Caregiver Worry Research Articles

Caregiver Ratings of Toddler Pain: The Role of Caregiver Psychological Predictors.

Young children's limited ability to self-report pain necessitates an understanding of the factors that influence pain ratings. The current paper examines the relative prediction of caregiver psychological factors and toddler pain behaviors on caregiver pain ratings post-vaccination. One hundred fifty-six parent-toddler dyads were video recorded during pediatric vaccinations. Child pain behaviors were coded before, during, and after the needle using the Face, Legs, Activity, Cry, Consolability Scale and the Neonatal Facial Coding System). Caregivers rated their child's pain after the needle, reported pre- and post-needle worry during the visit, and completed rating scales assessing other areas of psychological functioning within 2 weeks after the appointment. Regression models were estimated to examine the relative contribution of child and caregiver factors to the prediction of caregiver pain ratings. The regression model predicting caregiver pain ratings from the toddlers' pain-related distress (facial activity immediately after the needle, overall pain-related behavior immediately after, 1-min and 2-min post-needle) and caregiver worry were significant (adjusted R-square = 0.21), with caregiver pre- and post-needle worry being the only significant predictors of caregiver pain ratings. This study outlines that although child distress behavior remains a significant influence on pain ratings during toddlerhood, when caregiver worry (pre- and post-needle) was entered into the model, they were the only significant predictors of caregiver pain ratings.

Integrated Hospital- and Home-Based Palliative Care for Cancer Patients in Vietnam: People-Centered Outcomes.

Hospital-based palliative care (PC) linked to palliative home care is rarely accessible in low- and middle-income countries (LMICs). To study people-centered outcomes of a palliative home care team based at a major cancer center in Vietnam. The palliative home care team, consisting of at least one physician and one nurse, provided home PC when needed by patients of the cancer center who lived within 10 kilometers. A linguistically validated version of the African Palliative Outcomes Scale was integrated into standard clinical data collection. We retrospectively reviewed data from the 81 consecutive patients on prevalence and severity of pain and other types of physical, psycho-social, and spiritual suffering at the first home visit (baseline) and at the first follow-up visit and measured any differences. There was great demand for palliative home care. From baseline to follow-up, there was significant improvement in pain regardless of the baseline severity of pain (p < 0.003). Among patients with severe pain, breathlessness, nausea/vomiting, diarrhea, depression, or worry about illness at baseline, there was significant improvement (p < 0.001), and caregiver worry about the patient also improved significantly. Integration of hospital- and home-based PC for cancer patients is feasible and improves people-centered outcomes at low cost in Vietnam. These data suggest that benefits to patients, their families, and the health care system can accrue from integration of PC at all levels in Vietnam and other LMICs.

Caregiver Worry of Infection and Family Co-existence Difficulty and Association With Change in Children's Internalizing and Externalizing Symptoms During the Initial COVID-19 Lockdown in the UK and Turkey.

The study examined whether caregiver worry of COVID-19 infection and co-existence difficulty differentially predicted child mental health and wellbeing during the lockdown in two culturally different countries that were severely affected by the pandemic: the UK and Turkey. Co-existence difficulty is the hardship experienced by family members living all together in the same house at the same time during the lockdown period. Participants were 1849 caregivers of children between 5- and 12-years old living in the UK (n = 995) and Turkey (n = 854), who completed an electronic survey distributed via social networks during the initial phase of the COVID-19 lockdown (July and August 2020). Caregivers completed a set of questionnaires on child and family wellbeing and on whether the child's internalizing and externalizing symptoms changed during the lockdown as compared to before. Worry of COVID-19 infection was higher amongst caregivers in the Turkish sample and was associated with higher levels of child internalizing symptoms during the lockdown in the Turkish sample, however there were no statistically significant differences in the size of the impact of worry of infection on the children's internalizing symptoms between the two countries. Co-existence difficulty independently predicted increase in children's internalizing and externalizing symptoms during the lockdown in both samples. Families in the UK experienced a higher level of difficulty with co-existence compared to the families living in Turkey but the magnitude of the impact of co-existence difficulty on children's outcomes between the two samples was not significantly different.The findings suggest that public health strategies should aim to reduce social anxiety and invest in the development of programs aimed at supporting families to overcome the challenges of co-existence during times of public health crisis.

