Caregiving Demands Research Articles

DAILY SLEEP HEALTH AMONG WORKING INFORMAL CAREGIVERS OF OLDER ADULTS: DELVING INTO CAREGIVING DEMANDS

Abstract Caregiving demands are a key stressor, but little is known about the relationship between caregiving demands and sleep health among working informal caregivers of older adults. We conducted a 5-day daily diary study to examine the relationship between caregiving demands and sleep health among working informal caregivers of older adults in Singapore (N=193). For each day, we examined ‘anticipated caregiving difficulty’ in the morning; in the evening, we assessed ‘total hours spent on caregiving,’ ‘total number of care activities (e.g., personal care, toileting, running errands),’ and ‘experienced caregiving difficulty.’ We further explored their interaction effects on sleep health. Covariates included sociodemographic status, self-rated health, depressive symptoms, and care recipients’ functional status. We found that anticipating more caregiving difficulty in the morning was significantly associated with poor sleep health in the evening on top of covariates and actual caregiving demands. We also found a significant interaction between ‘anticipated caregiving difficulty’ and ‘experienced caregiving difficulty.’ Specifically, the relationship between experienced caregiving difficulty in the evening and poorer sleep health was stronger among individuals who anticipated a lower level of difficulty that morning (1SD-lower). Individuals who anticipated a higher level of caregiving difficulty in the morning (1SD-higher) had worse sleep health in the evening regardless of the level of caregiving difficulty experienced during the day. Our findings suggest that the impacts of ‘anticipated caregiving difficulty’ on sleep health go beyond actual caregiving difficulty experienced. The mismatch between anticipated and experienced caregiving difficulty plays a role in sleep health at night.

FACES OF FORTITUDE: DIVERSE CAREGIVERS PROVIDING COMPLEX CARE

Abstract Last year, more than 56 million family caregivers provided unpaid care to a family member, a number that will grow along population aging and increased prevalence of chronic and serious illness. The demands, resources and outcomes of family caregiving are shaped by the social and environmental context and the particular demands associated with the condition of the care recipient. In 2021, California adopted a Master Plan on Aging, including two investments to strengthen community-based supports for caregivers: Improving caregiver resource centers and adult day programs. This mixed method symposium highlights the fortitude of family caregivers and community-based organizations. We focus on specific health conditions in understudied family caregiver populations as well as the interface with formal services. The first paper examines experiences of caregiving and home care among caregivers of persons with Amyotrophic Lateral Sclerosis. The second paper compares caregiving activities and outcomes among caregivers of individuals with Parkinson’s Disease/Lewy Body Dementia to those with Alzheimer’s Disease and related dementia and other chronic conditions. The third paper examines building family capacity through family and nurse collaboration during acute illness. The fourth presentation describes the impact of adult day care services from the perspectives of family caregivers of persons with dementia. The final presentation, using a large statewide database, describes caregiving demands, unmet needs and resource gaps of diverse family caregivers to inform a caregiving equity plan for the State of California. Together, these papers reflect complexity, diversity and fortitude in family caregiving.

Participation factors in a self-quantification program for family caregivers of community-dwelling older adults with long-term care in Japan

ObjectiveThis study aimed to examine the characteristics of participation in the self-quantification program for family caregivers (CGs) who provide long-term care to community-dwelling older adults. The family CGs, allocated based on the percentage of the nation’s older population who needed care and met the inclusion criteria, who provided caregiving at least once a week for those aged 65 + and who were certified as needing care under the Japanese long-term care insurance program, were collected through online monitors. We compared the characteristics of the program participants and nonparticipants using logistic regression.ResultsA total of 2653 family CGs, including 195 study participants who engaged in self-quantification over 60 days and 2,458 nonparticipants who did not engage in self-quantification, were included in the analysis, with complete data available for all variables of interest. The survey included program participants who were predominantly male (55.9%), with an average age of 54.8 years (SD = 10.2). Participants tended to be fully employed (OR = 1.8; p < 0.01), but they were likely to experience greater burdens (OR = 1.8; p < 0.01) and daily caregiving demands (OR = 1.01; p < 0.01). This research highlights the potential efficacy of self-quantification programs for extensively burdened family CGs, illustrating that the requisites for support vary in accordance with the distinct characteristics of these CGs.

