Caregiving Demands Research Articles

Living Arrangements and Gendered Work Prospects Among Chinese Grandparents

Recent literature on grandparenthood in China overwhelmingly focuses on the role of grandparents as caregivers for grandchildren. However, many become grandparents at an age when they are still active in the labor force. Using data from the China Health and Retirement Longitudinal Study (2011-2015), this study examines the extent to which coresidence with grandchildren affects grandparents’ labor force participation and work hours. Results from our fixed-effect models show that, living with grandchildren has a positive effect on men’s work participation and hours worked, especially for those with flexible jobs. For women with inflexible jobs, coresidence with grandchildren has a negative impact on their work prospect. Furthermore, grandparents in skipped generational households are less likely to scale back in work than those in multigenerational households, indicating a high level of double burden from both work and caregiving responsibilities. Our study extends prior work by emphasizing grandparents’ role as active workers and highlights the importance to understand work and caregiving demands in a gendered and dynamic household context.

Timing and Support Matter: Caregiving Demands at the Intersection of Stress Process and Life Course Perspectives

Extensive research documents the outcomes of family caregiving. However, perspectives differ, with some suggesting that caregiving provides psychological rewards and others suggesting that the stress of caregiving carries psychological costs. We argue that both of these perspectives are correct, but their applicability will differ based on the timing of caregiving and the availability of social support. A life course perspective suggests that the timing of a stressor in the life course will create variations in its mental health impacts, whereas a stress process perspective suggests that the consequences of a given stressor for mental health will vary based on the availability of social support. A synthesis of these two perspectives then suggests that social support will act as stress buffer differently depending on the age of caregiver. To examine these questions, we use a subsample of respondents who reported caregiving (N=20,441) in the 1st wave of the Canadian Longitudinal Study on Aging. Analyses provide evidence of different outcomes of caregiving, according to both the timing of caregiving and the availability of support. In particular, a high level of caregiving demands are associated with greater depression and lower life satisfaction. Social support inhibits both associations, and the association between high demands and life satisfaction is stronger in older caregivers. Social support does not buffer high caregiving demands more strongly at older ages, though, showing two distinct process. Demanding caregiving appears particularly detrimental for psychological well-being as people age, and the efficacy of social support resources do not increase to compensate.

Support Needs as Perceived by Grandparent-Caregivers: A Qualitative Systematic Review

Caregiving can have adverse mental and physical health outcomes. Older grandparents who are primary caregivers for their grandchildren report multiple health conditions such as depression, anxiety, hypertension, cardiac disease and chronic fatigue, which are caused by or otherwise exacerbated by the caregiving demands. We conducted this qualitative systematic review to identify support needs that contribute to such poor health outcomes and as perceived by grandparent-caregivers for minor grandchildren. We searched relevant databases (PubMed, PyschINFO, CINAHL, and Social Work s) using terms such as: child rearing, parenting, child custody, grandparents, support needs, and caregiving. Studies were included for review if they were written in the English language; used only qualitative methods; and were published from January 1990 to January 2020. Included studies were critically appraised using the Critical Appraisal Skills Programme checklist. Data were extracted from these studies and synthesized using meta-ethnography. Of the 2828 studies identified, 58 studies from 12 countries met all inclusion criteria for review. Three main themes emerged from the review: 1) grandparent-caregivers’ personal needs, and 2) grandchildren needs. Both themes were further divided into subthemes of health (mental & physical), financial, social (interpersonal, cultural and environmental factors and services). Findings from this review have potential to: 1) inform design of comprehensive interventions and screening needed to address perceived support needs; and 2) identify gaps in and barriers to available support resources for older grandparent-caregivers. Further research is needed on comprehensive assessment of support needs and risk for poor health outcomes among grandparent-caregivers.

