Caregivers Of Older Patients Research Articles

Mediating Role of Self-Efficacy in the Relationship Between Social Support and Perceived Stress Among Caregivers of Older Patients Under Hemodialysis

Mediating Role of Self-Efficacy in the Relationship Between Social Support and Perceived Stress Among Caregivers of Older Patients Under Hemodialysis

Benefit-finding profiles and comparison of caregiving ability among informal caregivers of patients with lung cancer: A latent profile analysis

ObjectiveThis study aimed to explore the benefit finding (BF) profiles among informal caregivers of patients with lung cancer, identify demographic and disease characteristics, and analyze differences in caregiving ability between profiles. MethodsThis cross-sectional study utilized convenience sampling to select 272 informal caregivers of patients with lung cancer from a tertiary care hospital in Guangzhou, China. The research instruments used included the Demographic and Disease Characteristics Questionnaire, the revised version of the BF Scale, and the Chinese version of the Family Caregiver Task Inventory. Data analysis was performed using latent profile analysis, chi-square test, Fisher's exact probability test, Kruskal–Wallis test, and multivariate logistic regression. Results(1) BF can be divided into three profiles: “high benefit—family and personal growth” (Profile 1, 7.7%), “moderate benefit—unclear perception” (Profile 2, 44.9%), and “low benefit—coping ability deficient” (Profile 3, 47.4%). (2) Having a cocaregiver and a disease duration of 6–12 months were more likely to belong to Profile 1; caregivers of patients aged 40–60 years tended to belong to Profile 2; caregivers of older patients with disease duration > 12 months and clinical stage II or III were more likely to belong to Profile 3. (3) There were significant differences in the total score of caregiving ability and the scores of each dimension among the different BF profiles (P < 0.001), and the caregiving abilities of Profile 1 and Profile 2 were higher than those of Profile 3. ConclusionsThere was heterogeneity in BF among informal caregivers of patients with lung cancer. Healthcare professionals can identify the key profiles of lung-cancer caregivers based on characteristics such as age, clinical stage, disease duration, and cocaregiver status and enhance their caregiving ability through targeted nursing guidance.

Prevalence and risk factors of burden among caregivers of older emergency department patients

The number of older individuals that live independently at home is rising. These older individuals often rely on caregivers who have a similar age and health status. Therefore, caregivers may experience a high burden. We determined the prevalence and associating factors of burden among caregivers of older patients in the emergency department (ED). A cross-sectional study of primary caregivers of patients aged ≥ 70 years visiting the ED of a Dutch teaching hospital was performed. Structured interviews were conducted with patients and their caregivers. Caregiver burden was measured using the caregiver strain index (CSI). Additionally, data from questionnaires and medical records were extracted to determine potential associating factors. Univariate and multivariate regression analyses were conducted to identify independent determinants for burden. Seventy-eight caregivers (39%) experienced a high burden. Multivariate analysis showed a significant association between high caregiver burden and patients with cognitive impairment or dependency for instrumental activities of daily living (IADL) and more self-reported hours of care per day. Almost 40% of older patients in the ED have a caregiver who experiences a high burden. Formal assessment in the ED may help provide adequate care to the patients and their caregivers.

Caregiver burden in older Indian patients with cancer- Experience from a tertiary care center

IntroductionMost of the long-term care for older adults with chronic or debilitating illnesses is provided by unpaid family members or informal caregivers. There is limited information on caregiver burden among caregivers of older patients with cancer in India. Hence, we assessed the prevalence and severity of caregiver burden among caregivers of older Indian patients with cancer. Materials and MethodsThis was an observational study conducted at the geriatric oncology clinic at Tata Memorial Centre, Mumbai, India. Caregivers of patients aged 60 years and over with a diagnosis of cancer were assessed for caregiver burden using the Zarit Burden Interview. Descriptive statistics were used for demographic and clinical variables. Factors impacting caregiver burden were analyzed using multiple linear regression analysis. ResultsCaregiver burden was assessed among 127 caregivers of older Indian patients with cancer. The median patient age was 69 years (range 60–90). Most patients were men (75.6%). There were 33 female caregivers (26%), and 94 male caregivers (74%). The median caregiver burden score was 12 (IQR 6–20). Caregiver burden was “little/none” in 97 (76.4%), “mild-moderate” in 25 (19.7%), “moderate-severe” in four (3.1%) and “severe” in one (0.8%) of the caregivers assessed. On multivariate analysis, factors that significantly impacted caregiver burden scores were the presence of psychological issues in the patient and the caregiver's educational level. DiscussionCaregiver burden was low among caregivers of older Indian patients with cancer seen at a single center. Caregivers of patients with psychological disorders, and those who had less schooling reported higher caregiver burden.