Correlates of Formal Service Use and Help-Seeking Among Caregivers of Older Adults.

Informal caregiving plays a critical role in affecting older adults' quality of life. Utilizing organized and effective formal support helps mitigate caregiver burdens and meet caregiving demands. This study examined the correlates of formal service use and help-seeking in a nationally representative sample of caregivers of older adults, drawing on data from 2017 National Study of Caregiving. Multiple linear regression analyses were conducted to investigate potential correlates, including predisposing (e.g., age), enabling (e.g., education), and need (e.g., care recipient's dementia status) factors. Results showed that racial minorities, better education, caring for older adults with dementia, and more ADL and IADL limitations were associated with greater service use. Caregiver role overload was positively associated with both service use and help-seeking. Findings address the knowledge gap by identifying the risk and protective factors for both service use and help-seeking, which can help practitioners identify the at-risk caregivers and direct tailored services accordingly.

Social worlds of Appalachian women caregivers of older relatives living with dementia.

Over 11 million people in the United States provide care for an older family member with dementia, with this responsibility primarily falling on daughters and wives. In Appalachia, a mountainous region in the U.S characterized by close families, family members were crucial to ensuring that care needs were met for people living with dementia during the COVID-19 pandemic. However, we know little about the well-being of family caregivers during the public health crisis. Guided by a Limited Future Time Perspective postulate, which posits that as people age they begin to prioritize emotionally meaningful relationships over instrumental goals, we asked how dementia caregiving changes the social lives of family caregivers situated within kin networks; and how a public health crisis (i.e., COVID-19 pandemic) affects caregivers who are already at risk for social isolation and feelings of loneliness. Participants were recruited from a regional health care system and four Area Agencies on Aging. In our longitudinal study we invited family caregivers to be interviewed at multiple time points over a 4-year period. The sample for this study was women caregivers interviewed (N = 27; age range 32-81, m = 63). Interviewers followed a semi-structured protocol with questions designed to elicit descriptions about (a) changes in formal and informal support over time, (b) the person living with dementia's symptoms and disease progression, and (c) how the pandemic affected caregivers' and persons living with dementia's social worlds. We found three types of caregivers: (1) caregivers who had social lives interdependent with their relative with dementia, (2) caregivers and persons living with dementia whose social lives were restricted due to dementia symptoms and caregiving demands, and (3) caregivers and their relative living with dementia who maintained separate social lives. Dementia symptoms more than social distancing measures contributed to caregivers' shrinking social worlds particularly for those with interdependent social lives despite living amongst kin. This study is important in understanding how women in Appalachia fared during a pandemic in the context of dementia caregiving. This research supports the need for respite services and dementia care training for respite workers.

Personal and workplace factors influencing the resilience of nurses caring for women with cervical cancer in a resource-constrained setting in Ghana.

Cervical cancer has been identified as the fourth most common form of malignancy affecting and killing women globally. Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation and the burden of care. Resilience has been identified as one of the effective ways of helping nurses to cope well with the stress of oncology nursing, but this remains undetermined in Ghana. This study explored personal and workplace factors influencing the resilience of nurses caring for women diagnosed with advanced cervical cancer (stage III and IV) in a resource-constrained setting in Ghana. Using a qualitative approach, we recruited twenty nurses and midwives who had worked for a year and above caring for advanced-stage cervical cancer patients at the national referral hospital in Ghana. We conducted in-depth interviews between July, 2022 to September, 2022 which were audio-taped with participants' consent. Transcription was done verbatim, and analysis conducted using thematic analysis approach with the aid of NVivo 10.0. The results revealed experience as a safety toolkit, inherent desire to help/care for the patient, emotional numbness and maintaining professional outlook as personal factors influencing resilience among the participants. Regarding the workplace factors influencing resilience, we identified the main theme of demands of caregiving for advanced cervical cancer patients with the following sub-themes; severity of cases managed, nature of care rendered, activities of care given, reshuffling, schedules and gender mirroring as an exacerbator of psychological suffering. Resilience among nurses and midwives caring for terminally ill cervical cancer patients is influenced by longer years of service, intrinsic motivation to work as a nurse, and the defense strategy of emotional numbness and professionalism at the individual level. Also, the huge demand of caregiving serves as a major workplace factor affecting the resilience of nurses and midwives. We recommend strategies such as regular ward conferences and in-service trainings aimed at enhancing job-experience, inherent desire to render care and professionalism be adopted in resource-constrained settings to improve nurses' resilience. In addition, political actors and management of hospitals must prioritize allocation of resources for advanced cervical cancer care with particular focus on providing more specialized nurses and midwives.

