Family Caregiving Relationships Research Articles

Family Caregivers' Perceptions and Experiences of Supporting Older People to Cope With Loneliness: A Qualitative Interview Study.

Loneliness has become a significant public health issue among community-dwelling older adults particularly those with multimorbidity. Family caregivers are crucial care resources for dependent older adults living in the community before transitioning to institutional services. However, understanding of their perceptions in supporting older adults with multimorbidity to cope with loneliness is limited. This qualitative study aimed to elucidate on the experiences of caring and explore the experiences and perceptions of family caregivers in supporting older community-dwelling adults with multimorbidity to cope with loneliness. Eleven family caregivers, aged 51-93 years old, with at least 2 years of caregiving experience were purposively recruited and interviewed individually. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was utilised to report the study. Three key themes were generated from the inductive analysis: (1) recognising older adults' loneliness through the expression of unusual emotions, behaviour/s, social network alteration and speech; (2) variations in perceptions and responses to loneliness among different family caregiving relationships; and (3) challenges in addressing loneliness. Positive feedback from cared-for older adults was appreciated by their family caregivers which in turn motivated further actions to alleviate loneliness. The findings emphasised the importance of developing specific patients and family caregivers centred interventions, such as communication skills training to enhance effective communications. Cultural values and norms of individuals should be respected in those interventions, ensuring that emotional expression is facilitated in a comfortable way for both older patients and family caregivers.

‘When there is love between a father and mother, the child will also be loved’: a qualitative exploration of the links between couples’ relationships, parenting and early childhood development in Mwanza, Tanzania

IntroductionThe relationship between parents is a key component of the family system that is associated with various child outcomes. However, less is known about how caregivers and community members make...

Smarthealth technology study protocol to improve relationships between older adults with dementia and family caregivers.

The aim of this study is to develop a Smarthealth system of monitoring, modelling, and interactive recommendation solutions (for caregivers) for in-home dementia patient care that focuses on caregiver-patient relationships. This descriptive study employs a single-group, non-randomized trial to examine functionality, effectiveness, feasibility, and acceptability of the novel Smarthealth system. Thirty persons with Alzheimer's Disease or related dementia and their family caregivers (N=30 dyads) will receive and install Smarthealth technology in their home. There will be a 1-month observation phase for collecting baseline mood states and a 2-month implementation phase when caregivers will receive stress management techniques for each detected, negative mood state. Caregivers will report technique implementation and usefulness, sent via Ecological Momentary Assessment system to the study-provided smartphone. Caregivers will provide daily, self-reported mood and health ratings. Instruments measuring caregiver assessment of disruptive behaviours and their effect on caregivers; caregiver depressive symptoms, anxiety and stress; caregiver strain; and family functioning will be completed at baseline and 3months. The study received funding in 2018 and ethics board approval in 2019. This study will develop and test novel in-home technology to improve family caregiving relationships. Results from this study will help develop and improve the Smarthealth recommendation system and determine its usefulness, feasibility, and acceptability for persons with dementia and their family caregiver. The Smarthealth technology discussed will provide in-home stress reduction resources at a time when older adults may be experiencing increasingly high rates of isolation and anxiety and caregiver dyads may be experiencing high levels of relationship strain. This study was registered with Clinical Trials.gov (Identifier NCT04536701).

Taking care of you and me: How choosing for others impacts self-indulgence within family caregiving relationships

Consumers frequently make choices for family members they take care of or from whom they receive care (e.g., their children or partner), yet marketing research has given little attention to how these other-oriented choices might impact the chooser’s self-indulgence. In this research we consider familial caregiving relationships as a relevant and ubiquitous context of other-oriented choices and identify the role of the chooser (i.e., caregiver versus care-receiver) as an important moderator that determines when virtuous other-oriented choices within caregiving relationships lead to licensing and when they encourage consistent virtuous consumption behaviors.Three studies demonstrate that making virtuous food choices for others affect the chooser’s subsequent self-regulatory behavior in two ways: After making a virtuous choice for a care-receiving other (e.g., a young child), caregivers (e.g., parents) are more likely to license, and thus to subsequently self-indulge (Study 1, 3). In contrast, care-receivers are more likely to act consistently with an initial virtuous choice for the caregiver and thus are less likely to self-indulge (Study 2, 3).Our findings extend research on moral licensing and consistency effects by demonstrating that—within familial caregiving relationships—the degree to which one receives and provides care may determine when choosers engage in licensing and when they act consistently with an initial virtuous other-oriented choice.

Commitment and Human Tone: the Difference between Traditional Service and Nursing Care.

