Female Spousal Caregivers Research Articles

The trajectory of frailty index among spousal caregivers: longitudinal evidence from China

Abstract Background Very few studies have investigated the association between providing unpaid caregiving to a spouse and the frailty of caregivers. This study aims to examine the impact of providing spousal care on frailty among the middle aged and older Chinese population. Methods Data were derived from the 2011, 2013, 2015, and 2018 waves of China Health and Retirement Longitudinal Study (CHARLS) including 4,008 participants aged 50 and above. Frailty was assessed using a composite mean score based on 41 indicators according to Rockwood frailty criteria, including self-reported health, medically diagnosed conditions, medical symptoms, functional activities assessment, Activities of Daily Living (ADLs), and Instrumental Activities of Daily Living (IADLs). A growth curve model was employed to investigate the differences in frailty among caregivers and non-caregivers. Results Compared to non-caregivers, spousal caregivers were more likely to have a higher frailty when adjusted for all covariates (Beta=0.010, SE = 0.003, p < 0.001). Furthermore, female caregivers exhibited a higher rate of change of frailty index over time (Beta=0.002, SE = 0.001, p < 0.05) compared to female non-caregivers, while no such effect was found in males. Conclusions The findings of this study reveal that providing unpaid care to a spouse is associated with an increase in the frailty index over time particularly among female caregivers. These insights underline the necessity for Chinese policymakers to develop and implement targeted interventions aimed at reducing burden on spousal caregiving, thereby preventing an increase in frailty among these caregivers. Such measures would also align with the broader objective of promoting healthy ageing. Key messages • Chinese policymakers need to develop and implement targeted interventions to reduce the burden on female spousal caregivers and prevent increased frailty. • Focusing on the frailty of female spousal caregivers is crucial for promoting healthy aging.

Gender differences in cancer spousal caregiving: A systematic review.

Cancer does affect not only the lives of the patients but also that of their spouses. The aims of this systematic review are to (i) explore the gender differences in the impact of caregiving for cancer on spousal caregivers, (ii) facilitate the conceptual understanding of gender differences in caregiving, and (iii) identify directions for future research and clinical practice targeting spousal caregivers. A comprehensive search was conducted of the electronic databases of MEDLINE, PsycINFO, EBSCO, and CINAHL Plus for papers published in English between 2000 and 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify, select, appraise, and synthesize the studies. A total of 20 studies from seven countries were reviewed. Findings of the studies were presented using the biopsychosocial model. Spousal caregivers of cancer patients suffered from physical, psychological, and socioeconomic morbidities, with female spousal caregivers reporting a higher level of distress. The gendered positioning of spousal caregivers in the societal context had further brought about over-responsibility and self-sacrifice among women. The gendered positions of cancer spousal caregivers further illustrated the gender differences in the caregiving experiences and consequences. Health-care professionals in routine clinical practice should be proactive in identifying physical, mental, and social morbidities among cancer spousal caregivers, particularly female ones, and providing timely interventions. Health-care professionals should recognize the pressing need for empirical research, political engagement, and action plans to address the health status and health-related behaviors of patients' spouses along the cancer trajectory.

PERSPECTIVES OF THE FEMALE SPOUSE IN DEMENTIA CAREGIVING IN FORMAL CAREGIVING RESOURCE USE

Abstract The purpose of this qualitative descriptive study was to explore female spousal caregivers’ decisions regarding the use of formal caregiving resources in caring for a partner with dementia. Participants included 11 female spouses who provided caregiving to their husbands with dementia in the home setting. Findings suggested that a caregiver’s willingness or reluctance to use any resources were influenced by factors that related to them (e.g., assessment of their skills/abilities), their husband (e.g., his belief he didn’t need help) and, to a lesser degree, the resource qualities (e.g., cost). Caregivers seemed to make the decision to use resources only after careful consideration of their husband’s needs, his understanding of what he needed, and how well the resource would fit for him and whether he would accept that help. Interestingly, factors like cost and access were less germane to the caregiver’s decision. This implies that the decision-making process for a wife caregiver in regards to the care for a partner with dementia is complex and involves their readiness and needs as the caregiver, the needs and readiness of the persons with dementia, and the qualities of the resources. These factors are all dynamic, and clinicians and formal caregiving services need to have ongoing conversations and assessments throughout the caregiving journey to assess both the caregiver’s willingness and reluctance to start a specific service.

