Caregivers Of Community-dwelling Older Adults Research Articles

Time Use and Well-Being in Family and Other Unpaid Caregivers of Older Adults.

Caregivers report limited freedom to engage with others, participate in physical activities, pursue leisure activities, and sleep. Few studies have focused on caregivers' time use across different activities, particularly how different patterns of time use are associated with well-being. This study aimed to (a) identify time-use profiles of family caregivers of older adults and (b) examine associations between identified time-use profiles and caregiver well-being. We analyzed data from 1,640 family caregivers of community-dwelling older adults from Round 7 (2017) of the National Study of Caregiving and the National Health and Aging Trends Study. Latent profile analysis was used to estimate time-use profiles based on 4 indicators (i.e., regenerative time, discretionary time, eldercare-related committed time, non-eldercare committed time). We conducted regressions to examine the relationship between the latent profiles and well-being outcomes. Three profiles of caregivers emerged based on time-use patterns. The Overloaded profile (20%) spent the greatest time in non-eldercare committed activities, such as household activities and paid work. The Flexible profile (49%) spent the most amount of time in social activities and physical activities, and the least amount of non-eldercare committed time compared to the other 2 caregiver types. Lastly, the Occupied profile (31%) allocated time relatively evenly in all activities. When comparing well-being outcomes, caregivers in the Flexible profile had lower levels of anxiety than the Occupied profile. The profiles acknowledge the diverse experiences of caregivers, underscoring the significance of granting them greater latitude in balancing eldercare responsibilities and personal life for enhanced well-being.

Exploring Experiences of Pain Management Among Family Caregivers of Community-Dwelling Older Adults With Dementia.

Pain is often underreported and under-treated in older adults with dementia. The role of family caregivers (FCGs) in managing pain for their loved ones with dementia living in community has been significantly burdensome. Surprisingly, research has not delved into the experiences of FCGs' concerning pain management in this context. A qualitative descriptive study was conducted to gain a deep understanding of FCGs' experiences in managing pain for their loved ones. Family caregivers participated in semi-structured face-to-face or telephone interviews. Inclusion criterion included being an adult providing care to community-dwelling older adults with dementia. Recruitment stopped upon reaching thematic saturation. Basic demographic characteristics was also collected. Constant comparison analytic method was employed. The study included 25 FCGs in central Virginia, spanning ages from 29 to 95. Participants were predominantly white, female, married, and had a minimum high school education. Most of them were adult children (52%) or the spouses (28%) of the care recipients. Four thematic categories emerged around exploring FCGs' pain management experiences: (1) Values; (2) Barriers; (3) Support; and (4) Adaptation. Each theme included sub-themes. Family caregivers follow their values to make decisions in pain management. Barriers existed for effective pain management. Adaptation and support from professional or formal caregivers greatly improved FCGs' perception of their competence in pain management. The finding underscores the need for further research and the development of interventions aimed at enhancing FCGs' perception of self-efficacy in this crucial aspect of caregiving.

Influence of medical care tasks on subjective burden and gain among older adults’ family caregivers: structural equation modeling for testing the role of formal and informal support

BackgroundThe number of caregivers performing medical care tasks at home for older adults is expected to increase. Family caregivers, who are not healthcare professionals, are likely to find these activities difficult and burdensome. However, appropriate support may decrease the negative and increase the positive aspects of caregiving. This study investigated direct associations between caregivers providing medical care at home and their negative and positive appraisals of caregiving (burden and gain), indirect associations through healthcare professional support and informal support, and whether the associations between medical care tasks and caregivers’ appraisals of caregiving differed based on the support received.MethodsInterview surveys were conducted in 2013, 2016, and 2019 in a Tokyo Metropolitan Area city with family caregivers of community-dwelling older adults who were certified as requiring care in Japan’s long-term care insurance system. This study analyzed the combined data from each survey (n = 983). Structural equation modeling (SEM) analysis was utilized to examine direct associations between providing medical care and caregiver appraisals and indirect relationships through healthcare professional support and informal support. The modulating effects of these forms of support on the relationship between medical care and caregiver appraisals were assessed using multigroup SEM analyses.ResultsApproximately 9% of family caregivers provided medical care at home. The results of SEM analyses, controlled for care recipients’ physical and cognitive difficulties; caregivers’ age, sex, and economic condition; and survey year, revealed no direct associations between providing medical care and caregivers’ sense of burden and gain. They also did not reveal any indirect effects through either healthcare professional support or informal support. However, the results of multigroup SEM analyses indicated that caregivers providing medical care who used home-visit services by physicians and/or nurses, compared to those who did not, tended to exhibit a greater sense of gain.ConclusionsThese results suggest that family caregivers providing medical care at home can positively change their appraisals of caregiving if they receive appropriate support. Home medical care services provided by healthcare professionals can effectively support caregivers. Developing strategies and policies to make medical care services at home more accessible to caregivers is crucial.

