High Levels Of Caregiver Burden Research Articles

The impact of anxiety on the cognitive function of informal Parkinson's disease caregiver: Evidence from task-based and resting-state fNIRS.

Informal Parkinson’s disease (PD) caregivers are considered to experience high levels of caregiver burden, negatively affecting the health of caregivers. However, few studies explored the relationship between anxiety in caregiver burden and cognitive function in informal PD caregivers. Although, no study has even investigated the neural mechanisms underlying this connection. This study aimed to conduct comprehensive cognitive and clinical assessments and evaluate brain activity from task-based state and resting-state using functional near-infrared spectroscopy (fNIRS). A total of ten informal PD caregivers and 15 matched, healthy, non-caregivers were recruited. Comprehensive cognitive and clinical assessments were conducted to evaluate five cognitive domains and mental states. Neural activity induced by verbal fluency task (VFT) and brain connectivity during resting state were monitored, and their correlations with the neuropsychological and clinical tests were explored. Our results showed that compared to non-caregiver, an informal PD caregiver exhibited no difference in most cognitive domains of function but performed better in attentional function, along with higher levels of anxiety. Decreased activation over prefrontal regions during VFT and hypo-connectivity within the frontoparietal network (FPN) and between default mode network (DMN) and FPN in the resting state were confirmed in this study as a result of the negative effects of anxiety on the brain. Furthermore, Spearman’s correlation found that neural activity in FPN during task-based state and resting state was negatively correlated with the severity of anxiety. These findings indicate that despite normal or even better cognitive function, informal PD caregivers have impaired brain function, and this deficit in neural activity was related to anxiety.

Economic hardships of Korean American family caregivers of persons with dementia: a mixed-methods study

Objectives. This study examined the relationships between economic hardships (i.e. perceived financial hardship and job interference) and caregiver burden among Korean American family caregivers of persons with dementia and explored their lived experience caring for their loved ones. Methods. Using a mixed-methods research design, we first conducted a survey with 36 Korean American family caregivers. We also conducted semi-structured, in-depth, individual interviews (n = 33) and subsequently compared the results. Results. Cohabiting with their loved ones, the total duration of caregiving, and financial hardship were statistically significant predictors of higher levels of caregiver burden. Our thematic analysis resulted in four themes: (1) financial hardship, (2) early retirement, (3) dual responsibilities contributing to physical and emotional challenges, and (4) a lack of caregiver support. Conclusion. Our findings suggest the importance of developing culturally appropriate interventions that are affordable and accessible to Korean American family caregivers of persons with dementia.

Associates of Perceived Quality of Life in Chinese Older Adults Living with Cognitive Impairment

ABSTRACT The aim of this study is to examine perceived quality of life in Chinese older adults living with cognitive impairment and explore its associations with caregivers’ characteristics. Questionnaires were administered in person to 271 caregiver-care recipient dyads from urban communities in mainland China in 2019. We used the 40-item Alzheimer’s Disease-related Quality of Life tool and asked caregiver respondents to indicate care recipients’ life conditions. The questionnaire asked caregivers about their sociodemographic characteristics, levels of informal social support, caregiver burden, and depressive symptoms. Caregivers’ higher levels of caregiver burden (β = > −0.19, p < .01) and depressive symptoms (β = > −0.19, p < .01) amongst caregivers were significantly associated with lower quality of life among care recipients. Informal support from relatives and friends to caregivers did not significantly affect quality of life of care recipients. The results suggested that reducing caregivers’ burden and depressive symptoms are essential to promote quality of life of care recipients. Formal support from health professionals, service organizations, and communities are urgently called to promote the wellbeing of Chinese families affected by cognitive impairment.