Elderly Care Provision and the Impact on Caregiver Health in China

AbstractWith the fast pace of population aging, industrialization, and urbanization in China, the main source of elderly care is changing. Using China Health and Retirement Longitudinal Survey data, we investigate the elderly care provision situation and find that spouses are currently the most important elderly care providers in China. We use a model to depict the trade‐off between a caregiver's own health and the care quality obtained by the care recipient. The model predicts that under some conditions, the caregivers will provide care at the cost of their health. Employing a stratified propensity score matching method, we find that spouses' caregivers are more likely to have depression, physical pain, and hypertension than noncaregivers. The negative effects are larger for caregivers with a high level of care intensity or less support from other resources. Female spousal caregivers tend to suffer more from depression and physical pain than male spousal caregivers. Our findings suggest that policies toward “healthy aging” should target not only the disabled elderly but also their spousal caregivers who are also elderly people.

Connecting the Dots: Pain Mental Models of Spousal Caregivers of Veterans with Dementia and Pain

Abstract Pain is prevalent among persons with dementia (PWDs), yet often goes underrecognized and undertreated. Exploring caregivers’ pain mental models may provide valuable insight into how they conceptualize pain, and how such conceptualizations affect their identification of and response to PWDs’ pain. We identified and described the pain mental model(s) of spousal caregivers of community-dwelling veterans with dementia and pain through a secondary qualitative thematic analysis of recordings of a psychosocial intervention aimed at preventing aggression in PWDs with pain. Thirty female spousal caregivers (11 Black, 10 non-Hispanic White, and 9 Hispanic) comprised the present sample. Two themes were identified: Pain Assessment Beliefs and Knowledge (PA) and Pain Management Beliefs and Knowledge (PM). In our proposed mental model framework, PA and PM affect the ways caregivers answer two PA-related questions (Is there a problem?, Is this problem pain?) and three PM-related questions (Is the pain treatable?, Is it worth treating?, How do I prefer to treat it?). Caregivers are moved to action when they “connect the dots” by identifying a problem in PWDs’ behavior, labeling the problem as pain, and identifying a response (i.e., a treatment approach) they consider worth trying. Disconnects in caregiver understanding of PWDs’ behavior are common in this sample, and predictably lead to inaction. The proposed mental model provides further explanation about how caregivers do or do not synthesize and apply pain knowledge and experience, allowing for the identification of potential areas of intervention (e.g., pain psychoeducation) to improve pain treatment for the PWDs under their care.

Exploring the Experiences of Female Spousal Caregivers

Abstract Date Presented 03/26/20 This study examined the differences between two groups of caregivers following a novel intervention. Caregivers who reported clinically significant change scores on the COPM satisfaction scale engaged in more social activities and made comments indicating they had moved beyond the burdens of caregiving than caregivers who did not. These findings suggest the importance of addressing caregivers’ social participation to possibly increase caregiver satisfaction and decrease burden. Primary Author and Speaker: Patricia Watford Contributing Authors: Karen Atler

The Transition From Spousal Caregiver to Widowhood: Quantitative Findings of a Mixed-Methods Study.