Understanding Caregiver Burden with Accessing Sickle Cell Care and Their Perspective on Telemedicine

Background: Sickle cell disease (SCD) is associated with a wide range of complications. However, a multitude of barriers prevent SCD patients from receiving adequate healthcare, including difficulties with transportation and lack of provider knowledge about disease sequelae. Importantly, studies have demonstrated the benefits of telemedicine in addressing barriers to healthcare. Few studies have explored barriers which affect the pediatric SCD patient population in areas such as the Midwest, wherein the geographical landscape can prohibit healthcare access. Furthermore, few studies have established acceptability of telemedicine among caregivers and patients with SCD. The objective of this study was to increase understanding of barriers to care and perceptions of telemedicine by caregivers of pediatric SCD patients. Methods: An 88-item statewide survey was distributed to caregivers of children with SCD cared for at Riley Hospital for Children in Indianapolis, IN. Caregivers were contacted by the research team via secure text messaging or in-person. Questions for the survey were developed based on previously performed semi-structured interviews with caregivers and the validated Barriers to Care Questionnaire (BCQ). The survey included questions regarding their experience accessing care, including barriers and facilitators of care, as well as their perspective on the use of telemedicine in SCD. Responses were analyzed using t-tests or chi square tests where appropriate. Results: Of the 300 caregivers contacted, 101 completed the survey, resulting in a response rate of 34%. The majority had 1 child with SCD, with most having Hb SS genotype. Eighteen percent of families drove more than 1 hour to access comprehensive sickle cell care. Caregivers reported having a median of 2 other healthcare providers that their child regularly sees. However, nearly 10% did not have an established primary care provider. Caregivers identified a median number of 6 barriers to accessing SCD care, with other household responsibilities, childcare, lost time from work and school as the most common. About 20% of caregivers felt these barriers affected their and/or their child's well-being and/or mental health at times, yet less than half reported their healthcare team ever discussing ways to address these barriers. Approximately 40% felt having a child with sickle cell disease impacted their daily stress and/or mental health. Sixty-three percent of caregivers worried about others (e.g. school staff) caring for their child, and nearly 50% worried about the care and knowledge of medical providers other than their SCD team. Forty percent of caregivers had participated in some form of telemedicine, the majority being direct-to-consumer. Eighty-one percent were willing to participate in telemedicine visits sometimes or always. However, nearly half felt the lack of a physical exam was a negative for telemedicine, and about 25% stated it was harder to build trust via telemedicine. Willingness to participate in telemedicine was not associated with prior telemedicine use, perceived positives/negatives of telemedicine, caregiver worry about others caring for their child, or distance from SCD center. Conclusion: The experiences of caregivers accessing healthcare for their child with SCD suggests caregiver burden and barriers to care that may be unique to patients with SCD. Additionally, while the majority are willing to participate in telemedicine for future sickle cell care, the negatives of telemedicine that caregivers reported are significant. Future studies should evaluate models of telemedicine care adapted for this specific population.

Caregiver Experiences Managing Persistent Childhood Asthma During the COVID-19 Pandemic.

COVID-19 has adversely affected child wellness, but it is unclear whether the pandemic led to changes in home management of chronic diseases like asthma. We surveyed 93 caregivers of children with persistent asthma from 2 ongoing asthma trials to measure changes in home asthma management, stressors, access to health care, and caregivers' worry about COVID-19 affecting their child's health. We conducted descriptive analyses, and assessed whether caregiver worry about COVID-19 was associated with asthma management, stressors, health care access, or recent symptoms. Most (80%) caregivers worried that COVID-19 would affect their child's health, and >50% restricted their child's physical activity to avoid asthma symptoms. We observed a dose-dependent relationship between increasing worry about COVID-19 and activity restrictions, financial hardship, difficulty obtaining asthma medications, and nocturnal asthma symptoms. These findings raise concern that children with persistent asthma may be at particular risk for weight gain and obesity-associated asthma morbidity due to the pandemic.

