Different Types Of Caregivers Research Articles

Young Children’s Digital Literacy Practices with Caregivers in the Home Environment: Voices of Chinese Parents and Grandparents

The development of children’s digital literacy is essential in the 21st century. Digital technologies have been adopted by both parents and grandparents to enhance children’s quality of education, in accordance with the Sustainable Development Goals (e.g., SDGs 4 and 17). Many children have been provided with all types of digital tools and e-devices from birth, which puts their caregivers in a challenging position. In that context, investigating the attitudes, beliefs, communication, and practices of caregivers when interacting with young children while utilizing digital technologies is crucial for comprehending the disparity in digital literacy between parents and grandparents. In this study, we adopted a mixed research design to examine Chinese intergenerational caregiving during the COVID-19 pandemic and different types of caregivers’ beliefs, practices, and communication with children through various digital tools in the home environment. A caregiver-reported survey was conducted to investigate the primary caregivers’ beliefs, practices, and communication using digital media tools with children at home. Intergenerational interviews with 18 families further identified the different methods of caregiving between parents and grandparents. Mixed attitudes were found concerning popular technologies commonly used at home and children’s digital literacy practices, and we heard intergenerational concerns about children’s use of digital technologies. This study shows that Chinese fathers are generally more supportive of digital practices at home, while mothers are more restrictive of their children’s use of digital technology tools. Grandparenting may be overwhelming for Chinese seniors in the 21st century.

Diversity of kidney care referral pathways in national child health systems of 48 European countries.

Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours. In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology. The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Children's Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists. Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain.

Measurement of Health-Related Quality of Life in Individuals With Rare Diseases in China: Nation-Wide Online Survey.

Rare diseases (RDs) affect millions of people worldwide, and these diseases can severely impact the health-related quality of life (HRQoL) of those affected. Despite this, there is a lack of research measuring HRQoL using the EQ-5D-5L, which is one of the most widely used generic preference-based instruments to measure HRQoL in populations living with RDs. This study aimed to measure HRQoL using the EQ-5D-5L in a large number of patients with various types of RDs in China, and to examine the relationship between respondents' socioeconomic characteristics and preference-based health utility scores. The data used in this study were obtained from a web-based survey conducted in China. The survey aimed to explore and understand the health and socioeconomic status of patients with RDs in China. We recruited registered and eligible members, including patients or their primary caregivers, from 33 RD patient associations to complete the questionnaires via their internal social networks. HRQoL was measured using the EQ-5D-5L utility score, which was calculated based on an established Chinese value set. Utility scores have been presented based on demographics and disease-related information. Univariate linear regression analysis was used to assess the differences in the EQ-5D-5L utility scores between subgroups. A total of 12,502 respondents completed the questionnaire and provided valid responses, including 6919 self-completed respondents and 5583 proxy-completed respondents. Data from 10,102 participants over the age of 12 years were elicited for analysis. Among patients with RDs, 65.3% (6599/10,102), 47.5% (4799/10,102), 47.0% (4746/10,102), 24.8% (2506/10,102), and 18.4% (1855/10,102) reported no problems for "self-care," "usual activities," "mobility," "pain/discomfort," and "anxiety/depression," respectively. A full health state was reported by 6.0% (413/6902) and 9.2% (295/3200) of self- and proxy-completed patients, respectively. Among self-completed patients, 69.9% (4826/6902) and 50.4% (3478/6902) reported no problems for "self-care" and "usual activities," respectively, whereas only 17.7% (1223/6902) reported problems for "anxiety/depression." Proxy-completed respondents showed a higher proportion of reporting extreme problems than self-completed respondents in all 5 dimensions. The mean utility scores reported by self- and proxy-completed respondents were 0.691 and 0.590, respectively. Different types of caregivers reported different utility scores, and among them, proxy-completed (mother) respondents reported the highest mean utility score. The establishment of a normative profile for RD patients can facilitate patients' adaptation and assess the effectiveness of interventions to improve the HRQoL and well-being of this population. Differences between self- and proxy-completed HRQoL assessed by the EQ-5D-5L have been identified in this study. This finding highlights the importance of incorporating perspectives from both patients and their proxies in clinical practice. Further development of the patient cohort is necessary to assess long-term changes in HRQoL in the RD population.