BACKGROUND: The number of persons diagnosed with dementia is projected to triple to 14 million by 2050. The significance of these projections is particularly relevant to older women (>65 years), who are more likely to provide dementia caregiving for a husband than vice versa. Research has identified consistent themes around the impact of caregiving during the caregiving experience, yet there is limited research exploring the ongoing impact during the transition to widowhood. Moreover, there is a paucity of research examining differences between rural and urban spousal dementia caregivers. AIMS: The aims were to compare differences between older rural and urban spousal caregivers on physical and mental health factors affecting the transition from caregiver to widow and to identify resources the women used during this transition over 12 months. METHOD: This mixed-methods longitudinal study recruited 13 urban and nine rural female spousal caregivers. Participants were interviewed three times over 12 months. The dependent variables were depression (measured using Center for Epidemiologic Studies Depression Scale), physical and mental functioning (measured using the 12-item Medical Outcomes Study–Short Form Health Survey Version 2). RESULTS: No statistically significant differences were detected between rural and urban female caregivers on the dependent variables. However, rural caregivers scored higher on depression and lower on both physical and mental functioning compared to their urban counterparts. CONCLUSIONS: The findings have clinical and research implications. Psychiatric nurses are well positioned to provide education related to dementia information deficits; implement interventions that facilitate bereavement, resilience, self-care, and identity; advocate for additional services; and conduct larger scale studies with a more diverse sample of female spousal caregivers.

Addressing the Needs of Female Spousal Caregivers Through Journaling and a Time-Use Log

Abstract Date Presented 04/04/19 This pilot mixed-method study explored the use of an activity log and a reflective journal to increase participation in meaningful occupation for female spousal caregivers. Results indicated increased quality of life and satisfaction in performance of meaningful activities. This study increases understanding of caregivers’ occupational performance and adds to the evidence base of OT by exploring an intervention to decrease the negative effects of caregiving. Primary Author and Speaker: Patricia Watford Contributing Authors: Vanessa Jewell, Karen Atler

Trapped like a butterfly in a spider's web: Experiences of female spousal caregivers in the care of husbands with severe mental illness.

To explore the experiences of female spousal caregivers in the care of husbands with severe mental illness. Family involvement in the care of patients with chronic illness is essential to provide a backbone of support for them. However, little is known about how female spousal caregivers are confronted with challenges while taking care of their husbands with severe mental illness. An exploratory qualitative study. Fourteen female spousal caregivers of people with severe mental illness (defined here as schizophrenia, schizoaffective disorders and bipolar affective disorders) were recruited using purposive sampling and were interviewed using a semistructured in-depth interview method. Data were analysed by conventional content analysis until data saturation was achieved. Care of a husband with severe mental illness had a disruptive influence on the emotional relationships of the family and resulted in emotional detachment over time. Despite the caregivers' struggle to protect their families, the lack of supportive resources caused emotional exhaustion. Caregiving tasks interfering with their many other responsibilities, along with being a reference for family matters, led to loss of self. Consequently, they experienced psychological distress because of the transition to a caregiver role without any supportive resources. Constant caring, without supportive resources, forced them to do various roles and manage other issues within the family. Being unprepared for a caregiving role led to the psychological distress of female spousal caregivers. Therefore, adequate information, education and supportive resources must be provided for spouses to facilitate their transition to caregiving roles. It is necessary to pay close attention to the spousal caregivers' own mental health problems while they care for their mentally ill husbands. Mental health professionals should adopt a new approach to the prioritisation and planning of policies that support both family caregivers and patients.

Lived Experience of Caregivers of Persons with Dementia and the Impact on their Sense of Self: A Qualitative Study in Singapore.

The prevalence of dementia is increasing, especially in Asia. Caregivers of people with dementia are at greater risk of psychological morbidity; however, most studies on caregiving have been conducted in Western populations. As a caregiver's experience can be influenced by cultural factors, this needs exploring further. This study explored the lived experience of caregivers of dementia patients in Singapore and the impact of caring on their sense of self. Six Chinese female spousal caregivers were interviewed and their experiences were analyzed using interpretative phenomenological analysis (IPA). Four super-ordinate themes were identified: impact of caregiving, acceptance of destiny, taking control, and view of self. The findings reflected the influence of Confucian values. Clinical implications are discussed, including more culturally sensitive services.