Exploring Spirituality, Loneliness and HRQoL In Hispanic Cancer Caregivers

Providing care to an aging society in the new normal requires increased attention to the informal caregivers who support the health and well-being of older adults with chronic conditions. Hispanic caregivers carry a high caregiver-associated burden. Health disparities experienced by Hispanics, coupled with the emotional, social and physical demands of caregiving, may set an unprecedented risk for lower health-related quality of life (HRQoL). In a quantitative analysis, we investigated the relationship between spirituality, loneliness and HRQoL in Hispanic cancer caregivers using baseline data from the Support for Latinas with Breast Cancer study (N= 234 Hispanic caregivers). Findings suggested an indirect effect of spirituality on HRQoL through reduced loneliness among more spiritual caregivers, effects that were independent of age. The second study was conducted using qualitative semi-structured interviews (N= 10) with Hispanic caregivers. Interviews evaluated spirituality and HRQoL in Hispanic cancer caregivers who reported variable levels of loneliness. Five themes emerged: caregiver experience, coping strategies, loneliness, religion to gain strength or support, and spirituality to gain strength or support. Results supported the role of spirituality in promoting higher HRQoL in Hispanic cancer caregivers and elucidated pathways to intervene on HRQoL through spirituality. With Hispanics often underutilizing formal services, having an improved understanding of caregiving experiences, particularly related to spirituality, will support the development of culturally-relevant strategies and programming to promote HRQoL for Hispanic caregivers.

Trajectories, Turning Points, and Interruptions: How Social Inequality Shapes Women’s Later-Life Health

We explore women’s health in midlife and later life at the nexus of structural sexism and the life course perspective, applying Dannefer’s (2018) concept of life course reflexivity, which emphasizes social dynamism with potential health-changing ‘input’ at all ages. We present three types of reflexive changes in the gendered life course that shape women’s health as they age: (1) trajectories of lifetime labor market disadvantage leading to limited health-protective resources in later life; (2) turning points in family structure and need, with draining caregiving demands; (3) interruptions in midlife, such as divorce, erasing the social and economic benefits of marriage. We provide support for critical arguments that theoretical work on the life course has too-often utilized the ‘privileged’ or the ‘male’ life course with insufficient attention to structural sexism as a fundamental cause of women’s health disparities in later life.

Trajectories, Turning Points, and Interruptions: How Social Inequality Shapes Women’s Later-Life Health

As the Hmong community continues to grow and age in the United States (US), mainstream healthcare providers may encounter Hmong older adults who prefer their cultural end-of-life (EOL) care. The challenge for these providers is to offer culturally sensitive EOL care to Hmong older adults within the realm of the Western healthcare system. One factor contributing to this challenge may be the lack of knowledge regarding Hmong older adults’ EOL care preferences. Another is Hmong EOL care is interwoven with care from domains such as culture, religion, and spirituality. The purpose of this study is to garner an understanding of the care preferences of Hmong older adults during the dying process. A qualitative study using inductive content analysis was conducted. Thirty Hmong older adults who reside in Wisconsin participated in semi-structured interviews that were audio recorded and transcribed. Data was analyzed using inductive content analysis by Elo & Kyngäs (2008). The findings revealed that participants preferred care at EOL in the domains: physical, psychosocial, cultural, religious, and spiritual. Physical care included ADL’s while psychosocial care related to communication and companionship. Cultural care included children as caregivers and decision-makers. Religious and spiritual care surrounded Animism and Christian beliefs such as soul calling and prayers. Findings also suggest Hmong older adults’ care preferences as heterogenous and holistic. The findings have implications for the Hmong community and formal care services to collaborate on how culturally sensitive care can be provided to Hmong older adults at end of life.

Virtual CARE for Caregivers of PWD: Adapting to the New Normal

Caregivers of persons with dementia (PWD) often experience increases in depression, anxiety, and burden as the disease progresses. In fact, as the PWD’s neuropsychiatric symptoms increase and independence in ADLS decrease, caregivers psychological and physical health outcomes worsen. The literature suggests that caregiver interventions that teach specific skills are more beneficial than psychoeducational interventions, particularly regarding the amelioration of the psychological impacts of informal caregiving. However, because of caregiving demands, caregiver’s own physical limitations, and competing obligations, it can be difficult to attend caregiver support or education programs outside the home. With the emergence of the COVID-19 pandemic, arranging such interventions became more complex, Therefore, we report on preliminary qualitative outcomes of a study investigating the feasibility and acceptability of converting an in-person, group dementia caregiver education intervention, CARE, to a telehealth platform. We report the findings of two objectives: 1) lessons learned when attempting to convert an in-person group intervention to telehealth and 2) experience and perceived benefit of attending a virtual group from the perspective of the participants of our first two groups. Briefly, our findings demonstrate the strong need for technological support. Participants report positive experience regarding the convenience of attending the group from their home, the benefits of the assigned exercises, and the support they found from other group members. The COVID-19 pandemic has forced many to embrace the virtual option as they adapt to a new normal. There are undoubtedly hurdles to overcome, but there are also advantages to be leveraged.

