Health Outcomes Of Family Caregivers Research Articles

Communication Patterns and Characteristics of Family Caregivers and Persons Living With Dementia: Secondary Analysis of Video Observation.

It is essential to characterize communication patterns for better health outcomes for family caregivers and persons living with dementia. This study aimed to examine the relationships between communication patterns and the characteristics of dyads of family caregivers and persons living with dementia. A secondary analysis was conducted using 75 video-recorded home care observations from 19 dyads. Participant characteristics and caregiver burden, depression, and sense of competence were collected from the parent study. The video-recorded dyadic communication patterns were assessed using a coding scheme developed based on Communication Accommodation Theory and Classical Test Theory. The relative frequency of the communication patterns was compared between groups. Overall, 8311 caregiver and 8024 care recipient communication behaviors were observed. Caregiver communication patterns were categorized as facilitative, disabling, and neutral. Care recipient communication patterns were categorized as engaging, challenging, and neutral. Caregiver gender, care recipient gender, care recipient education level, dementia diagnosis length, types of dementia, dyadic gender difference, burden, depression, and competence of caregiver, and types of communication were significantly associated with caregiver communication. Dementia diagnosis length, caregiver competence, dyadic gender difference, and types of communication were significantly associated with care recipient communication. The findings demonstrated different communication patterns depending on individual and dyad characteristics and evidence for dyadic communication support to promote meaningful interaction for persons living with dementia. Further analysis is needed to identify mediating factors and causal relationships.

Conducting family meetings on families with dementia: An integrative review.

To explore the role of family meetings for individuals living with dementia and their family caregivers. Integrative review. We conducted searches in the Cochrane Library, PubMed, CINAHL, and Embase databases (up to December 2022). Additionally, an ancestry search strategy was employed to supplement the retrieval of published literature related to family meetings or family conferences for people with dementia and their family caregivers. The review integrated 11 articles, comprising seven quantitative studies, two qualitative studies, and two case reports. The findings did not indicate a significant improvement in end-of-life quality for individuals with dementia in the family meetings group compared to those receiving usual care. Limited evidence suggested some improvement in mental health outcomes for family caregivers. Both intervention and control groups incurred high care costs. However, family meetings appeared to delay nursing home placements for individuals with dementia. Two qualitative studies provided insights into the experiences of families and healthcare professionals participating in family meetings, highlighting opportunities and challenges in implementing such meetings. Additionally, two case reports offered specific and illustrative accounts of typical family meetings. Family meetings can delay nursing home placements for elderly individuals with dementia. Families dealing with dementia perceive family meetings as an opportunity to collaborate with professionals in providing comprehensive care. Further research is needed to explore the effectiveness of family meetings in decision-making for families affected by dementia. Additionally, addressing timing and process coordination issues in family meetings is crucial for optimising their practices among families dealing with dementia. In order to make family meetings more accessible to families of individuals with dementia, we offer the following recommendations for future research and practice: Rather than a blanket rejection, the decision regarding the participation of individuals with dementia in family meetings should be based on their specific condition and the needs of their family. Coordination and harmonisation of opinions and perceptions among family members of individuals with dementia can sometimes be complex for healthcare professionals. The involvement of family coordinators may simplify this process. To determine the optimal timing for holding family meetings that can better assist families dealing with dementia, we propose that the right to initiate a meeting be granted to the family. This allows them to convene with healthcare professionals and address their concerns at their convenience.