Abstract 70: Gender Moderates the Associations between Caregiving and Health Status in Stroke Caregivers

Background: Women who are caregivers report more burden than men in similar caregiving situations. Caregiving is associated with poor health outcomes but there is lack of evidence about whether gender moderates the association. The purpose of this study was to examine whether gender moderates the association between caregiving and health status based on relationship of caregiver with stroke patients (spouse vs. non-spouse) and caregiver being of the same or opposite gender as patient Method: Caregivers (N=277, 74% female, mean age 53 years) of stroke survivors completed questionnaires after the initial 2 months of post-stroke management. Difficulty and time spent with caregiving tasks were assessed using the Oberst Caregiving Burden Scale. Perception of life changes due to caregiving was assessed using the Bakas Caregiving Outcome Scale. Health status was assessed using a visual analog scale of the Euro Quality of Life questionnaire. Hierarchical multiple regressions were used with an interaction variable (gender x caregiving). Results: Longer time caregiving, difficulty of caregiving tasks, and negative changes in life were significantly associated with poor health status. Significant gender moderation was found only for spousal caregivers and for caregivers who were the opposite gender from patients. For female spousal caregivers, there were strong associations between difficulty of caregiving tasks and health status, and between perception of life changes and health status, but not for male spousal caregivers (Figure1). Similar results were found for caregivers who were the opposite gender from patients. Conclusion: Gender in caregiver and patient, and relationship with stroke patients may be beneficial to identify caregivers at high risk of poor health. Further research is needed to examine the dynamics that influence caregiving relationships to be able to individualize interventions responsive to gender and relationship of caregiver to patient.

Abstract 12062: Patient and Caregiver Heart Failure Symptom Response Behaviors in 364 Patient-Caregiver Dyads

Introduction: Recognition and response to symptoms of heart failure (HF) is critical to reducing the risk of hospitalization and mortality. Although many patients have support from caregivers, little is known about caregivers’ contributions to HF symptom response behaviors. We hypothesized that patient-, caregiver-, and dyad-level factors would be associated with better symptom response behaviors. Methods: This was a secondary analysis of data on 364 Italian HF patient-caregiver dyads. HF symptom response behaviors were measured using patient and caregiver versions of the Self-Care of Heart Failure Index (0-100; higher = better). Health status (SF-12) and relationship quality (single item) were collected from patients and caregivers. Patient cognition and comorbidities were measured using the MMSE and Charlson Index. Caregiver social support was measured with the Carers of Older People in Europe Index. Hospitalizations were abstracted from the medical record. Multilevel modeling was used for all analyses. Results: Patients were older (age 76.3±10.8 years), predominantly male (57.3%) and most had NYHA Class II/III HF (72.2%). Caregivers were younger (age 57.7±14.6 years), and most were female (51.7%) and adult child (53.6%) or spousal (34.0%) caregivers. Symptom response behaviors were poor in patients (49.1±19.6) and caregivers (54.7±18.3). Patient gender (male β=-4.60±1.92, p<0.05), better cognition (β=0.40±0.19, p<0.05), worse caregiver health (β=-0.43±0.14, p<0.01), and higher relationship quality (β=2.28±0.83, p<0.01) were significant determinants of better patient symptom response. Nonspousal relationship (β=6.62±1.96, p<0.001), fewer patient comorbidities (β=-2.32±0.79, p<0.01), better patient health (β=0.41±0.12, p=0.001), more hospitalizations (β=3.06±1.41, p<0.05), higher relationship quality (β=2.12±0.84, p<0.01), and higher caregiver social support (β=1.09±0.43, p<0.05) were significant determinants of better caregiver symptom response. Conclusions: Combinations of individual and relationship factors were significant determinants of patient and caregiver responses to HF symptoms. Assessment of patient and caregiver as a dyad may be useful in evaluating risk for poor management of HF symptoms.