A Discussion on the Training System and Career Planning of Long-Term Care Personnel-A Case Study of the A Skin-Graft With Love Foundation

<p>現今台灣已是高齡化社會，長照人員需求日與俱增，但因人力需求未能有完整規劃，導致人才缺乏窘境的關鍵因素，如何補足照顧人員的缺口，且能留任優秀的人才，將是當前非常重要的課題。故有關長照人員的「培訓」與「職能發展」是目前長照體系中迫切探討與重視的一環。</p> <p>本文主分六章節進行論述，筆者在執業的過程中看到一些長照人員的問題，所以提出自身淺見與各位分享。文中主要分享切膚之愛基金會居服員的培訓制度與職能規劃。希冀透過此議題讓夥伴們，共同一起來關心此議題，進而達到拋磚引玉的效果。</p> <p> </p><p>Contemporary Taiwan is an aged society, which has consequently led to its increasing demand for long-term caregivers. However, the lack of a functional plan has led to a dearth in recruitment, thus making the recruitment and retainment of capable personnel a top priority. In addition, topics relative to the training and career development of long-term caretakers in the existent system would be of utmost importance for discussion.</p> <p>This paper is divided into six chapters, each sharing observed problems regarding long-term caregivers during the author’s previous work experience. This paper mainly focuses on sharing the current training system and career planning of A Skin-Graft with Love Foundation. It is our sincere hope that we may achieve more in hopes for a valuable exchange by coming forth together in discussion.</p> <p> </p>

The preliminary efficacy of Caring of Caregivers Organically (CoCO) health education program on the health of Latina caregivers of persons with Alzheimer’s disease and related dementias

AbstractBackgroundBy 2060, the prevalence of Alzheimer’s disease and related dementias (ADRD) in Latinos is projected to increase by 832%,1 representing an increased demand of caregivers. Caregiving has been shown to increase risk for depression and anxiety,2 poorer quality of life (QoL)3 and health behaviors.4 There is a critical need to create linguistically and culturally responsive interventions to promote caregiver health as they often forgo their own health to help the person with ADRD. CoCO is a health education program centered on caregiver’s physical and mental health. The purpose of this study was to assess the preliminary efficacy of CoCO on health‐related QoL, health behaviors, and symptoms of depression among Latina ADRD family caregivers.MethodsFourteen Latina ADRD family caregivers were randomized to the 8‐week, 2‐hours per week CoCO health education program delivered by health companions (n=8, mage=59.41±11.1) or a wait‐list control group who received the CoCO manual (n=6, mage=43.3±18.2). Health‐related QoL was assessed through the RAND 36‐item Health Survey (SF‐36).5 The Positive Health Behaviors scale6 was used to assess engagement in healthy activities. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale.7‐8 T‐tests were used to assess change in the measures per group pre‐post intervention. Cohen’s d was used to calculate effect sizes.ResultsThere were statistically significant increases in depressive symptoms pre‐post in both the intervention group (PreM=14.1±13.3, PostM=22.5±14.9, p=.007, d=1.32) and the control (PreM=5.5±3.6, PostM=14.0±10.0, p=.046, d=1.08). There were statically significant decreases in the emotional well‐being domain of the SF‐36 questionnaire in the control group only (PreM=79.3±18.5, PostM=67.3±15.5, p=.030, d=1.23). Cohen’s d values showed medium effect sizes showing a positive directionality in the physical activity domain of the health behavior scale for the intervention group only (PreM=5.50±4.90, PostM=7.75±4.03, p=.152, d=0.57).ConclusionParticipants in the intervention demonstrated medium effects for the physical activity domain, suggesting an increase in physical activity. However, findings also indicate increased depressive symptoms and poorer health‐related quality of life. Health education interventions promoting health behavior changes in Latina ADRD family caregivers might benefit from including more extensive problem solving and coping strategies to improve depressive symptoms and QoL.

