Caregiver Mastery Research Articles

Reaping caregiver feelings of gain: The roles of socio-emotional support and mastery

Objectives: Existing studies indicate that the presence of social support increases the likelihood of caregivers experiencing feelings of gain from caregiving; however, researchers have not yet investigated the mechanism through which social support is linked to caregiver feelings of gain. Informed by Bandura's Social Cognitive Theory, the present study investigated whether a sense of caregiving mastery serves as a key mechanism. Method: Sixty-three family caregivers of dependent elders completed surveys to assess caregiver feelings of gain, socio-emotional support (from family, friends, spouse/partner) and mastery. To evaluate the hypothesized mediation model, a series of structural equation modeling (SEM) analyses were conducted with the maximum likelihood method by Lisrel 8.8. Results: Socio-emotional support from family members was found to be an important resource for caregiver feelings of gain. SEM analyses further revealed that the mechanisms by which socio-emotional support influences caregiver feelings of gain vary depending on its source (i.e. family members, friends, and partners). Conclusion: As hypothesized, caregiving mastery played a mediating role for non-partner family socio-emotional support whereas it did not for partner socio-emotional support. Based on availability or absence of specific sources of support, caregiver intervention programs should be individually tailored to enhance their potential impact.

Telemonitoring of Heart Failure Patients and Their Caregivers: A Pilot Randomized Controlled Trial

Heart failure (HF) is the leading cause of rehospitalization in older adults. The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions, emergency department visits, costs, and risk of hospital readmission for patients with HF. One hundred two patient/caregiver dyads were randomized into 2 groups postdischarge; 84 dyads completed the study. Hospital readmissions, emergency department visits, costs, and days to readmission were abstracted from medical records. Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms, quality of life, and caregiver mastery. There were no significant differences due to telemonitoring for any outcomes. Caregiver mastery, informal social support, and electronic home monitoring were not significant predictors for risk of hospital readmission. Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit.

Determining Care Management Activities Associated with Mastery and Relationship Strain for Dementia Caregivers

To identify specific care management activities within a dementia care management intervention that are associated with 18-month change in caregiver mastery and relationship strain. Exploratory analysis, using secondary data (care management processes and caregiver outcomes) from the intervention arm of a clinic-level randomized, controlled trial of a dementia care management quality improvement program. Nine primary care clinics in three managed care and fee-for-service southern California healthcare organizations. Two hundred thirty-eight pairs: individuals with dementia and their informal, nonprofessional caregivers. Care management activity types extracted from an electronic database were used as predictors of caregiver mastery and relationship strain, which were measured through mailed surveys. Multivariable linear regression models were used to predict caregiver mastery and relationship strain. For each care manager home environment assessment, caregiver mastery increased 4 points (range 0-100, mean+/-standard deviation 57.1+/-26.6, 95% confidence interval (CI)=2.4-5.7; P=.001) between baseline and 18 months. For every action linking caregivers to community agencies for nonspecific needs, caregiver mastery decreased 6.2 points (95% CI=-8.5 to -3.9; P<.001). No other care management activities were significantly associated with this outcome, and no specific activities were associated with a change in caregiver relationship strain. Home assessments for specific needs of caregivers and persons with dementia are associated with improvements in caregivers' sense of mastery. Future work is needed to determine whether this increase is sustained over time and decreases the need for institutionalization.

Telemonitoring of Heart Failure Patients and Their Caregivers: A Pilot Randomized Controlled Trial

Heart failure (HF) is the leading cause of rehospitalization in older adults. The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions, emergency department visits, costs, and risk of hospital readmission for patients with HF. One hundred two patient/caregiver dyads were randomized into 2 groups postdischarge; 84 dyads completed the study. Hospital readmissions, emergency department visits, costs, and days to readmission were abstracted from medical records. Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms, quality of life, and caregiver mastery. There were no significant differences due to telemonitoring for any outcomes. Caregiver mastery, informal social support, and electronic home monitoring were not significant predictors for risk of hospital readmission. Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit.

The Influence of Caregiver Mastery on Depressive Symptoms

The purpose of this study was to explore how the relationship between care recipients' problem behaviors and caregivers' depressive symptoms varies as a function of caregiver mastery, controlling for the effects of caregiver age, gender, and relationship to the care recipient in caregivers of people with primary malignant brain tumor (PMBT). A cross-sectional design was used to gather data via telephone interviews from 95 caregivers of people with primary malignant brain tumor, recruited from 2003 to 2004 from a brain tumor treatment center, two national support groups, and a statewide cancer registry. Measures for the study included the Neuropsychiatric Inventory-Questionnaire, Caregiver Mastery, and the Center for Epidemiologic Studies-Depression. A stepwise regression procedure was used to evaluate potential moderating and mediating relationships. Data did not indicate that caregiver mastery was a moderating variable. The analysis showed caregiver mastery as a partial mediator, with both a direct effect of care recipients' problem behaviors on caregivers' depressive symptoms and an indirect effect through caregiver mastery. Concerning the indirect effect, care recipients' problem behaviors were related to lower levels of caregiver mastery, which in turn were related to more depressive symptoms in caregivers. Findings showed a link between care recipients' problem behaviors and caregivers' depressive symptoms, a relationship that has not been well established in oncology. This association indicates one mechanism through which problem behaviors in the care recipient might lead to caregiver depressive symptoms.