CAREGIVERS & COLONOSCOPIES: A QUANTITATIVE COMPARATIVE STUDY OF CAREGIVERS’ PREVENTATIVE HEALTH BEHAVIORS

Abstract That many caregivers experience some degree of burden is well-established, but little research has investigated the association of burden on caregiver preventative health behaviors. A lack of adherence to these behaviors, including to recommended colonoscopy and mammography screenings, routine vaccinations, annual clinic visits, and HIV testing, may portend worsening health outcomes for family caregivers if diseases are left undetected or untreated; such outcomes could also be caused by and contribute to the crisis of lack of care to meet demand. Survey questionnaires (N=326) were completed by 214 current caregivers and 112 former caregivers from the national MIT AgeLab Caregiver Panel. Respondents predominately identified as white (88%) and female (83%), with a median age of 40-49 years old. Questions assessed caregiving intensity, health status, reported caregiving burden, and adherence to preventative health screenings and vaccinations (per USPTF age- and gender-based recommendations). Among all caregivers, just 17% reported that they were up-to-date with appropriate preventative health screenings. Current caregivers were less likely than previous caregivers to be up-to-date. Controlling for age, income level, and health status, caregiving intensity (as measured by hours per week) was an independent predictor of adherence to preventative health screenings. These findings suggest that current caregivers who are providing high-intensity care are less likely to be engaging in preventative health behaviors for themselves. This finding is concerning for the future health of these caregivers as well as their care recipients and highlights the need for primary care preventative health initiatives specifically targeting family caregivers.

Posttraumatic Stress Symptom Trajectories in Family Caregivers of Patients With Acute Cardiorespiratory Failure

Overall, 1 in 3 family caregivers of patients who require intensive care unit (ICU) admission will experience significant posttraumatic stress symptoms (PTSSs), but little is known about how PTSSs evolve over time. Measuring PTSS trajectories could facilitate the development of targeted interventions to improve mental health outcomes for family caregivers of critically ill patients. To measure 6-month PTSS trajectories among caregivers of patients with acute cardiorespiratory failure. This prospective cohort study was conducted in the medical ICU of a large academic medical center among adult patients requiring (1) vasopressors for shock, (2) high-flow nasal cannula, (3) noninvasive positive pressure ventilation, or (4) invasive mechanical ventilation. Each patient was enrolled along with their primary caregiver, ie, the unpaid individual who provided the most physical, emotional, or financial support prior to ICU admission. Family caregiver PTSSs were assessed using the Impact of Events Scale-Revised within 48 hours of ICU admission, following ICU discharge, and 3 and 6 months after enrollment. Latent class growth analysis was used to measure PTSS trajectories. Preselected patient and caregiver characteristics measured at ICU admission were analyzed for association with trajectory membership. Six-month patient and caregiver outcomes were analyzed by caregiver trajectory. Overall, 95 family caregivers were enrolled and provided baseline data; mean (SD) age was 54.2 (13.6) years, 72 (76%) were women, 22 (23%) were Black individuals, and 70 (74%) were White individuals. Three trajectories were identified: persistently low (51 caregivers [54%]), resolving (29 [31%]), and chronic (15 [16%]). Low caregiver resilience, prior caregiver trauma, high patient severity of illness, and good patient premorbid functional status were associated with the chronic trajectory. Caregivers with the chronic PTSS trajectory had worse 6-month health-related quality of life (mean [SD] total 36-item Short Form Survey score, persistently low trajectory: 104.7 [11.3]; resolving trajectory: 101.7 [10.4]; chronic trajectory: 84.0 [14.4]; P < .001) and reduced effectiveness at work (mean [SD] perceived effectiveness at work score, persistently low trajectory: 86.0 [24.2]; resolving trajectory: 59.1 [32.7]; chronic trajectory: 72.3 [18.4]; P = .009). In this study, 3 distinct PTSS trajectories among ICU family caregivers were observed, with 16% of caregivers experiencing chronic PTSSs over the subsequent 6 months. Family caregivers with persistent PTSS had lower resilience, prior trauma, higher patient severity of illness, and higher baseline patient functional status compared with family caregivers with persistently low PTSS, with adverse effects on quality of life and work. Identifying these caregivers is an essential first step to develop interventions tailored to those with the greatest need for support.