The Effect of Intergenerational Parenting Mode on Children’s Outdoor Activities: A Case Study of Downtown Shanghai Communities

The miniaturization of Chinese urban families has led to an increasing trend of “intergenerational parenting” among urban families. However, the influence of different types of caregivers on children’s outdoor activities remains unclear. This study aimed to investigate the impact of various accompanying modes used by different caregivers on the outdoor activities of preschool children. The research employed mixed methods, including questionnaires and interviews, and focused on the intergenerational relationship in communities in Shanghai, China. The findings of this research reveal that caregivers from different generations adopt distinct accompanying modes when engaging in children’s outdoor activities. Grandparents tend to prioritize protection, while parents prefer to spend more time playing with their children. These preferences can be attributed to the division of labor within families and the social and physical environment of the communities in urban central areas. By shedding light on the intergenerational dynamics and caregiving approaches, this study provides a unique Chinese perspective on understanding the factors influencing children’s outdoor activities and experiences.

Qualitative study exploring heterogeneity in caregiving experiences post-stroke in Singapore

ObjectiveStroke, a common illness in older adults, accounts for up to 4% of direct medical costs in developed nations. Informal caregiving contributing a significant proportion of economic burden post-stroke warrants...

A latent survival model integrated computer simulation-based evaluation for nursing home staffing

Nursing homes (NHs) are critical facilities for caring frail older adults with around-the-clock formal care and personal assistance. To ensure quality of care for NH residents, an adequate staffing level is of great importance. Current NH staffing practice is mainly based on experience and regulation. The objective of this paper is to investigate the viability of experience-based and regulation-based strategies, as well as alternative staffing strategies to meet the heterogeneous service demand of NH residents at reduced labor cost under various scenarios of census compositions. We propose a predictive analytics integrated computer simulation model to characterize the heterogeneous service demand of NH residents, and further evaluate and identify promising staffing strategies at the facility level. Specifically, we propose a predictive model based on latent survival analysis to characterize diverse length-of-stay (LOS) with multiple discharge dispositions among NH residents. Further, we develop a simulation model with the incorporation of predictive analytics and domain knowledge to characterize the heterogeneous service demand of NH residents on different types of caregivers over time. Based on the simulation model, we develop a graphical user interface for the simulator to evaluate different staffing strategies at the facility level and inform NH administrators about promising strategies. We use real NH data to validate the proposed model and demonstrate its effectiveness. The proposed predictive LOS model considering multiple discharge dispositions exhibits superior prediction performance and offers better staffing decisions at reduced costs than those without the consideration. With the improved modeling fidelity via integrating predictive analytics with computer simulation, the proposed model is flexible to evaluate various staffing strategies using total labor cost as a performance metric, and can identify promising staffing strategies to meet the service demand of NH residents. Promising staffing strategies with the suggested staff-to-resident (SR) ratio can significantly reduce the total labor cost of multiple types of caregivers, as compared to the benchmark strategies, such as the SR ratios based on industrial practice or minimum requirement of state regulation. Moreover, we construct multiple scenarios of different census compositions of NH residents to demonstrate the capability of the proposed model. Our proposed model can facilitate NH staffing decision making to meet the heterogeneous service demand of NH residents at reduced labor costs.

HEALTHY CAREGIVER SELECTION AMONG DEMENTIA CAREGIVERS: THE ROLE OF SOCIAL SUPPORT

Abstract As of 2019, more than 4 million older adults aged 65+ in the United States are cognitively impaired, including the diagnoses of mild cognitive impairment (MCI) and dementia. Caregivers to these older adults bear significant burden, reflected as high prevalence of chronic stress and mental health problems among the caregiver population. It is thus crucial to understand the wellbeing of the caregiver population to design effective policies. Previous studies have documented survival advantage of dementia caregivers compared to non-caregiving individuals as well as other types of caregivers, namely caregivers to persons with MCI or other types of chronic conditions. However, it remains less clear how the role of social support explains dementia caregiver’s survival advantage. In this paper, we directly compare the level and type of social support between different types of caregivers, and examine to what extent the difference in social support explains the survival and health advantage of dementia caregivers compared to caregivers to persons with MCI, non-cognitive impairment chronic conditions and non-caregiving individuals. We use the 12 waves of the Health and Retirement Study and apply multivariate and survival analysis to calculate difference in age-specific hazard ratios. Our preliminary results show that dementia caregivers tend to secure stronger support from family members than caregivers to persons with MCI. Our results have potential to shed light on the empirical puzzle of healthy caregiver selection effect and have direct implications for designing effective intervention to improve health of the caregiver population.