Couple-oriented education and support intervention: Effects on individuals with osteoarthritis and their spouses.

Objective: To determine whether a couple-oriented intervention for osteoarthritis (OA) was more efficacious than a patient-oriented intervention and whether each intervention was more efficacious than usual medical care. Research Design: 242 older adults with OA and their spouses were randomly assigned to patient-oriented education and support, couple-oriented education and support, or usual care. Results: Intent-to-treat analyses indicated no significant differences between the 3 study conditions in outcomes for individuals with OA or their spouses. Completers analyses showed that at the 6-month follow-up, contrary to prediction, individuals with OA who received the patient-oriented intervention reported greater reductions in pain and improvements in physical function than those who received the couple-oriented intervention. At the postintervention assessment, spouses who received the coupleoriented intervention reported greater reductions in stress and a trend toward less critical attitudes than spouses of individuals with OA who received the patient-oriented intervention. Moderator analyses indicated that female spouses and spouses with high marital satisfaction who received the couple-oriented intervention also experienced better outcomes in terms of depressive symptoms and caregiver mastery. Conclusions: A couples approach to education and support for OA may offer no advantage for individuals with OA but may prove helpful for spouses, thereby indirectly benefiting individuals with OA over time.

Caregiving appraisal after traumatic brain injury: The effects of functional status, coping style, social support and family functioning

Perception of caregiving after traumatic brain injury (TBI) has been shown to be an important part of both survivor and family adjustment. The roles of coping style, family functioning, perceived social support and the TBI survivor's functional status have not been fully examined with respect to appraisal of caregiving. This study examined these factors with respect to both positive and negative appraisals of caregiving in four main areas: perceived burden, caregiving relationship satisfaction, beliefs about caregiving, and mastery with caregiving. Sixty primary caregivers of individuals who sustained a TBI within the last 6 months to 15 years were administered the Caregiver Appraisal Scale, as well as the Coping Inventory for Stressful Situations, a 21-item version of the Family Assessment Device, and the Social Provision Scale. These findings were examined in relation to the TBI survivor's scores on the Disability Rating Scale and the Functional Independence Measure at the same time points post-injury. Results revealed that the majority of caregivers in those with moderate to severe brain injuries experienced dissatisfaction with many aspects of caregiving, especially with respect to feelings of burden and mastery. Additionally, emotionally-focused coping, behavioral control issues with respect to family functioning, and perceived social support appear to be most highly related to perceptions of burden, whereas perceived social support alone was the strongest factor in one's perception of caregiving mastery and satisfaction with the caregiving relationship. Interestingly, caregiving ideology was most closely related to avoidance-oriented coping. These results have direct implications for the development of interventions for caregivers of persons with TBI, especially with respect for the need to assess coping style and the development of social support networks.

Impact of coping skills intervention with family caregivers of hospice patients with cancer

Family caregivers for cancer patients experience high levels of stress and burden and diminished quality of life (QOL). Interventions to improve coping skills of caregivers have been shown to be effective with other populations, but their impact has not been assessed in the difficult context of hospice care. The purpose of this study was to determine whether hospice plus a coping skill training intervention improved family caregivers' QOL, burden, coping, and mastery, compared with hospice plus emotional support, and usual hospice care. A three group randomized controlled trial was conducted including baseline, 16 day, and 30 day assessments conducted from March 1999 to May 2003. The sample consisted of 354 family caregivers of community dwelling hospice patients with advanced cancer. Patient/caregiver dyads were randomly divided into three groups, including a control group (n = 109) who received standard hospice care, a group (n = 109) who received standard hospice care plus three supportive visits, and a group (n = 111) who received standard care plus three visits to teach a coping skills intervention. Primary outcomes included caregiver QOL, caregiver burden due to patient symptoms, caregiver burden due to tasks, and caregiver mastery. At the 30-day follow-up, the coping skills intervention led to significantly greater improvement in caregiver QOL (estimate = -0.16, standard error [SE] = 0.07, P = 0.03), burden of patient symptoms (estimate = 0.28, SE = 0.07, P < 0.001), and caregiving task burden (estimate = -0.01, SE = 0.01, P = 0.038) than did the other two conditions. None of the groups showed significant change in overall caregiving mastery, caregiver mastery specific to caregiving tasks, problem-focused or emotion-focused coping. The coping skills intervention was effective in improving caregiver QOL, reducing burden related to patients' symptoms, and caregiving tasks compared with hospice care alone or hospice plus emotional support. Structured caregiver skill-training interventions for caregivers are promising even in the difficult environment of end-of-life care and for families already receiving benefits of hospice care.