Care Recipient Diagnosis Moderates the Relationship Between Caregiver Worry and Vigilance

Family members of persons diagnosed with dementia or a traumatic brain injury (TBI) are often relied upon to provide daily support to their care recipients. However, research on the differing experiences of caregivers based on care recipient diagnosis is limited. The aim of this study was to examine the impact of worry and feelings of vigilance among caregivers of people with cognitive impairment due to either TBI or dementia. This sample included 61 caregivers (88.5% female, mean age 57.3±15.5) of persons with either a TBI (n = 32) or dementia (n = 29). Worry was assessed with the Penn State Worry Questionnaire and Vigilance was assessed with the Caregiver Vigilance Scale. Linear regressions revealed that after controlling for age, care recipient diagnosis moderated the relationship between worry and caregiver vigilance. Specifically, worry was significantly associated with caregiver vigilance in those caring for someone with dementia; however, a similar relationship was not seen in those caring for someone with a TBI. This suggests caregivers of people with TBIs have a different experience of worry and vigilance than caregivers of people with dementia. These findings demonstrate the need for more research on the unique needs of caregivers of people with TBIs. Additionally, this research suggests interventions targeting worry may be particularly effective in supporting caregivers of people with TBIs.

Family Caregiver Problems in Outpatient Palliative Oncology.

Background: Understanding challenges of family caregivers within specific palliative care contexts is needed. Objective: To describe the challenges of family caregivers of patients with cancer who receive outpatient palliative care. Methods: We summarized the most common and most challenging problems for 80 family caregivers of cancer patients receiving outpatient palliative care in the midwestern United States. Results: Caregiver worry and difficulty managing side effects or symptoms other than pain, constipation, and shortness of breath were most common. "Financial concerns" was cited most as a "top 3" problem. Almost half of caregivers reported "other" problems, including family members, patient physical function, care coordination, and patient emotional state. Conclusions: The most common and most challenging problems of family caregivers of cancer patients receiving outpatient palliative care may differ from those experienced in other serious illness care contexts. Comparative studies on caregiver problems across the cancer care continuum can help develop and refine interventions.

Caregiver worry and injury hazards in the daily lives of Ugandan children

:Background:Over 95% of unintentional injury-related childhood deaths globally occur in low- and middle-income countries, such as Uganda. Risks for injury in settings like rural Uganda are vastly understudied despite differing patterns of child injury risk. The present study investigated the prevalence and type of hazards in children’s environments in rural Uganda, as well as the relationship between hazard exposure and parent attitudes and perceptions regarding unintentional injury.Methods:Our sample included 152 primary caregivers in Eastern Rural Uganda who had children in either 1st or 6th grade. All parents/guardians completed caregiver surveys following verbal instructions. Surveys assessed demographic information, child hazard exposure, and parent beliefs regarding child injury. Results:Almost all parents (98.5%) reported daily exposure for their children to at least one of the hazards assessed. Caregiver's perceived likelihood of child injury was positively related to hazard exposure (r = .21, p less than .05). This relationship remained significant when controlling for family demographics, child grade level, and child injury history (F (7, 126) = 2.25, p less than .05).Conclusions:Our results suggest that Ugandan parents are aware of the risks of children’s exposure to hazards, but may lack the tools to address it. Development of injury prevention interventions focusing on behavioral change techniques may help reduce childhood injury and injury-related deaths in Uganda.

Exploring the Use and Appeal of Playpens to Protect Infants from Exposure to Animals, Animal Feces, and Dirt in Rural Ethiopia.