Explaining caregiver burden in a large sample of UK dementia caregivers: The role of contextual factors, behavioural problems, psychological resilience, and anticipatory grief

Objectives Dementia caregiver burden is a significant public health concern, affecting both the wellbeing of caregivers and their care-recipients. This study investigated a range of variables associated with caregiver burden in a large sample of UK dementia caregivers. Clinical characteristics and novel psychological constructs were used – including anticipatory grief and psychological resilience. Anticipatory grief refers to the process of experiencing loss prior to the death of a significant person. Method Caregivers of persons with dementia (N = 530) completed a survey obtaining the Zarit-Burden Interview (ZBI-SF) and other psychological and demographic/caregiving-related factors. Results Findings illustrate that 71% of the sample experienced high levels of caregiver burden and around 95% met the criteria for clinically significant levels of burden. A regression model explained 49% of the variance in subjective caregiver burden; contextual factors (care-recipients living situation, frequency of caregiving), behavioural challenges in the care-recipient (memory-related problem behaviours), caregiver psychological resilience and caregiver anticipatory grief (heartfelt long & sadness, worry & felt isolation) were all significant variables. Caregiver anticipatory grief, followed by psychological resilience, had the strongest association with burden Conclusion Caregiver anticipatory grief and psychological resilience, have a significant interaction with the clinical presentation of the dementia sufferer in explaining subjective caregiver burden. More grief and resilience-focused interventions targeting both the practical and emotional challenges are imperative to reduce burden and thus to ensure caregiver wellbeing.

Patient-Related Factors Influencing Caregiver Burden in Parkinson’s Disease Patients: Comparison of Effects Before and After Deep Brain Stimulation

Background:Caregivers of Parkinson’s disease (PD) patients provide important support during the pre- and postoperative phase of deep brain stimulation (DBS). High levels of caregiver burden have been reported after DBS. However, a comparison between preoperative and postoperative burden and associated factors has been insufficiently studied.Objective:To investigate the influence of DBS on caregiver burden, and to identify the differential impact of patient-related factors on caregiver burden before and after DBS.Methods:Consecutive patients referred for DBS eligibility screening or during one-year follow-up assessments were included. Caregiver burden was measured with the short Zarit Burden Interview (ZBI-12). Inverse Probability Weighting (IPW) was used to compare caregiver burden between preoperative and postoperative assessments.Results:We included 47 patients (24 screening, 23 follow-up) (median age 65 years, 29.4% female sex). DBS did not impact caregiver burden (screening: median ZBI-12 9.5 (IQR 3.25, 16.75); follow-up median ZBI-12 6 (IQR 4, 14); IPW-coefficient 0.57 (95% CI –2.75, 3.89)). Worse caregiver burden during DBS screening was associated with worse patient-related scores on depressive symptoms, anxiety, QoL, and impulsiveness. Worse scores on depressive symptoms, anxiety, apathy, postural-instability-gait-disorder, and QoL were associated with worse caregiver burden at one-year follow-up.Conclusion:DBS appears not associated with changes in caregiver burden. Various symptoms are valued differently between screening and follow-up assessments in terms of caregiver burden. Early recognition of caregivers “at risk” may improve guidance of patient-caregiver dyads throughout the DBS process.

Caregiver burden and its associated factors among family caregivers of persons with dementia in Shanghai, China: a cross-sectional study

ObjectiveTo assess the level of caregiver burden and factors associated with it among family caregivers of persons with dementia (PWD) living in communities of Shanghai, China.DesignCross-sectional study.SettingCommunities in Hongkou District...

Caregiver burden, treatment complexity, and the veterinarian-client relationship in owners of dog with skin disease.

BackgroundIncreasing complexity of treatment plans is associated with higher levels of caregiver burden in owners of dogs with skin disease. It is possible that elevated caregiver burden resulting from treatment complexity could, in turn, affect the veterinarian–client relationship.Hypotheses/ObjectivesWe expected that treatment complexity, caregiver burden, and the client’s perception of the veterinarian–client relationship would be related to each other. We also expected an indirect effect of caregiver burden on the cross‐sectional association between treatment complexity and the veterinarian–client relationship, and that this effect would be robust to adjustment for the dog’s skin disease course and severity.ParticipantsParticipants were 349 owners of dogs with skin disease recruited through online consumer panels.Materials and methodsCross‐sectional online assessments were completed for caregiver burden, treatment plan complexity, veterinarian–client relationship, and skin disease course and severity. Demographic information also was collected.ResultsThe indirect effect of caregiver burden on the relationship between treatment complexity and veterinarian–client relationship was statistically significant, accounting for 42.76% of the variance in the model. After controlling for disease severity and course, that effect remained statistically significant, accounting for 37.76% of the variance.Conclusions and clinical importanceFindings support the notion that greater treatment complexity is related to the owner’s perception of the veterinarian–client relationship via caregiver burden. Efforts to reduce caregiver burden by using the simplest effective treatment may benefit the veterinarian–client relationship.