Clinical Characteristics and Prognostic Relevance of Different Types of Caregivers for Elderly Patients with Acute Heart Failure-Analysis from the RICA Registry.

Background: Patients with heart failure encompass a heterogeneous group, but they are mostly elderly patients with a large burden of comorbid conditions. Objective: The aim of this study was to compare the clinical characteristics and the prognostic impact on hospital admissions and mortality in a population of patients with HF with different types of caregivers (family members, professionals, and the patient himself). Methods: We conducted an observational study from a prospective registry. Patients from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. Patients with heart failure were classified, according to the type of main caregiver, into four groups: the patient himself/herself, a partner, children, or a professional caregiver. A bivariable analysis was performed between the clinical, analytical, therapeutic, and prognostic characteristics of the different groups. The endpoints of the study were all-cause mortality at 1 year; mortality at 120 days; and the readmission rate for HF at 30 days, 120 days, and 1 year of follow-up. In all cases, the level of statistical significance was set at p < 0.05. Results: A total of 2147 patients were enrolled in this study; women represented 52.4%, and the mean age was 81 years. The partner was the caregiver for 703 patients, children were caregivers for 1097 patients, 199 patients had a professional caregiver, and only 148 patients were their own caregivers. Women were more frequently cared for by their children (65.8%) or a professional caregiver (61.8%); men were more frequently cared for by their spouses (68.7%) and more frequently served as their own caregivers (59.5%) (p < 0.001). No statistically significant differences were observed in relation to readmissions or mortality at one year of follow-up between the different groups. A lower probability of readmission and death was observed for patients who received care from a partner or children/relative, with log-rank scores of 11.2 with p= 0.010 and 10.8 with p = 0.013. Conclusions: Our study showed that the presence of a family caregiver for elderly patients with heart failure was associated with a lower readmission rate and a lower mortality rate at 120 days of follow-up. Our study also demonstrated that elderly patients with good cognitive and functional status can be their own caregivers, as they obtained good health outcomes in terms of readmission and mortality. More prospective studies and clinical trials are needed to evaluate the impact of different types of caregivers on the outcomes of patients with heart failure.

Social and Gender Differences in Informal Caregiving for Sick, Disabled, or Elderly Persons: A Cross-Sectional Study.

IntroductionInformal caregivers are in increasing demand to provide care for sick, disabled, and elderly persons in the years to come, also in the Nordic welfare states. Informal caregivers can provide different types of care, such as personal care, supervision, and practical help, and previous research has shown that women take on a heavier care burden than men. However, structural differences in care tasks and caregiver burden in the Norwegian population is an under-researched area of study.ObjectiveThe study objective is to explore different types of informal care and caregivers in the Norwegian population and assess how different types of caregivers are distributed across socio-demographic groups.MethodsA cross-sectional population survey was conducted in 2014. A random sample of 20,000 people above 16 years of age was drawn from the national population register. The net sample consisted of 4,000 individuals, giving a response rate of 20.2%. Data were collected using telephone interviews. We used descriptive statistics, crosstabulations with chi-square tests and multinomial regression analyses.ResultsFifteen and seven percent of the respondents reported that they regularly helped persons with special care needs outside and inside their own household, respectively. Women were more likely than men to give personal care, whereas men were overrepresented among caregivers providing practical help only. The mean age of caregivers providing practical help only was significantly lower than for caregivers providing personal care.ConclusionOur results indicate that women take on a heavier care load, both by providing more personal care then men and in that they spend more time caring. It is important that nurses and other healthcare professionals in community care have knowledge about structures of inequality in informal caregiver tasks and burden so that they can better identify opportunities for improved coordination between formal and informal care.