.The persistence and pervasiveness of growth stunting in low- and middle-income countries spur reexamination of disease transmission pathways related to water, sanitation, and hygiene. Animal feces constitute a more important reservoir of enteric pathogens in homes in low-income countries than previously recognized, and exploratory object mouthing and direct ingestion of soil and animal feces represent underexplored exposure pathways. The effectiveness, adoption, constraints, and scale-up potential of measures for reducing infant and young children’s exposure to fecal pathogens are recently beginning to be systematically explored. This mixed methods study tested the feasibility and appeal of using playpens to establish a hygienic “safe zone” for infants in rural Ethiopia. We conducted home trials of three playpen designs, including two models made from locally available materials through user-centered design. After using playpens for several weeks, caregivers reported extensive benefits, ranging from perceived safety to developmental and hygiene benefits for infants and relief from physical stress and worry for caregivers. We observed many playpens contaminated with Escherichia coli after weeks of use, though at concentrations below those of the common room floor on which infants might otherwise have played. Caregivers reported daily playpen use, but for intervals likely insufficient to protect infants from pathogen exposure affecting growth. We determine that playpens alone cannot plausibly protect infants from environmental contamination, but our results support further exploration of the potential benefits and commercial viability of scaling up use of playpens in rural, agricultural households as part of a comprehensive approach to child development and women’s empowerment.

An Exploratory Study on Opinion of Tracking System For Patient With Dementia among Mental Health Team Member of Pune City

Introduction and objective: Patient with dementia who wander are at high risk of harm self and posethreat to self and stress and worry for care givers too. Care givers feel under stress and worry dueto this symptoms. The objective of this study was to to determine the opinion from mental health careteam member or tracking system for patient with Dementia and to find association between opinions ofmental health team members and selected demographic variable. Material and Method: Quantitative NonExperimental research approach was used and research design was Descriptive Exploratory Research Designto explore on opinion of tracking system for patient with dementia among mental health team member ofPune city. Sample size was 30 and non-probability convenience sampling technique. Tool had two sections.Part A involved the demographic variables age, gender, marital status, designation, and years of experienceand part B was structured opinionnair 0 to 2 numerical rating scale which is further divided into 3 categoriesYes, No, Don’t Know. Result: Mental health team members is in opine for demand of tracking system forpatient with dementia. ANOVA test used to check the association between opinion of mental health teammember and selected demographic variable. The p-values are less than 0.05, there is a significant associationbetween opinion of mental health team member and years of experience of mental health team members andwith other demographic variables there is no any significant association.

Children With Poorly Controlled Asthma: Randomized Controlled Trial of a Home-Based Environmental Control Intervention

To determine the efficacy of a home-based environmental control (EC) intervention, based on biomarkers for allergen sensitization and secondhand smoke (SHS) exposure, in reducing asthma emergency department (ED) visits among inner-city children with persistent asthma.Children (mean age: 6.3 years) with physician-diagnosed persistent asthma (n = 222) were recruited from an asthma ED visit from August 2013 to February 2016. Subjects had had ≥2 ED asthma visits or >1 hospitalization in the past 12 months and were residents in the Baltimore metropolitan area. Children in foster care and other significant nonasthma respiratory conditions were excluded.In this prospective randomized controlled trial, children in the intervention or attention control group were stratified by age. All children had serological immunoglobulin E testing to common environmental allergens and salivary cotinine measurements for SHS exposure. Caregivers completed surveys about the child’s indoor exposure to mice, cockroaches, cats, and dogs at the baseline, 6-month, and 12-month time points. The intervention group had a medical follow-up visit in the ED within 7 days of enrollment, 2 home nurse visits for asthma follow-up, a targeted EC educational and remediation program based on the child’s sensitizations, and motivational interviews with caregivers of children with a positive salivary cotinine result to encourage a ban on home smoking. The control group had 3 home nurse visits, basic EC education without remediation, and a smoking cessation referral.Most (204 out of 222) completed the study at 1 year. Subjects were 65% boys, 94% African American, and 94% Medicaid insured. Approximately 75% had moderate to severe asthma with >1 asthma ED visit in the previous 3 months. Eighty-three percenthad positive serological allergy test results, and 56% had positive salivary cotinine results. The asthma medication ratio of controller to total controller or rescue canisters used, cotinine levels, mouse or cockroach exposure, symptom-free nights, and caregiver worry about medication side effects were no different between groups. Children who resided in homes with no SHS exposure and who were in the control group, atopic children, younger children, and children with an asthma medication ratio >0.5 were more likely have a repeat ED visit. For children with positive SHS exposure, time to first repeat ED visit did not differ by group. For children with no SHS exposure and after adjusting for age, allergic sensitization, and medication fills, the control subjects (70%) were more likely than intervention subjects (45%) to have a repeat ED visit. Overall, baseline increased controller and rescue medication fills were the only factors associated with increased risk for repeat ED visits for all subjects.Home-based, targeted EC intervention was not more effective in reducing repeat asthma ED visits in children with persistent asthma and SHS exposure compared with controls.This study further illustrates that achieving good asthma control truly requires a consistent, multipronged approach. Indoor allergies and SHS are problematic factors in asthma management, and smoking and/or indoor allergen interventions in other studies have reported mixed success in improving asthma outcomes. The type or number of interventions in this study may have been inadequate and/or did not account for all other caregiver or social challenges. Not considering the baseline and asthma medical management during the study is a significant limitation. Also, this study included mostly inner-city, minority subjects with very poorly controlled asthma, so possibly, these interventions could have different outcomes in other populations.