Navigating Challenges and Coping Strategies Among Family Caregivers of Memory-Impaired Stroke Survivors in Metro Cebu, Philippines

This study explored the lived experiences of family caregivers for stroke survivors with memory impairments in Metro Cebu, Philippines, using a qualitative design. In-depth semi-structured interviews with six caregivers were analyzed using Yin’s five-phase thematic analysis. Three key themes emerged: (1) Nurturing Patient Well-Being, highlighting the emotional and physical demands of caregiving; (2) Navigating the Trials of Caregiving, detailing the emotional, psychological, and financial challenges caregivers face; and (3) Altered Life Course, illustrating the lifestyle changes and coping mechanisms employed. The findings emphasize the need for structured support systems and tailored caregiving guidelines for occupational therapists to assist caregivers.

The dual roles of empathy in mediating structural empowerment and compassion fatigue among Chinese nurses

BackgroundNurses in dynamic healthcare environments face escalating challenges that impact their efficacy and well-being. These challenges arise from both the increasing complexity of medical procedures and the intense emotional demands of caregiving, often leading to compassion fatigue. A global prevalence of burnout at 30.0% was observed over the past decade. This study examines the relationship between structural empowerment, empathy (cognitive and affective), and compassion fatigue among Chinese nurses. Understanding these relationships is crucial for developing strategies to mitigate compassion fatigue. It also contributes to enhancing nurses’ well-being.MethodsConducted at a public hospital in Shanghai, this cross-sectional study surveyed 305 nurses, with 277 valid responses. Structural empowerment was measured using the Conditions for Work Effectiveness Questionnaire-II, empathy with the Kiersma-Chen Empathy Scale, and compassion fatigue with the Compassion Fatigue Short Scale. We performed correlation and mediation analyses to explore the direct and indirect effects of structural empowerment on compassion fatigue through empathy.ResultsA significant negative direct effect of structural empowerment on compassion fatigue was evidenced by a coefficient of -0.165 (confidence interval: [-0.311, -0.013]). Further analysis revealed a negative indirect effect through cognitive empathy, indicated by an effect of -0.103 (confidence interval: [-0.220, -0.008]). Increased structural empowerment was linked to higher levels of cognitive empathy, which correlated with decreased compassion fatigue. Conversely, the mediation through affective empathy showed a positive indirect effect, indicated by an effect of 0.126 (confidence interval: [0.047, 0.229]). This suggests that higher structural empowerment was associated with increased affective empathy, leading to higher levels of compassion fatigue.ConclusionThe study illuminates the dual role of empathy within the framework of structural empowerment and its impact on compassion fatigue. Cognitive empathy serves as a protective factor, reducing susceptibility to compassion fatigue, while affective empathy appears to heighten vulnerability. These findings provide direct evidence supporting the dual processing pathways of empathy. It is recommended that healthcare policies integrate organizational support with targeted empathy training, such as cognitive reappraisal, emotion regulation, and peer support, to effectively counteract compassion fatigue among nurses. However, due to the cross-sectional nature and the single-hospital setting, the findings should be interpreted cautiously.

Development and Validation of Sensitivity for Needs of Elderly Scale Among Caregivers Based on Maslow’s Theory

The world currently lives in an aging society. Demand for elderly caregivers and services is rapidly rising. Elderly care encompasses not only medical care, but also the art of human care. Love and respect are usually considered the backbone of the modality of caregivers. This study aimed at developing a sensitivity for needs of elderly scale (SNES) among caregivers. Maslow’s theory of hierarchical needs, especially stage 3 (love and belongingness needs) and stage 4 (esteem needs), was used as a conceptual framework. This study consisted of four steps. The sample groups for the first two steps of item quality and exploratory factory analysis were 420 nursing students. A three-factor model emerged, which includes the sensitivity of needs for love and empathy, the sensitivity of needs for respect, and the sensitivity of needs for honor and dignity. The newly constructed measure consisted of 10 items, which explained the variance by 52.18%. The third step of confirmatory factor analysis, using a new group of 384 nursing students, indicated the model fit. In the final step, the scale was validated using 171 elderly caregivers. Moderate to strong absolute magnitudes of correlations between the new scale and psycho-moral strength, core self-evaluation, future orientation and self-control, moral disengagement, and caring behavior were found. Incremental validity was tested. Discussion and recommendations for further research and implications of the newly constructed measure were offered.