Different Experiences of Adult Child and Spousal Caregivers with Family Conflict

Previous research indicates that different types of caregivers report distinct levels of family conflict (Dieker et al., 2019). However, as half (52%) of the participants in the previous study did not report family conflict, the purpose of this study was to examine the relationships among types of caregivers, family conflict, and caregiver burden in those who experience family conflict. Participants (N = 277; aged 19 to 87; M = 52.96) comprised of 197 adult child and 80 spousal caregivers. They completed the Caregiver Reaction Scale (O’Malley & Qualls, 2017) to assess different aspects of the caregiving experience. Hierarchical regressions (block 1: demographics, block 2: family conflict) were computed to predict caregiving burden. For spousal caregivers, the final model explained 2.2% of the variance in caregiving burden, F(7, 69) = 0.22, p = .98. None of the variables were significant. Additionally, family conflict did not uniquely influence caregiving burden beyond demographics, Fchange(2, 69) = 0.03, p = .97. For adult child caregivers, the set of predictors accounted for 20.5% of the variance in caregiving burden, F(7, 183) = 6.75, p < .001. Having more family beliefs and support conflict predicted greater caregiving burden (ps < .01). Family conflict scores also significantly explicated caregiver burden beyond demographics, Fchange(2, 183) = 17.60, p < .001. Results suggest that family conflict is a stronger driver of caregiver burden for adult child than spousal caregivers. Findings imply the need for clinicians to target appropriate interventions for adult child caregivers to reduce caregiver burden.

Estilos de cuidado y la implicación como protector psicológico del cuidador de personas con Parkinson en España

Carers of people with Parkinson's disease (PD) experience stressful situations as a result of performing their role as caregivers. This can have a negative outcome on their quality of life. A greater understanding of the relationship between the variables assessed in caregivers can be important in implementing effective intervention programs. The aim of this study was to explore the personality and coping strategies used by family caregivers of people with PD, analyzing their relationship with psychological distress and the carer involvement. A cross-sectional study based on a sample of 106 caregivers of people with Parkinson's disease tested the hypothesis that personality and coping strategies can contribute to identifying differences in carer involvement and psychological distress. Caregiver psychological distress was assessed using the CORE-OM questionnaire. The CORE-OM is able to distinguish the population within the clinical and non-clinical range. NEO Five-Factor Inventory (NEO-FFI) was used to assess personality. Coping strategies were evaluated with the COPE-28 inventory. An operational measure of the carer involvement was also used. For this purpose, an adaptation of the Katz index assessing basic functional capacity was made. Results: First, all cases were clustered according to personality variables and coping strategies. A K-means cluster analysis was performed and two groups were requested. After this, binary logistic regression analysis was used to test the research hypothesis. The resulting clusters in the above analysis were selected as predictors. Two analyses were performed. In the first, the dependent variable in logistic regression analysis was the psychological distress of the caregivers (dichotomized variable: clinical and non-clinical). Results showed that people clustered within cluster 1 had a 9.250 times higher risk of psychological distress than those included in cluster 2 (OR = 9.250; p &lt; .001). In a second logistic regression analysis, the dependent variable was participation in care (dichotomized variable: low - high carer involvement). The group of people belonging to cluster 1 showed a carer involvement 4.125 times lower than the people grouped in cluster 2 (OR = 4.125; p &lt; .001). The results of this research suggest the existence of a relationship between psychological variables and carer involvement, showing two different styles of care, which are described based on the personality and coping strategies of the family caregivers. In addition, we found that these styles of care show clear differences in efficiency, reflected in greater carer involvement and a lower psychological distress. The results reported that the cluster of people with below-average scores on neuroticism and above-average scores on the other personality factors (extraversion, openness to experience, agreeableness, and conscientiousness) and coping strategies (planning; active coping; emotional support; social support; positive re-evaluation and acceptance) were associated with increased carer involvement and reduced risk of psychological distress. It has already been suggested that high scores in neuroticism may affect the need to take on a large number of care-related tasks or manage stressful situations in people with PD (Tew et al., 2013). However, our results indicate that the definition of different types of caregivers, where other care-related variables are also included, can help define more efficient styles of care. This is associated with increased carer involvement and minor psychological distress. We propose that in the future these variables be investigated in order to know the outcome of carer involvement and psychological distress, contributing to the description of more efficient care styles in family caregivers. https://doi.org/10.16888/interd.2022.39.1.2

