Caregivers In Singapore Research Articles

Why do pressure injuries still occur? A multicenter qualitative study of nurses and caregivers

BackgroundThe frequent occurrence of pressure injuries despite their preventability, raises important questions about our understanding of the barriers to care. This study explores the lived experience of nurses and caregivers in Singapore to establish a conceptual framework for better understanding pressure injuries arising in the community. MethodsA multicentre qualitative study was conducted utilising semi-structured interviews and focused group discussions of nurses and caregivers of patients with pressure injuries. Data was collected with a narrative inquiry approach and analysed with grounded theory. An iterative cycle of interviewing, coding, discussion and reflection was conducted until theoretical saturation. ResultsTen inpatient nurses and ten caregivers from the community were recruited. Analysis identified cognitive (awareness and caregiver training), emotional (motivation and empowerment), resource (human and infrastructural), and biomedical factors which collectively impacted the effectiveness of prevention. Additionally, constructs of learning and sustainability of caregiving played a crucial role in long term prevention. LimitationThe derived framework requires further validation with quantitative data and may not be generalizable to other cultural and economic populations. ConclusionMultiple constructs have been identified to have a synergistic effect in prevention. Targeted measures should be implemented by healthcare institutions to better equip caregivers in prevention.

Stress and Loneliness Among Family Caregivers of Older Persons With Cognitive Impairment: The Mediating Role of Social Isolation and the Moderating Role of Personal Mastery.

Relatively little attention has been paid to the underlying processes and conditions leading to loneliness among caregivers of older persons with cognitive impairment (PCI). Drawing upon the caregiver stress-process model and the social relationship expectations framework, this study examined the mediating role of social isolation and the moderating role of caregiver personal mastery in the association between PCI memory and behavioral problems and caregiver loneliness. Structural equation modeling was applied to cross-sectional data from 266 caregivers in Singapore. Caregiver-reported PCI memory and behavioral problems were associated with increased levels of caregiver loneliness. Caregiver social isolation partially mediated the association and caregiver personal mastery moderated the association. Caregivers with low mastery were more likely to experience loneliness due in part to social isolation resulting from their PCI's memory and behavioral problems. Tailored interventions should address caregiver social isolation and foster caregiver personal mastery.

Informal caregiving time and its monetary value in the context of older adults in Singapore

BackgroundLittle is known about the caregiving time of different types of caregivers in Singapore or its monetary value. We quantified the caregiving time of primary informal, secondary informal, and migrant domestic worker (MDW) caregivers of older adults and estimated the monetary value of caregiving time of primary and secondary informal caregivers. Methods278 primary informal caregivers reported the time provided by themselves, secondary informal caregivers and MDW caregivers in a typical week helping their care-recipients, aged ≥75 years, with activities of daily living (ADLs), instrumental ADLs, healthcare and social care use, other needs, and supervision of MDW caregivers. We estimated monetary value using the proxy good method. ResultsOn average, primary and secondary informal caregivers provided 33.0 (annual monetary value: S$15,959) and 8.4 (annual monetary value: S$4,062) caregiving hours/week. MDW caregivers provided even more – 42.0 h/week. Care-recipients received 60.5 h of care/week on average. Nationally, the monetary value of informal caregiving time for Singaporeans aged ≥75 years requiring human assistance was about S$1.28 billion. ConclusionThis study highlights the substantial time commitment of informal and MDW caregivers. Our estimates of the monetary value of informal caregiving time can inform economic evaluations of care models for older adults and policies for supporting informal caregivers, particularly in societies that rely heavily on informal care.

Feeling Alone Together: Loneliness in Older Adults with Cognitive Impairment and Their Family Caregivers with Low Mastery

Introduction: Loneliness in older persons with cognitive impairment (PCI) may beget loneliness in their family caregivers, depending on buffering resources caregivers possess. This study examined the association between loneliness in older PCI and loneliness experienced by their family caregivers, and the moderating role of caregiver mastery in this association. Methods: Dyadic data from 135 PCI and their family caregivers in Singapore were analyzed using multivariable regression. Loneliness was measured using a three-item UCLA loneliness scale. Mastery was assessed using a seven-item Pearlin instrument. Results: Multivariable regression showed that PCI loneliness and caregiver loneliness were weakly associated, taking other covariates into account. Notably, a significant interaction between PCI loneliness and caregiver mastery was observed, indicating that PCI loneliness was associated with caregiver loneliness only when caregivers had low mastery. Conclusion: Lonely PCI may share their feelings of loneliness with their caregivers, and this can lead to loneliness among caregivers if they have low mastery. Promoting caregiver mastery may help reduce caregiver loneliness, directly and indirectly as a buffer against PCI loneliness.