Care for Alzheimer's Disease

Cognitive impairment due to dementia deprives those afflicted with the disease of their autonomy and ability to take care of themselves, making them dependent on care provided by formal and informal resources. Moreover, as the disease progresses, behavioral and psychological symptoms of dementia (BPSD) may occur. BPSD are often troublesome to both caregivers and the patients themselves. The care burden is often heavy and disrupts the lives of family members surrounding the patient. Early screening and identification of cognitive decline will help those with the disease and family members prepare for better care and may reduce the patients' BPSD. Effective screening for dementia, which can be administered at ambulatory care facilities, is warranted. Vascular risk factors, especially type 2 diabetes mellitus, have been found to increase the risk of developing Alzheimer's disease (AD). The prevalence of type 2 diabetes mellitus is increasing in Japan. In this special issue, T. Matsuzawa et al. describe an index for screening for mild or moderate AD cases among the elderly with type 2 diabetes mellitus. The index includes self-reported answers to a questionnaire regarding subjective memory complaints and daily functioning and information on vascular risk factors obtained from clinical charts. The index had satisfactory discriminatory ability to identify those with AD among patients with diabetes. This may contribute to an effective screening for AD among those with diabetes, that is, known high-risk populations. Current treatments for AD are limited to alleviating symptoms, but not reversing the pathological progress. Pharmacological treatments for BPSD, which are critical for the well-being of both patients and caregivers, are also limited in their effectiveness. The study by H. Fukui et al. examines changes in sex hormones associated with the pathogenesis of AD before and after music therapy among patients with AD. They show that music therapy modified the secretion of sex hormones, and the results also suggest that problematic behavior may be reduced this way. The therapy has the potential to become a safe alternative treatment that is as effective as hormone replacement, but with fewer side effects. The underlying biological mechanism of effects shown in this study is convincing and a welcome addition to the field. The number of those suffering from dementia is increasing worldwide. Effective caregiving strategies and targeted care management programs are urgently needed to enhance the well-being of those with AD and their caregivers. T. Passos et al. examined the met and unmet needs of the elderly with mental health problems and their care in Portugal. The main unmet needs identified were daytime activities, social benefits, company, psychological distress, and incontinence. Some of these unmet needs may be universal across countries worldwide, but others may differ depending on specific health care systems and cultures. A comparison with similar surveys in other countries may help identify common unmet needs for patients and caregivers. M. M. Poysti et al. compare the characteristics and burdens of male and female spousal caregivers of patients with dementia in Finland. This is an important issue because the proportion of male caregivers is rapidly increasing in many countries. In the study, male caregivers experienced a lower burden than female caregivers even though female caregivers were responsible for more severe cases. The finding should be confirmed, and the reasons behind it should be explored further, so that factors that may reduce high caregiver burden can be identified. Finally, the economic and social costs for caring of the demented are of significant importance as the at-risk population grows rapidly around the globe. Japan has one of the fastest growing elderly populations, and in 2000 it launched a new public long-term care insurance system [1]. S. Shinagawa et al. report that the requisite costs in the Japanese long-term care insurance are different between AD and vascular dementia (VD). In this special issue, we highlight several important themes in the care for dementia. We hope that the results presented contribute to developing and providing better care of the demented and increase awareness of the importance of international studies of dementia caregiver issues. Hiroyuki Umegaki Hajime Takechi Hiroko H. Dodge

Spouses' experience of caregiving for cancer patients: a literature review

The spouse is generally the primary informal caregiver for cancer patients. Many studies have explored the experience of caregiving for cancer patients, but it is unclear whether there are gender differences in the spousal caring experience for cancer patients. This review describes the recent published research on the stress process of spousal caregiving experience for cancer patients, and aims to identify any gender differences in the caregiving experience. Electronic, manual and author's searches were conducted. Articles included were published in English and Chinese, from January 2000 to March 2012. Study population is couples coping with cancer. Focus is on caregiving experience for spouse with cancer, and findings include both male and female spousal caregivers in quantitative studies. The databases searched included MEDLINE, CINAHL, Science Citation Index Expanded, Scopus, PsycINFO and the China Academic Journal Full-text Database. The key search terms used were 'cancer' or 'oncology' or 'carcinoma' AND 'caregiver' or 'caregiving' or 'carer' AND 'gender differences' or 'gender' AND 'spouse' or 'couple' or 'partner'. Spousal caregiving experiences of cancer patients were explored by adopting the 'stress process' of the Cancer Family Caregiving Experience Model from the gender perspective. Twenty-five articles were identified and included in this review. It was revealed that female spousal caregivers perceived higher level negative experience in caregiving, such as lower mental health, lower physical health, poorer health-related quality of life, lower life satisfaction and decreased marital satisfaction than male spousal caregivers. However, female spousal caregivers are more likely to experience personal growth than male spousal caregivers. This review identified that female spousal caregivers for cancer patients had higher levels of negative experience in caregiving. A better understanding of the spousal caregiving experience will provide healthcare professionals with the information needed to develop interventions to support and prepare spousal caregivers to care for their loved ones with cancer.