Seizure detection devices: Exploring caregivers’ needs and wishes

IntroductionUser preferences for seizure detection devices (SDDs) have been previously assessed using surveys and interviews, but these have not addressed the latent needs and wishes. Context mapping is an approach in which designers explore users’ dreams and fears to anticipate potential future experiences and optimize the product design. MethodsA generative group session was held using the context mapping approach. Two types of nocturnal SDD users were included: three professional caregivers at a residential care facility and two informal caregivers of children with refractory epilepsy and learning disabilities. Participants were invited to share their personal SDD experiences and briefed to make their needs and wishes explicit. The audiotaped session was transcribed and analyzed together with the collected material using inductive content analysis. The qualitative data was classified by coding the content, grouping codes into categories and themes, and combining those into general statements (abstraction). Results“Trust” emerged as the most important theme, entangling various emotional and practical factors that influence caregiver’s trust in a device. Caregivers expressed several factors that could help to gain their trust in an SDD, including integration of different modalities, insight on all parameters overnight, personal adjustment of the algorithm, recommendation by a neurologist, and a set-up period. Needs regarding alerting seemed to differ between the two types of caregivers in our study: professional caregivers preferred to be alerted only for potentially dangerous seizures, whereas informal caregivers emphasized the urge to be alerted for every event, thus indicating the need for personal adjustment of SDD settings. ConclusionIn this explorative study, we identified several key elements for nocturnal SDD implementation including the importance of gaining trust and the possibility to adjust SDD settings for different types of caregivers.

Las personas trabajadoras del cuidado de niñas y niños en casa hogar de México

El propósito del artículo fue explorar la condición laboral de los encargados del trabajo de cuidados de niñas y niños en casas hogar de México. Para ello se realizó una investigación de carácter documental. Como referente, se tomó el Censo de Alojamiento de Asistencia Social, realizado en el 2015; así como información provista por el Consejo Nacional de Normalización y Certificación de Competencias Laborales, respecto a la certificación en el estándar de competencia EC0934 Atención de niñas, niños y adolescentes en establecimientos de asistencia social. La indagación permitió dar cuenta de distintos tipos de cuidadores, de un incipiente reconocimiento de esta actividad y de posibles líneas de investigación.

Caregivers and Tax Reform: Before and After Snapshots

The Tax Cuts and Jobs Act (TCJA) changed the way families are taxed, starting in tax year 2018. By rearranging a myriad of deck chairs, politicians painted rosy pictures of families reaping the benefits of tax reform. In reality, however, generalizations cannot be made and the extent to which any one family gains or loses depends on particular facts. Even more obscured is the way in which the TCJA changed –– and failed to change –– the taxation of different types of caregivers. This Essay seeks to provide needed clarity in this area. It begins by offering snapshots of how parents of minor children were taxed immediately prior to and after the TCJA’s enactment. Specifically, while the TCJA expanded some of the general benefits available to parents of minor children, it failed to expand — and in critical cases, even preserve — specific benefits that are contingent on “parenting model.” For instance, the TCJA departed from historical norms by rolling back benefits reserved for unmarried parents and failed to make long over-due inflation adjustments to provisions of the Code that allow dual earning couples and unmarried parents (but not sole earning couples) to recover childcare costs incurred to work outside the home. These snapshots reveal how Congress, through the TCJA, picked winners and losers, enacting tax reform that disproportionately favored sole earners at the expense of other parents. This Essay next turns to other types of care-giving, such as elder care, and develops two more pre-and post-reform snapshots. These pictures show how the inequities that result from Congress’ favoritism of sole earners extend to other care-giving arrangements and how these inequities compound for members of the “sandwich generation” who provide both parental and non-parental care. In the end, this Essay develops a series of snapshots that contrast starkly with rosy political rhetoric and which reveal that the TCJA not only failed to address many pre-existing tax inequities between caregivers but also made them worse.