Covid‐19 pandemic: A curse and a blessing for informal dementia caregivers — A qualitative study

BackgroundCaring for a relative or friend who lives with dementia is a complex and demanding process that affects the quality of life and the well‐being of the informal caregivers. Many previous studies show that informal dementia caregivers experience high levels of stress, psychological burden, and depression due to the demands of caregiving which include changes in one's personal and professional life, self‐neglect, and withdrawal from pleasurable activities. The COVID‐19 pandemic drastically changed people's lives and everyday interactions and the limited number of studies on this topic shows that it introduced additional challenges for dementia caregivers. These challenges include protecting themselves and the person they care for from infection, managing the behavioural and psychological symptoms of the disease, introducing changes in everyday routines, dealing with quarantine or isolation.MethodThe aim of this study was to gain a better insight into the experiences of informal dementia caregivers during the COVID‐19 pandemic. Semi‐structured interviews were conducted in the period of July‐September with nine participants from different countries and the data were analyzed using inductive thematic analysis resulting in extraction of five themes.ResultsThe results show that informal caregivers experience worsening of the behavioural and psychological symptoms of the person they care for, limited access to the institutions and the person they care for, fear of infection but also more free time for looking after the person with dementia.ConclusionThis was one of the first qualitative research aimed to understand the unique experiences of informal dementia caregivers during the COVID‐19 pandemic, and the first research ever that has included caregivers from North Macedonia. The results show that informal dementia caregivers experience additional burden and challenges due to the COVID‐19 pandemic which adds to their existing psychological distress. This can further compromise their health and well‐being, and result in lower quality of life for them and the person with dementia and requires more focused attention from the relevant medical and social services. It should also be taken into consideration when constructing policies for dementia management and formal support during the times of the pandemic.

Women's Experiences Navigating Paid Work and Caregiving During the COVID-19 Pandemic.

During the COVID‐19 pandemic, many women lost their jobs or chose to leave the workforce because of increased caregiving demands. Of women who remained employed, many faced increased complexity in negotiating their roles as employees and caregivers. On the basis of existing theory and research on the impact of women's caregiving responsibilities on their careers, we developed a model of the relationships among women's caregiving hours for children and adults, work‐family and family‐work conflict, perceived social support, and career satisfaction during the pandemic. We collected data from 475 university staff members and tested our model using a path analysis. Results suggested that caregiving hours for children directly influenced work‐family and family‐work conflict and that social support partially mediated the relationship between family‐work conflict and career satisfaction. We discuss how counselors might best work with women who are navigating multiple life roles during a period of family, community, and global challenges.

The impact of illness intrusiveness and overparenting on depressive symptoms in parents of youth with inflammatory boweldisease.

Inflammatory bowel disease (IBD) management creates significant caregiver demands that can interfere with parents' ability to engage in a number of role functions (i.e., illness intrusiveness) well into their child's adolescence, potentially resulting in excessive or misdirected parenting (i.e., overparenting). Disruptions and limited access to routine and valued activities (e.g., family, work, and leisure) due to IBD and excessive parenting may result in parents neglecting their own personal and emotional self-care needs, increasing their risk for depressive symptoms. To explore these associations, the present study examined parents' experience of illness intrusiveness and subsequent overparenting as serial mediators in the association between disease severity and parent depressive symptoms. Participants were 146 caregivers of adolescents with IBD from an outpatient pediatric gastroenterology clinic. During a scheduled outpatient visit, parents completed measures of illness intrusiveness, overparenting, and depressive symptoms. Pediatric gastroenterologists provided ratings of disease severity. Several direct and indirect associations were observed among the modeled variables. Notably, mediation analysis revealed a significant disease severity → illness intrusiveness → overparenting → depressive symptoms serial indirect effect. Parents' experience of greater IBD-induced lifestyle disruptions is associated with increased overparenting and a heightened risk for depressive symptoms. Parents should be encouraged to establish and maintain a healthy balance between parenting and self-care/role function activities, especially during adolescence when greater youth autonomy and independence are crucial. These types of clinical efforts may reduce the likelihood of parents experiencing depressive symptoms, and have the added benefit of improving adolescent IBD self-management.