Explaining Gender Differences in Depressive Symptoms Among Caregivers of Older Patients With Critical Illness

The aging of baby boomers makes caring for the elderly an increasingly important topic. As rising cost of health care, the care for seriously ill patients has gradually shifted from hospitals to families, particularly in the countryside. Along with growing demand for informal care, informal caregivers are at increased risk of depression. The aim of this study was to explore the potential protective factors or risk factors associated with depressive symptoms of caregivers for patients with critical illness (45 to 93 years of age) across gender groups, explain their different pathways of influence, and elucidate targeted measures to improve their outcomes (N=518). Results from the statistical model showed that the paths of effect from care needs to caregiver depressive symptoms differed between male and female informal caregivers. Care needs were not significantly associated with depression symptoms among informal caregivers, for either men or women. Care hours of more than 12 hours per day and financial difficulties at home are risk factors for depressive symptoms in caregivers, with significance of OR=3.42; 95%CI,1.97 to 5.94; P=0.000 and OR=2.98; 95%CI, 1.46 to 6.05; p=0.003, respectively. For male caregivers, years of caregiver education and the feel relied upon by relative's were both protective factors, whereas Job-Caregiving conflict, was a risk factor (P<0.05). For female caregivers, caregiver burden and higher caregiver age were its risk factors (P<0.05). These important findings demonstrate that to be effective in reducing depressive symptoms among informal caregivers, both cointerventions and triage interventions by gender are warranted.

Profile and needs of primary informal caregivers of older patients in Belgian geriatric day hospitals: a multicentric cross-sectional study

BackgroundWith the improvement of life expectancy, the world faces increasing demands for care of older persons. In this manuscript, we define the characteristics of primary informal caregivers (PIC) of patients aged 75 years and older admitted to geriatric day hospitals (GDH) in Belgium. A PIC is defined as the person who most often provides care and assistance to persons who need to be cared for. We describe PIC socio-demographic characteristics, satisfaction, burden and wishes about caring; the type of assistance provided and received, their self-rated health, socio-demographic and medical characteristics of proxies, in particular the presence of behavioural disorders.MethodsWe conducted a cross-sectional study in 25 GDH.ParticipantsFour hundred seventy-five PIC of patients ≥75 years and their proxies. PIC completed a questionnaire at the GDH assessing burden by Zarit Burden Index-12 (ZBI-12), self-rated health, social restriction due to caregiving and financial participation. We compared the characteristics of PIC with high and low burden, and the characteristics of spouses and adult children PIC. We also analyzed factors associated with a high burden in a multivariable logistic regression model.ResultsPIC were mainly women (72%), adult children (53.8%) and spouses (30.6%). The mean age was 64 ± 14 years for PIC and 84 ± 5 years for care recipients. PIC helped for most of Activities in Daily Living (ADL) and Instrumental ADL (iADL). The median ZBI-12 score was 10 [IQR 5–18]. In multivariable regression analysis, a high burden was positively associated in the total group with living with the relative (p = 0.045), the difficulty to take leisure time or vacation (p < 0.001), behavioral and mood disorders (p < 0.001;p = 0.005), and was negatively associated with bathing the relative (p = 0.017) and a better subjective health status estimation (p < 0.001).ConclusionPrimary informal caregivers, who were predominantly women, were involved in care for ADL and iADL. A high burden was associated with living with the relative, the difficulty to take leisure time or vacation and the relative’s behavioral and mood disorders. Bathing the relative and a subjective health status estimated as good as or better than people the same age, were protective factors against a high burden.