Mobile health applications for communication between caregivers of community-dwelling older adults: A scoping review

It is unclear how mobile health (mHealth) technology can be used for monitoring and communication between caregivers with spatial constraints. This systematic scoping review identifies the characteristics, functions, facilitators, and barriers of mHealth used for communication between various types of caregivers for older adults. Guided by Joanna Briggs Institute Scoping Review Methodology, all published peer-reviewed and grey literature indexed in PubMed, EMBASE, CINAHL, Cochrane Library, and Google Scholar from January 2012 to April 2022 were reviewed. Sixteen of 854 studies met the inclusion criteria. Findings suggested mHealth was primarily used for monitoring older adults’ health, educating about home care, alerting about emergencies, communicating with family members or health providers, and GPS-based location tracking. Responsibility for older adults and willingness to use facilitated usage, while old age-related challenges, illiteracy, lack of technical skills, and cell phone size and Internet connectivity-related limitations impeded it. These findings can help researchers and care providers design better mHealth solutions to provide families with real-time information on older adults.

Effect of a telecare-based intervention on stress levels in informal caregivers of older adults: protocol for a randomized controlled trial.

Due to caregiving commitments, caregivers of older adults may not have the time to make use of the onsite community services available to them during the day. With the support of advanced technology, telecare could be a convenient and easily accessible channel for providing individualized caregiving advice to caregivers. The aim of the study is to describe a research protocol that highlights the development of a telecare-based intervention program for reducing stress levels in informal caregivers of community-dwelling older adults. It is a randomized controlled trial. The study is supported by two community centers. The study participants will be randomly assigned to either the telecare-based intervention group or the control group. The former will receive a 3-month program comprised of three components: online nurse case management supported by a health and social care team, an online resource center, and a discussion forum. The latter will receive the usual services that provided by the community centers. Data will be collected at two time points - pre-intervention (T1) and post-intervention (T2). The primary outcome is stress levels, while secondary outcomes include self-efficacy, depression levels, quality of life, and caregiving burden. Besides taking care of one or more older adults, informal caregivers have to deal with work, chores, and take care of their children. This study will add valuable information to the knowledge gap on whether telecare-based interventions with the support of an integrated health-social team can alleviate the stress levels of informal caregivers of community-dwelling older adults. If successful, policymakers and healthcare professionals should consider incorporating telecare modalities in a primary health setting for informal caregivers to correspond with them, to relieve their caregiving stress and promote a healthy life. https://www.clinicaltrials.gov/, NCT05636982.

