Change In Work Status Research Articles

Vocational Outcomes After Traumatic Brain Injury; Prevalence and Risk Factors After 1 Year in a Multivariable Model

To determine the prevalence of employment status (ES) or full-time study after traumatic brain injury (TBI) in a representative population and its predictive factors. Prospective cohort study. Regional Major Trauma Centre. Participants: In total, 1734 consecutive individuals of working age, admitted with TBI to a Regional Trauma Centre, were recruited and followed up at 8 weeks and 1 year with face-to-face interview. Median age was 37.2 years (17.5-58.2); 51% had mild TBI, and 36.8% had a normal computed tomographic (CT) scan. Complete or partial/modified return to employment or study as an ordinal variable. At 1 year, only 44.9% returned to full-time work/study status, 28.7% had a partial or modified return, and 26.4% had no return at all. In comparison with status at 6 weeks, 9.9% had lower or reduced work status. Lower ES was associated with greater injury severity, more CT scan abnormality, older age, mechanism of assault, and presence of depression, alcohol intoxication, or a psychiatric history. The multivariable model was highly significant (P < .001) and had a Nagelkerke R2 of 0.353 (35.3%). Employment at 1 year is poor and changes in work status are frequent, occurring in both directions. While associations with certain features may allow targeting of vulnerable individuals in future, the majority of model variance remains unexplained and requires further investigation.

Retirement and Social Activities in Japan: Does Age Moderate the Association?

Although retirement age is increasing in aging societies, its impact on individuals and communities is unclear. This study examined how age moderates the linkage between transition into retirement and participation in productive and non-productive social activities after retirement, using a nationwide longitudinal survey with a probability sample of Japanese aged 60 and over (n = 3,493). Multinomial logistic regression analyses were performed to predict changes in volunteering and hobbies/learning during 3-5 years of follow-up and their participation level at the follow-up. The significant interactions between change in work status (remained working as reference, full/partial retirement, remained not-working) and age at baseline showed that fully retired persons were more likely to increase these activities than remained workers only when they retired by their early seventies. Thus it is important to encourage engagement in social activities before retirement and remove psychological and environmental barriers that hinder starting new activities at old age.

EULAR Points to Consider (PtC) for designing, analysing and reporting of studies with work participation as an outcome domain in patients with inflammatory arthritis

BackgroundClinical studies with work participation (WP) as an outcome domain pose particular methodological challenges that hamper interpretation, comparison between studies and meta-analyses.ObjectivesTo develop Points to Consider (PtC) for design, analysis...

A longitudinal analysis of employment in people with severe mental illnesses in India

PurposeLittle is known about the longitudinal trajectories of employment in people with severe mental illnesses (SMI) in developing countries, including India. We examined stability and change in work status, interest in work, problems and benefits related to work among employed participants, and barriers and desired job supports among unemployed participants. MethodsWe conducted a one-year follow-up with 550 participants with SMI receiving psychiatric outpatient treatment in two hospitals in two districts in India. A total of 459 (83.5%) participants completed follow-up interviews. ResultsRates of employment were stable across the one-year period, with over 60% employed at baseline and follow-up assessment. More than 80% who worked at both assessments were working in the same job for an average duration of 10 years. Among participants who were unemployed at baseline, 16.9% started working at follow-up, an outcome associated with interest in work and efforts to find work at baseline. Interest in work of those unemployed at both assessments was lower at follow-up than baseline, but over 60% of participants wanted to work across both assessments, and endorsed desired supports for their job search. ConclusionsThere is considerable stability of work in people with SMI in India. Working in the same job for the long term may have contributed to consistent work. Most unemployed participants who wanted to work at baseline were not working at follow-up, and expressed a desire for help with job search, suggesting the need for vocational services to help people with SMI in developing countries obtain employment.

Employment After Breast Cancer Diagnosis and Treatment Among Women in the Sister and the Two Sister Studies.