311 - A step forward understanding the burden on caregivers of older patients with Parkinson Disease – an ICF-based approach

Background:Burden of care might be highly dependent of specific characteristics of the disease (Lee et al., 2019). Uncertainties remain about factors that influence burden of care in Parkinson Disease (PD).Aim:To identify a list of ICF-related domains identified by caregivers of older patients with PD.Methods:Caregivers of people with PD were recruited in Portugal Parkinson Foundation, if they take care of someone with PD older than 65 yrs, and for more than 6 hours/day. A focus group was video recorded, based on the following questions: Can you please tell us how did you spent your day before you're a caregiver; there are any differences in your daily routine now? How do you feel or think when you're caring for a relative? Can you tell us if there is any kind of daily activity more pleasant or more embarrassing? Verbal interactions during focus group were transcribed and codified using International Classification of Functioning and Disability (ICF) domains.Results:Seven caregivers (5 females; 40-73 yrs; 5 were spousal) were enrolled. Thirty-six caregivers’ references were about body functions and structures (91.67% - mental functions: “I feel tired…it is a constant monotony”); fifty-seven references were about activities and participation (“I need to assist him with bathing”; “when he wants to standing from his favourite chair, he always need help…and his body is very stiff”);eleven references were about environmental factors, mostly about medication and family/health professionals assistance.Discussion:Our results demonstrated that caregivers are worried about their mental health and routine preservation, which is in accordance with previous studies in this topic (Tessitore et al.,2018). However, new caregivers’ perceptions were found in our study, which are very specific domains in PD: body motion rigidity and medication for patients’ psychomotor agitation. A previous study stated that control of mental symptoms in PD are the most powerful predictors of caregivers' burden (Hooker et al., 2000), but do not consider the importance of Parkinson’s motor symptoms.Conclusion:Burden of care in PD is mostly associated with the need of preservation in daily routines, but also with management of mental and motor symptoms in PD.

Burden in Tunisian Family Caregivers of Older Patients with Schizophrenia Spectrum and Bipolar Disorders; Associations with Depression, Anxiety, Stress, and Quality of Life

ABSTRACT Background There are very little data on the burden among caregivers of older adults with severe mental diseases. We aimed to assess the perceived burden among caregivers of family members with schizophrenia spectrum and bipolar disorders. Method A cross-sectional study was carried out with 52 older patients with schizophrenia spectrum and bipolar disorders and their family caregivers. Caregivers were assessed with the medical outcome survey short form (SF-36), the Zarit Burden Interview (ZBI) and the Depression Anxiety and Stress scales (DASS-21). Results Caregivers’ mental quality of life was impaired with an average mental score of 59.05. For a threshold value of 17, the level of perceived burden was considered as high for 42.3% of caregivers. After controlling for demographic variables (age and gender) and patients’ health-related variables (level of dependency, comorbidities, age onset of illness, number of hospitalizations and duration of clinical remission), caregivers’ levels of depression, stress, and SF-36 physical component significantly contributed to their perceived burden. Conclusions Certain modifiable risk factors play an inescapable role in increasing the level of burden among caregivers of older patients with serious mental illnesses. Clinical Implications Improving the quality of life and psychological well-being of family caregivers should be considered an integral part of treatment for serious mental illness in older adult patients.

BEING WOMEN AND BEING DEMENTIA CAREGIVERS: SELF-CONCEPTS IN THE MAKING OF VIETNAMESE FEMALE CAREGIVERS

In Vietnam, the majority of dementia caregivers are women. They play multiple social roles, and confront role conflicts and caregiving burdens with insufficient social supports. Dementia caregiving alters their self-concepts, or who they think they are. This paper aims to explore self-concepts of Vietnamese female caregivers of older relatives with Alzheimer’s Disease (AD). In total, 21 face-to-face, semi-structured interviews, including six follow-up interviews, with 13 Vietnamese female caregivers of older patients with AD were conducted. These 13 caregivers were from 44 to 71 years old, mostly spouses of the patients with AD (n = 8), and retired (n = 9). Thematic coding procedure and the program MaxQDA12 were used for data analysis. Results show that the self-concepts of female caregivers in dementia care were complex, contextualized, and manifested in different aspects. First, self-concepts of these female caregivers were the outcome of the interactions between the guided-self and the performed-self. Their guided-self was the self that their social norms and cultural traditions told them about who they should be, while their performed-self was the self they demonstrated to the outside world. The mismatch between these two types of self caused distress among caregivers. Second, caregivers’ self-concept was the combination of the three key types of the self: the moral-self (a filial daughter or a responsible wife); the feminine-self (a patient and graceful women); and the worthy-self (a devoted and helpful caregiver). Understanding Vietnamese women’s self-concepts associated with their sociocultural context will better inform the development of support programs for them.