“Who Are Our Support Networks?” A Qualitative Study of Informal Support for Carers

There is little information about the types of social support and content of assistance for informal carers. This article aims to fill this knowledge gap by studying 37 informal carers in a region of the UK. It was found that adult children were the main source of support for older carers regardless of ethnic backgrounds, minority ethnic carers supported their husband to fulfill traditional caring duties by taking care of mother-in-law in the same household. Young carers received support mainly from uncles and aunts to look after sick parents while adult carers obtained information and peer support from the internet. Surprisingly, support from neighbors was limited. Additionally, social support for carers was undermined by the stigmatization of drug and alcohol misuse and mental illness. It is proposed that different types of online support services and appropriate educational programs need to be offered to carers to set up self-help groups and tackle stigmatization associated with health problems. It is suggested that future studies can use a large representative sample to give a comprehensive picture on the contents of informal support for different types of caregivers and the impact of social support on helping informal carers to fulfill their duties.

Disease-related stressors of caregiving burden among different types of family caregivers of persons with schizophrenia in rural China.

Little is known about the impacts of schizophrenia on different types of caregiving burden. This study aims to examine how the severity of schizophrenia, social functioning and aggressive behavior are associated with caregiving burden across different kinship types. The analytic sample included 300 dyads of persons with schizophrenia and their family caregivers in Xinjin, Chengdu, China. The 10th edition of the International Classification of Diseases (ICD-10) was utilized to identify the patients, whose symptom severity, social functioning and aggressive behavior were measured. Caregiving burden was estimated using the Burden Scale for Family Caregivers-short (BSFC-s). A higher level of burden was significantly associated with female caregivers, larger family size, lower income, worse symptoms, poorer functional status and more aggressive behaviors. Parent caregivers showed greater burden if the patients had better functioning of social interest and concern or more aggression toward property. Mother caregivers showed greater burden than fathers. Spouses tended to perceive greater burden if the patients had better marital functioning, poorer occupational functioning or more aggressive behaviors toward property. Patients attacking others or a father with schizophrenia was related to a higher burden of child caregivers. A heavier burden of other relatives was correlated with patients' more verbal aggression and self-harm. This study shows the distinct impacts of disease-related factors on the caregiving burden across different kinship types. Our findings have implications for health-care professionals and practitioners in terms of developing more targeted family-based or individualized intervention to ameliorate burden according to kinship types and deal with behavioral and functional problems in schizophrenia.

Symposium The future of informal care

Due to the reform of long term care in 2015, there is growing concern about whether groups at risk receive the care they need. People in need of care have to rely more on help from their social network. The increased need for informal care requires resilience and organizational skills of families, but also of volunteers, professionals and employers. What does this mean for the provision of informal care in the next decennia? The symposium 'The future of informal care', organized on January 26 2017 by the National Institute for Social Research and the Institute for Societal Resilience of the Vrije Universiteit, addressed possible answers to this question. In her inaugural speech Alice de Boer discussed social inequality as possible determinant and outcome of informal care. Some conclusions:Until 2050 the absolute number of 75-plus doubled to about 3 million persons, but the number of informal caregivers will decrease. In addition to the importance of social and economic resources (the 'have & have-nots'), the ability to arrange care (the 'can & can-nots') gains importance.Almost half of the older employers provides informal care just before retirement. Flexibility in working hours and work location facilitates combining work and care, but about half of the employers indicates that partial retirement and working at home are no options.Informal caregivers and professionals often provide care from comparable perspectives and identities. Addressing similarities rather than differences improves their chances for collaboration.The number of adult children providing household care to older parents increased between 2002 and 2014. This suggests an increase in family solidarity, but current reform policies may increase the gender inequality in caregiving families.Spouses and children remain primary caregivers in the future, preferably supported by many different types of caregivers. Not everybody has the capabilities to organize and direct such a large care network.Providing informal care increases the risk for overburden and absence at work or education. Informal caregivers at risk remain, also in the future, women, spouses, migrants, and younger carers.

The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review.