Purpose Women undergoing diagnosis and treatment for breast cancer may face challenges in employment. We investigated the impact of demographic, clinical, workplace, and psychosocial characteristics on loss of employment after a breast cancer diagnosis and treatment. We further describe changes in work status and work environment for cancer survivors who sustain employment. Methods We analyzed responses from a survey of breast cancer survivors from the Sister Study and the Two Sister Study cohorts who reported being employed at the time of their breast cancer diagnosis and who reported employment status (lost vs. sustained employment) at the time of survey administration. Multivariate logistic regression was used to identify the effects of lymphedema, neuropathy, problems with memory or attention, social support, health insurance, and sick leave on lost employment, adjusting for demographic characteristics, cancer stage, treatment, and general health. Results Of the 1675 respondents who reported being employed at the time of diagnosis, 83.5% reported being 'currently' employed at the time of the survey. Older age, peripheral neuropathy, lack of sick leave, late stage at diagnosis, a recurrence or a new cancer, problems with memory or attention, and poor general health were significantly associated with lost employment. Conclusions The long-term effects of breast cancer treatment and workplace provisions for leave and accommodation may have a substantial effect on women's ability to sustain employment. The findings from this study highlight challenges reported by cancer survivors that may inform clinical and occupational interventions to support survivors' return to work.

Impact of Q-fever fatigue syndrome on patients' work status.

BackgroundChronic illnesses can increase the risk of unemployment, but evidence on the specific impact of Q-fever fatigue syndrome (QFS) on work is lacking.AimsThe aim of this study was to describe and quantify the impact of QFS on work.MethodsChanges in work status from 1 year prior to 4 years after acute Q-fever infection of QFS patients were retrospectively collected with a self-report questionnaire measuring employment status and hours of paid work per week. In addition, information on work ability, job satisfaction and need for recovery after work was collected in 2016. Data were compared to participants from the general population.ResultsThe proportion of employed QFS patients from 1 year prior to 4 years after acute infection decreased from 78 to 41%, while remaining relatively constant in the general population (82 to 78%). Working QFS patients showed a decrease in mean hours of paid work from 35 to 22 h per week, which is significantly steeper compared to the general population (31–28 h per week) (P < 0.001). QFS patients showed a significantly lower work ability (P < 0.001), lower job satisfaction (P = 0.006) and greater need for recovery (P < 0.001) compared to the general population.ConclusionsThe number of QFS patients with paid work decreased over the years, while patients who continue to work experience lower work ability, job satisfaction and increased need for recovery. Occupational physicians should be aware of the occurrence and severity of the impact of QFS on work, even after many years.

Effects of work status changes and perceived stress on glycaemic control in individuals with type 1 diabetes during COVID-19 lockdown in Italy

AimsTo evaluate the effects of COVID-19 lockdown on blood glucose control in individuals with type 1 diabetes (T1D) and to explore determinants of glucose variability. MethodsFifty T1D patients undergoing continuous/flash glucose monitoring were recruited. The study’s primary outcome was the change of time in range (TIR) from before to lockdown period. Three time-point comparisons of TIR, mean glucose levels (MG), estimated (e)HbA1c, time above (TAR) and below range (TBR), moderate/severe hypoglycemic events between pre-lockdown, lockdown and post-lockdown period were also performed. Information on lockdown-associated perceived stress, changes of work status and physical activity were recorded. ResultsTIR significantly decreased (75(63–84)% vs.69(50–76)%,p < 0.001) whereas MG (154 ± 15 mg/dl vs.165 ± 25 mg/dl, p = 0.027) and eHbA1c (7.3(6.6–7.8)%vs.7.5(6.7–8.2)%,p = 0.031) increased from pre- to lockdown period; overall glucose control significantly improved when restriction ended. Lockdown-associated work loss/suspension independently predicted impaired TIR after adjustment for potential confounders (Standardizedβ: −0.29; 95%CΙ: −18.7 to −2.25;p = 0.01). Greater TAR, TBR and hypoglycemic events were also reported during the lockdown. ConclusionIn T1D Italian individuals, blood glucose control significantly worsened during the COVID-19 lockdown; work instability and related issues represented the main determinant of impaired glucose variability in this population.