Sleep Quality in Caregivers of Older Patients with Schizophrenia Spectrum and Bipolar Disorders: A Case-Control Study

ABSTRACT Objectives Prior literature has documented the global burden of serious mental illnesses. The present study aimed to compare the sleep quality in caregivers of older patients with schizophrenia spectrum and bipolar disorders with control participants who did not serve as caregivers. Methods We performed a case–controlled, cross-sectional study among family caregivers of older patients with psychotic disorders in Razi Hospital, Tunisia. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index Scale (PSQI). Results Fifty caregivers of older patients (≥ 60 years) with schizophrenia spectrum and bipolar disorders, and 50 matched controls were enrolled. The three sub-dimensions of the PSQI, namely subjective sleep quality, sleep duration, and sleep efficiency, as well as overall PSQI scores, were worse for caregiver participants. Hierarchical multiple regression analyses predicting PSQI scores revealed that caregivers’ age and marital status were the only significant predictors in the final model. Conclusions Older adults with severe mental disorders constitute a vulnerable population which generates a significant burden of care, and impacts their caregivers’ subjective sleep quality. Clinical Implications Family interventions, including sleep interventions, should be considered as an integral component of treatment for serious mental illnesses. When promoting sleep quality, older and single caregivers should be targeted.

Engaging older patients with cancer and their caregivers as partners in cancer research.

Active patient partner engagement with Stakeholders for Care in Oncology and Research for our Elders board (a diverse group of older patients with cancer, caregivers of older patients with cancer, survivors, and patient advocates) to conduct what, to the authors' knowledge, is the largest randomized geriatric assessment clinical trial published to date has been shown to be feasible and to result in tangible and invaluable benefits for both the research team and patient partners alike. Actively engaging patient partners should be an essential component of the development, conduct, and completion of all clinical research.

The cost-effectiveness of a telephone-based intervention to support caregivers of older people discharged from hospital

BackgroundA telephone intervention for caregivers of older people discharged from hospital was shown to improve preparedness to care, reduce caregiver strain and caregiver distress. No cost-effectiveness analysis has been published on this, or similar interventions. The study aims addressed here were to examine whether positive outcomes for caregivers resulting from the Further Enabling Care at Home (FECH) program changed the use and costs of health services by patients; and to assess cost-effectiveness.MethodsA single-blind randomised controlled trial compared FECH to usual care. FECH involved a specially trained nurse addressing support needs of caregivers of older patients discharged from hospital. A minimum clinically important difference in preparedness to care was defined as an increase in Preparedness for Caregiving scale score of ≥ two points from baseline. Designated data collection was at: Time 1, within four days of discharge; Time 2, 15–21 days post-discharge; and Time 3, six weeks post-discharge. A last observation carried forward approach to loss to follow-up was used, with a sensitivity analysis including only those who completed all time points. Patient use of hospital, emergency department (ED) and ambulance services were captured for 12 weeks post-discharge using administrative data. Costs included nurse time supporting caregivers, resources used by the nurse, and time taken training the nurse to deliver FECH. Cost-effectiveness was assessed using decision trees for preparedness for caregiving.ResultsSixty-two intervention dyads and 79 controls provided complete data. A significantly greater proportion of intervention group caregivers reported improved preparedness to care to Time 2 (36.4% v 20.9%, p = 0.029), though this was not sustained to Time 3. The intervention cost $AUD268.28 above usual care per caregiver. No significant differences were observed in health service use between groups. The incremental cost-effectiveness ratio for each additional caregiver reporting improved preparedness to care at Time 2 was $AUD1,730.84.ConclusionsTo our knowledge this is the first work to calculate the cost-effectiveness of a telephone-delivered intervention designed to support caregivers of older people post-discharge, and will support decision-making regarding implementation. Further research should examine different settings, and assess impacts on health service use with larger samples and a longer follow-up.Trial registrationAustralian and New Zealand Clinical Trial Registry: ACTRN12614001174673. Registered 07/11/2014.

Effect of progressive muscle relaxation on the caregiver burden and level of depression among caregivers of older patients with a stroke: A randomized controlled trial.