OBJECTIVE The purpose of this study was to provide a systematic and comprehensive review of the existing literature regarding postfusion rehabilitation. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted an exhaustive review of multiple electronic databases. Potential articles were screened using inclusion/exclusion criteria. Two authors independently analyzed these studies using predefined data fields, including study quality indicators such as level of evidence and availability of accepted patient-reported outcomes measures. These findings were synthesized in a narrative format. A third author resolved disagreements regarding the inclusion of a study. RESULTS Twenty-one articles with I or II levels of evidence were included in the review. The authors divided the findings of the literature review into several groups: rehabilitation terminology, timing and duration of postfusion rehabilitation, the need for rehabilitation relative to surgery-related morbidity, rehabilitation's relationship to outcomes, and cognitive and psychosocial aspects of postsurgical rehabilitation. Current evidence generally supports formal rehabilitation after lumbar fusion surgery. Starting physical therapy at the 12-week postoperative mark results in better outcomes at lower cost than an earlier, 6-week start. Where available, psychosocial support improves outcomes. However, a number of the questions could not be answered with high-grade evidence. In these cases, the authors used "best evidence available" to make recommendations. There are many cases in which different types of caregivers use clinical terminology differently. The data supporting an optimal protocol for postfusion rehabilitation remains elusive but, using the data available, the authors have crafted recommendations and a model protocol, which is currently undergoing prospective study. CONCLUSIONS Rehabilitation has long been a common feature in the postoperative management of patients undergoing spinal fusion. Although caregivers from multiple disciplines agree that the majority of their patients will benefit from this effort, the supporting data remain sparse. In creating a model protocol for postlumbar fusion rehabilitation, the authors hope to share a starting point for future postoperative lumbar fusion rehabilitation research.

Predictors of types of caregiver burden

This study identified the types of caregiver stress and the caregiver and care management characteristics that are associated with this stress. 169 caregivers were recruited from a variety of community settings that cater to caregivers in a New England metropolitan area. They completed the Zarit Burden Interview (ZBI) and a questionnaire concerning their care recipient and caregiving arrangements. Principal Components Analysis on the ZBI resulted in five factors: personal strain/loss, uncertainty/inadequacy, social strain/embarrassment, anger, and dependency. The average age of the caregiver was 59.95 years (SD = 11.75) and the average age of the CR was 83.44 years (SD = 7.88). Of the 169 caregivers, 82% were women, 61.5% daughters/in-law or wives (12.9%), 34.3% were solo caregivers; 16.8% little or no burden, 39.9% reported mild to moderate burden, 35% moderate to severe burden, and 8.4% had severe burden. Dependency (22.4%) and personal strain/loss (13.7%) had the highest proportions reported as “often” to “nearly always.” The ZBI was predicted by only two caregiver characteristics, indicating that it is not sensitive to the experiences of different types of caregivers. Caregivers experience different types of burden depending on their gender, kinship roles, and levels of involvement in the care of their older relative. Solo caregiver status and age (younger) significantly predicted most if not all 5 burden types. Solo and young caregivers experienced the highest levels of caregiver burden. Social work practice must identify the caregiver’s life stage and other and self-expectations in relation to dependency, personal loss, embarrassment, anger, or uncertainty.

Individual determinants of task division in older adults' mixed care networks

Older adults in need of long-term care often receive help from both informal and formal caregivers. The division of tasks between these different types of caregivers may vary among such mixed care networks. Traditional models of task division suggest that formal and informal caregivers may either supplement each other or specialise in the care activities performed. Our study explores the determinants of various forms of task division in the Netherlands, using data collected in 2007 on 458 mixed care situations. Four types of task divisions of informal and formal care are distinguished: the complementation model [neither Activities of Daily Living (ADL) nor instrumental ADL (IADL) tasks shared, 14%], the supplementation model (both ADL and IADL tasks shared, 39%) and informal and formal specialisation (one type of task shared, one type of task not shared, 27% and 20% respectively). Marginal effects calculated with multinomial regression analyses show that the intensity of care provision, the informal caregivers' motives and the presence of privately paid help - more than care receiver's health - are related to type of task division with formal care. For example, when the informal caregiver provides more hours of help and out of a strong personal bond, the likelihood of informal specialisation increases, whereas the likelihood of formal specialisation decreases. When privately paid help is present, the complementation model is more likely, whereas the supplementation model is less likely to be found. Results are discussed regarding the differential consequences for co-ordination and co-operation in mixed care networks.