Depression and Caregiver Mastery in Grandfathers Caring for Their Grandchildren

Kin caregiving research tends to focus on the experiences of grandmothers. Often unnoticed and underserved are grandfathers who also take on this responsibility. Here, two groups of grandfathers participated in focus group interviews to discuss their experiences as caregivers to their grandchildren. Common themes for the grandfathers were the feeling of missing freedom, experiencing child rearing differently now than they had with their own children, and fear of what would happen to the children should their health fail. Thirty-three grandfathers also answered questions about themselves; their grandchild; need, use, and satisfaction with formal services; depression; and caregiving mastery. A sample of 33 grandmothers selected from a previous study was matched to the grandfathers on age, race, and marital status. Differences in depressive symptoms between the grandfathers and grandmothers were statistically significant. There was no statistically significant difference between the grandparent caregivers on caregiving mastery. These findings suggest that there may be differences in the impact of caregiving for grandmothers and grandfathers. These differences should be further investigated.

Influencing Factors that Affect the Psychological Well-being in Family Caregivers of Stroke Patients

The purpose of this study was to investigate the factors that affect the psychological well-being in family caregivers of stroke patients. The General Health Perception, short form 36, Health Survey Questionaire was used to measure health perception. The Caregiving Mastery Scale was used to assess the mastery, while the Psychological General Well-Being Index was used to examine the level of well-being. Subjective health, caregiving mastery, patient's ADL and caregiving duration influenced on caregiver's psychological well-being. Subjective health had effect on psychological well-being both directly and indirectly. Caregiving duration and patient's ADL had indirect effect on psychological well-being through caregiving mastery. It is need to develop a health program for the caregivers of stroke patient's and to provide nursing intervention to improve the caregiver's ability, thereby improving the well-being of the family caregivers.

Can culture help explain the physical health effects of caregiving over time among African American caregivers?

The purposes of this study were to longitudinally examine the health outcomes of 107 African American caregivers who provided care to their elderly dependent family members and to determine the role of culture in predicting health outcomes. With use of the stress and coping model of Pearlin and colleagues (1990) as a guide, the direct effects of background characteristics and stressors and the direct and mediating effects of resources (including culture) on two caregiver health outcomes (i.e., psychosocial health and physical functioning) were analyzed with hierarchical multiple regression analyses. Similar to other studies, we found that combinations of caregiver background characteristics, stressors, and resources at wave 1 had direct effects on African American caregivers' health outcomes at wave 3. Unlike previous studies, where culture was not measured, we found that cultural beliefs and values did help to explain health outcomes for African American caregivers. Specifically, culture justifications for caregiving, baseline psychosocial health, and caregiving mastery predicted wave 3 psychosocial health. Caregiver education, number of morbidities, and physical functioning at wave 1 were associated with physical functioning at wave 3. The findings from this study have implications for future studies, particularly in regard to cultural beliefs and values among African American caregivers.

The relationship between mastery and depression among Japanese family caregivers.

The present study examined the relationship between caregiver mastery and depressive symptoms among family stroke caregivers in western Japan (N = 100). Family caregivers were identified from a sample of rehabilitation hospitals; participation rate was 100 percent for all eligible caregivers. Caregivers with high mastery were found to have significantly fewer depressive symptoms than low mastery caregivers and were significantly more likely to use a respite caregiver. They also reported significantly less burden, yet paradoxically were significantly more likely to rate their care-recipients as more functionally dependent on them. Caregiver age, health status, and caregiving duration did not relate to mastery. However, men had a significantly higher sense of mastery. In general, findings parallel those for Western family caregivers, although mean mastery scores for Japanese caregivers were lower than those reported for American family caregivers.

A multidimensional measure of caregiving appraisal: validation of the Caregiver Appraisal Scale in traumatic brain injury.