Physical and mental health of family caregivers of older parents and grandchildren in China

BackgroundFamilies have been recognized as the primary source of care for younger and older family members in Chinese tradition. The aim of this study was to examine the association between informal caregiving for aging parents and/or grandchildren and health outcomes of family caregivers in mainland China. MethodsUsing data from the 2013 and 2018 waves of China Health and Retirement Longitudinal Study (CHARLS), we conducted univariate comparisons of demographics characteristics between informal caregivers and non-caregivers using t-test and chi square test. We used linear regression and negative binomial regression to examine the physical and mental health outcomes of family caregivers aged 45 and over living in mainland China. This cross-sectional study was based on the self-reported measures of caregiving status, demographic factors, and health outcomes. ResultsCompared to non-caregivers, informal caregivers were more likely to be women, younger in age, married, living in rural areas, and with less years of education. Older age, being male, being married, living in an urban area, having a higher level of education, and having better self-reported health were associated with better mental health outcomes among family caregivers. Being male, younger age, and working, and having better self-reported health, were associated with better physical function among family caregivers. Caregivers who only cared for their grandchildren reported greater life satisfaction, fewer depressive symptoms, and a higher level of physical function than non-caregivers. In addition, caregivers who cared for only their parents reported fewer depressive symptoms than non-caregivers. ConclusionsHealth practitioners and policymakers should consider the needs for additional resources for family caregivers of older adults and children. Targeted policies and programs may improve family caregivers’ health, especially for female family caregivers living in rural areas.

Mental health outcomes and experiences of family caregivers of children with disabilities during the COVID-19 pandemic in Bolivia.

This study examined whether certain demographic characteristics, caregiver strain, and coping behaviors were associated with the mental health outcomes of family caregivers of children with disabilities in Bolivia during the COVID‐19 pandemic. A mixed‐methods convergent study design was used with virtual interviews to quantitatively assess caregivers' demographic characteristics, caregiver strain, coping behaviors, and mental health outcomes, as well as qualitatively assess how the pandemic affected their family. Approximately 32%–71% of caregivers experienced poor mental health outcomes (stress, anxiety, and depression), especially among those experiencing poor health, high caregiver strain, and those using maladaptive coping strategies. Qualitative responses revealed that they experienced several unique stressors during the pandemic that affected them and their children. These findings highlight the need for culturally tailored prevention and treatment interventions to help offset the adverse effects of the COVID‐19 pandemic on the mental health outcomes of this at‐risk population.

Effects of Physical Activity Programs on Health Outcomes of Family Caregivers of Older Adults with Chronic Diseases: A Systematic Review

This systematic review was conducted to analyze and capture the most recent trends in physical activity interventions for family caregivers of older adults with chronic disease as found in randomized clinical trials over the last 10 years (2010–2020). We used PubMed, CINAHL, Embase, PsycInfo, and the Cochrane Library. We synthesized participants’ demographics, physical activity interventions and family caregivers’ health outcomes. The Cochrane Collaboration Risk of Bias Tool was used to assess risk of bias of the included studies. Sixteen studies were included and most studies (n = 11) had a moderate risk of bias. Physical activity programs with mixed modes (e.g., aerobic and resistance exercise), mixed delivery methods (e.g., in-person and telephone) and mixed settings (e.g., supervised gym-based sessions and unsupervised home-based sessions) were used most frequently. Physical activity interventions significantly improved psychological health but had inconsistent effects on physical health. This review provides current trends and research findings that suggest types of physical activity interventions and components that improve family caregivers’ health and wellness.

Internet‐based supportive interventions for family caregivers of people with dementia: A systematic review and meta‐analysis