Objective. To describe the transformation of decisive moments that arise within the nurse-patient and family caregiver interaction to turn them into moments of care capable of favoring adaptation.Methods. In a high complexity hospital in the city of Bogotá (Colombia), a "nursing methodological research"-type study was conducted. It was developed in five stages: 1) identification of the institutional route of patients and their caregivers and, within it, the moments of encounter with nursing; 2) typical day of the nurse; 3) analysis of the nurse-patient and family caregiver encounters; 4) literature review on how to strengthen the nurse-patient and family caregiver relationship; and 5) proposal to transform decisive moments into moments of care.Results. Patients and their family caregivers usually experience six moments of encounter with nursing that include admission, assessment, satisfaction of basic needs, administration of medication, shift change, and discharge; all of them cross-cut by education and communication. Recognition of experiences during moments of encounter allowed transforming them into moments of nursing care.Conclusion. The transformation of decisive moments into moments of nursing care to favor adaptation of patients and their family caregivers is consequence of the nursing commitment and human nature expressed in every encounter of the care process.

OLDER ADULTS’ TECHNICAL SUPPORT NEEDS FOR HOME VIDEO TELEHEALTH VISITS

With newly approved (2017) Medicare reimbursement for video telehealth (VT) visits into the home, there is the opportunity to increase the reach of clinical services to populations for whom travel to a medical center is challenging. Older adults and their caregivers are prime targets for video telehealth due to mobility challenges and other barriers to accessing care. Video telehealth offers a potentially convenient visit format option, however, technology use has been reported to be lower with older adults. We sought to determine if older adults’ relatively lower rates of technology adoption translate into increased technical support needs during Home Video Telehealth (HomeVT). We have offered medical dementia management visits via HomeVT since 2013. We have tracked both who was operating the technology in the home and what technical issues arose for each HomeVT encounter. We determined the frequency of technical difficulties requiring involvement of a telehealth technician as a function of family caregiver relationship. In 49% of the >200 HomeVT visits, the person operating the technology was the person with dementia’s (PWD) spouse, with the other 51% being the PWD’s adult child. While 35% of all HomeVT visits required the assistance of a telehealth technician (THT), the older caregivers (PWD’s spouses) required significantly more THT assistance than the younger (PWD’s adult children) caregivers (p<0.005). Older adults are able to participate in HomeVT visits but require significantly more technical support than younger users do. Availability of real-time technical support is critical for HomeVT program success, particularly when serving older adult users.

Blood ties and strong ties: a two-way linkage? Some non-trivial implications of the care workers market in a Mediterranean region

ABSTRACTTaking their cue from a seeming dissonance between the theory of commodification and exploitation of migrant care workers and the case study of the outsourced self proposed by Hochschild, the author speculates whether or not the family–caregiver relationship may be equal and inclusive. The argument is unraveled by posing another question en route: what specific ‘catalysts’ can trigger ‘high-intensity affective relationships’? Elster defines 'essentially byproduct' the result of a process lacking any direct and conscious link between outcome and intention, and requiring the relaxation of the control of reason in order to be fulfilled. The author mixes significant theoretical results coming both from the relational Palo Alto School and from history of families studies, concluding that an equal and inclusive relationship may be like an Elster’s ‘essentially byproduct’ of a market relationship , when a high-intensity affective relation acts as a ‘catalyst’. The frame suggested in this article seems consistent with recent constructionist reinterpretations of the idea of kinship, which take shape and evolve through ‘everyday experiences’. Kinship thus shifts towards a more complex undefined category, that of Karsten’s relatedness. Speaking of which, the author argues some logical reasons suggesting a generalized adoption of the term only with great care and caution.

Implications of Smart Wear Technology for Family Caregiving Relationships: Focus Group Perceptions

Technological advances in monitoring vulnerable care-recipients are on the rise. Recent and future development of Smart Wear technology (devices integrated into clothing that monitor care-recipients) might assist family caregivers with tasks related to caring for young children, relatives with disabilities, and frail spouses or parents. However, the development and use of this technology in family caregiving contexts is in its infancy. Focus group interviews of family caregivers were conducted to explore perspectives regarding the potential integration of Smart Wear technology into their family caregiving. Responses were analyzed qualitatively for themes related to perceptions of how Smart Wear could impact relationships between caregivers and care-recipients. Three major themes emerged: quality and quantity of interaction, boundary issues, and implications for anxiety. Implications and recommendations are discussed regarding maximizing the potential benefits of Smart Wear technology in ways that promote and protect healthy relationships among caregivers and care-recipients.