Effects of gender and dementia severity on Alzheimer’s disease caregivers’ sleep and biomarkers of coagulation and inflammation

Background: Being a caregiver for a spouse with Alzheimer’s disease is associated with increased risk for cardiovascular illness, particularly for males. This study examined the effects of caregiver gender and severity of the spouse’s dementia on sleep, coagulation, and inflammation in the caregiver. Methods: Eighty-one male and female spousal caregivers and 41 non-caregivers participated (mean age of all participants 70.2 years). Full-night polysomnography (PSG) was recorded in each participants home. Severity of the Alzheimer’s disease patient’s dementia was determined by the Clinical Dementia Rating (CDR) scale. The Role Overload scale was completed as an assessment of caregiving stress. Blood was drawn to assess circulating levels of D-dimer and Interleukin-6 (IL-6). Results: Male caregivers who were caring for a spouse with moderate to severe dementia spent significantly more time awake after sleep onset than female caregivers caring for spouses with moderate to severe dementia ( p = .011), who spent a similar amount of time awake after sleep onset to caregivers of low dementia spouses and to non-caregivers. Similarly, male caregivers caring for spouses with worse dementia had significantly higher circulating levels of D-dimer ( p = .034) than females caring for spouses with worse dementia. In multiple regression analysis (adjusted R 2 = .270, p < .001), elevated D-dimer levels were predicted by a combination of the CDR rating of the patient ( p = .047) as well as greater time awake after sleep onset ( p = .046). Discussion: The findings suggest that males caring for spouses with more severe dementia experience more disturbed sleep and have greater coagulation, the latter being associated with the disturbed sleep. These findings may provide insight into why male caregivers of spouses with Alzheimer’s disease are at increased risk for illness, particularly cardiovascular disease.

Change in Depression of Spousal Caregivers of Dementia Patients Following Patient's Death

Caring for an elderly spouse with dementia places a heavy burden on spousal caregivers and often results in chronic depression. Little has been written about change in depression caregivers experience from before to after the death of the spouse with dementia. This longitudinal study examines change in depression of spousal caregivers that occurs following death of the dementia patient. Two theoretical models, the Relief and Stress Models, are discussed in terms of caregiver depression after the death of the dementia-patient care-recipient spouse. These two theoretical models were tested using longitudinal data from the National Institute on Aging sponsored Health and Retirement Study. Both male and female spousal caregivers report an increase in depression after the death of the dementia-patient care-recipient spouse. As time passed following the spouse's death, the conjugally bereaved husbands showed a decrease in depression while the conjugally bereaved wives continued to report increased depression.

The trajectory of minor stroke recovery for men and their female spousal caregivers: literature review

This paper is a report of a narrative review to examine the current state of knowledge regarding the impact of minor stroke on male patients and their female spousal caregivers' recovery trajectory and quality of life. Minor stroke survivors are often discharged early in the recovery process. The perception of the healthcare community that these patients and their female spousal caregivers will experience an uneventful recovery may lead to inadequate preparation for the postdischarge period. A range of databases was searched to identify papers addressing 'minor stroke', 'transitions', 'quality of life', 'chronic disease', 'caregivers' and 'spouse caregivers', including AARP Ageline, AMED, CINAHL, Evidence Based Medicine Reviews, MEDLINE and PsychInfo. Papers published in English from 1990 to December 2006 were included. Thirty-four papers were in the final data set. Minor stroke survivors and their female spousal caregivers may experience major challenges in adaptations postdischarge. The trajectory of minor stroke recovery may necessitate a re-evaluation of life plans, rethinking of priorities and integration of resulting disabilities into current and emerging life situations for both stroke survivors and their female spousal caregivers. In many cases these adaptations are compounded by transitions associated with the normal ageing process. While there is extensive literature on stroke recovery and the role of caregivers in general, there is little available describing the recovery of minor stroke survivors in relation to the normal ageing process. Further research is needed examining recovery from a transitional perspective, to support nurses and other health professionals discharge planning.