Factors Influencing the Ability to Achieve Valued Outcomes among Older Long-Term Unemployed People

This qualitative study aims to explore the valuable functionings—things that people consider to be important—of the older long-term unemployed and their ability to achieve valued outcomes. Semi-structured interviews were conducted with 20 long-term unemployed people aged 45 and over. Participants were included through purposeful sampling. The theoretical frameworks of the latent deprivation theory and the capability approach were used to develop an interpretive analysis. Nine valuable functionings were identified: social contact, feeling appreciated, structure, feeling useful, meaningfulness, autonomy, financial resources, paid work, and being active. These valuable functionings were partly accessible through the activities that people performed, varying from physically active and physically passive activities to informal work. The functionings of meaningfulness, autonomy, financial resources, and paid work seemed to be difficult to achieve. We identified three groups. The first consisted of people whose work status changed when they entered the benefit system; for them paid work was still a valuable functioning, and they experienced the most difficulties in achieving valued outcomes. The second group also experienced a change in work status once they started to receive benefits, but those people adapted to their new situation by attributing greater value to other functionings. The third group had no change in work status, e.g., housewives who had applied for a benefit because they were not able to make ends meet after a divorce. This group did not experience a loss of functionings due to unemployment, nor did they try to achieve other functionings. The results of this study indicate a need for a more personalized, tailor-made approach, with an emphasis on an individual’s valued outcomes instead of on rules and obligations.

Prompt Mental Health Care (PMHC): work participation and functional status at 12\u2009months post-treatment

BackgroundAnxiety and depression are associated with substantial functional impairment. Prompt Mental Health Care (PMHC), the Norwegian adaptation of IAPT is currently piloted across Norway, as a means to improve access to evidence-based care for adults with anxiety disorders (including subthreshold cases) and minor to moderate depression. The aims of the current paper were to examine the change in work status and functional status from pre- to post-treatment and 12 months post-treatment among clients at the first 12 PMHC pilot sites, and whether degree of change differed across sociodemographic characteristics.MethodsA prospective cohort design was used, including working age clients receiving treatment between October 2014 and December 2016 (n = 1446, participation rate = 61%). Work status and functional status were self-reported, the latter by the Work and Social Adjustment Scale (WSAS). Changes in work status and WSAS score were examined through multilevel models based on maximum likelihood estimation. Likelihood ratio tests were performed to determine whether the interaction between time and the respective background variables were statistically significant.ResultsA substantial increase in regular work participation was observed from pre- to post-treatment, which further had increased at 12 months post-treatment. The increase was driven by a corresponding reduction in proportion of clients working and receiving benefits (OR 0.38 [0.29–0.50] baseline to final treatment, OR = 0.19 [0.12–0.32] final treatment to 12-months post-treatment), while no statistically significant change was observed in proportion out of work. Large improvement (ES = − 0.89) in WSAS score was observed from pre- to post treatment. WSAS score at 12 months post-treatment remained at the post-treatment level.ConclusionsPrevious research has shown substantial symptom improvement among clients receiving treatment in PMHC. The current findings indicate that PMHC might also be able to aid adults struggling with mild to moderate anxiety and depression in returning to usual level of functioning. The degree to which the observed improvements are attributable to the treatment need nonetheless to be confirmed in a trial including a control group and with more complete follow-up data from registries.

Clinical Course and Impact of Complex Regional Pain Syndrome Confined to the Knee.

Although complex regional pain syndrome (CRPS) of the knee is comparable to CRPS of the ankle/foot at time of diagnosis, no reports are available concerning the course of knee CRPS. Therefore, this study investigated the clinical course in terms of the symptoms and signs, health-related quality of life (HR-QoL), and work status of patients diagnosed with CRPS of the knee. Observational, descriptive study. Single-center study. Patients with CRPS of the knee. Patients self-reported their past and current CRPS symptoms, HR-QoL, and work status; all underwent a physical examination. A comparison was made of changes in symptoms over time between patients with CRPS of the knee and those with CRPS of more distal locations. In total, 32 patients were enrolled. The follow-up time was 11.5 ± 6.29 years since diagnosis, and symptoms and signs showed a significant decrease over time. Twelve patients (37.5%) rated their health as (generally) positive. Patients who were still able to work (31.3%) stated that their physical health gave them at least some problems in the performance of their job. A change in symptoms occurred significantly less often in CRPS of the knee. CRPS of the knee changes in terms of symptoms over time, but significantly less than CRPS of other locations. A change in work status was reported in 82% of the patients due to their CRPS, and in 91%, the pain interfered with their daily life. CRPS of the knee is a painful condition with persistent symptoms causing a diminished HR-QoL.