Caregiving Intensity, Duration, and Subjective Financial Well-Being Among Rural Informal Caregivers of Older Adults with Chronic Illnesses or Disabilities.

Rural informal caregivers (IC) experience major financial and economic constraints in caring for their older family members. Rurality combined with increased caregiving demands and intensity, poor economic opportunities, and limited financial resources and policies create multiple financial stressors and can lead to poor financial well-being. A cross-sectional survey was conducted to understand how caregiving demands, intensity, and duration impact the subjective financial well-being of rural caregivers of older adults. Informal caregivers (N = 196) residing in 12 rural counties in the central North Region of the Midwestern US participated in the survey. Ordinary Least Squares and Linear Probability Model regressions were conducted to measure the association among the study variables. Our findings showed a moderate level of subjective financial well-being among informal caregivers (average = 51.62; SD 14.52). Caregiving intensity negatively affected financial well-being (β = -1.470, p < 0.05). More than half of informal caregivers (58%) were not satisfied with their household income, and 30% found it difficult to meet their family's needs with their current income status. Longer hours of care are associated with financial burden and insecurity and can significantly influence the financial health and well-being of rural informal caregivers of older adults. Older caregivers were found to manage their financial constraints more effectively. Future comparative and longitudinal studies with a more diverse sample are required to infer long-term interactions among the different variables in this study.

Abstract 4135780: Predictors of Engagement in a Coaching Intervention for Heart Failure Caregivers

Background: Even the best intervention will not be effective without engagement in the experience. We developed and tested a virtual health coaching intervention ("ViCCY”, Virtual Caregiver Coach for You) for informal caregivers of patients with HF in a RCT. Of the 125 caregivers in the intervention group, completion rates varied (mean 6 ± 4 sessions, median 9; 21% no sessions). The aim of this study was to identify factors associated with intervention engagement defined as receipt of ≥8 of 10 intervention sessions over a 6-month period based on core intervention content. Methods: This explanatory sequential mixed methods study was conducted in two phases. First quantitative data were analyzed with respect to number of completed sessions, sociodemographics, and the Credibility-Expectancy Questionnaire measuring expectations regarding intervention effectiveness. We used multivariable logistic regression to quantitatively identify salient predictors of caregivers’ intervention engagement. Then, based on the number of sessions completed, 24 caregivers assigned to ViCCY were interviewed to explore individual, family, community, and societal factors associated with intervention engagement. Transcribed interviews were coded using content analysis. Results: Each one hour increase in hours caregiving was associated with reduced odds of completing ≥8 sessions. Race other than White and income insufficient to make ends meet were associated with reduced odds of completing ≥8 sessions. Each unit increase in intervention credibility was associated with increased odds of completing ≥8 sessions. Interviews with participants who completed some sessions revealed common challenges such as the patient’s HF progression and life events including caregiver health issues, balancing multiple responsibilities, and interpersonal issues. Reluctance to accept help from an unfamiliar individual through a virtual network and perceiving additional resources as burdensome also hindered participation. Practical issues such as finding a suitable space for virtual meetings and scheduling conflicts interfered. In those who did not complete any sessions, the main reason for non-engagement was misunderstanding of what to expect in the intervention. Conclusions: The daily lives of HF caregivers are influenced by caregiving demands exacerbated by social determinants of health. These issues may reduce the capacity of caregivers to accept help and ultimately act as a barrier to program engagement.