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BackgroundMany studies from India have evaluated the caregiver burden among the family members of patients of schizophrenia and have reported the same to be high. However, none of the studies have specially looked at the elderly caregivers.AimTo evaluate the caregiver burden among the elderly caregivers of patients with schizophrenia.Methodology100 elderly caregivers (age > 60 years) were evaluated on Family Burden Scale (FBS)ResultsMean age of the patients was 38.2 years (SD 10.33) and the mean duration of education was 12.24(SD 3.96) years. Majority of the patients were males (n=61) and currently unmarried (n=67). Mean age of the caregivers was 65.06 years (SD 6.21) and the mean duration of education was 9.76 years (SD 5.16). There were nearly equal number of caregivers where male (N=49) and female (N=51). Mean Total Family Burden Scale Score for the study sample was 30.40 (SD 12.37). In terms of various domains of FBS, the mean weighted score was highest for the domain of disruption of leisure activities [mean (SD): 1.53(0.55)], followed by disruption of daily activities [mean (SD): 1.38(0.63)], impact on mental health [mean (SD): 1.27(0.47), disruption in interaction [mean (SD): 1.23(0.68)], financial burden [mean (SD): 1.15(0.69)], and least for impact on the physical health [mean (SD): 0.94(0.57)].ConclusionElderly caregivers of patients experience high level of caregiver burden and the hierarchy of distribution of caregiver burden among the elderly is different than that reported for the adult caregivers.

The Relationship between Burden and Financial Factors for Help-Seeking Older Adult Caregivers

Older adult caregivers often experience unique financial challenges (Schultz & Eden, 2016). The purpose of the present study was to explore the relationship between caregiver finances and caregiver burden for this sample. A sample of 131 caregivers seeking counseling services completed questionnaires assessing demographics, care recipient functioning (ADLs/IADLs), and finances (yearly income, impact of caregiving on finances). A majority, 74.8% of caregivers, indicated financial burden since caregiving. A hierarchical multiple regression was computed to predict caregiver burden. The caregiving characteristics block explained 8.1% of the total variance in caregiver burden, F(7, 123) = 1.54, n.s. Specifically, being younger was significantly associated with more caregiver burden. Adding the care recipient functioning block explained an additional 6.9% of the variance in caregiver burden, Fchange(2, 121) = 4.93, p < .01. The caregiving characteristics and care recipient functioning model accounted for 15% of the total variance in caregiver burden, F(9, 121) = 1.55, p < .05. Again, younger age uniquely predicted greater caregiver burden. Lastly, caregiving finance factors contributed an additional 13.5% of the variance, Fchange(4, 117) = 5.54, p < .001. Thus, the final caregiver characteristics, care recipient functioning, and caregiving finances model accounted for 28.5% of the total variance in caregiving burden, F(13, 117) = 3.59, p < .001. Specifically, having less income and greater monthly expenses related to caregiving predicted higher levels of caregiver burden. These findings imply that those with fewer resources may benefit from intervention for the heavier burden they perceive compared to peers with more financial resources.

The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia

Grandparents are increasingly providing extensive and custodial care for their grandchildren. Many factors have contributed to a societal rise in caregiving among grandparents, including addiction, incarceration, dual-income families, and the cost of childcare. Past work has highlighted positive effects of grandparenting (e.g. reduced dementia risk); however, research is limited that examines the day to day challenges grandparent caregivers experience. The goal of this research was to examine daily experiences of stressors, positive events, physical symptoms, and daily mood of grandparent caregivers. Participants (n=18 grandparent caregivers) filled out a diary survey for five consecutive days that measured daily stressors and positive events. A total of 90 diaries were completed. Stressors were reported on 97.6% of days. Multilevel analysis examining emotional and physical reactivity to daily events showed that, controlling for age and gender, on days when participants reported more stressors than average, they reported higher negative affect (p=.019), lower positive affect (p=.003) and more physical symptoms (p=.002). Positive events were not significantly associated with daily mood or daily physical symptoms. Overall, the findings supported the hypothesis that grandparent caregivers experience emotional and physical reactivity to the daily challenges they experience. Future research should examine resources and supports to reduce the impact of daily stressors, as well as the particular challenges among underrepresented groups, particularly Black and Latino grandparents, who provide disproportionate levels of care for their grandchildren. The current study highlights the potential vulnerability and daily needs for support among grandparents who provide regular and custodial care for their grandchildren.