TIME-USE AND WELL-BEING IN FAMILY AND OTHER UNPAID CAREGIVERS OF OLDER ADULTS

Abstract Due to the intensive time commitment for caregiving, caregivers report limited freedom to engage with others, participate in physical activities, pursue leisure activities, and have adequate time for sleep. Few studies have focused on caregivers’ time-use across different activities, particularly how different patterns of time-use are associated with well-being. This study aimed to: (1) identify time-use profiles of family caregivers of older adults and (2) examine associations between identified time-use profiles and caregiver well-being. We analyzed 1,640 family caregivers of community-dwelling older adults by combining secondary data from Round 7 (2017) of the National Study of Caregiving and the National Health and Aging Trends Study. We conducted latent profile analysis to estimate time-use profiles including covariates and outcomes. Three classes of caregivers emerged based on time-use patterns. The High Committed class (20%) spent the longest time in non-eldercare related committed activities, such as household activities and paid work. The High Discretionary class (49%) spent the highest amount of discretionary time, including social activities, physical activities, and other free-time activities. They also spent the least amount of non-eldercare committed time compared to the other two caregiver types. Lastly, the Balanced class (31%) allocated time relatively evenly in all activities. When comparing well-being outcomes between time-use profiles, caregivers in the High Discretionary class had worse self-rated health but lower levels of anxiety than the Balanced class. Research on time-use and caregiver well-being may help identify at-risk caregiver groups based on lifestyle profiles and develop targeted policies to promote better caregiver well-being.

Resilience as a protective factor against elder abuse by family caregivers: findings from a cross-sectional study in Hong Kong

PurposeThis study aims to explore the risk and protective factors of abuse on older adults by family caregivers, with a special focus on the protective role of caregiver resilience in elder abuse.Design/methodology/approachThis cross-sectional survey was conducted on a purposive sample of 600 family caregivers of community-dwelling older adults in Hong Kong (mean age = 71.04 and female = 67.2%). Caregivers reported in a guided interview about elder abuse behaviours, caregiver burden, care recipients’ agitated behaviours, caregiver resilience, self-efficacy, social support and basic demographic characteristics. Hierarchical linear regression analyses were conducted to examine the predictors of different forms of elder abuse.FindingsCaregiver resilience was predictive of lower levels of verbal abuse, physical abuse, injury and financial exploitation but not potentially harmful behaviour (PHB). Social support was independent with all forms of elder abuse, while self-efficacy predicted greater physical abuse after the adjustment of confounding variables. Caregiver burden and agitated behaviours by care recipients remained as significant risk factors in the final models when protective factors were considered.Research limitations/implicationsThis study extends current knowledge on the protecting role of resilience in elder abuse in family caregiving. Mixed findings revealed on social support and self-efficacy also highlight the complexity of the prediction of caregiver abuse. Further research should address this area.Practical implicationsThe findings of this study warrant the inclusion of caregiver resilience as a key component in developing interventions to prevent elder abuse. Addressing caregiver burden and agitated behaviours have the potential in preventing elder abuse.Social implicationsThe findings raise awareness of the importance of supporting caregivers in the community to prevent elder abuse.Originality/valueResearch concerning the protective factors of elder abuse is in a preliminary stage. To the best of the authors’ knowledge, this study is among the first which successfully demonstrates the protective role of resilience in caregiver abuse on older adults. The findings shed invaluable light on the design of effective interventions.

Lonely in a Crowd: Social Isolation Profiles and Caregiver Burden Among Family Caregivers of Community-Dwelling Older Adults With Cognitive Impairment.

This study identified distinct social isolation profiles among caregivers, each formed by varied combinations of social disconnectedness and loneliness, and examined if and how the profiles were associated with caregiver burden. Latent class analysis and multivariable regression were applied to data from 266 caregivers of community-dwelling older Singaporeans with cognitive impairment. Two caregiver social isolation profiles were identified: strongly connected, not lonely (86%), and moderately connected, lonely (14%). Moderately connected and lonely caregivers tended to perceive a higher level of burden than strongly connected and not lonely caregivers. Moderately connected and lonely caregivers were also more likely to be burdened by their care recipients' poor health than their connected and not lonely counterparts. Caregivers who feel "lonely in a crowd" are vulnerable to caregiving stress and burden. Tailored interventions, such as cognitive behavioral therapy, are needed to reduce the loneliness of moderately connected caregivers.