Process Evaluation of Internet-Based Cognitive Behavioral Therapy Intervention for Informal Caregivers

Background: Informal caregivers are individuals who provide care for ill, frail, or otherwise dependent family members, siblings, or friends. Due to the caregiving demands, informal caregivers are known to experience negative mental health symptoms, such as stress or anxiety. Interventions based on Internet-based Cognitive Behavioral Therapy (ICBT) principles have been previously found to be effective for different populations and could also be considered as a plausible support option for informal caregivers. However, findings regarding effectiveness alone might not be sufficient for informing about the overall feasibility of the intervention.Objective: The aim of this process evaluation study was to evaluate the feasibility of a previously developed ICBT intervention for informal caregivers in Lithuania. More specifically, we evaluated the suitability of the intervention in relation to its content and delivery mode.Methods: Two studies were conducted. Study 1 consisted of participant evaluations of an 8-week, 8-module long therapist supported ICBT intervention. Evaluations for the Study 1 were retrieved from previously unused data, obtained from pilot testing of the intervention in which 63 informal caregivers took part. The evaluations contained of qualitative data (participant comments), as well as quantitative data (evaluations of each of the sessions). The Study 2 was an online stakeholder focus-group discussion conducted via Zoom. Eight stakeholders took part in the discussion, among whom there were social workers, medical professionals as well as individuals with caregiving experience themselves. Data were analyzed using descriptive statistics, thematic analysis, and data coding.Results: Results of the Study 1 showed that most of the pilot randomized controlled trial participants evaluated content and format of the intervention positively. These results were complemented by the findings in the Study 2, in which stakeholders evaluated the intervention as suitable and promising. In addition, stakeholders made certain suggestions for improving the intervention's usability for the informal caregivers. This included improving the instructions, providing with more guidance, and considering personalization options.Conclusion: The process evaluation helped to evaluate the feasibility of the ICBT intervention for informal caregivers in Lithuania from the two perspectives: users and stakeholders. Our findings suggest that the intervention is suitable for the target population.

Changes in Physical Activity and Sedentary Behaviors During COVID-19: Associations with Psychological Distress Among Mothers.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic increased mothers’ caregiving demands, potentially placing them at increased risk for reduced engagement in healthful behaviors and high psychological distress.PurposeThe purpose of this study was to describe perceived changes in moderate-vigorous physical activity (MVPA) and sedentary behaviors and the prevalence of different measures of psychological distress (depressive and anxiety symptoms, perceived stress, and positive and negative affect) among mothers. We also evaluated the associations of perceived change in MVPA and sedentary behaviors with measures of psychological distress.MethodsWe conducted a cross-sectional survey with 317 mothers living with children (0–20 years old) at home. Mothers self-reported perceived changes in MVPA and sedentary behaviors from before the pandemic to during COVID-19 stay-at-home orders and early reopening, and levels of depression and anxiety symptomatology, perceived stress, and positive and negative affect during the pandemic.ResultsCompared to pre-pandemic levels, 39% of mothers reported engaging less in MVPA, and 63% reported engaging in more sedentary activities. One-quarter and 31% of mothers reported moderate/severe depressive and anxiety symptoms, respectively, and 78% medium/high levels of perceived stress. Adjusted linear regression analyses revealed that reduced MVPA and increased sedentary behaviors were associated with high average scores of depressive and anxiety symptoms, perceived stress, negative affect, and low scores of positive affect.ConclusionA large proportion of mothers reported being less physically active and more engaged in sedentary behaviors, which were associated with increases in psychological distress. Clinical and public health intervention efforts should consider how to improve mothers’ physical and mental health as the country emerges from this crisis.