Exploring the Lived Experiences of Caregiving for Older Family Members by Young Caregivers in Singapore: Transition, Trials, and Tribulations.

Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.

FEELING ALONE TOGETHER: LONELINESS IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT AND THEIR CAREGIVERS WITH LOW MASTERY

Abstract Loneliness can be contagious because lonely people tend to share their loneliness with others. According to this perspective, loneliness in older persons with cognitive impairment (PCI) may beget loneliness in their family caregivers. However, not all caregivers of lonely PCI experience loneliness. This may be because caregivers have buffering resources that mitigate the contagion of loneliness. Nevertheless, empirical evidence on whether and how PCI and caregiver loneliness are related is lacking. Therefore, we examined the association between PCI loneliness and caregiver loneliness, and the moderation role of caregiver mastery on this association. We used dyadic data from 135 PCI and their family caregivers in Singapore. Descriptive statistics and bivariate correlation showed that PCI reported higher levels of loneliness than their caregivers, and PCI and caregiver loneliness were weakly related. Multivariable regression showed that PCI loneliness was not associated with caregiver loneliness, taking other covariates into account. Nevertheless, we found that the interaction between PCI loneliness and caregiver sense of mastery was significant, such that PCI loneliness was significantly associated with caregiver loneliness when caregivers had low mastery. In conclusion, lonely PCI may share their loneliness with their caregivers, and this may lead to caregiver loneliness if caregivers have low mastery. Tailored interventions should be designed to reduce loneliness among PCI and their caregivers and improve caregiver mastery as a protective factor against the spread of loneliness between PCI and caregivers.

Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers.

Person-centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change. This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers. Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement. Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers. What is already known on this subject Little is known about patients and caregivers' experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements. What this study adds to existing knowledge This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. What are the clinical implications of this work? This research highlights the importance of considering the consumers' perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers.

Impact of a COVID-19-Related Lockdown on the Experience of Informal Caregiving in Singapore

Introduction: Lockdowns, while limiting COVID-19 transmission, can affect provision of care by informal caregivers and their caregiving experience. We assessed, among informal caregivers in Singapore, (a) the perceived impact of a 2-month (April to May 2020) nationwide lockdown on their care provision, (b) correlates of different perceptions of the impact of the lockdown on care provision, and (c) association of different perceptions of the impact with negative and positive experiences of caregiving. Methods: In the August 2020 wave of the Singapore Life Panel (SLP; nationally representative, longitudinal monthly survey of Singapore citizens and permanent residents aged 50–70 years at baseline), 1,094 participants identified as informal caregivers reported whether their care provision became easier, remained the same, or became harder during the lockdown, compared to before the lockdown. We used multinomial logistic regression to assess the association of caregiver, care recipient, and caregiving context characteristics with their perceptions. Linear regression models examined the association of their perceptions with negative and positive experience domains of the modified Caregiver Reaction Assessment. Results: Just over one-third (36.1%) of the informal caregivers reported that their care provision became harder during the lockdown compared to before the lockdown. However, nearly one-fifth (18.0%) said that it became easier, and the rest (45.9%) said that it remained the same. Care provision was more likely to be perceived as having become harder among caregivers who were male, of Chinese ethnicity, in worse health, whose care recipients had functional limitations, who did not have caregiving support from cohabiting family members before the lockdown, and who had caregiving support from non-cohabiting family members before the lockdown. The perception that care provision became easier was less likely among caregivers who were of higher age, were unemployed, were socially isolated, and whose care recipients had functional limitations. Caregivers who perceived that care provision became harder during the lockdown were worse-off in negative experiences of caregiving. Conclusion: A nationwide lockdown did not make care provision harder for all informal caregivers. However, informal caregivers for whom it did were more likely to have greater negative experiences of caregiving. The heterogeneity of the impact of lockdowns and the possibility of offering flexibility to non-cohabiting family members who support caregiving should be important considerations when planning for such disruptions.