Gender Differences in the Community Service Use Attitudes of Older Spousal Caregiver-Care Recipient Couples

ABSTRACT Prior research has consistently overlooked spousal care recipients' attitudes toward service use within the caregiver-care recipient dyadic context. To address this gap in knowledge, this exploratory study collected data from both caregiver and care recipient spousal informants to compare their community service use attitudes by gender. This study employed a purposive sample of 30 older spousal caregiver-care recipient couples (N = 60). Service use attitude measures were adapted from the Community Service Attitude Inventory. For the entire sample, caregivers and care recipients had similar attitude scores at the group level of comparison. In the caregiver subsample, female spousal caregivers reported a higher level of confidence in service system compared with male spousal caregivers. Male spousal caregivers reported a higher worry and fear attitude compared with female spousal caregivers. In the care recipient subsample, female spousal care recipients reported a higher wait-and-see attitude compared with male spousal care recipients. The findings support the need to assess specific gender-related service use attitudes of older spousal couples in research and practice contexts.

Are there Sex Differences in Emotional and Biological Responses in Spousal Caregivers of Patients with Alzheimer’s Disease?

The purpose of this study was to compare emotional and biological responses of men and women who are spousal caregivers of patients with Alzheimer's disease (AD). Quality-of-life measurements, bioinstrumentation data, and immunophenotype assessments were obtained from female and male spousal caregivers of patients with AD. Spousal caregivers (women, n = 45 with average age 69.7; men, n = 16 with average age 71.4 years) completed questionnaires that assessed psychosocial variables. Blood was drawn and lymphocyte subsets (including natural killer [NK] cell number) were determined using flow cytometry. The degree of relaxation was determined measuring muscle tension (EMG) in the frontalis and trapezius muscles, skin conductance, skin temperature, and heart rate. Male spousal caregivers, as compared to female spousal caregivers, had significantly lower levels of stress, depression, caregiver burden (subjective), anxiety, anger-hostility, and somatic symptoms and higher levels of mental health, sense of coherence, NK cell number, and social and physical functioning. There were no statistically significant differences between the 2 groups in social support, coping resources, or T, T suppressor, or activated T cells. Women had more T helper cells and fewer NK cells than men. Men had fewer manifestations of a physiological stress response, as indicated by bioinstrumentation parameters. Unique sex-specific issues need to be considered when strategies are implemented to assist the increasing number of caregivers as our society ages.

Health promotion behaviors in Chinese family caregivers of patients with stroke.

The purpose of this study was to explore the relationship between and among the caregiver's personal factors, the care recipient's functional status, the caregiver's perceived self-efficacy, social support, reactions to caregiving, and health promotion behaviors in family caregivers of community-dwelling stroke patients in Taiwan. A structured home-interview survey methodology was used to collect data from 134 primary caregivers responsible for care of stroke patients in Taipei, Taiwan. The study results indicated that, in general, caregivers were female spousal caregivers (mean age 52 years, average caregiving period 24 months). Regression analyses revealed that the caregiver's health status was the strongest positive predictor of caregiver self-efficacy. Spousal caregivers with a better-perceived health status were more satisfied with their resources of social supports. Spousal caregivers with poor perceived health status had a higher level of caregiving strain. Results for the overall model indicated caregiver's social support and the care recipient's functional status made significant contributions in explaining the caregiver's health promotion behaviors. Implications for further practice suggest establishing community training programs and support groups for family caregivers.