A Nature-Immersive Virtual Reality Intervention to Support Hospice Family Caregivers: Qualitative Findings from a Pilot Study

ObjectiveFamily caregivers (FCGs) of cancer patients who are in hospice experience psychological challenges and poor quality of life (QOL) as a consequence of caregiving demands and anticipatory loss. Supportive interventions are needed. Exposure to nature offers a source of relaxation; however, FCGs are often homebound and have limited opportunities for respite. Technology-mediated nature experiences delivered via virtual reality (VR) may be an alternative. The purpose was to explore the perspectives of hospice FCGs who completed a nature-immersive VR intervention for the enhancement of their emotional health and QOL. MethodsNine scenes, including a tropical beach, green meadow, underwater ocean, and red savanna, were offered. Participants were asked to select one scene to view for a minimum of 10 minutes for five consecutive days at home. Semi-structured interviews were conducted via videoconferencing software and audio-taped, then transcribed, coded, and analyzed using content analysis. ResultsNine participants (aged 33-76 years old) were interviewed. Two content categories included 1) feasibility and 2) acceptability. Participants reported ease-of-use and denied encountering difficulties. Scenes were relaxing and calming, providing mindfulness and escapism elements. Participants enjoyed the interactive, multisensory experience, offering views of wildlife and nature sounds. Two reported motion sickness and eye strain with longer use. Suggestions included extending the study duration and the option to explore other scenes. ConclusionsFindings provide preliminary evidence for the efficacy of a nature-based VR intervention. Larger, diverse samples, with group randomization, are warranted. Technology-mediated nature experiences offer support for the emotional health and QOL of hospice FCGs. Trial registrationN/A.

Informing Psychosocial Care for Young Couples Coping with Early-Onset Breast Cancer: A Cross-Sectional Examination of Unmet Service Needs and Their Association with Psychological Distress in the First Year Post-Diagnosis.

Objective: Young women diagnosed with breast cancer report greater psychological and physical morbidity than both older women and healthy peers. Similarly, young partners experience elevated cancer-related distress. Psychosocial oncology programs are not frequently attuned to the needs of young adult patients and may exclude their social networks. This marks a critical gap in psychosocial care delivery. The study investigated unmet service needs, psychological distress, and care preferences of young couples managing breast cancer in the first year post-diagnosis. Methods: Forty dyads (n = 80) of women aged 18-45 and their partners completed measures of anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and a service use questionnaire adapted from previously published Adolescent and Young Adult (AYA) literature. The resulting 25 items assessed perceived care needs and service utilization across three domains: informational, emotional/supportive, and practical issues. Descriptive statistics, cross-tabulations, and bivariate correlations were computed. Actor and partner effects of unmet needs on mental health outcomes were investigated with generalized estimating equations (GEE). Results: Patients and partners were in their late thirties, mostly non-Hispanic White, married, highly educated, and employed. Approximately 60% of patients and 43%-66% of partners presented one or more unmet service needs, which correlated with greater distress. Unmet needs about information related to exercise, recurrence, nutrition, and symptom management were prevalent. Unmet supportive service needs of both patients and partners included age-appropriate programs, sexual health, and family counseling. Women reported practical needs for work/school accommodations, integrative care, financial issues and health coverage; while financial concerns, health insurance, and caregiving demands were priorities for partners. Conclusion: Young couples facing early-onset breast cancer experience large proportions of unmet service needs. These challenges were exacerbated by the lack of developmentally targeted psychosocial programs pertaining to informational, supportive, and practical care needs. Enhancing providers' understanding of the psychosocial issues affecting young couples' well-being, and the implementation of systematic procedures to detect and respond to their distress, is urgently needed.

Descriptive Study on Nature of Perceived Stress of Mothers of Children with Autism Spectrum Disorder - A Qualitative Analysis

This study examines the nature and impact of parental stress specifically among mothers of children with Autism Spectrum Disorder (ASD). Parental stress is a significant concern in families raising children with ASD due to the unique challenges associated with the condition. The study aims to explore the factors contributing to maternal stress, including caregiving demands, social support, coping mechanisms, and personal resilience. Methodologically, in-depth interviews as the mono-method approach are employed, to measure stress levels with qualitative insights into mothers' experiences. Participants are recruited from diverse socio-economic backgrounds to ensure a comprehensive understanding of the phenomenon. Findings highlight the multifaceted nature of parental stress in this population, shedding light on the specific stressors and protective factors that influence maternal well-being. Implications for interventions and support services aimed at alleviating maternal stress and promoting family resilience are discussed based on the study's results.