Health Profiles among Community-Dwelling Older Adults with Cognitive Impairment and Their Implications for Caregiving Experience

Introduction: Identifying health conditions of persons with cognitive impairment (PCI) in the community and exploring their implications for caregiving experience are vital for effective allocation of healthcare resources. This study examined distinct PCI health profiles among community-dwelling PCI and their association with caregiving burden and benefits. Methods: Latent profile analysis and multivariable regression were applied to dyadic data from 266 PCI and their caregivers in Singapore. Results: Three PCI health profiles were identified: less impaired (40% of PCI), moderately impaired (30%), and severely impaired (30%). Caregivers for severely impaired PCI were more likely to report a higher level of caregiving burden, and caregivers for moderately impaired PCI were more likely to report a higher level of caregiving benefits, compared to caregivers for less impaired PCI. Conclusion: The findings captured heterogeneity in health status among PCI in the community. Tailored interventions, based on PCI health profiles, should be designed to reduce caregiving burden and increase caregiving benefits.

A prospective cohort study of decision-making role preferences of patients with advanced cancer and their family caregivers.

This study aimed to examine (1) the evolution of patients-caregiver dyad decision-making role preferences over 3years and the predictors of these preferences; and (2) discordance in decision-making role preferences among dyads. A total of 311 patients with advanced solid cancer and their caregivers in Singapore reported their preferences for decision-making roles every 3months. The predictors for decision-making role preferences among dyads were identified via the actor-partner interdependence framework using a mixed-effect ordered logistic model. The proportion of patients and caregivers preferring patient-led decision-making was higher at the end of third year compared to baseline (patients: 40% vs. 20%, p value <.01; caregivers: 33% vs. 21%, p value=.03). Patients with female (odds ratio [OR], 1.74; p value <.01) and older (1-year OR, 1.02; p value <.01) caregivers and younger patients (1-year OR, 0.97; p value <.01) preferred higher involvement in decision-making. Caregivers with tertiary education (vs. lower education) (OR, 1.59; p value= .02) and those who accurately understood patients' treatment goals (OR, 1.37; p value= .01) preferred greater patient involvement in decision-making. Conversely, caregivers of female patients (OR, 0.68; p value= .03) and younger patients (1-year OR, 0.98; p value <.01) preferred lesser patient involvement in decision-making. The proportion of patient-caregiver dyads with discordance in preferred decision-making was lower at the end of the third year (51%) compared to baseline (68%) (p value <.01). Despite a reduction in the proportion of dyads with discordance toward the end-of-life, the percentage with discordance remained high throughout the illness trajectory. Interventions facilitating open communication between dyads should be pursued in efforts to decrease dyadic discordance.

Understanding Bereavement Experiences and Coping Among Bereaved Family Caregivers in Singapore: Positive Meaning Reconstruction in the Dual Process Model.

The aim of this retrospective qualitative study was to examine the bereavement experiences and coping of family caregivers, with the Dual Process Model (DPM) as the theoretical framework. A purposive sample of 15 bereaved family caregivers, who had lived with and/or cared for their dying spouse or parent, were recruited from a local hospice. Using the interpretative phenomenological analysis approach, all one-to-one interviews were audio-recorded, transcribed, and entered into NVivo 12 Plus software for analysis. The major themes in this study mirrored well-established components of the DPM, including the concept of overload from the revised model. The cognitive processes of meaning making, an integral component of the DPM, were also discovered and put forth as a fifth theme to illustrate reconstruction of positive meaning. This is posited as an adaptive outcome to successful oscillation between loss-oriented and restoration-oriented grieving processes and, hence, leading to implications for bereavement care and support.

Occupations of Terminally Ill Chinese Older Adults and Their Caregivers in Singapore: A Qualitative Exploratory Study.

Occupations are everyday activities people do that bring meaning and purpose to life and is culturally shaped. This research aimed to explore the occupations of Chinese older adults living with a terminal illness and their caregivers in Singapore. Using a qualitative exploratory approach, 16 care recipient-family caregiver dyads were recruited from a local hospice provider. Semi-structured interviews were carried out and reflexive thematic analysis was employed. Three themes and seven subthemes described the challenges and changes to daily life faced by care recipients and caregivers as they adjusted to living with the terminal condition. Findings suggest that in a family-centric society, the occupations of care recipients are greatly impacted by their families. It is imperative to engage with family members in goal setting and intervention plans to facilitate therapy gains and carry-over into real life. These results may be applicable to other family-centric societies, but further research is required.