The Effect of “Pathway” to Diagnosis for Childhood ITP on Caregiver Quality of Life at Time of Diagnosis

Background: Immune thrombocytopenia (ITP) is an immune mediated bleeding disorder characterized by isolated thrombocytopenia. ITP can have a variety of presentations from asymptomatic to life threatening bleeding. Although childhood ITP is most often a self-resolving illness which can be closely observed without intervention, it can be associated with significant impact on quality of life (QoL). Prospective studies of QoL in ITP patients show that there is not always a correlation with treatment or disease severity. The pathway from initial presentation to final diagnosis varies and may include encounters with emergency room, primary care or specialty providers. There have been no published studies to date showing the impact of factors prior to the diagnosis of ITP on treatment decision making and QoL. Objective: To identify the role of physician-patient and physician-caregiver interactions on the QoL and emotional well-being of patients and their families. Ascertaining the impact of pre-diagnosis factors may provide an opportunity to improve access and quality of care provided. Methods: The ITP Consortium of North America (ICON) "Pathways" study was a multicenter observational prospective cohort study focused on the pathways to diagnosis of ITP. The study was supported by a Foundation for Morristown Medical Center Research Fund Grant. Subjects were included if they had presumed primary ITP and were age &gt;12 months to &lt;18 years. Subjects were excluded if they had secondary ITP, including Evans syndrome. Treatment was determined by the physician. Subjects were consented and presented with questionnaires to be completed at the conclusion of the initial hematology visit. The hematologist also completed survey data at that time. Survey data forms included demographic form, physician form, Peds QL Family Impact Questionnaire, Kids ITP tools (KIT) Parent Impact Report and parent proxy report, and child (patient) KIT self-report. There was a parent questionnaire which included a question about worry with a scale from 0 to 10. Study data were collected and managed using REDCap electronic data capture tools hosted at Atlantic Health System. Correlation between variables were calculated using Pearson coefficient or Spearman's rho depending on the distribution of the data variables. Results: Sixty subjects and caregivers were enrolled at 6 ICON centers; 52 were eligible for inclusion. The majority (40%) had Grade 1 bleeding. Most patients (82%) were seen in outpatient hematology clinic by the hematologist and had been referred by the emergency room (73%). The median time to consultation with a hematologist from onset of symptoms was 7 days (1-199) and the median time to diagnosis by hematologist from initial contact with a health care provider was 5 days (0-154). Most subjects had seen 2 health care providers prior to the hematologist. KIT proxy report cumulative scores were a mean of 76.03 (SD 14.72). There was no significant difference between the time to diagnosis or the time from initial encounter with health care provider to hematologist and initial level of worry (p=0.70 and 0.90, respectively). There was also no significant difference between the time to diagnosis or the time from initial encounter with health care provider to hematologist and KIT proxy scores (p=0.96 and 0.50, respectively). However, there was a significant decline in level of worry (scale 0-10) prior to the hematologist visit (median 8, range 1-10) to after the visit (median 4, range 1-10). The association between number of medical providers encountered prior to diagnosis and KIT proxy scores was not significant (p=0.45) (Table). Conclusions: In this study at 6 teaching institutions, we were unable to detect a significant difference in proxy-reported KIT scores relative to the number of health care providers seen or time from diagnosis until the first encounter with the hematologist. We were, however, able to detect a significant change in the level of caregiver worry pre- and post- visit with the pediatric hematologist, supporting a benefit of specialist care to the caregivers of children with ITP. This study was limited by its small sample size and retrospective design. ITP is considered a benign disease but is associated with a significant amount of worry and impact on QoL for patients and caregivers which warrants further investigation. Disclosures Lambert: CSL Behring: Consultancy; Amgen: Consultancy, Other; Bayer: Other: Ad boards; Novartis: Other: Ad boards, Research Funding; Shionogi: Consultancy; Kedrion: Consultancy; Sysmex: Consultancy; AstraZeneca: Research Funding; PDSA: Research Funding. Grace:Agios Pharmaceuticals, Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding.