The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia.

Anticipatory grief is the process of experiencing normal bereavement before the physical death of a significant person. To date, anticipatory grief has been related to higher levels of caregiver depression, anxiety, subjective burden, and poorer problem solving. Additionally, higher levels anticipatory grief are observed in caregivers of those with Alzheimer’s Disease and Related Dementias (ADRD) compared to caregivers of those with mild cognitive impairment, implying a relationship between disease severity and caregiver anticipatory grief. Analyses were performed on data for ADRD caregivers (n=56) enrolled in the IU Telephone Acceptance and Commitment Therapy for Caregiver (TACTICs) trial; an RCT evaluating an ACT intervention for ADRD caregivers with anxiety. Inclusion criteria included identifying as the primary caregiver of an ADRD patient, and clinically significant anxiety (GAD7 score >10). The average age of caregivers was 61.9 years, 41.1% were spouses, 83.9% were white and 14.3% were black. Mean anticipatory grief scores were notably higher (84.6) compared to the previously reported means across the literature (74.9). Using multiple regression models, we determined a caregivers’ anticipatory grief, as measured by the anticipatory grief scale, is not significantly associated with the patients’ dementia severity, as measured by the Dementia Severity Rating Scale (DSRS) (p=0.66), Results revealed that higher levels of caregiver burden, as measured by the Zarit Burden Index, are significantly associated with more anticipatory grief (p< 0.01). Understanding these relationships contributes to a better understanding of ADRD caregivers, identifying “high-risk” caregivers, and informing future interventions and care.

Associates of Perceived Quality of Life in Chinese Older Adults Living With Cognitive Impairment

This study examined perceived quality of life in Chinese older adults living with cognitive impairment in a group of urban Chinese older adults and explore its associations with caregivers’ characteristics. Questionnaires were administered in person to 300 caregiver-care recipient dyads from three urban communities in mainland China in 2019. The 40-item Alzheimer’s Disease-related Quality of Life tool asked caregiver respondents to indicate care recipients’ life conditions. Higher levels of caregiving burden (β = -0.19, p < 0.01) and more depressive symptoms (β = -0.19, p < 0.01) amongst caregivers were significantly associated with lower quality of life of care recipients. The results suggested that reducing caregivers’ burden and depressive symptoms are essential to promote quality of life of care recipients. Formal support from health professionals, service organizations, and communities are urgently called for to promote the wellbeing of Chinese families affected by cognitive impairment.

The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia

Background/Objective: Anticipatory grief is the process of experiencing normal bereavement before the physical death of a significant person. To date, anticipatory grief has been related to higher levels of caregiver depression, anxiety, subjective burden, and poorer problem solving. Additionally, higher levels anticipatory grief are observed in caregivers of those with Alzheimer’s Disease and Related Dementias (ADRD) compared to caregivers of other conditions. The primary objective of this analysis is to determine the relationship between caregiver anticipatory grief and dementia severity, as measured by the Anticipatory Grief Scale (AGS) and Dementia Severity Rating Scale (DSRS), respectively.&#x0D; Methods: Multiple regression analyses were performed on data for ADRD caregivers (n=56) enrolled in the IU Telephone Acceptance and Commitment Therapy for Caregivers (TACTICs) trial; an RCT testing an ACT intervention for ADRD caregiver anxiety. Inclusion criteria included identifying as the primary caregiver of an ADRD patient and clinically significant anxiety (GAD7 score &gt;10).&#x0D; Results: The average age of caregivers was 61.9 years, 41.1% were spouses, 83.9% were white and 14.3% were black. Mean anticipatory grief scores were notably higher (84.6) compared to the previously reported means across the literature. Multiple regression models showed a caregivers’ anticipatory grief is not significantly associated with the patients’ dementia severity as measured by the Dementia Severity Rating Scale (t=0.87). Results also revealed that higher levels of caregiver burden, as measured by the Zarit Burden Index, are significantly associated with more anticipatory grief (t=&lt; 0.1).&#x0D; Conclusion and Potential Impact: Understanding these relationships contributes to better understanding ADRD caregivers, identifying “high-risk” caregivers, and informing future interventions and care.