This study aimed to investigate the effect of progressive muscle relaxation on the caregiver burden and level of depression among the caregivers of older patients with a stroke. This randomized, controlled experimental study was conducted between December, 2015 and July, 2017 with the caregivers of older patients with a stroke who had been admitted to the home care unit of a state hospital. The caregivers were randomly assigned to intervention (n = 23) and control (n = 21) groups, based on the study's inclusion criteria. The caregivers in the intervention group practiced progressive muscle relaxation exercises at home 3 days per week for 8 weeks. The control group had no intervention. The mean age of the older patients with a stroke was 80.15 ± 9.86 years and the mean duration of the disease was 39.07 ± 44.69 months. The mean age of the caregivers was 50.29 ± 12.62 years, 84.1% of whom were female, 38.6% were elementary school graduates, and 86.4% were married. It was found that there was a statistically significant decrease in the mean Zarit Caregiver Burden Scale and Beck Depression Scale scores of the caregivers in the intervention group after practicing progressive muscle relaxation, but this decrease was not statistically significant when the intervention and control groups were compared. This study showed that there was a statistically significant decrease in the caregiver burden and level of depression among the caregivers in the intervention group after progressive muscle relaxation exercises, but that there was no statistically significant difference when the intervention and control groups were compared.

Burden on caregivers of older patients with bipolar disorder

ABSTRACTObjectives: Available data suggest high burden on caregivers of patientswith bipolar disorder (BD), yet the well-being of patients with BD increasingly depends on family members, partners and close friends. Aspatients with BD get older, the need for informal care may shift. We aimed to describe the caregivers of older adults with BD (OABD) and explore what patients' and caregivers' characteristics are associated with caregiver burden.Method: Forty-seven caregivers of OABD were questioned about their perceived burden and depressive symptoms. Linear regression analyses were performed to examine the influence of various patients' and caregivers' characteristics on caregiver burden or depression.Results: More than half of all caregivers experienced some degree of burden,and 6.4% reported depressive symptoms. The number of psychiatric admissions and social functioning were the only patients' characteristics associated with higher burden. Caregiver burden was significantly associated with caregiver's other obligations. None of the patient or caregiver characteristics was significantly associated with depression in caregivers of OABD.Conclusion: In OABD, even with few residual symptoms, more than half of all caregivers experience substantial burden. Future studies are needed to confirm if improving social functioning and preventing psychiatric hospitalizations decrease the burden on the caregivers of OABD.

Effects of the amount of rice in meals on postprandial blood pressure in older people with postprandial hypotension: a within-subjects design.

To determine the effect of the amount of rice carbohydrates consumed during mealtime on the extent of decrease in postprandial blood pressure in older people with postprandial hypotension. The incidence of postprandial hypotension is as high as 74% in older people with hypertension. A within-subjects repeated measures design was used. Thirty-nine older people in nursing homes received a full serving and a half-serving of rice on two separate days, in random order blood pressure and heart rate were measured before each meal and every 15minutes for a total of 120minutes after each meal. Data were analysed using repeated measures analysis of variance and the paired t-test with a Bonferroni adjustment using IBM spss version 19.0. The control and intervention conditions yielded significantly different patterns in systolic blood pressure and diastolic blood pressure. Postprandial hypotension was less frequent under the intervention condition; however, decrease in rice intake did not significantly affect heart rate. Reducing the amount of rice intake per meal prevents postprandial blood pressure decreases in the older people. Small and frequent meals with decreased carbohydrate content are recommended to prevent postprandial hypotension and its complications in the older people. Patients, dieticians and caregivers of older patients should be aware of the importance of diet, especially of decreasing the amount of carbohydrate in a meal. Smaller and more frequent meals are recommended for older people to slow gastric emptying.

The Use of the Self-Standing Turning Transfer Device to Perform Bed-To-Chair Transfers Reduces Physical Stress among Caregivers of Older Patients in a Middle-Income Developing Country.