Development and psychometric evaluation of an instrument to assess Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) in Indonesian community-dwelling older adults

BackgroundThe prevalence of pressure injuries among community-dwelling older adults in countries worldwide is still a serious problem. In Indonesia, older adults mostly rely on family members for (medical) care. Therefore, involving family members in the prevention and treatment of pressure injuries (PIs) could potentially decrease its prevalence rates. However, family members are usually not trained for such tasks. Hence, it is essential to first get more insight into the current state of affairs on family members’ knowledge, attitude and actual practice of preventing PIs. Due to the lack of an existing instrument to measure knowledge, attitude and practice of family caregivers in preventing PIs, this study focuses on the development and evaluation of psychometric properties of such an instrument.MethodsThree phases of instrument development and evaluation were used, including item generation, instrument construction and psychometric testing of the instrument. A total of 372 family caregivers of community-dwelling older adults who randomly selected participated in this study. Principal factor analysis, confirmatory factor analysis and Cronbach’s alpha were performed to evaluate factor structure and internal consistency of the Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) instrument.ResultsThe final version of the KAP-PI-instrument consists of a 12-item knowledge domain, a 9-item attitude domain, and a 12-item practice domain with Cronbach’s Alpha values of 0.83, 0.93 and 0.89, respectively. The instrument appeared to be both reliable and valid.ConclusionThe KAP-PI instrument can be used in family nursing or community nursing practice, education, and research to assess knowledge, attitude and practice of pressure injury prevention of family caregivers.

Giving voice to informal caregivers of community-dwelling older adults: A systematic review of empowerment interventions.

Taking care for older adults can place informal caregivers at risk for developing health problems. Therefore, interventions aiming to empower informal caregivers have been developed. Empowerment refers to a health promotion process including strategies to improve informal caregivers' self-care behaviours, stress-management and caregiving skills. In literature, empowerment-oriented interventions often target subsamples of informal caregivers defined through the care receiver's condition. These interventions, however, do not adequately capture the complexity of care needs and might even exclude informal caregivers taking care for older people without a specific diagnosis or with a subthreshold condition. Therefore, the aim of this systematic review is to provide an overview of the content and effectiveness of empowerment-oriented interventions directed at informal caregivers of community-dwelling older adults. Following the PRISMA guidelines, a systematic review was performed by searching the following databases: PubMed, PsycINFO, EMBASE and Web of Science. From a total of 6798 unique publications, 13 intervention studies, of which seven randomised controlled trials, were eligible for inclusion. According to the Mixed Methods Appraisal Tool, eight studies scored poor. The intervention studies under review represented different domains of empowerment, with cultivation of positive feelings being the most prevalent one. Social participation and physical health received little attention in interventions. Although no adverse intervention effects were observed, the studies reported mixed results with 57 positive and 47 neutral effects. The limited number and poor quality of studies emphasise the need for future research investigating the effectiveness of empowerment-oriented interventions targeting informal caregivers of older adults.

Paid Help and Caregiving Experiences of Black Caregivers of Community-Dwelling Older Adults

ABSTRACT Objectives We examine associations between use of paid help and caregiving-related experiences (emotional, financial, and physical difficulty) of Black family and unpaid caregivers of older adults. Methods We examine a sample of N = 572 non-Hispanic Black caregivers of community-dwelling older adults receiving help with daily activities from the 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC). Guided by Pearlin’s Stress Process Model, logistic regression models examine associations between assisting with finding paid help and caregiver experiences. Results Black caregivers who helped care recipients find paid help more often had a college degree or higher, were helping older adults who received assistance with three or more self-care/mobility activities or who were living in poverty and were not receiving help with caregiving from family and friends. In fully-adjusted models, assisting with finding paid help was associated with emotional (AOR 1.92, 95% CI 1.27, 2.92 p < .01) and physical (AOR 2.16, 95% CI 1.04, 4.51; p = .04) difficulty. Conclusions Greater efforts are needed to support Black family and unpaid caregivers who are caring for older adults using paid help. Clinical Implications Future interventions that target Black caregivers of older adults using paid help could be useful for improving caregiving experiences.

Adapting the Namaste Care Program for Use with Caregivers of Community-Dwelling Older Adults with Moderate to Advanced Dementia: A Qualitative Descriptive Study.

