Caregiving Appraisal Scale was transculturally adapted to the Spanish population following the methodology of direct and back translation. The Spanish version of the Revised Caregiving Appraisal Scale was administered to a total of 182 family caregivers of older dependent people. The study began in January 2016 and ended in December of the same year. The construct validity was studied by means of the scree plot and parallel analysis. The exploratory factorial analysis was carried out, and the correlation between factors was studied. To verify the reliability of the process, Cronbach's alpha and homogeneity were calculated by the corrected total item correlation. The validity of the convergent criterion was studied by means of the Pearson correlation coefficient, using the Zarit Caregiver Load Interview and the Family Satisfaction Scale as the gold standard. The construct validity revealed three factors: 'Subjective Burden' (15 items), 'Satisfaction' (7 items) and 'Competence' (3 items). The Cronbach alpha was .86 for 'Subjective Burden', .74 for 'Satisfaction' and .74 for 'Competence'. The corrected total item correlation was greater than .25. The validity of the convergent criterion of the 'Subjective Burden' and 'Competence' factors with the 'Zarit Caregiver's Load Interview' presented a very high statistically significant correlation, unlike 'Satisfaction' which presented a low positive correlation with the 'Family Satisfaction Scale'. The Spanish version of the Revised Caregiving Appraisal Scale is a valid and reliable scale according to the tests performed on a random sample of family caregivers of older dependent people in Spain. This scale will enable the simultaneous assessment of negative ('Subjective Burden' and 'Competence') and positive ('Satisfaction') perceptions among family caregivers of older dependent people.

The Economic Burden of Localized Prostate Cancer and Insights Derived from Cost-Effectiveness Studies of the Different Treatments.

Simple SummaryProstate cancer is one of the most frequent and impacting malignant neoplasms for men. In particular, localized prostate cancer has a notably high incidence and prevalence, despite which a solid consensus on treatment and procedure of care has not yet been reached. This article aims to shed light on this challenge by characterizing the economic burden and cost-effectiveness of different treatment strategies for localized prostate cancer after analyzing published comparable data from studies conducted in OECD countries.Prostate cancer has huge health and societal impacts, and there is no clear consensus on the most effective and efficient treatment strategy for this disease, particularly for localized prostate cancer. We have reviewed the scientific literature describing the economic burden and cost-effectiveness of different treatment strategies for localized prostate cancer in OECD countries. We initially identified 315 articles, studying 13 of them in depth (those that met the inclusion criteria), comparing the social perspectives of cost, time period, geographical area, and severity. The economic burden arising from prostate cancer due to losses in productivity and increased caregiver load is noticeable, but clinical decision-making is carried out with more subjective variability than would be advisable. The direct cost of the intervention was the main driver for the treatment of less severe cases of prostate cancer, whereas for more severe cases, the most important determinant was the loss in productivity. Newer, more affordable radiotherapy strategies may play a crucial role in the future treatment of early prostate cancer. The interpretation of our results depends on conducting thorough sensitivity analyses. This approach may help better understand parameter uncertainty and the methodological choices discussed in health economics studies. Future results of ongoing clinical trials that are considering genetic characteristics in assessing treatment response of patients with localized prostate cancer may shed new light on important clinical and pharmacoeconomic decisions.

Does the inclusion of societal costs change the economic evaluations recommendations? A systematic review for multiple sclerosis disease

BackgroundMultiple sclerosis imposes a heavy burden on the person who suffers from it and on the relatives, due to the caregiving load involved. The objective was to analyse whether the inclusion of social costs in economic evaluations of multiple sclerosis-related interventions changed results and/or conclusions.MethodsA systematic review was launched using Medline and the Cost-Effectiveness Analysis Registry of Tufts University (2000–2019). Included studies should: (1) be an original study published in a scientific journal, (2) be an economic evaluation of any multiple sclerosis-related intervention, (3) include productivity losses and/or informal care costs (social costs), (4) be written in English, (5) use quality-adjusted life years as outcome, and (6) separate the results according to the perspective applied.ResultsTwenty-nine articles were selected, resulting in 67 economic evaluation estimations. Social costs were included in 47% of the studies. Productivity losses were assessed in 90% of the estimations (the human capital approach was the most frequently used method), whereas informal care costs were included in nearly two-thirds of the estimations (applying the opportunity and the replacement-cost methods equally). The inclusion of social costs modified the figures for incremental costs in 15 estimations, leading to a change in the conclusions in 10 estimations, 6 of them changing from not recommended from the healthcare perspective to implemented from the societal perspective. The inclusion of social costs also altered the results from cost-effective to dominant in five additional estimations.ConclusionsThe inclusion of social costs affected the results/conclusions in multiple sclerosis-related interventions, helping to identify the most appropriate interventions for reducing its economic burden from a broader perspective.