To investigate the factor structure and concurrent validity of the Caregiver Appraisal Scale (CAS) in a sample of caregivers of adults with traumatic brain injury (TBI). Prospective cohort study. Two sites: (1) Outpatient clinics associated with a comprehensive inpatient brain injury rehabilitation program and (2) a comprehensive residential postacute rehabilitation program in the Southern United States. One hundred forty-nine caregivers of adults with TBI enrolled in the TBI Model Systems Project and 92 caregivers of adults with TBI admitted to a residential postacute rehabilitation program. Most caregivers were women and either parents or spouses of the injured person. Caregiver Appraisal Scale (CAS); Subjective Burden Scale (SBS); Objective Burden Scale (OBS); General Health Questionnaire (GHQ). Principal components analysis with varimax rotation yielded four factors: perceived burden (PB), caregiver relationship satisfaction (CRS), caregiving ideology (CI), and caregiving mastery (CM), which were found to be fairly stable across treatment settings. Adequate concurrent validity was demonstrated for the perceived burden factor, and adequate internal consistency was found for three of four scales. Preliminary support for the use of the CAS in caregivers of adults with TBI was obtained. However, further scale development, particularly for the CM factor, will likely improve the stability and usefulness of this instrument.

介護マスタリーの構造と精神的健康に与える影響

介護マスタリーの構造と精神的健康に与える影響

Caregiver Mastery of Hoarding Behavior in a Patient with Dementia

Caregiver Mastery of Hoarding Behavior in a Patient with Dementia

Service Use, Caregiving Mastery, and Attitudes Toward Community Services

The purpose of this study was to determine correlates of selected caregiver attitudes toward community services in a sample of 215 spouse caregivers of persons with dementia. Predictors of two types of attitudes differed, confirming the multidimensionality and specificity of attitude for mation. Caregivers with higher levels of caregiving mastery, lower levels of caregiverprepared ness, less education, and more helpers had a greater likelihood of having confidence and trust in use of services. Women, African Americans, service users, and those with lower levels of caregiv ing mastery had a greater likelihood of accepting government and community services. The find ings highlight the complexity of the idea that improving attitudes toward community services will lead to greater use of caregiver support resources.

Conceptualization and measurement of doing family caregiving well.

To review progress in the conceptualization and measurement of five concepts related to doing family caregiving well: caregiving mastery, self-efficacy, competence, preparedness, and quality. Families are increasingly involved in providing complex care to ill or aged family members at home. Their ability to do caregiving well is vitally important and a focus of nursing practice in many clinical settings. Concepts were organized into two groups: those that refer to caregivers' perceptions of how well they are providing care and those that refer to professional assessment of the quality of care provided. Family caregiving literature from nursing, gerontology, psychology, and social work, 1987-1996. There is growing interest in doing family caregiving well. However, research in this area is limited by the current state of development of ideas and measures. Two issues that should be addressed to advance research are the perspective taken on doing caregiving well and change over time in doing caregiving well.

Factors associated with family caregivers' choice not to use services

The purpose of this descriptive study was to determine adaptation by family caregivers of persons with Alzheimer's disease who did not use community services. Previous research has focused on the use of services, highlighting the need for studies examining factors associated with service nonuse. Lawton and Nahemow's ecology model of adaptation and aging served as the foundation for this study; the relationship between personal competence and environmental press depicts a level of adaptation. A mail and telephone survey of 70 caregivers revealed reasons for not using services to which they had been referred, as well as patterns of adaptation to caregiving. Personal competence, measured as perception of caregiving mastery, emerged as a significant factor in service nonuse. Caregiver gender and daily hours of caregiving, an environmental press factor combined with perception of mastery to most often correctly classify respondents' high and low adaptation. Strategies for enhancing caregiver competence should be given highest priority by primary health care professionals.

Race, Control, Mastery, and Caregiver Distress

This study investigated the relationship between race, psychological resources of sense of control and caregiver mastery, and distress outcomes of caregiver depression and role stain among 77 African American and 138 White spouse caregivers of persons with dementia. Patterns of association between psychological resources and caregiving distress outcomes varied by type of outcome. Sense of control had a direct negative relationship with depression. Caregiver mastery moderated the effects of stressors on depression and was the only significant psychological resource predicting role strain. Although African American caregivers were less likely to report caregiver depression and role strain, there were no race differences in the process influencing caregiver distress.

Assessing impact on family caregivers to Alzheimer's disease patients

Abstract This study examined both positive and negative impact of caregiving in a sample of 110 caregivers to an aging family member suffering from Alzheimer's disease. Family caregivers' appraisals along dimensions of subjective burden, negative impact, caregiving satisfaction, and caregiver mastery were correlated with the extent of memory and behavior problems of the patient and caregivers' coping style, locus of control, self-esteem, ego strength, level of depression, and perceived environmental support. Results provide additional evidence for the multidimensional structure of caregivers' subjective appraisals. Correlational findings suggest the potential treatment utility of multicomponent intervention programs addressing both positive and negative dimensions of family caregivers' experience.