AbstractBackgroundFamily caregivers of people with dementia always experience high levels of psychological burden and physical strain, so effective and practical support is essential. Internet‐based interventions can provide convenient and efficient support and education to potentially reduce the physical and psychological burden associated with providing care. This review aimed to (1) assess the efficacy of internet‐based supportive interventions in ameliorating health outcomes for family caregivers of people with dementia, and (2) evaluate potential effects of internet‐based supportive interventions access by caregivers on their care recipients.MethodAn electronic literature search was conducted in the PubMed, Embase, Web of Science, CINAHL, Cochrane Library, and PsycINFO databases to identify relevant studies that were published up to November 2019. The two reviewers worked independently to identify randomized controlled trials (RCTs) that met the inclusion criteria and extracted data independently. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for systematic reviews of interventions. Standardized mean difference (SMD) with 95% CI was applied to calculate the pooled effect sizes.ResultIn total, fifteen RCTs met the eligibility criteria and were included in this systematic review. The meta‐analysis showed that internet‐based supportive interventions significantly ameliorated depressive symptoms (SMD = ‐0.20; 95% CI ‐0.31 to ‐0.10; p = 0.0002), perceived stress (SMD = ‐0.36; 95% CI ‐0.53 to ‐0.19; p &lt; 0.0001), anxiety (SMD = ‐0.33; 95% CI ‐0.51 to ‐0.16; p = 0.0002), and self‐efficacy (SMD = 0.19; 95% CI 0.05 to 0.33; p = 0.007) in dementia caregivers. No significant improvements were found in caregiver burden or coping ability. Three studies assessed the unintended effects of internet‐based supportive interventions access by caregivers on their care recipients. The results showed that internet‐based supportive interventions had potential benefits on the quality of life and neuropsychiatric symptoms in care recipients.ConclusionInternet‐based supportive interventions were generally effective at ameliorating depressive symptoms, perceived stress, anxiety, and self‐efficacy in dementia caregivers, although negative results were found in some RCTs. Future researchers are encouraged to adopt personalized internet‐based supportive interventions to improve the health of family caregivers and their care recipients.

Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Systematic Review and Meta-Analysis.

BackgroundCaring for people with dementia is perceived as one of the most stressful and difficult forms of caring. Family caregivers always experience high levels of psychological burden and physical strain, so effective and practical support is essential. Internet-based supportive interventions can provide convenient and efficient support and education to potentially reduce the physical and psychological burden associated with providing care.ObjectiveThis review aimed to (1) assess the efficacy of internet-based supportive interventions in ameliorating health outcomes for family caregivers of people with dementia, and (2) evaluate the potential effects of internet-based supportive intervention access by caregivers on their care recipients.MethodsAn electronic literature search of the PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, and PsycINFO databases was conducted up to January 2020. Two reviewers (ML and YZ) worked independently to identify randomized controlled trials (RCTs) that met the inclusion criteria and independently extracted data. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMDs) with 95% CIs were applied to calculate the pooled effect sizes.ResultsIn total, 17 RCTs met the eligibility criteria and were included in this systematic review. The meta-analysis showed that internet-based supportive interventions significantly ameliorated depressive symptoms (SMD=–0.21; 95% CI –0.31 to –0.10; P<.001), perceived stress (SMD=–0.40; 95% CI –0.55 to –0.24; P<.001), anxiety (SMD=–0.33; 95% CI –0.51 to –0.16; P<.001), and self-efficacy (SMD=0.19; 95% CI 0.05-0.33; P=.007) in dementia caregivers. No significant improvements were found in caregiver burden, coping competence, caregiver reactions to behavioral symptoms, or quality of life. Six studies assessed the unintended effects of internet-based supportive intervention access by caregivers on their care recipients. The results showed that internet-based supportive interventions had potential benefits on the quality of life and neuropsychiatric symptoms in care recipients.ConclusionsInternet-based supportive interventions are generally effective at ameliorating depressive symptoms, perceived stress, anxiety, and self-efficacy in dementia caregivers and have potential benefits on care recipients. Future studies are encouraged to adopt personalized internet-based supportive interventions to improve the health of family caregivers and their care recipients.Trial RegistrationPROSPERO CRD42020162434; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162434

WHAT DETERMINES THE USE OF MEANING FOCUSED COPING IN DEMENTIA CAREGIVING?

Meaning-focused coping has been identified as an important factor contributing to more positive adjustment and health outcomes for family caregivers of persons with dementia. Yet, there is less evidence about what determines the use of this coping strategy. Based on the Meaning Making Model, this quantitative exploratory study identified the relationship between meaning focused coping and intrinsic motivation towards caregiving, quality of relationship between the care dyads and level of religiosity. Two hundreds and five family caregivers of PWD were recruited from a geriatric clinic from March 2018 – Feb 2019. A battery of questionnaires including the Meaning-Focused Coping Scale, Relationship Quality Scale, the Duke University Religion Index and Intrinsic Motivations to Care was administered in face-to-face interview. By using hierarchical regression analysis to control the effects of caregivers’ demographic profile, caregiving history, clinical severity of dementia, and level of neuro-psychiatric symptoms, the results indicated that a higher intrinsic motivation to caregiving (β = 1.457, p = 0.044), better dyadic relationship quality (β = 0.768, p = 0.004) and a higher level of religiosity (β = 0.969, p = 0.001) are independently related to a higher likelihood of using meaning-focused coping. The findings shift the paradigm of caregiver support from a deficit model to helping them to appraise the meaning of caregiving in dyadic relational, spiritual and motivational perspectives. The application of strength-based and person-centered approach to caregiver supportive program will be discussed.