Protective factors associated with mental health symptoms in caregivers of persons with dementia

AbstractBackgroundCaregivers (CGs) of persons with dementia (PWDs) have relatively high levels of caregiver burden, depression, and anxiety. This observational, cross‐sectional study examined the extent to which preparedness for caregiving and knowledge about dementia might be associated with lower levels of these mental health symptoms.MethodAt the entry into a dementia care coordination program, CGs (N = 74) were surveyed about personal characteristics, characteristics of the PWD they care for (N = 74), mental health symptoms, and their perceptions about caregiving. Three univariate linear regressions were conducted to assess associations between protective factors (i.e., preparedness for caregiving, dementia knowledge) and CGs’ levels of depression, anxiety, and caregiver burden, controlling for CG age, CG education, and PWD level of functional independence in activities of daily living (ADLs).Result(Table 1). Neither preparedness for caregiving or dementia knowledge were significantly associated with CG depression or anxiety. However, younger CGs reported higher levels of depression (B = ‐.007, t = ‐3.33, p = 0.001) and anxiety (B = ‐.12, t = ‐2.91, p = 0.005). CGs with higher preparedness for caregiving reported lower CG burden (B = ‐.67, t = ‐2.51, p = 0.015), and CGs of PWDs with lower functional independence reported higher CG burden (B = ‐2.19, t = ‐2.96, p = 0.004).ConclusionResults of this cross‐sectional, observational study indicate that CGs’ preparedness for caregiving is associated with CG burden and that younger GGs had higher levels of depression and anxiety. These findings suggest that CG age may impact CG mental health and provide opportunities for intervention including targeting mood in younger CGs and increasing CG preparedness to potentially decrease CG burden. Additionally, emotional preparation for providing care to PWDs may be more important for reducing CGs’ burden than teaching specific knowledge about what to expect in dementia, and CGs of PWDs with lower functional abilities may benefit from targeted supports to reduce burden.

Caregiver Burden in a Culturally Diverse Memory Clinic Population: The Caregiver Strain Index-Expanded

Introduction: Although qualitative studies have highlighted substantial barriers to dementia diagnosis and care in culturally diverse populations in Europe, quantitative studies examining the level of caregiver burden in these populations have been lacking thus far and are urgently needed. Methods: We compared the caregiver burden levels on the Caregiver Strain Index (CSI)-Expanded of 63 culturally diverse patient-caregiver dyads from a multicultural memory clinic with 30 native Dutch patient-caregiver dyads and examined the association between caregiver burden and determinants of burden. Results: Informal caregivers in the multicultural memory clinic cohort experienced a high level of caregiver burden (mean CSI-score multicultural cohort: 6.1 [SD: 3.3]; mean CSI-score native Dutch cohort: 4.8 [SD: 3.2]). Burden was significantly associated with impairment on proxy-rated and objective measures of cognitive functioning, such as the Informant Questionnaire on Cognitive Decline and the Rowland Universal Dementia Assessment Scale, and with instrumental activities of daily living. Burden was the highest in spousal caregivers. The positive subscale of the CSI-Expanded provided limited additional information. Conclusion: Caregivers of culturally diverse patients experience a high level of caregiver burden, in particular at more advanced disease stages. This study highlights the need to screen culturally diverse caregivers in European memory clinics on caregiver burden to identify those in need of caregiver support.