Family/friend caregivers are highly involved in supporting older adults with dementia who are 65 years of age or older with daily activities, especially when these older adults with dementia are living at home. There is a need for psychosocial interventions for caregivers of older adults with moderate to advanced dementia, as most interventions focus on persons at earlier stages. Namaste Care is a psychosocial, multisensory program intended to enhance quality of life for people with advanced dementia and their caregivers; however, it has not yet been adapted for use in a home setting. In this study, caregivers collaborated in adapting Namaste Care during workshops so that it could be delivered by caregivers of older adults with moderate to advanced dementia at home. Key findings were that Namaste Care resonated with the daily activities of caregivers, but that the intervention required modifications to ensure that it could be tailored to the needs and realities of caregivers and persons with dementia.

Understanding Burden in Caregivers of Adults With Dysphagia: A Systematic Review

A previous review suggested that dysphagia is negatively associated with burden in caregivers of community-dwelling older adults. Other literature suggests similar patterns of burden may be found across adult patient populations. The current study, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted to determine the impact of dysphagia on caregivers of adults, regardless of etiology. Five electronic databases were searched using terms based on a review by Namasivayam-MacDonald and Shune (2018) but included all adults rather than only older adults. Searches were limited to English-language empirical studies discussing caregiver burden, included caregivers of adult care recipients, had some care recipients with dysphagia, did not include palliative care, and published in a peer-reviewed journal. The search yielded 1,112 unique abstracts, of which 17 were accepted. Across studies, caregiver burden was found to increase due to dysphagia in care recipients. Commonly reported dysphagia-related causes of burden included changes in meal preparation, disruption in lifestyle, effects on social life, lack of support, insertion of feeding tubes, and fear of aspiration. In general, dysphagia-related caregiver burden was a common experience across caregivers, regardless of patient population, caregiver age, and relationship between caregiver and care recipient. Meta-analyses suggest 71% of caregivers of adults with dysphagia experience some degree of burden. These findings support that dysphagia negatively impacts caregiver burden and suggests sources of burden that clinicians can address within dysphagia management to support caregivers. However, more research is needed to better delineate sources of burden, especially those specific to various dysphagia etiologies, to better meet the needs of our patients.

Caregiving and COVID-19: Perspectives from a Care Coach

Family caregivers of community-dwelling older adults have faced unprecedented caregiving challenges during the COVID-19 pandemic. Examining the accumulated impact on family caregivers can help health and aging service providers design resources and supports that are resilient to emergency situations, and reduce negative psychological and physical consequences and risk of abuse within caregiving dyads. Data was collected as part of a pilot intervention in which “Care Coaches” provided telephonic coaching sessions to family caregivers of older adults. We examined Care Coach observations documented after coaching sessions with 24 family caregivers between March 2020 and February 2021. Two coders employed thematic analysis to generate codes and themes. The sample was 70% female, 80% were the spouse or significant other of their care receiver, the mean age was 61, and 53% were Non-Hispanic White. Themes and sub-themes included: (1) increased caregiver burden and diminished care networks due to fear of exposure to or contraction of COVID-19, (2) barriers to accessing in-home personal assistance services and home-delivered meals despite intervention efforts, and (3) the exacerbation of caregiver social isolation due to COVID-19 lockdown policies. Findings highlight the ways in which COVID-19 has amplified caregiver burden through the breakdown of formal and informal support systems. Potential adaptations of community-based services for older adults and their caregivers include remote service liaisons and need assessment of caregiver dyads to assure access to home-based personal assistance services and nutrition support for those at greatest risk of negative consequences during emergency service lapses.