Caregiving demands, job demands, and health outcomes for employed family caregivers of older adults with dementia: Structural equation modeling

Many family caregivers are also employed full- or part-time and are known to be affected by job demands. This study explored the mediating effect of job demands on the relationship between caregiving demands and caregiver health outcomes in primary family caregivers of older persons with dementia in Taiwan (N = 214). A cross-sectional design using a self-completed structured questionnaire was implemented. Structural equation modeling analyses showed that job demands partially mediated the relationship between caregiving demands and caregiver health outcomes. The indirect effect of caregiving demands on caregiver health outcomes through job demands was 0.208 (95% confidence interval: 0.053 - 0.335). Nurses should evaluate job demands when screening for high-risk caregiver groups vulnerable to high caregiving demand. Interventions aimed at lessening both caregiving demands and job demands may improve caregiver health outcomes for family caregivers of older adults with dementia.

Advancing Care for Family Caregivers of persons with dementia through caregiver and community partnerships

BackgroundThere are currently 15 million Americans who provide over 80% of the care required by their family members with Alzheimer’s disease and other dementias. Yet care for caregivers continues to be fragmented and few evidence-based interventions have been translated into routine clinical care and therefore remain inaccessible to most family caregivers. To address this gap, the Caring for the Caregiver program is being developed at UT Health San Antonio, School of Nursing to improve support services and health outcomes for family caregivers. Our purpose is to describe the engagement process undertaken to assess caregiver and community needs and how findings are informing program development.MethodsWe are using a model of public engagement that consists of communication of information, collection of information from stakeholders, and collaboration where stakeholders are partners in an exchange of information to guide program activities. An assessment of the community was undertaken to identify resources/services for family caregivers. Subsequently, stakeholders were invited to a community-academic forum to discuss strategies to build on existing strengths for family caregiving and to identify gaps in care. Detailed notes were taken and all discussions were recorded and transcribed for analysis. Data were analyzed using thematic content analysis.ResultsWe conducted site visits with 15 community agencies, interviewed 13 family caregivers, and attended community events including support groups and health and senior fairs. Fifty-three diverse stakeholders attended the community-academic forum. Participants identified existing assets within our community to support family caregivers. Consistent among groups was the need to increase awareness in our community about family caregivers. Themes identified from the discussion were: making the invisible visible, you don’t know what you don’t know, learning too late, and anticipating and preparing for the future.ConclusionsIncorporating caregiver and community stakeholders was critical to ensure that the priorities of our community are addressed in a culturally responsive accessible program for family caregivers. The forum served as important mechanism to partner with the community and will be an annual event where we can continue to work with our stakeholders around needs for practice, education, and research.

Effects of a Health and Social Collaborative Case Management Model on Health Outcomes of Family Caregivers of Frail Older Adults: Preliminary Data from a Pilot Randomized Controlled Trial.

Family caregiving is an important form of informal care provided to frail, community-dwelling older adults. This article describes a health and social collaborative case management (HSC-CM) model that aims to optimize the support given to caregivers of frail elderly adults. The model was characterized by a comprehensive assessment to identify the caregiver's needs; a case management approach to provide integrated, coordinated, continued care; and multidisciplinary group-based education customized to the caregiver's individualized needs. A pilot study using a randomized controlled trial study design was conducted to evaluate the effects of the HSC-CM on caregiver burden and health-related quality of life of family caregivers of frail elderly adults. Sixty family caregivers (mean age 61.3 ± 15.5) of frail older adults recruited from a community center for elderly adults in Hong Kong were randomly assigned to receive a 16-week HSC-CM intervention or usual care. Case managers who conducted a comprehensive assessment of the care dyads to identify caregiver needs using a case management approach to optimize care coordination and continuity led the HSC-CM. These case managers served as liaisons for multidisciplinary efforts to provide group-based education according to caregiver needs. Family caregivers who participated in the HSC-CM had significantly greater improvement on the Caregiver Burden Index (p = .03) and on the Medical Outcomes Study 36-item Short-Form Survey subscales, including vitality (p = .049), social role functioning (p = .047), and general well-being (p = .049). This study provides preliminary evidence indicating that client-centered care, a case management approach, and multidisciplinary support are crucial to an effective caregiving support initiative. A full-scale study is required to validate these findings.