Life satisfaction, perceived social support of mothers of children with cerebral palsy, and motor function of their children

Cerebral palsy (CP) is a leading cause of long-term disability in children worldwide where severe cases may require complete dependence on caregivers for mobility, self-care, and social participation. The demand for caregiving may negatively impact the level of life satisfaction of the caregivers, especially the mothers. This study was thus carried out to evaluate the level of life satisfaction of mothers of children with CP, its association with perceived social support, and the motor function of their children.MethodThe study involved 58 mothers of children with CP and their children. The level of life satisfaction, perceived social support, and socioeconomic status of the mothers were assessed using the satisfaction with life scale, the multidimensional scale of perceived social support, and the modified Kuppuswamy Socioeconomic Scale, respectively. The motor function of the children with CP was assessed using the Gross Motor Function Classification System (GMFCS).ResultAbout 38% of the mothers of children with cerebral palsy were fully satisfied with their lives. There was no significant association among the level of life satisfaction, perceived social support of mothers of children with CP, and the motor function of their children.ConclusionSix out of ten mothers of children with cerebral palsy are somewhat dissatisfied with life. It was recommended that measures to relieve factors leading to dissatisfaction with life should be put in place by national health policymakers.

Demographics, Clinical Characteristics, and Well-Being of Veterans with TBI and Dementia and Their Caregivers.

This study provides a detailed examination of older Veterans with traumatic brain injury (TBI) and dementia and their caregivers, focusing on Veterans' demographic, clinical, functional, safety risk, and behavioral characteristics and caregivers' demographic, clinical, and care-related characteristics and well-being. Veterans' caregivers (N = 110) completed a telephone-based survey. Veterans averaged eight comorbid health conditions, with over 60% having chronic pain, hypertension, post-traumatic stress disorder, or depression. Caregivers reported helping with an average of three activities of daily living, with the highest percentages of Veterans needing assistance with grooming, dressing, and bathing. Almost all Veterans needed assistance with shopping, cooking, medication management, housework, laundry, driving, and finances. Veterans averaged two safety risks, the most common being access to dangerous objects, access to a gun, and not being able to respond to emergency situations. Although Veterans averaged 14 behavioral concerns, caregivers reported that their family needs relating to TBI were generally met or partly met, and they voiced confidence in their ability to respond to behaviors and control their upsetting thoughts. Caregivers' mean burden score was severe, while mean depression and anxiety scores were mild. Caregivers reported an average of 10.5 h per day providing care and 20.1 h per day on duty. The findings demonstrate the increased presence of impairments, safety risks, and behavioral issues in Veterans with comorbid TBI and dementia, as well as increased impacts on families' burdens and care provision requirements. Clinicians should be alert for and educate TBI patients and caregivers on the warning signs of post-TBI dementia and its associated functional, behavioral, and safety risk profile, as well as challenges related to caregiver well-being. Healthcare policymakers must consider the increased caregiver demands associated with comorbid TBI and dementia, as well as the need for expanded long-term support and services.

The Impact of Children's Health Shocks on Parents' Labor Earnings and Mental Health

Abstract We provide novel evidence on the causal impact of a child's health shock on parents' labor market outcomes. Using high-quality Finnish and Norwegian administrative data, we construct counterfactuals for treated households with families who experience the same shock in later years. We find a sharp break in mothers' earnings trajectories after the event, while we do not find significant effects for fathers. Our findings do not align with the hypothesis of household specialization explaining these adjustments. Instead, the evidence suggests that these changes are driven by increased caregiving demands, with mothers bearing the primary burden. We also document a substantial impact on parents' mental well-being.

Approximately half of the nursing students confirmed their willingness to participate in caring for older people: a systematic review and meta-analysis