Very Poorly Controlled Asthma in Urban Minority Children: Lessons Learned

Very poorly controlled (VPC) asthma in children is associated with ongoing acute exacerbations but factors associated with VPC are understudied. To examine the risk factors associated with VPC asthma in urban minority children. This descriptive study examined asthma control levels (well-controlled [WC], not well-controlled [NWC], and VPC) at baseline and 6 months in children participating in an ongoing randomized controlled trial of an emergency department/home environmental control intervention. Data collection occurred during the index emergency department visit and included allergen-specific IgE and salivary cotinine testing and caregiver interview of sociodemographic and child health characteristics. Follow-up data were collected at 6 months. Unadjusted analyses examined the association of sociodemographic and health characteristics by level of asthma control. Multivariate analysis tested significant factors associated with VPC asthma at 6 months. At baseline most children were categorized with VPC asthma (WC, 0%; NWC, 47%; VPC, 53%) and rates of VPC minimally improved at 6 months (WC, 13%; NWC, 41%; VPC, 46%). Risk for VPC asthma was twice as likely in children with allergic rhinitis (odds ratio [OR], 2.42), having 2 or more primary care provider asthma visits within the past 3 months (OR, 2.77), or caregiver worry about medication side effects (OR, 2.13) and 3 to 4 times more likely when asthma control was assessed during the fall or spring season (OR: fall, 3.32; spring, 4.14). Improving asthma control in low-income, high-risk children with VPC asthma requires treatment of comorbidities, attention to caregiver medication beliefs, and adept use of stepwise therapy.

Associations between caregiving worries and psychophysical well-being. An investigation on home-cared cancer patients family caregivers.

Caregiving to a family member with cancer might have health implications. However, limited research has investigated the psychophysical health of home-cared cancer patients family caregivers. In a previous study, we have found that a prolonged worry in daily life is a crucial variable compared to caregivers' psychophysical symptomatology. This investigation was designed to further examine the well-being of family caregivers, explore the domains of worry, and assess to what extent "content-dependent" worry could be associated with the caregivers' health The sample consisted of 100 family caregivers of oncological patients assisted at home. Participants completed a battery of self-report questionnaires (Penn State Worry Questionnaire, Worry Domain Questionnaire, Hospital Anxiety and Depression Scale, Family Strain Questionnaire Short Form, and Psychophysiological Questionnaire of the Battery CBA 2.0). The level of worry was medium-high among participants, and caregivers worry more about their occupation and future. Depression, anxiety, and somatic symptomatology levels resulted mild, while strain level resulted high. Statistical analyses confirm the conclusions of the previous study, revealing a significant positive correlation between worry levels and caregivers' psychophysical health. Innovatively, it has been highlighted that who has higher scores of content-dependent worry shows also higher levels of strain, somatic symptoms, anxiety, and depression Not only trait-worry ("content-free" measure) but also content-dependent worry is associated with strain and negative health outcomes. People may worry about different targets, and it might be useful to further investigate what are the specific worriers of family caregivers in order to promote their physical and emotional well-being.