The Impact of a Breast Cancer Diagnosis on Women´s Work Status

Background: Many women diagnosed with breast cancer are of working age at the time of diagnosis, so the impact of a diagnosis and treatment regimen on their lives can cause financial stress-partly by impacting on their ability to continue in paid employment. The financial fallout from not working, changes in employment status and the hidden costs associated with cancer treatment can add to financial toxicity. Aim: Our aim was to identify changes in work status after a diagnosis of breast cancer. Our secondary aim was to determine if there was a correlation between different treatment modalities and work status at 12 month follow-up. Finally, we wanted to consider the role of treatment and change in work status on the financial stress experienced by patients after their diagnosis and treatment. Methods: An audit of the medical record of women who present to Western Health with a diagnosis of early breast cancer and consequently attended the nurse led breast cancer survivorship clinic (SC) between October 2015 and October 2016 was performed to identify employment status at diagnosis and at review in SC 12 months later. Results: 114 patients attended the SC in a 1 year period- 2 were males and both retired at diagnosis. The records of 111 women were reviewed. 46 of the 84 women &lt; 65 years, were in paid employment at diagnosis. 38 of these 46 women were working in some capacity at 12 month review though only 28 were working the same, having decreased hours since diagnosis. 17 of the 111 (15%) women reported financial stress at the 12 month review. 9 of the 19 (42%) women with changed work status reported financial stress. 2 of the 28 (7%) women working the same hours reported financial stress. 14 of the 19 (74%) women who had changed work status had chemotherapy. 65% of those who reported financial stress (11/17) had chemotherapy as part of their treatment. 10/19 (53%) had changed or stop working since axillary dissection. Conclusion: Our data suggest that 83% of women returned to work in some capacity- most at the same level, and these women were unlikely to report financial stress. Women who returned to work at reduced hours, increased hours, or did not return to work at all were more likely to report significant financial concerns at one year postdiagnosis. Health care professionals as part of ongoing care should be aware of the financial impact a cancer diagnosis and its treatments, and should aim to refer appropriately.

Work Transitions in Breast Cancer Survivors and Effects on Quality of Life

Purpose Work transitions among breast cancer survivors remain an underexplored area. We aimed to examine prevalence and determinants of changes in work status, and the effect of these changes on quality of life of breast cancer survivors. Methods A cross-sectional study of 410 female breast cancer survivors randomly drawn from a larger study sample pool (n = 2644), members of "Leumit" healthcare fund, who werediagnosed with primary nonmetastatic invasive breast cancer in the years 2002-2012. The study questionnaire included questions on work characteristics and health-related quality-of-life and was completed by all women contacted. Work transition was defined as a downgrade (from full-time to part-time), termination, or retirement, and was contrasted to no change in work status (retention of full-time or part-time). Work transition was assessed at two intervals: between breast cancer diagnosis and treatment, and between breast cancer diagnosis and time of the survey. Results A total of 206 breast cancer survivors (50%) were employed prior to their diagnosis, of whom 12% stopped working, and 79% downgraded to part-time during treatment. At the time of survey (mean 8 ± 3years post-diagnosis), 33% of those employed prior to their diagnosis stopped working or retired, 48% downgraded to part-time, and 19% had no change in their work situation. Work transition between diagnosis and time of thesurvey was significantly associated with poorer quality-of-life. In multivariable analyses, work transition between diagnosis and time of the survey was positively associated with being immigrant compared to native-born Israeli (odds ratio (OR) 4.65; 95% confidence interval (CI) 1.91-11.37; P = .001), and inversely with education level of college or over compared to high school or less (OR 0.27; 95% CI 0.09-0.86; P = .026). Conclusions Breast cancer survivors with characteristics pointing at underprivileged social circumstances more often experienced changes in work status after surviving breast cancer, irrespective of diagnosis, comorbidity or treatment. Breast cancer patients with immigrant status and/or lower educational attainment need more support to be able to keep their job.

The impact of a breast cancer diagnosis on women’s work status.