Manual transfer of elderly patients remains commonplace in many developing countries because the use of lifting equipment, such as hoists, is often considered unaffordable luxuries. The aim of this study was, therefore, to evaluate the usage and potential benefits of a low-cost, mechanical turning transfer device among elderly patients and their caregivers on a geriatric ward in a developing country in South East Asia. Fifty-six inpatients, aged 66–92 years, on a geriatric ward, and their caregivers were recruited. Participants were asked to transfer from bed-to-chair transfer with manual assistance, and the task was repeated using the Self-standing Turning Transfer Device (STurDi). The time taken to perform manual transfers and STurDi-assisted transfers was recorded. Physical strain was assessed using the perceived physical stress-rating tool for caregivers with and without the use of the device. User satisfaction was evaluated using the usefulness, satisfaction, and ease of use questionnaire. There was a significant reduction in transfer-time with manual transfers compared to STurDi-assisted transfers [mean (SD) = 48.39 (13.98) vs. 36.23 (10.96); p ≤ 0.001]. The physical stress rating was significantly lower in STurDi-aided transfers compared to manual transfers, shoulder [median (interquartile range) = 0 (1) vs. 4 (3); p = 0.001], upper back [0 (0) vs. 5 (4); p = 0.001], lower back [0 (1) vs. 5 (3), p = 0.001], whole body [1 (2) vs. 4 (3), p = 0.001], and knee [0 (1) vs. 1 (4), p = 0.001]. In addition, majority of patients and caregivers definitely or strongly agreed that the device was useful, saved time, and was easy to use. We have therefore demonstrated in a setting where manual handling was commonly performed that a low-cost mechanical transfer device reduced caregiver strain and was well received by older patients and caregivers.

Burdens among Caregivers of Older Adults with Advanced Cancer and Risk Factors

Family caregivers of older cancer patients face many challenges in managing illness. The burden impacts physical, emotional, spiritual, and social health. The objective of this study was to identify burden among caregivers of older patients with advanced cancer, and associated factors. Caregivers of older cancer patients were randomly interviewed from March-September 2012. Information on baseline characteristics and caregiver burden using the Zarit Burden Inventory (ZBI) was collected. Descriptive statistics were used to analyze baseline data, with univariate and multiple linear regression to analyze factors associated with higher burden. One hundred and fifty participants were assessed. The mean ZBI was 19.2 ± 12.9 (95%CI, 17.1, 21.2). Two-thirds of caregivers reported no burden (63%) and the main impact variable on ZBI was guilt. High burdens were associated with single caregiver, relationship with the patient as siblings, presence of migraines, and cancer types of the patients. Caregiver burden of Thai cancer patients is low. This unexpected small number could be the result of the socio-cultural viewpoint. Assessment of caregivers and focusing on related factors should be incorporated into treatment plans.

Difficulties, coping strategies, satisfaction and burden in informal Portuguese caregivers

To characterise the main difficulties, coping strategies, sources of satisfaction and levels of burden disclosed by informal caregivers of older people who are dependent due to physical and mental causes, in the Portuguese context and to compare the impact between caregivers for older people with physical dependence and caregivers for older people with mental dependence. Caring for a dependent older person is a complex process that puts two people in interaction, each with their own traits and their own histories of private life. When performing this role, the care provider needs to know how to deal with difficulties through a range of coping strategies. The outcome of this relationship may result in burden as a result of the volume of care, the complexity of care or the caregiver's inability to provide needed care. Caring for a family member can also be a source of satisfaction thanks to the pleasure of giving back and/or providing well-being. This is a quantitative, analytical and correlational study. This study was conducted among two distinct groups-caregivers of older people without dementia (physical impairment) and caregivers of patients with dementia (impairment of a predominantly cognitive nature). Data were collected by administering a previously defined questionnaire that sought to gather various sorts of information (sociodemographic, clinical and environmental) and that included certain specific instruments, such as dependency ratio, cognitive assessment tests, an index of difficulties, a satisfaction index, an index of coping strategies and a burden scale. The sample consisted in 184 caregivers over 40years of age, of which, 101 cared for dependent people without cognitive impairment and 83 cared for people with dementia. Most caregivers were women (87%), most were married (78·8%), with a low level of education (33·7% did not complete primary school and only 7·1% had any postsecondary education). Most were spouses or daughters (75·5%). The caregivers of older patients with dementia had lower levels of satisfaction, with a mean difference of 12·95 percentage points, p<0·001. It appears that caring for older people with dementia implies a greater burden, with a mean difference of 15·4 percentage points, p<0·001. There is a strong correlation between difficulties and burden (r=0·89, p<0·001) and between the effectiveness of coping strategies and satisfaction (r=0·92, p<0·001). This study suggests that caregivers of older people with dementia are more vulnerable due to their higher levels of burden, which are associated with higher levels of difficulties and reduced sources of satisfaction. These data are essential for the management and implementation of health programmes that can reduce the vulnerability of caregivers. Programmes should address caregivers' difficulties and burden as a way to promote satisfaction with providing care.