The Experiences of Family Caregivers of Community-Dwelling Older Adults with Dementia in Providing Daily Oral Care

Individuals with dementia increasingly rely on caregivers for daily oral care over time. This study explored the experience of family caregivers of community-dwelling individuals with dementia in providing oral care and their interest in caregiver oral education using the concepts of Social Cognitive Theory. Twenty-three caregivers ages 19-80 participated in a semi-structured qualitative interview that also included a structured questionnaire. Majority of caregivers were female (83%) with an average age of 56 years; 29% were spouses. Fifty-four percent of care recipients had natural teeth only, 42% had teeth and dentures, and 4% had dentures only. Caregivers were generally knowledgeable about the importance of oral health, but some expressed a lack of knowledge in how to perform oral care for others. Caregivers reported high levels of outcome expectation, agreeing that providing oral care would improve care recipient’s oral health. Caregivers expressed mixed levels of self-efficacy; many cited reduced self-efficacy due to resistance or refusal of care. Quantitative data showed that higher confidence in knowledge and oral care skills was associated with greater confidence in providing oral care (r=0.726, p<0.001). Intent to participate in a caregiver oral health education program was associated with positive outcome expectations (r=0.73, p=0.007) and desire to learn the signs and symptoms of mouth pain and infection (r=0.72, p=0.009). Increasing family caregiver’s oral health knowledge and skills, outcome expectations, and self-efficacy to provide care may help improve the oral health of persons with dementia. Additional qualitative and quantitative data and implications for practice will be presented.

Social support moderates the effect of stress on the cortisol awakening response in dementia family caregivers

Dementia caregiving has been associated with a range of adverse effects on the physical health of the caregiver. However, the specific mechanisms underlying the relationship between dementia caregiver stress and ill health remain unclear. The aim of this study was to investigate, using available prospective data, the relationship between perceived stress (burden) and pre-clinical indices of ill-health (cortisol awakening response and secretory immunoglobulin A) amongst dementia caregivers. The potential moderating effect of social support on the perceived stress-physiological stress/health relationship was also explored. Participants (N = 31) were caregivers of community-dwelling older adults living with dementia who were enroled in a psychoeducation support program and provided data (study questionnaire and saliva samples) at two timepoints (T1 and T2), 10 weeks apart. Hierarchical regressions were used to determine if changes in stress and social support predicted change in each of the physiological outcomes. Findings indicate that caregivers with more hours of care at T1, or with greater satisfaction with social support, were more likely to exhibit an adaptive cortisol awakening response at T2. Moreover, social support was found to buffer the effect of caregiver stress and hours of caregiving on the cortisol awakening response. Implications for future interventions targeting caregiver health are discussed.

Discordance between dementia caregivers' goal of care and preference for life-extending treatments.

Many older adults with severe dementia receive potentially life-extending treatments even when caregivers do not wish to prolong their life inappropriately. Explore factors that influence caregiver preferences for potentially life-extending treatments for older adults with severe dementia, and reasons for discordance between overall end-of-life care goal and treatment preferences. Semi-structured in-depth interviews asking caregivers their overall end-of-life care goal for older adults and preferences for intravenous (IV) antibiotics, tube feeding and cardiopulmonary resuscitation (CPR). A total of 26 caregivers of community-dwelling older adults with severe dementia in Singapore. Reflexive thematic analysis. Most caregivers' (77%) overall end-of-life care goal was 'no life extension'. Yet, 80% preferred IV antibiotics for a life-threatening infection, 60% preferred tube feeding and 45% preferred CPR. Caregivers preferred these treatments because they (1) perceived letting go by withholding treatments as unethical, (2) felt they had no choice as they deferred to the health care provider, (3) wanted to alleviate suffering rather than extend life and (4) desired trying minimally invasive treatments that had the potential to be withdrawn. Themes explaining discordance were (1) feared regret about making the 'wrong' decision, (2) considered treatments to address immediate needs even when long-term goal did not match providing that treatment and (3) anticipated disagreement with other family members on overall goal of care. To reduce discordance between caregivers' overall end-of-life care goal and preferences for life-extending treatments, clinicians can use a shared decision-making approach involving discussions of both their overall end-of-life care goal and treatment preferences.