Family caregiving during the COVID-19 pandemic: factors associated with anxiety and depression of carers for community-dwelling older adults in Hong Kong

BackgroundThe COVID-19 pandemic disrupts the daily routine and increases the caregiving load of the family carers of older adults. This study examined how the pandemic may impact mental health and investigated the prevalence of anxiety and depressive symptoms in family carers of older people.MethodsTwo hundred and thirty-six family carers of older adults participated in this cross-sectional survey study. Outcome measures included their symptoms of anxiety and depression, pandemic-related psychosocial factors, external factors, and the practice of preventive behaviours.ResultsCaseness prevalence of anxiety and depression among family carers was 25 and 56% respectively. Working carers were more depressed than non-working, while younger carers reported more anxiety and depression symptoms than older. Hand hygiene and getting drugs from the hospital positively predicted depression while healthy lifestyle negatively predicted depression. These variables, together with perceived risk and severity and the worry of getting infected, predicted anxiety.ConclusionsThe prevalence of mental health symptoms was alarming. Telemedicine practice, including online pharmaceutical services and the Internet Hospital plus Drug Delivery platform, could be a solution in alleviating the burden and worry of infection of family carers. Tailored-made interventions by age and working status of the family carers are recommended.

Family dynamics in dementia care: A phenomenological exploration of the experiences of family caregivers of relatives with dementia.

WHAT IS KNOWN ON THE SUBJECT?: Several studies explore and describe the role of family dynamics in dementia care. However, few focus specifically on the diversity of family relationships that influence family caregivers' experiences of providing care to a relative with dementia. The role of family caregivers engaging in unpaid care of relatives with dementia is becoming more and more critical as the numbers of people living with dementia increase across the globe. Family caregivers are a diverse group of people as there are different categories of kinship relations and thus cannot be viewed as a single collective. They are linked intricately to their family and social support systems, however, they often experience limited family support, and tensions between family members can be a major source of stress. Hence, health professionals need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is unique in that it focuses on a range of family relationships in which a person with dementia finds themselves. It highlights that this network of complex connections influences the caregiving process. The study demonstrates the important role that siblings can play in sharing the caregiving load. However, this sharing is rarely balanced or fair and there is always someone in the family who carries the heaviest load. Communication between family members is frequently a challenge, with family members experiencing denial or an inability to understand the challenges encountered by the family caregiver. Most studies focus on the relationship between the family caregiver and the relative with dementia alone, rather than the family network of the family caregiver and how it influences the caregiving process. This study is unique as it focuses on family dynamics and the family network, particularly the range of family relationships in which family caregivers and their relative with dementia find themselves. Other studies tend to focus on a specific kinship category and the family network, such as an adult child, caring for their parent, but this study presents a wide variety of kinship categories to demonstrate the diversity of family caregiving contexts. The family caregivers in this study all highlighted the need or desire for effective support from the family network. Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: The findings suggest the need for communication (training and therapeutic) interventions between family caregivers and other family members (secondary caregivers). Mental health nurses are often well positioned to offer the family caregiver the option to undertake such an intervention. The findings emphasize the diversity of family caregiving situations and argue that mental health nurses can assess the nature of the care situations and work with families on how best to address the needs of the relative with dementia and the main caregiver. However, tensions frequently exist between family members, some of which existed prior to the relative acquiring dementia and other tensions as a consequence of the relative acquiring dementia. Mental health nurses could assist as a mediator between family members in order to assist families to become more cohesive. ABSTRACT: Introduction This article explores the diverse nature of family caregivers, focusing on the different categories of kinship relations. Family caregivers are linked intricately to their families, but often experience limited family support, causing stress and tension between family members. Aim The article aims to explore the family relationships of family members caring for relatives with dementia in order to provide an insight into the role of such relationships on the caregiver relative with dementia dyad. Method A phenomenological, exploratory-descriptive design was used. Eight participants took part and data were obtained using collages and semi-structured interviews. Results A range of family relationship patterns was highlighted including sibling involvement in the caregiving process; spousal involvement in supporting a caregiver of a parent; and spousal involvement in caring for their spouse. Discussion The family caregivers highlighted the need or desire for effective support from the family network. Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. Implications for Practice Mental health nurses need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers and assist families to become more cohesive.