The perception of barriers of family caregivers in the use of oral opioids in older patients with cancer

Background and Objective: Cancer pain remains poorly controlled in up to 90% of cancer patients. Untreated pain has detrimental effects on older patients and their caregivers. Fear of addition and concerns about side effects of the use of opioids are predominant patient barriers. Currently, there are very limited studies conducted to identify the barriers from the perspectives of family caregivers. This paper describes the barriers to the use of opioids perceived by family caregivers of older patients with cancer. Methods: Family caregivers of patients with cancer aged 55 or above, and received oral opioids for pain relief at homewere recruited from the National University Cancer Institute in Singapore. Measuring instruments included the Caregiver Pain Medicine Questionnaire (CMPQ). Results: Among the 17 caregivers who participated in the study, the median age was 45.0 years [interquartile range (IQR)=17.0]). Majority of them were female (70.6%), and were the patient's adult children (58.8%). Almost half of the caregivers (n=8, 47.0%) did not receive formal education, or were primary graduates. The median duration of care was 12.0 months (IQR 59.0). Most of the patients were female (58.8%), and the median age was 66.0 years (IQR=11.5). Majority of them were treated with a single type of oral opioids (n=15, 88.2%), with 8 (47.1%) receiving tramadol while 9 (52.9%) receiving morphine. About a quarter of patients were diagnosed with gastrointestinal cancer (n=4, 23.5%), and majority of them with metastatic diseases (n=11, 64.7). The median pain score was 7.0 out of 10 (IQR=5.8). The overall median score of CMPQ was 2.76 (IQR=0.6) (score range 1–5, with higher score representing high level of agreement, in which there is potential barrier to pain management). Subjects reported the highest potential barrier to pain management in “Fatalism” and “Concern about tolerance” (median=3.00, IQR=1.8), followed by “Concern about side effects” (median=2.86, IQR=0.4), and “Reluctance to administer” (median=2.83, IQR=0.8). A moderate significant negative relationshipwas found between the duration of care and “Reluctance to report/communicate about pain” (r=−0.530, p=0.029), suggesting that the longer the duration of caregiving, the more willing caregivers would be in reporting the patient's pain. Conclusion: Fatalism, concern about tolerance, and concern about side effects are the top three barriers to the use of opioids perceived by family caregivers of older patients with cancer. Empowerment and education programmes about pain management directed at family caregivers would be useful in improving their knowledge and attitudes about pain management and using oral opioids, and thus improve pain control of older patients with cancer. Nevertheless, the study was relatively small and limits the ability to generalise from the data, so a larger population group is required to confirm our findings.

P-739 - Educational program for caregivers of old patients with history of suicidal ideation or suicidal attempts in psycho-geriatric ward: a polit study

Introduction The elderly suicidal rate in Hong Kong is alarmingly high comparing with other western countries. The main caregiver experienced great stress after their old relatives had attempted suicide. Thus, an educational program for caregivers of older patients with history of suicidal ideation or suicidal was conducted in psycho-geriatric ward in Hong Kong. Aim The study aims to evaluate the effectiveness of an educational program for caregivers of target patients. Objectives 1. To assess the care needs of subjects so as to develop and implement an educational program for them. 2. To evaluate the effectiveness of educational program. Methods 8 caregivers of the patient who presented with suicidal idea or attempted suicide before current admission, and were diagnosed depression in study ward were recruited by convenience sampling. According to literature review, an educational program was developed and conducted. The pre-and-post quiz paper of education contents, caregiver strain index (CSI) and evaluation form of program arrangement were used to evaluated the program. Results The CSI were significantly dropped in physical and psychological aspects and slightly dropped in future plan adjustment and financial burden. The post quiz scores revealed that most subjects had increased in knowledge about elderly suicide, depression and caring techniques. The evaluation forms results showed all subjects were satisfied with the program arrangement, educational contents and teacher, who was a registered nurse. Conclusion The educational program was able to empower the caregivers of depressed elderly and ensure their contingency care in community after discharge.