Burden of informal care in stroke survivors and its determinants: a prospective observational study in an Asian setting

BackgroundInformal caregiving is an integral part of post-stroke recovery with strenuous caregiving demands often resulting in caregiving burden, threatening sustainability of caregiving and potentially impacting stroke survivor’s outcomes. Our study aimed to examine and quantify objective and subjective informal care burden after stroke; and to explore the factors associated with informal care burden in Singapore.MethodsStroke patients and their informal caregivers were recruited from all five tertiary hospitals in Singapore from December 2010 to September 2013. Informal care comprised of assistance provided by informal caregivers with any of the activities of daily living. Informal care burden was measured by patients’ likelihood of requiring informal care, hours of informal care required, and informal caregivers’ Zarit’s Burden Score. We examined informal care burden at 3-months and 12-months post-stroke. Generalized linear regressions were applied with control variables including patients’ and informal caregivers’ demographic characteristics, arrangement of informal care, and patients’ health status including stroke severity (measured using National Institute of Health Stroke Scale), functional status (measured using Modified Rankin Scale), self-reported depression, and common comorbidities.ResultsThree hundred and five patients and 263 patients were examined at 3-months and 12-months. Around 35% were female and 60% were Chinese. Sixty three percent and 49% of the patients required informal care at 3-months and 12-months point, respectively. Among those who required informal care, average hours required per week were 64.3 h at 3-months and 76.6 h at 12-months point. Patients with higher functional dependency were more likely to require informal care at both time points, and required more hours of informal care at 3-months point. Female informal caregivers and those caring for patients with higher functional dependency reported higher Zarit’s Burden. While informal caregivers who worked full-time reported higher burden, those caring for married stroke patients reported lower burden at 3-months point. Informal caregivers who co-cared with foreign domestic workers, i.e.: stay-in migrant female waged domestic workers, reported lower burden.ConclusionsInformal care burden remains high up to 12-months post-stroke. Factors such as functional dependency, stroke severity, informal caregiver gender and co-caring with foreign domestic workers were associated with informal care burden.

Towards conceptual convergence: A systematic review of psychological resilience in family caregivers of persons living with chronic neurological conditions.

BackgroundThe demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this specific population is warranted.AimIn this systematic review we aimed to: (1) examine the origins and conceptualizations of resilience; (2) summarize current resilience measurement tools; and (3) synthesize correlates, predictors and outcomes of resilience in family caregivers of persons with CNCs.DesignWe sourced English articles published up to July 2020 across five databases using search terms involving CNCs, family caregivers and resilience.ResultsA total of 50 studies were retained. Nearly half (44%) of the studies used trait‐based resilience definitions, while about one third (36%) used process‐based definitions. Twelve different resilience scales were used, revealing mostly moderate to high‐resilience levels. Findings confirmed that resilience is related to multiple indicators of healthy functioning (e.g., quality of life, social support, positive coping), as it buffers against negative outcomes of burden and distress. Discordance relating to the interaction between resilience and demographic, sociocultural and environmental factors was apparent.ConclusionsIncongruity remains with respect to how resilience is defined and assessed, despite consistent definitional concepts of healthy adaptation and equilibrium. The array of implications of resilience for well‐being confirms the potential for resilience to be leveraged within caregiver health promotion initiatives via policy and practice.Patient or Public ContributionThe findings may inform future recommendations for researchers and practitioners to develop high‐quality resilience‐building interventions and programmes to better mobilize and support this vulnerable group.

Assessment of self-efficacy for caregiving in oncology: Italian validation of the caregiver inventory (CGI-I)

BackgroundThe Caregiver Inventory (CGI), a measure of self-efficacy for caregiving that takes into account aspects of caregiving that are neglected by current measures of caregiving, was translated into Italian and validated.MethodsNinety-one caregivers from a variety of locations in Italy completed the CGI-Italian (CGI-I) as well as the Hospital Anxiety and Depression Scale (HADS) and the Family Strain Questionnaire - Short Form (FSQ-SF).ResultsA confirmatory factor analysis based on the original CGI factor structure resulted in an adequate fit of the CGI-I using standard fit indices. Thus, the original factor structure was validated in the CGI-I: Managing Medical Information (α = 0.87), Caring for Care Recipient (α = 0.68), Caring for Oneself (α = 0.78), and Managing Difficult Interactions/Emotions (α = 0.55). The CGI-I total score was inversely related to anxiety (HADS, r = − 0.35, p = <.05), and depression (HADS, r = − 0.45, p = <.05). In addition, the CGI-I was inversely related to caregiver stress (FSQ-SF, r = − 0.39, p = <.05). Care of Oneself and Managing Difficult Interactions/Emotions emerged as the strongest and most robust negative relationships with anxiety, depression, and caregiver stress, which replicated, with similar constructs, findings from the original CGI.ConclusionsThe results of this study established the CGI-I as a reliable and valid measure of self-efficacy for caregiving. This study also confirms the importance of self-care and managing difficult communication in the process of successfully navigating the demands of caregiving and in constructing interventions for caregivers who need support.