Usability and functional validation of artificial intelligence‐enabled technology services in dementia care using a controlled trial in clinical practice

AbstractBackgroundMany community settings lack emotional, social, and educational resources to support persons living with dementia (PLWD) and their families, which contribute to the stressors associated with caregiving, termed "caregiver load." This paper describes the impact of artificial intelligence (AI)‐enabled personalized assistive and decision support services on improving dementia care management and reducing caregiver load. We present a study that assesses AI’s usability and functionality in the outpatient setting and is built off of two prior pilots, with each pilot expanding in its scope of technology provided, target population, and caregiving needs.Objectives: The study’s primary outcome is the functionality and usability of AI services, collectively called NeuViCare, as measured by the System Usability Scale (SUS) from caregivers. Secondary outcomes include: 1) reduction in caregiver load as measured by Oberst Caregiving Burden Scale (OCBS); and 2) increase of caregivers’ knowledge as measured by Dementia knowledge assessment scale (DKAS).MethodsThis one‐arm, open‐labeled trial is recruiting ten patients with MOCA scores of less than 26 and impaired activities of daily living and their one designated caregiver. Caregivers must have a smartphone, tablet, or laptop to access NeuViCare and to utilize all four of its HIPAA and FHIR compliant services for three months: 1) Task‐Support Service 2) Resource Advisor 3) Community; and 4) Knowledge Advisor. Periodic touchpoints with caregiver participants are in place as a safety measure.ResultsThe first pilot’s target population was aides from a national home care agency. The survey‐study reported NeuViCare's user experience to be “very positive” and “easy to use”; the quality of its information to be “clear, concise and with good depth”; and, 3) its value to be “useful for less experienced caregivers”. The second pilot focused on family caregivers from Mumbai. This study showed that Knowledge Advisor provided 97% correct answers. This third pilot study targets informal caregivers, and we hypothesize that mean SUS scores will be significantly associated with reduced OCBS scores.ConclusionEffectiveness of AI technology in reducing caregiver load will lead to a scalable, cost‐effective solution that can be made available to caregivers everywhere.

Artificial intelligence‐led decision support services to reduce caregiver load related to persons with cognitive impairment

AbstractBackgroundThe number of people in the US living with cognitive impairment (including Alzheimer’s Disease and other dementia) is over 5.8M today, and is expected to increase to nearly 14M by 2050 [c.f. alz.org]. The rapidly growing population of informal caregivers is subject to high stress due to patient behavioral symptoms, increased demands on caregiver time, and lack of knowledge about new care giving tasks. Many of these tasks are complex and time consuming such as determining and coordinating services/resources for the patients, seeking information and talking with the clinical team about patient conditions and care plans, and arranging for someone to care for their charge.MethodWe hypothesize that the power of artificial intelligence (AI) technology can be harnessed to meaningfully support caregivers in time consuming, complex tasks encountered in care giving and thereby reduce their load before, during and after diagnosis. We have developed a set of ARTful (accountable, responsible, and transparent) AI services to support informal caregivers of patients with mild cognitive impairment who are being diagnosed and treated at a hospital Memory Clinic. Barriers to adoption of AI technology services include usability (as defined in the System Usability Scale), acceptability (fear of AI) and experience (digitally unprepared) on the part of patient/caregiver pairs.ResultIn this paper, we present case studies covering service onboarding, caregiver exploration and patterns of use of the AI technology, and initial assessment of its impact on adherence to care plans and on caregiver burden. Preliminary findings indicate that well‐thought out AI‐led solutions can reduce caregiver load and increase care plan adherence. A double‐blind study is planned to quantitatively assess impact as measured by scores on the Oberst Caregiver Burden Scale.ConclusionA demonstration of the effectiveness of this technology in reducing caregiver load will lead to a scalable, cost‐effective solution that raises the standard of current practices in neurodegenerative care, and leads to improved health outcomes.

Risks of Deep Reinforcement Learning Applied to Fall Prevention Assist by Autonomous Mobile Robots in the Hospital

Our previous study proposed an automatic fall risk assessment and related risk reduction measures. A nursing system to reduce patient accidents was also developed, therefore reducing the caregiving load of the medical staff in hospitals. However, there are risks associated with artificial intelligence (AI) in applications such as assistant mobile robots that use deep reinforcement learning. In this paper, we discuss safety applications related to AI in fields where humans and robots coexist, especially when applying deep reinforcement learning to the control of autonomous mobile robots. First, we look at a summary of recent related work on robot safety with AI. Second, we extract the risks linked to the use of autonomous mobile assistant robots based on deep reinforcement learning for patients in a hospital. Third, we systematize the risks of AI and propose sample risk reduction measures. The results suggest that these measures are useful in the fields of clinical and industrial safety.