Impact of COVID-19 Measures on Discharge Planning and Continuity of Integrated Care in the Community for Older Patients in Singapore.

Introduction:The COVID-19 pandemic affects the process of care transition for patients with underlying chronic conditions. This study aims to explore the impact of the pandemic measures on discharge planning and continuum of care for vulnerable older patients from multi-stakeholder perspectives.Methods:We conducted focus group discussions and individual interviews with healthcare workers, community partners, government officials and family caregivers in Singapore. All interviews were audio-recorded, transcribed verbatim and thematically analysed.Results:A total of 53 individuals participated in the study. Discharge planning and care continuity in the community were affected primarily by the limited step-down care options and remote assessment of discharge needs. Participants felt a need to revisit the decision of ‘essential’ community services through engagement of all stakeholders to enhance care community.To improve better care transition, participants suggested the need for clearer communication of guidelines, improved intersectoral collaboration, shared responsibility of patient care through community engagement and employment of novel models of care.Conclusion:The pandemic measures generated challenges of safe discharge of patients and care continuity in the community. Findings shed light on the need to proactively assess care pathways and catalyse novel models to improve care transition beyond the pandemic.

Four of a kind: Salient caregiver archetypes to better understand the psychosocial needs and behavioral patterns of dementia caregivers in Singapore

BackgroundFamily caregivers’ lived experiences are often perceived as a homogenous entity, preventing effective identification of unique caregiving needs and appropriate support. Our study examined and classified the varying dementia caregiving experiences in an Asian setting, through establishing caregiver archetypes. MethodsSecondary analysis of semi-structured interviews conducted with 16 dementia family caregivers in a Singapore hospital was performed. Thematic analysis and typological analysis were utilized. ResultsFour caregiver archetypes (Reluctant, Ambivalent, Enlightened, and Selfless) were identified: Reluctant caregivers possessed poor understanding of dementia and experienced immeasurable distress; Ambivalent caregivers carried mixed feelings towards caregiving and felt unsupported; Enlightened caregivers preserved care-recipients’ dignity and accepted challenges with priority on sustainable care; Selfless caregivers were overly-devoted and enmeshed in the caregiver identity. ConclusionOur findings are useful in providing a framework for: (1) rapid understanding of informal caregivers’ varying needs, (2) targeted support in a holistic caregiver-centered manner.

Changes In Mental Health, Social Engagement, and Physical Activities During the COVID-19 Pandemic

The current COVID-19 pandemic has profoundly changed our behaviors and health, especially vulnerable community-dwelling older adults. This symposium includes three presentations that evaluated the pandemic’s impacts on mental health, social engagement and physical activity in healthy community-living older adults and those with dementia. Dr. Wenjun Li and his team examined the pandemic impact on mental health and social engagement among relatively healthy older adults residing in suburban and rural neighborhoods in Central Massachusetts, USA. The study reported significant variations in pandemic impacts by sex, age, race, income, living arrangement, and neighborhood housing density, suggesting the pandemic has had disproportionally negative impacts on socially and economically disadvantaged vulnerable older adults. Dr. W. Quin Yow and her team evaluated the impacts of government mandated social distancing and lockdowns on older adults with dementia and their caregivers in Singapore. The study found significant increases in irritability, aggression and hallucinations among older adults with dementia, and possible deterioration of health conditions and heightened moderate level of stress. The results suggest that social distancing may have resulted in negative outcomes in this vulnerable population with dementia and their caregivers. Dr. Ladda Thiamwong reported her team’s efforts on forming an international aging research collaborative to mitigate heath consequences of COVID-19 crisis from the international perspective. The team consists of ten scholars from five countries, including Hong Kong, Nepal, Singapore, Thailand, and the United States. They collect data using combinations of online and face-to-face surveys. Their important findings will be discussed in detail in this symposium.