Singaporean Dementia Caregivers’ Preference for Care Recipients’ Life-Extending Interventions

Family caregivers of older adults with severe dementia are decisive in use of potentially life-extending interventions for their care recipients. We conducted in-depth interviews with 26 caregivers of community-dwelling older adults with severe dementia in Singapore to assess their preferences for intravenous (IV) antibiotics for a life threatening infection, tube feeding, and cardiopulmonary resuscitation (CPR), and reasons thereof. Most caregivers’ (77%) end-of-life care goal was ‘no life extension’. Yet, 80%, 60% and 45% preferred IV antibiotics, tube feeding and CPR, respectively, as they: 1) perceived letting go by withholding interventions as unethical, 2) felt they had no choice, deferring to health care providers (HCPs), 3) wanted to alleviate suffering, and 4) desired trying minimally invasive (and potentially withdrawable) interventions. There was discordance between caregivers’ end-of-life care goal and preferences for life-extending interventions. HCPs can suggest intervention options that concur with caregivers’ end-of-life care goal, and use a shared decision-making approach. Part of a symposium sponsored by the Aging Among Asians Interest Group.

Zarit burden interview among caregivers of community-dwelling older adults in a caribbean setting (Jamaica): Reliability and factor structure.

The Zarit Burden Interview has been the most popularly used tool for measuring caregiver burden and with the 60years and over population in Jamaica and developing countries expected to increase, caregiver burden and its assessment assume increased importance. Establishing the reliability and underlying factor structure of instruments such as the ZBI is critical. This study sought to determine the reliability of the Zarit Burden Interview and to assess its underlying factor structure. The ZBI was administered to 180 caregivers of community dwelling older persons in Jamaica in a nationally representative sample across four geographic health regions in 2016. The factor structure was identified using exploratory factor analysis (EFA) with Varimax rotation. Cronbach's alpha was used to assess internal consistency/reliability of the instrument. The internal consistency/reliability of the ZBI instrument was high (Cronbach's α=0.859) and the corrected item-total correlations ranged from 0.134 to 0.730. The ZBI mean score was found to be 16.92±12.04. EFA produced a six-factor model comprised of 19 items which explained 48.97% of total variance, and was subsequently reduced to four (37.27% of total variance) via the use of parallel analysis and scrutiny of confidence intervals. The four factors identified were 'personal strain', 'social relations disruption', 'resource strain/imbalance' and 'role intensity'. The ZBI-22 tool is a reliable instrument for evaluating caregiver burden among community dwelling older persons in Jamaica. A four factor model has emerged providing greater insights on the underlying constructs of the ZBI, the most widely used caregiver burden assessment tool.

Namaste care delivered by caregivers of community-dwelling older adults with moderate to advanced dementia: A mixed methods study protocol.

The aim of this study is to adapt and evaluate the feasibility, acceptability, and preliminary effectiveness of a multisensory, psychosocial intervention called Namaste Care delivered by family and friend caregivers of community-dwelling older adults with moderate to advanced dementia. A multiphase mixed methods design combining quantitative and qualitative methods will be used. This study is composed of two phases. Phase 1 is guided by a qualitative description approach. Small group workshop sessions with 8-10 caregivers of community-dwelling older adults with moderate to advanced dementia will be conducted to adapt Namaste Care. In Phase 2, 10-20 caregivers will receive training and implement the adapted Namaste Care approach at home. A one group, before-after design will be used to evaluate feasibility, acceptability and preliminary effectiveness of the approach over 3months. Feasibility will be assessed using quantitative measures and acceptability will be explored using qualitative methods. Outcomes to evaluate preliminary effectiveness include quality of life (QoL), positive perceptions of caregiving, self-efficacy, and caregiver burden. There are currently few skill-building interventions that can be delivered by caregivers of people with moderate to advanced dementia at home. Caregivers should be involved in developing programs to enhance program relevance. This research will be the first to explore the feasibility of implementing the Namaste Care approach at home by caregivers. Study results will provide important information about the feasibility and preliminary effects of an adapted form of Namaste Care. This program has the potential to improve the QoL of caregivers and may prevent hospitalization or long-term care placement of older persons with moderate to advanced dementia. The revised Namaste Care program supports building the skills of caregivers so that their needs and the needs of older persons with dementia living at home are being addressed.