23 Background: The diagnosis and treatment of cancer often causes financial stress, partly by impacting on the ability to continue in paid employment. Our aim was to identify changes in work status 12 months after a diagnosis of breast cancer. Methods: An audit of the medical records of women who presented to the Western Health (Victoria, Australia) nurse led breast cancer Survivorship Clinic (SC) between October 2015 and October 2016 was performed to identify employment status at diagnosis and at their review at SC 12 months later. Results: 111 records were reviewed. The mean age was 55 (range 28-82yrs). 84 of these women (76%) were 65 years of younger at the time of diagnosis. 46 of the 84 women ≤65 years were in paid employment at diagnosis (55%), and 38 (83%) were still working in some capacity at review in the SC. Of the 38 still working, 28 were working in the same capacity, 8 were working reduced hours, and 2 were working increased hours. Women who had axillary dissections were most likely to have changed work status. Financial stress was reported by 8/19 of women who stopped working or had changed work hours, including 9 no longer in paid employment and 10 with changed hours. 2/28 women working in the same capacity reported financial stress. 65% of those who reported financial stress (11/17) had chemotherapy as part of their treatment. Conclusions: A breast cancer diagnosis has the ability to influence a woman's work status one year after diagnosis. Health professionals should appreciate the potential work concerns and financial stresses continuing to affect their patients.

Use of integrative services is associated with maintenance of work schedule during and after cancer treatment

IntroductionCancer diagnosis affects employment status. Our health network offers supportive services to cancer patients. We hypothesized patients who used these services were more likely to continue to work during and after treatment. MethodsA mailed survey was used to assess employment before, during, and after treatment, and support services used. Chi-square analysis was performed. ResultsThe response rate was 34% (273/782). 87% of patients worked full or part time before cancer diagnosis, 68.8% continued to work during treatment, and 73.9% returned to work after treatment. 61% of patients used at least one type of support service. Patients who had no change in work status during treatment and who returned to work less than one month after treatment were more likely to use services. ConclusionsMost patients used support services, continued to work during treatment, and returned to pre-cancer employment status. Physicians should encourage patients to pursue supportive therapies.

Modelo dinámico para analizar el desempleo en egresados de programas de educación superior

The research is framed in a quantitative explanatory approach, whose objective was to analyze a model to describe the unemployment rate conditioned to the probability of moving from an occupational state to a state of unemployment, in face of different characteristics of the graduation profile of the individuals from universities of North of Santander. Within this frame of reference, the changes in work status in graduates for the years 2014 and 2016 were studied; through multistage conglomerate sampling. Results: high predictive values and adequate adjustments characterized logit-type models adjusted. Through their coefficients, a measure of the differences in labor inertia between different academic programs was obtained. The adjusted logit model was an optimal model for measuring unemployment rate in professionals.

Resource utilization in patients with head and neck cancer: Analysis of CCTG HN6 (NCT00820248).

6067 Background: As new treatments for head and neck cancer arise, further information is required regarding resource utilization. The Canadian Cancer Trials Group HN.6 study included collected resource utilization data prospectively on patients with locally advanced squamous cell carcinoma of the head and neck treated with cisplatin or panitumumab plus radiotherapy (RT). Methods: The HN.6 phase III trial enrolled 320 patients across Canada between 2008-2011. The economic analysis was conducted from the societal perspective. Resource utilization was collected prospectively for 3 categories: outpatient, hospitalization and institutionalization (end of life care) at baseline, 8 weeks, every 3 months(mo) for 2 years and every 4 mo until 3 years. Lost productivity questionnaires were collected in the last week of RT. Descriptive statistics were used to summarize the outcomes. Categorical variables were reported by percentage and continuous variables were reported by mean and standard deviation. Results: Of 320 pts randomized, resource utilization and lost productivity data were available for 317 (99%) and 285 (89%) pts, respectively. Eighty nine pts required 130 emergency room visits (mean 1.46±0.85). There were 696 (mean 3.74±3.22) office visits among 186 pts and 367 (mean 3.95±6.43) outpatient visits among 93 pts. Surgeons, radiation oncologists and emergency room physicians were the top three providers of outpatient care with 234 (mean 2.05±1.54), 137 (mean 1.67±1.19) and 118 (mean 1.4±0.78) visits for 114, 82 and 84 pts, respectively. CT scans (286), lab tests (418), x-rays (182) and other tests (400) were conducted in 136, 180, 120 and 194 pts, respectively. Three pts were institutionalized for end of life care (mean 28 days±26.06), and 214 pts were hospitalized (mean 14.5 days±28.8). One hundred and thirteen (41%) pts reported a change in work status at the end of RT. Conclusions: Radical treatment for locally advanced SCCHN is resource intensive. Tracking resources utilized prospectively in clinical trial settings and reporting this information consists of an efficient way to inform health resource allocation decisions. Clinical trial information: NCT00820248.