Development and validation of caregiver stress and support scale for caregivers of individuals with disabilities in Singapore

Purpose Few available measures include culturally salient stressors and support systems for caregivers of offspring with disabilities in Asia. The purpose of this study was to develop and validate a self-report measure that included relevant stressors and sources of support for caregivers of offspring with disabilities. Materials and methods Open-ended interviews with eight caregivers in Singapore, along with existing measures were used to develop items. The original 34 items were administered to caregivers of offspring with disabilities in Singapore (n = 234, 85% mothers). Based on an examination of factor loadings, internal consistency, and feedback from professionals, the scale was revised and administered to 370 caregivers (78% mothers), along with other measures of stress, support, depression, and well-being. Results Exploratory factor analysis of the original 34-item scale yielded two factors, Sources of Stress and Sources of Support. After scale revision, confirmatory factor analysis showed that a two-factor structure demonstrated a fair fit. The subscales showed adequate internal consistency and test-retest reliability, and significant associations in expected directions with other measures of stress and support, as well as with depressive symptoms and well-being. Conclusions The measure has adequate reliability and validity, with implications for use by local service providers. Implications for rehabilitation Caregivers face unique challenges, such as stressors associated with caregiving, with varying support systems available to reduce the stress. A psychometrically-sound measure can be used to assess sources of stress and support, monitor services, and address service gaps for caregivers. The Sources of Caregiver Stress and Support Scale is a contextually-sensitive self-report measure for caregivers of people with disabilities in Singapore.

The challenges and positive aspects of informal stroke caregiving in Singapore

Informal stroke caregiving can pose a high caregiver burden on stroke caregivers; however, there is a lack of such data in Singaporean stroke caregivers. This study aimed to investigate the level of caregiver burden and the positive aspects of caregiving experienced by stroke caregivers in Singapore.

Acute paediatrics tele-support for caregivers in Singapore: an initial experience with a prototype Chatbot: UPAL.

Acute paediatrics tele-support for caregivers in Singapore: an initial experience with a prototype Chatbot: UPAL.

Lifestyle and Symptom Management Needs: A Network Analysis of Family Caregiver Needs of Cancer Patients.

Previous research on the needs of family cancer caregivers (FCCs) have not elucidated associations between specific caregiving needs. Network analysis, a statistical approach that allows the estimation of complex relationship patterns, helps facilitate the understanding of associations between needs and provides the opportunity to identify and direct interventions at relevant and specific targets. No studies to date, have applied network analysis to FCC populations. The aim of the study is to explore the network structure of FCC needs in a cohort of caregivers in Singapore. FCCs (N = 363) were recruited and completed a self-report questionnaire on socio-demographic data, medical data on their loved ones, and the Needs Assessment of Family Caregivers-Cancer scale. The network was estimated using state-of-the-art regularized partial correlation model. The most central needs were having to deal with lifestyle changes and managing care-recipients cancer-related symptoms. The strongest associations were between (1) having enough insurance coverage and understanding/navigating insurance coverage, (2) managing cancer-related pain and managing cancer-related symptoms, (3) being satisfied with relationships and having intimate relationships, and (4) taking care of bills and paying off medical expenses. Lifestyle changes, living with cancer, and symptom management are central to FCCs in Singapore. These areas deserve special attention in the development of caregiver support systems. Our findings highlight the need to improve access to social and medical support to help FCCs in their transition into the caregiving role and handle cancer-related problems.

Asian Attitudes and Perceptions Toward Hospital-At-Home: A Cross-Sectional Study.

Introduction: Hospital-at-Home (HaH) programmes are well-established in Australia, Europe, and the United States. However, there is limited experience in Asia, where the hospital is traditionally seen as a safe and trusted space for healing. This cross-sectional study aimed to explore attitudes and perceptions among patients and caregivers in Singapore toward this care model.Methods: A quantitative study design was adopted to collect data among patients and their caregivers from medical wards within two acute hospitals in Singapore. Using a series of closed-ended and open-ended questions, the investigator-administered survey aimed to explore barriers and facilitators determining patients' and caregivers' responses. The study questionnaire was pretested and validated. Data were summarised using descriptive statistics, and logistic regression was performed to determine key factors influencing patients' decisions to enrol in such programmes.Results: Survey responses were collected from 120 participants (101 patients, 19 caregivers; response rate: 76%), of which 87 respondents (72.5%) expressed willingness to try HaH if offered. Many respondents valued non-quantifiable programme benefits, including perceived gains in quality of life. Among them, reasons cited for acceptance included preference for the comfort of their home environment, presence of family members, and confidence toward remote monitoring modalities. Among respondents who were unwilling to accept HaH, a common reason indicated was stronger confidence toward hospital care.Discussion: Most patients surveyed were open to having acute care delivered in their home environment, and concerns expressed may largely be addressed by operational considerations. The findings provide useful insights toward the planning of HaH programmes in Singapore.