Aged 70 and still a child: complexities, strains and gains of older children caring for their (near) centenarian mothers.

Longer lives increase the possibility of caring duties, which means that older adults looking after their ageing parents-as well as their own partners-is becoming an increasingly common scenario in developed countries. To explore the caregiving demands of very old caregiving dyads and the experience of maintaining the identity of a child at such an advanced age. Qualitative study. 15 participants (four males), all aged 70 or over and caring for their mothers, aged between 95 and 105years old. Semi-structured interviews analysed thematically. Caregivers are willing to care for their mothers 'until death tears them apart', despite the double strains they face, that is more self-limitations and added care receiver need. On a positive side, they feel 'happy, thankful and proud' for still having their mothers alive. They also describe that maintaining the identity of a child at such an advanced age was somewhat unthought of and unexpected but an important source of pride. These findings suggest that these oldest-old caregiving dyads are characterised by a relationship shaped by strong feelings of extended filial love, constituting a family feature that needs further understanding. Findings also underscore the challenges these carers face in dealing with several agents (secondary caregivers) and entities in the care provision.

Neglected Needs of Family Caregivers during the COVID-19 Pandemic and What They Need Now: A Qualitative Study.

COVID-19 has had a negative impact on family caregivers, whether the care receivers lived with the caregiver, in a separate community home, in supportive living, or in long-term care. This qualitative study examines the points of view of family caregivers who care in diverse settings. Family caregivers were asked to describe what could have been done to support them during the COVID-19 pandemic and to suggest supports they need in the future as the pandemic wanes. Thorne’s interpretive qualitative methodology was employed to examine current caregiver concerns. Thirty-two family caregivers participated. Family caregivers thought the under-resourced, continuing care system delayed pandemic planning, and that silos in health and community systems made caregiving more difficult. Family caregivers want their roles to be recognized in policy, and they cite the need for improvements in communication and navigation. The growth in demand for family caregivers and their contributions to the healthcare system make it critical that the family caregiver role be recognized in policy, funding, and practice.

Objectively measured sleep and physical function: Associations in low-income older adults with disabilities

Late-life sleep health has been tied to physical function, but little is known about these associations among socially disadvantaged populations. We determined cross-sectional associations of sleep with physical function in low-income, predominantly Black older adults with disabilities. One hundred thirty-six older adults (mean age 76.0 years, 83.8% women, 82.4% Black). Primary predictors were actigraphic total sleep time (TST), wake after sleep onset (WASO), and subjective sleep complaints. Outcomes were objective physical performance (Short Physical Performance Battery (SPPB)) and participant-reported difficulties in basic and instrumental activities of daily living (ADLs and IADLs). In regression models adjusted for potential confounders, both longer TST and greater WASO were associated with lower SPPB scores and increased IADL difficulty. Participants with a mean TST in the longest (>7.5 hours) vs. intermediate (6.3-7.5 hours) tertile had 27% higher odds of additional IADL difficulty (incident rate ratio=1.27, 95% confidence interval [CI] 1.03, 1.58). Each additional 10 minutes of WASO was associated with 0.13 point lower SPPB scores (B = -0.13, 95% CI -0.25, -0.01) and increased IADL difficulty (B=0.02, 95% CI 0.0003, 0.04). Sex moderated the associations of WASO with IADL and ADL difficulties: associations were stronger for males. Subjective sleep complaints were not statistically significantly associated with function. Among disabled, low-income, mostly Black older adults, objective measures of long sleep and greater WASO are associated with poorer physical function. Effect sizes for the associations were modest; however, findings may have important implications given the significant consequences of decreased function on quality of life and caregiving demands.