Caregiving Load and Respite Service Use: A Comparison between Older Caregivers and Younger Caregivers

ABSTRACTStudy aims were to explore differences in predictors of respite care use between older (aged 65+) and younger caregivers (aged 18–64 years), and associations between caregiving load and respite care use using multivariate logistic regression analysis and unpaid caregiver (n= 10,500) data from the 2009 California Health Interview Survey. Caregiving load comprised number of care recipients, weekly hours in caregiving, and caregiving duration. Variables with a significant association with respite care for older caregivers were female gender, income, and health insurance. For younger caregivers, respite care use associations were with ethnicity, caregiving relationship, education, and availability of substitute help.

Longitudinal Changes in and Modifiable Predictors of the Prevalence of Severe Depressive Symptoms for Family Caregivers of Terminally Ill Cancer Patients over the First Two Years of Bereavement.

Bereaved families endure tremendous grief. However, few studies have longitudinally investigated caregivers' bereavement grief for more than one year postloss and none is from family-oriented Asian countries. We explored longitudinal changes in and modifiable predictors of severe depressive symptoms for Taiwanese family caregivers of terminally ill cancer patients over the first two years postloss. For this descriptive, longitudinal study, severe depressive symptoms (Center for Epidemiological Studies Depression Scale score ≥16) were measured 1, 3, 6, 13, 18, and 24 months postloss. To identify modifiable factors (preloss depressive symptom levels, subjective caregiving burden, objective caregiving load, preparedness for patient death, and postloss social support) associated with postloss severe depressive symptoms, we used multivariate logistic regression modeling with the generalized estimating equation. Bereaved caregivers (N = 285) were recruited by convenience from a medical center in northern Taiwan. Bereaved family caregivers' prevalence of severe depressive symptoms peaked one month postloss (73.3%) and significantly decreased to 15.2% 24 months after the patient's death. After adjusting for confounders, bereaved caregivers were more likely to have severe depressive symptoms if they had heavy objective caregiving load and higher preloss depressive symptom levels. However, their likelihood of severe depressive symptoms was buffered by being better prepared for the patients' death and having greater social support. Bereaved family caregivers' severe depressive symptoms decreased significantly over the first two years postloss. Healthcare professionals should appropriately assess at-risk bereaved caregivers when patients are still alive and provide effective interventions to facilitate caregivers' return to normal life.

Vulnerable characteristics and interest in wellness programs among head and neck cancer caregivers.

Head and neck cancer (HNC) caregivers have poorer psychological health compared to patients and the general population but have not yet been targeted for wellness programs to reduce adverse psychosocial or physical health outcomes. To inform development of such programs, we identified potential vulnerabilities to poor outcomes and examined wellness program preferences among HNC caregivers. We also examined whether interest in wellness programs varied by potential vulnerabilities among HNC caregivers. Surveys were administered to caregivers (n=33) of HNC patients undergoing major surgery. Sociodemographic factors, caregiving characteristics, psychosocial functioning, and health behavior data were collected. Fisher's exact tests and t tests were used to examine characteristics associated with interest in the different types of wellness programs. Many caregivers reported a heavy caregiving load (88% live with patient and 73% provide daily care), a smoking history (42%), and compromised psychosocial functioning (45% with depressive symptoms and 33% with anxiety above population norms). Most caregivers were interested in wellness programs focused on diet/exercise (71.9%); cancer education (66.7%); stress reduction (63.6%); and finances, caregiving, and well-being (57.6%). Caregivers endorsed highest interest in programs offered during the patient's medical treatment (63.6%), and mail was the preferred program format (50.0%). Those with more depressive symptoms reported more interest in programs focused on cancer education (p=0.03); stress reduction (p=0.05); and educational classes on finances, caregiving, and well-being (p=0.01). Wellness programs offering a menu of options should be developed for HNC caregivers.

Bluetoothに基づく人感センサを利用した遠隔介護支援システムの試作

A remote elder care is important but it is difficult to support their correct dosing. We developed a remote elder care support system, which enables users to synchronize handwriting, and photos in real-time on ordinal smartphones and tablet devices. However, a caregiver was hard to check care receiver's dosing timely. And, it is undesirable to attach additional sensors to ordinal devices to reduce caregiver's load. To solve the problem, we developed a motion detector based on the attenuation of Bluetooth signals, the 2.4 GHz band. The advantages of our method are that equipment of any devices to detect care receivers is unnecessary and non-expert can sets the system flexibly. We experimented the attenuation of Bluetooth signals by a human body, thus we concluded that Bluetooth could be used for a motion detector.