APC Injuries With Symphyseal Fixation: What Affects Outcome?

To evaluate the influence of the symphyseal position at union, implant failure, and the type of posterior ring injury on validated outcome measures. Retrospective review with prospectively collected validated outcome data. Two academic level 1 trauma centers. We evaluated 54 patients with operatively treated anterior-posterior compression (APC) type 2 and 3 injuries. Thirty-five APC type 2 and 19 APC type 3 injuries were reviewed at a minimum of 2 years after surgery. Average follow-up was 7 years. Patients were evaluated with validated EuroQol five dimensions (EQ5D), EuroQol health index, Visual Analog Score (VAS) pain, Majeed pelvic scores, and change in work status. The final anterior-posterior (AP) radiograph available was reviewed for implant failure and displacement. Revision surgery was documented based on implant status and displacement at final follow-up. There were trends toward better outcomes for APC type 2 for EQ5D and VAS pain. Patients with injury severity score (ISS) >16 had worse reported health, Majeed scores, and VAS pain. Nineteen patients had failure of fixation. There were no differences in any outcome measure; trends toward better Majeed score were found for patients with intact fixation. Displacements >15 mm anteriorly at final follow-up negatively affect outcomes with significantly worse EQ5D, reported health, and Majeed score. Two patients required revision surgery. There were no differences in final outcomes. No significant differences were found for APC type 2 versus type 3 injuries. Higher injury severity score resulted in worse outcomes and more pain. Outcomes were not effected by implant failure; however, major loss of reduction (>15 mm) anteriorly did negatively impact outcomes. Patients with failure who were revised to union did not have worse outcomes. Prognostic level IV. See Instructions for Authors for a complete description of levels of evidence.

Longitudinal examination of temporality in the association between chronic disease diagnosis and changes in work status and hours worked

ObjectivesTo examine the longitudinal relationship between incidence of diagnosed chronic disease and work status and hours worked.MethodsA dynamic cohort approach was taken to construct our study sample using the Canadian...

The relationship between work and family preferences and behaviors

Proposed theories to explain gender inequality in the labor market and family, such as gender specialization within families and gender segregation in the labor markets, lack consideration for individual preferences. Preference theory accounts for individual choice and gendered preferences but has been substantially criticized, indicating a need for further research. This study uses Swedish longitudinal data to explore how preferences for work and family relate to behavior. We explore three critical issues raised in previous research: gender differences in preferences; the relationship between work and family changes and subsequent preferences; how preferences relate to work and family behaviors. Our results showed small general gender differences in preferences, although women had a stronger preference for both children and work than men. Changes in work status were further related to changes in work preferences, while changes in family status were related to changes in family preferences. Moreover, preferences had poor predictive power in relation to work and family behaviors. Our results indicate that preferences do not explain gender inequality in Sweden. The relationship between preferences and behaviors seems bidirectional and preferences and behavior within the family sphere has little to do with preferences and behavior within the work sphere.

Work Impact and Emotional Stress Among Informal Caregivers for Older Adults.

With the growing aging population and reliance on informal caregivers in the United States, many individuals will take on the role of caregiver as an adult. We examined whether informal caregivers experience work interference or a change in work status (i.e., retiring/quitting) due to caregiving. We also explored whether experiencing work interference or a change in work status was associated with greater emotional stress. This secondary analysis is drawn from the Fifth National Survey of Older Americans Act (OAA) program participants, which included 1,793 family caregivers. The present analysis is on caregivers of working age (18-64 years) providing care to another adult, which included 922 caregivers. Ordinal logit models were used to assess associations between experiencing work interference or a change in work status and emotional stress. Study weights were applied for all analyses. At the time of the survey, more than half (52.9%) of caregivers were employed full- or part-time. Among nonworking caregivers (i.e., not working or retired) at the time of the survey, 39.8% responded that they had quit or retired early due to caregiving demands. Among employed caregivers, 52.4% reported that informal caregiving had interfered with their employment. Importantly, those respondents who reported work interference or a change in work status were more likely to report higher levels of emotional stress associated with caregiving demands. These findings suggest the need to further explore work among informal caregivers and associations with emotional stress, as well as consider work-based policy approaches, organizational and/or societal, to support informal caregivers.