Self-transcendence, spiritual perspective, and sense of purpose in family caregiving relationships: a mediated model of depression symptoms in Korean older adults

Objectives: This study used structural equation modeling to test the mediated model of late-life depression to understand the mechanisms that account for the direct and indirect effects of spiritual variables and purpose in life on depression within the context of Korean family caregiving relationships.Method: A secondary analysis study design used data from a study that tested a theory of family interdependence of 157 Korean elder-family caregiver dyads in Seoul, Korea.Results: Both caregivers’ and elders’ self-transcendence was positively related to their own sense of purpose in life. However, only elders’ spiritual perspective was related to purpose in life. Also, elders’ purpose in life was positively associated with caregivers’ purpose in life. Furthermore, there was a strong negative relationship between elders’ purpose in life and their depressive symptoms, but there was not a significant negative relationship between caregivers’ purpose in life and elders’ depressive symptoms. Last, elders’ purpose in life mediated the negative effects of elders’ self-transcendence and spiritual perspective and of caregivers’ self-transcendence and purpose in life on elders’ depression.Conclusion: The findings suggest that purpose in life for both the caregiver and elder played an important role in elders’ depression. Self-transcendence also was related to decreased depression in elders. It is suggested that more attention be given to caregiver and elder purpose in life in developing interventions to reduce or avoid elder depression in Korean elders.

Family Caregivers, Patients, and Physicians

To the Editors:—The position paper “Family Caregivers, Patients, and Physicians: Ethical Guidance to Optimize Relationships” that was published in a recent issue of the Journal raises an important topic. We read the paper with great interest and agree with its stated objective to “heighten physician awareness of the importance and complexity of the patient–physician–family caregiver relationship, to maximize the benefits of those relationships, and to minimize the burdens on family caregivers”. To this end, we were surprised to note the omission of more than a few studies of central relevance (e.g. Petronio, S., J. Sargent, L. Andea, P. Reganis, and D. Cichocki. 2004. Family and friends as healthcare advocates: Dilemmas of confidentiality and privacy. Journal of Social and Personal Relationships 21: 33-52.). We recently completed a meta-analysis of empirical studies reporting on family presence during routine adult medical visits in which we identified nine observational studies that directly examined audiotaped or videotaped patient–provider–family communication within the context of routine medical visits, and an additional six studies that surveyed patients, families, and/or physicians regarding their experiences and preferences for family involvement in routine adult medical visits; only one of which was cited in the position paper. These studies collectively provide important information regarding the frequency of patient accompaniment, the behaviors assumed by family companions, as well as patient, family, and physician preferences, expectations, and experiences during triadic physician visits. The recommendations set forth in this paper would be strengthened if they acknowledged what has already been learned and reported in the published literature. We would also like to note that the term “family caregiver” used throughout the paper, which the authors define as “relatives, partners, friends, and neighbors who assist with activities of daily living and complex health care needs that were once the domain of trained health hospital personnel” may not accurately describe all individuals who accompany patients during health care encounters. Although some family members who accompany patients to health care encounters also engage in the provision of personal and health care assistance to the patients they accompany, there is reason to believe this is not always the case. The extent to which the family members who accompany patients during health care encounters also assist with health care and personal tasks in the community is an important question that to our knowledge has been unstudied to date.

REFLETINDO SOBRE QUEM É O CUIDADOR FAMILIAR

Trata-se de um ensaio reflexivo sobre o cuidador familiar. As limitações laborais e de consciência do doente quanto ao seu estado podem levá-lo à dependência, momento em que se torna necessário o cuidador familiar que trabalha a favor da recuperação total ou parcial do doente. Alguns aspectos no contexto familiar devem ser considerados como, grau de instrução do cuidador familiar bem como sua experiência prévia com situações de cuidado, e também o próprio contexto. Estes elementos subsidiam a relação enfermeiro-cuidador familiar no ato da orientação para o cuidado. Tem-se com isso que o cuidador familiar é um ser que sofre a limitação de seu ente tanto quanto o próprio doente, sendo uma figura ímpar, sensível, muitas vezes esquecido e ignorado, necessita de atenção para superar-se em suas atribuições como cuidador familiar.

Caregiver—carereceiver communication Part 2: Overcoming the influence of stereotypical role expectations

Part 1 of this paper explored the premise that a role predicament of caring exists within family caregiving relationships. It was argued that dysfunctional patterns of communication develop in family caregiving relationships not only in response to stereotypical expectations about older people but also in response to stereotypical expectations of both caregiver and carereceiver concerning their role in the caregiving relationship. The argument was grounded in data contained within a large comprehensive study of older people and their family caregivers. This paper builds on the earlier contention and holds that more productive and effective forms of communication and caregiving relationships can be promoted through modification of role expectations and behaviours. The Health Promoting Communication Model is introduced and proposed as an appropriate framework for guiding both prevention and intervention strategies for health promoting communication in family caregiving.

A Conceptual and Empirical Exploration of Personal Autonomy Issues Within Family Caregiving Relationships

We explored personal autonomy issues within family caregiving relationships and found little evidence of significant autonomy conflicts. Findings did suggest, however, that family members were more sensitive to autonomy issues than were their frail older relatives and that both groups defined the disability itself as the major impediment to autonomy in later life. Findings support the usefulness of an expanded definition of autonomy, emphasizing the importance of goal-directed behavior, which may be inhibited by intrinsic conditions as well as external forces.