Sleep in Dementia Caregivers and the Effect of a Nighttime Monitoring System

The purpose of this study was to determine if a nighttime home monitoring system, designed to track the movements of a care recipient with dementia, would relieve worry and improve sleep in caregivers of persons with dementia. In this controlled clinical trial, 49 dementia caregivers were followed for up to 1 year. Sleep was measured for 7-day intervals at nine points in time using actigraphy and a sleep diary. Although the experimental caregivers generally reported that the system was "of great help" in relieving worry about nighttime activity, no significant group differences were found using multilevel modeling analyses. With regard to total sleep time, time awake after sleep onset, and sleep quality, multilevel models did not demonstrate any changes in sleep between groups, either averaged over time or for the interaction of group and time. Since previous analysis of our qualitative data suggested improvements in caregiver worry and sleep, problems other than night awakenings may be perpetuating the sleep problem. Future studies should include testing of multimodal sleep interventions. Caregivers have high amounts of unwanted wake time during the night and additional research is needed to identify effective interventions to improve their sleep.

Factors Affecting Burden of Family Caregivers of Community-Dwelling Ambulatory Elders with Dementia in Korea

The purpose of the study was to test a staged causal model as a theoretical base to explain the burden of family caregivers of community-dwelling self-ambulatory persons with dementia (PWDs) in Korea. The model contained three stages including antecedents (Stage 1), behavior (Stage 2), and outcome (Stage 3). The antecedents were variables of the PWDs (e.g., cognitive impairment and activities of daily living [ADL] dependency of the PWDs) and caregiver variables (e.g., age, gender of caregiver, and the relationship of caregiver to PWD). Stage 2 focused on wandering behavior. In Stage 3, the outcome variable was caregiver burden. A total of 83 noninstitutionalized, community-dwelling elders with dementia and their family caregivers participated. The instruments used in this study were the Korean version of Mini Mental State Examination, K-PADL (Korean-Physical Activities of Daily Living), Korean-Revised Algase Wandering Scale-Community Version, and K-CWOB (Caregiver Worry, Overload, and Role Captivity Scale-Korean) Korean versions of standardized Western instruments. Results indicate that cognitive impairment and ADL dependency had an indirect influence on caregiver burden through wandering behavior. In addition, caregiver age had a direct impact on caregiver burden. The findings of this study suggest that further refinement of the underlying model is warranted.

La participation à l'aide et aux soins des conjoints et des enfants auprès de personnes âgées nouvellement hébergées en centre d'hébergement et de soins de longue durée

ABSTRACTThis study investigates the participation of family caregivers when an elderly relative is going to a nursing home. Twenty-two primary caregivers, whose relative, aged 60 years or older, had recently been admitted to a public nursing home, were interviewed. The content analysis reveals that caregivers worry about and do what is needed to ensure the physical, psychological, and social well-being of their elderly relative and take care of her/his belongings. Doing things for her/him gradually gives way to managing things. Caregivers carry out the duty of protecting their family members, stimulating them, and keeping a close watch on the work of the staff of the institution.

The Effect of Seasonal Allergic Rhinitis in Children on Caregivers' Lives: A Pilot Study

The objective of this pilot study was to assess the impact of seasonal allergic rhinitis in children on social and emotional aspects of the caregivers' lives. A five-item self-administered questionnaire was completed by 78 caregivers. The questionnaire assessed the following items: caregivers' worries about their child's health, caregivers' abilities to pursue social activities as well as non-work and work-related activities, and caregivers' abilities to work and to be productive at work. Results revealed that 66.7% of caregivers worry about the effects of allergies on their child's health; 28.2% of caregivers feel that their child's allergies interfere with their own social activities, while 21.8% feel that it interferes with their ability to conduct non-work-related daily activities. Among employed caregivers, 10.3% declared being affected in their ability to work, 8.2% declared being affected in their ability to be productive at work, and 12.3% missed work because of their child's allergies. Finally, we found that the use of outside, nonmedical services for the prevention of allergies was rarely sought by caregivers. A significant proportion of caregivers were concerned about their child's health. A lower number, but significant proportion of caregivers, felt restrained in their ability to pursue social and non-work-related activities. Similar conclusions were reached when caregivers were stratified by employment status. However, unemployed caregivers were significantly more affected than employed caregivers in their ability to conduct non-work-related activities. (Peditr Asthma Allergy Immunol 2000;14(2):119–124.)