BackgroundGlobal population aging poses a significant global challenge, necessitating an increased demand for proficient caregivers specialized in elderly care. In our study, a systematic review and meta-analysis were conducted to synthesize the evidence concerning nursing students’ willingness to participate in caring for older people.MethodsEligibility criteria focused on cross-sectional studies involving nursing students’ willingness to participate in caring for older people and were reported in English or Chinese. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WANFANG databases were searched from inception until July 24, 2022. The methodological quality assessment in the included studies was evaluated using the AHRQ instrument. The pooled effects of the nursing students’ willingness to participate in caring for older people were computed using a random-effects model. Funnel plots and Egger’s test were employed to evaluate publication bias. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity. Sensitivity analysis was conducted to verify the robustness of the meta-analysis findings. All statistical tests were conducted with Stata 16.0 software.ResultsA total of 68 studies of medium or high quality met the eligibility criteria, involving 30,328 nursing students. The rate of nursing students’ willingness to participate in caring for older people was 49.0% (95% CI = 46–53%, I2 = 98.1%, P = 0.000). The results of meta-regression analysis showed that the following four predictor variables were significantly associated with nursing students’ willingness to participate in caring for older people: experience of living with and caring for older people, nursing as their first choice and their year-level in education, respectively. Subgroup analyses for these four predictor variables revealed the following pooled estimates of nursing students’ willingness: having experience of living with older people (0.54, 95% CI = 0.46–0.62) vs. no such experience (0.38, 95% CI = 0.30–0.46), having experience of caring for older people (0.55, 95% CI = 0.48–0.63) vs. no such experience (0.38, 95% CI = 0.30–0.46), nursing as their first choice (0.54, 95% CI = 0.51–0.58) vs. not their first choice (0.44, 95% CI = 0.35–0.53), being in the first year of nursing education (0.44, 95% CI = 0.34–0.55), second year (0.45, 95% CI = 0.34–0.56), and third and fourth year (0.62, 95% CI = 0.53–0.71).ConclusionThe study found that approximately half of the nursing students confirmed their willingness to participate in caring for older people.The present study can serve as a resource for policymakers to increase the willingness of nursing students to participate in caring for older people.

Emotional labor, conflicting caregiving responsibilities and resilience among foreign female caregivers in Japan: A photovoice study

AbstractPrompted by Japan's aging population and the growing demand for migrant female caregivers, this study employs a participatory action research method—photovoice (N = 11) and interviews (N = 9) to investigate the emotional labor, conflicting caregiving responsibilities, and resilience among foreign female caregivers in Japan. A total of 47 photographs and nine interviews were gathered, revealing three main themes with several sub‐themes, such as discrimination, loneliness, ergonomic challenges, and emotional burden. The findings shed light on the stigmatization faced by foreign female caregivers in Japan, who are often perceived as inadequately qualified for their roles. It particularly emphasizes the difficulties they face in balancing their caregiving duties in Japan with the inability to care for their own families back home. Additionally, Japan's stringent immigration policies, patriarchal social structure and the experiences of discrimination further complicate their situation. We recommend that policies and programs focus on improving working conditions (such as reducing workload and increasing wages), supporting family unity, and providing greater flexibility for social integration among migrant caregivers.

P30: Agitation in Alzheimer’s Dementia: Conceptual Framework to Demonstrate the Burden of Illness

Introduction: Agitation in Alzheimer’s dementia (AAD) confers significant humanistic and economic burden; however, factors, and relationships between them, which drive the extent of this burden are poorly understood. The Objectives of this study was to review and gather evidence on the burden of AAD in order to develop a conceptual framework capturing its effects on patients, their families, clinicians (i.e., care teams), and society, which can then be used to guide further research into how the burden of AAD might be reduced.Methods: Evidence on the burden of AAD was identified via a targeted literature review. Data were classified into societal, patient/family/care team, and mitigating factors. A conceptual framework (i.e., a visual representation of variables and associations between them) was developed to map the relationships between factors and illustrate the precedents and downstream effects of agitated behaviors on patient and caregiver outcomes, including healthcare resource utilization (HCRU), costs, and admission to long term care(LTC).Results: Agitated behaviors were found to directly impact caregiving demands in terms of the number of hours required to care for patients. Similarly, levels of caregiver stress (i.e., total caregiver burden, personal strain, role strain, and guilt) were found to be associated with the frequency and intensity of AAD. Burden also extended to care teams via increased HCRU (i.e., pharmacy, outpatient, inpatient, and emergency room visits), and consequently costs, relative to non-agitated patients. Indirectly, through caregiving demands, agitation also affected the rate of placement in formal care and LTC, both of which are associated with incremental costs. Evidence also indicated that mitigating factors such as pharmacological treatment could impact the frequency and intensity of agitated behaviors, potentially affecting downstream HCRU and costs. Limited evidence exists on the optimal means of employing such strategies to limit caregiver demands and stress.Conclusions: This study demonstrated the complex interplay of factors which drive the burden of AAD and the need which exists for novel ways to improve outcomes for those impacted by the disease. Better insight into the mechanism by which agitated behaviors influence caregiver demands and stress could help improve mitigation strategies both within family units and the larger health system.