Psychosocial Health Outcomes for Family Caregivers Following the First Year of Bereavement

The authors examined psychosocial outcomes following the first year of bereavement, for 51 family caregivers, including both spouses and offspring. Researchers assessed caregivers during palliative care and again during the second year of bereavement, for social functioning, depression, and distress. For all family caregivers, only depression scores declined significantly between T1 and T2 (p < 0.05). Caregiver relationship and gender did not make a difference in recovery. Results demonstrate that poor psychosocial health outcomes exist beyond the first year of bereavement. Early identification of these caregivers is necessary to provide mental health professionals the opportunity to intervene proactively.

Factors that contribute to adult children caregivers' well-being: a scoping review.

The ageing of the population will increasingly result in reliance on the family for care in the community. Existing reviews have provided insights into the needs and health outcomes of family caregivers, but are disproportionately skewed towards spousal caregivers. Presently, a large majority of family caregivers are adult children. Adult children are distinct from spousal caregivers in terms of the combination of roles they occupy and the relationship they have with the care recipient. These unique considerations can have important implications for their well-being. A growing body of literature has investigated the factors that contribute to adult children caregivers' (ACCs) well-being; however, no reviews to date have synthesised this body of literature or appraised its methodological quality. Our objective was to identify the range and types of factors that contribute to ACC well-being across studies. A scoping review was conducted. Medline, Psycinfo, EMBASE and CINAHL databases (January 1996-August, 2012) were systematically searched for studies investigating ACC well-being. Inclusion/exclusion criteria were applied, methodological quality was appraised, the data were charted and a narrative synthesis was conducted. Fifty-five studies met our inclusion criteria. Factors that contribute to ACC well-being were found to be either: (i) care recipient-related (e.g. nature of limitations, amount of care required); (ii) caregiver-related (e.g. psychological dispositions of the ACC); or (iii) socially embedded (e.g. parent-child relationship, multiple role involvement, social support available to the ACC). Socially embedded factors that contribute to ACC well-being have received the most attention in the literature. Among these factors, ACC well-being is uniquely impacted by the quality of the parent-child relationship and combination of roles occupied. The majority of studies were cross-sectional. Future studies should therefore employ a longitudinal design to inform our understanding of the changes that take place in the parent-child relationship and multiple role involvement across the care-giving trajectory.

Health-Related Quality of Life and Self-Efficacy of Managing Behavior Problems for Family Caregivers of Vascular Dementia and Alzheimer's Disease Patients

Background: Little is known about the differences in patients' behavioral problems and health outcomes of family caregivers of patients with vascular dementia (VaD) and Alzheimer's disease (AD). Methods: A secondary analysis of baseline data on a subsample of caregiver-dementia patient dyads in a randomized clinical trial. Results: Family caregivers of VaD patients reported higher self-efficacy than caregivers of AD patients in handling verbally nonaggressive and verbally aggressive behaviors. Caregivers of VaD patients had poorer health-related quality of life (HRQoL) than caregivers of AD patients considering role disability due to physical health problems, bodily pain, social function, and physical component summary. Greater self-efficacy was associated with better mental health-related outcomes for family caregivers of VaD patients, and better self-care ability of VaD patients was associated with better caregiver mental health-related outcomes. Caring for a patient with more severe dementia predicted poor physical health-related outcomes in role disability due to physical health problems, but better overall mental health (mental component summary) for caregivers. Conclusion: This study is the first to examine and compare the behavioral problems of AD and VaD patients in a Chinese population, along with their family caregivers' self-efficacy and health outcomes. Family caregivers of patients with VaD might warrant specific attention to their HRQoL, with interventions developed to enhance their self-efficacy.

Trends in health outcomes for family caregivers of hip‐fractured elders during the first 12 months after discharge

This article reports on trends in health outcomes for family caregivers of hip-fractured patients and the effects of social support on these outcomes. Little is known about the impact of caregiving on the health outcomes of family caregivers of patients with hip fracture. For this prospective, correlational study, data were collected from 135 family caregivers of hip-fractured elders (2001-2005). Data on health-related quality of life and social support were collected from family caregivers at 1, 3, 6 and 12 months after discharge of the older hip-fractured patient. During the 12 months after the patients' discharge, family caregivers' scores improved significantly in role performance-related scales, including bodily pain, social function, role limitations due to emotional problems and role limitations due to physical problems. However, caregivers' scores for general health and mental health were significantly lower at 12 months [59·91 (sd = 24·54) and 65·91 (sd = 14·36) respectively] than at 1 month after discharge [64·35 (sd = 23·29) and 67·94 (sd = 18·47) respectively]. The trends for most subscale scores for health-related quality of life were positively related to perceived availability of social support. Caring for a hip-fractured older family member over a sustained period may enhance family caregivers' role performance, but have a negative impact on their perceived general health and mental health. These results suggest that home care nurses should develop interventions early after discharge to assess and improve family caregivers' health perception, mental health and social support.

Does Expressive Writing Reduce Stress and Improve Health for Family Caregivers of Older Adults?

We examined whether written emotional disclosure reduces stress and improves health outcomes for family caregivers of physically frail and cognitively impaired older adults, as it has been shown to do for certain student and clinical populations. Primary caregivers of older adults attending a day program were randomly assigned to expressive-writing (n = 14), time-management (n = 13), or history-writing (n = 13) conditions. Participants wrote for 20 minutes on four occasions over a 2-week period, and they completed self-report measures of caregiver burden and health prior to the intervention, immediately afterward, and at 1-month follow-up. Contrary to expectations, expressive-writing and history-writing participants performed similarly across outcomes. Only caregiver participants in the time-management condition experienced significant mental and physical health improvements after writing. The results of this study add to a growing body of research demonstrating equivocal effects of expressive writing with clinical samples, and they suggest the potential benefit of written time management for stressed caregivers.

Effects of Social Support and Coping of Family Caregivers of Older Adults with Dementia in Taiwan

The purpose of this study was to explore the relationship of demographic characteristics, contextual factors, social support, and coping on health outcomes of family caregivers of older adults with dementia in Taiwan. This study also examined caregiving stress and whether support moderated the effects of caregiver stress on health. Lazarus and Folkman's (1984) Stress model guided this study. The descriptive cross-sectional study included subjects who were primary family caregivers of older adults with dementia from two settings in southern Taiwan. A convenience sample of 148 participants was interviewed. Data analysis consisted of Pearson's correlations, and simple and multiple regression analysis. Findings indicated that younger caregivers, those with paid assistants, and those with longer duration of caregiving had better health. Females with lower income and without assistants had more depressive symptoms. In addition, moderating effects of social support were supported. The results from this study provided a basis for developing interventions to minimize negative impacts on caregivers.

Accessible Support for Family Caregivers of Seniors with Chronic Conditions: From Isolation to Inclusion

Accessible support programs can improve health outcomes for family caregivers of older relatives with a chronic condition. Over the course of 6 months, 27 experienced family caregivers provided weekly support via the telephone to 66 individuals, either new family caregivers of seniors recently diagnosed with stroke or newly vulnerable family caregivers (i.e., facing increasing demands from the deterioration of their senior relative's condition) of seniors with Alzheimer's disease. Qualitative data documented the perceived impact of the intervention, including increased satisfaction with support, coping skills, caregiving competence and confidence, and decreased caregiver burden and loneliness. Caregivers identified varied support processes that overcame support deficits in their social networks. These processes can facilitate replication in future research and inform practice, programs, and policies.