The burden of Alzheimer’s caregivers and social support in the Tunisian family

Abstract Background Alzheimer is a pathology that concers the patient and his family having a physical, social, economic and psychological impact. Research on family caregivers is still lacking and little is known about caregivers burden and ist associated factors in Tunisia. The aim of this study were to describe caregiver burden among Tunisian family caregivers of patients with alzheimeŕs disease, its associated factors and ist relationship to social support. Methods We conducted a cross-sectional study among 118 family caregivers during three months at the neurology outpatient departments of two university hospitals. Sahloul, Sousse and Taher Sfar, Mahdia. Using the Zarit Burden Interview-22 (ZBI)items and the Medical Outcome Study-Social Support Survey to assess burden and social support among the caregivers. Results We included 118 caregivers of patients with Alzheimeŕs disease,with an average age of 45±15 years. Women were more predominant with a sex ratio of 0.57.Half of caregivers were the descent of patients. The Mean years of caregiving was 5±3 years with an average of 13 hours ±3 of care assistance per day. The mean ZBI Score was 38.4±18.5 and 16.1% of caregivers percived a severe burden. The mean ZBI Score was higher in female, retired, lowmsocio economic status and in rural area with a statistically significance difference. We found that caregiver burden and social support were highly correlated (p &amp;lt; 0.001,r=-0.41)indicating that a high level of caregiver burden was asoociated with a less level of social support. Conclusions The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high. A considerate help and support from helth care and social institutions is required by taking into account the factors that contribute to caregivers burden and considering the importance of social support in alleviating caregiver burden. Key messages The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high. High level of caregiver burden was asoociated with a less level of social support.

Machine learning approach to measurement of criticism: The core dimension of expressed emotion.

Expressed emotion (EE), a measure of the family's emotional climate, is a fundamental measure in caregiving research. A core dimension of EE is the level of criticism expressed by the caregiver to the care recipient, with a high level of criticism a marker of significant distress in the household. The Five-Minute Speech Sample (FMSS), the most commonly used brief measure of EE, requires time-consuming manual processing and scoring by a highly trained expert. In this study, we used natural language processing and supervised machine learning techniques to develop a fully automated framework to evaluate caregiver criticism level based on the verbatim transcript of the FMSS. The success of the machine learning algorithm was established by demonstrating that the classification of maternal caregivers as high versus low EE was consistent with the classification of these 298 maternal caregivers of adult children with schizophrenia using standard manual coding procedures, with area under the receiver operating characteristic curve (AUROC) of 0.76. Evidence of construct validity was established by demonstrating that maternal caregivers of adults with schizophrenia, who were classified as having a high level of criticism had higher levels of caregiver burden, reported that their child had more psychiatric symptoms and behaviors and perceived that their child had greater control over these symptoms and behaviors. Additionally, maternal caregivers who had high levels of criticism reported having a poorer quality of relationship with their child with schizophrenia than maternal caregivers low on criticism. Rapid measurement of criticism facilitates the incorporation of this dimension into research across a broad range of caregiving contexts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

550 - Caregiver Burden and Geriatric Patients Undergoing Electroconvulsive Therapy in the COVID-19 Era

IntroductionCaregivers are essential in providing valuable patient information to medical providers. With limited available research investigating caregiver burden among those caring for patients receiving ECT and the new life challenges presented by the COVID-19 pandemic, it is more important now than ever to take a closer look at the caregivers’ experiences.MethodsEmory’s Wesley Woods Geriatric Hospital is one of the busiest ECT services in the country with around 2000 treatments completed every year. In this chart review, researchers are looking at caregivers’ responses to the Zarit Caregiver Burden Interview. This assessment includes 22 questions assessing the caregivers’ current emotional state in order to examine the impact of the patient’s condition oncaregiver wellbeing. The score ranges from 0 (no burden) to 88 (severe burden). Other objective assessments completed with ECT patients are BDI (Beck Depression Inventory), BDI Suicide, Sheehan Disability Scale, ECCA (Electrocompulsive Cognitive Assessment), GAD-7 (Generalized Anxiety Disorder Scale), and CGI (Clinical Global Impression). The purpose of this chart review is to investigate whether the higher severity of depression in patients correlates with higher levels of caregiver burden and whether the pandemic contributed to caregiver burden.ResultsThe Zarit Caregiver Burden Interview has been administered on twelve caregivers (n=12; 6 male and 6 female), all providing care for patients currently undergoing ECT for depressive symptoms. Out of the twelve caregivers, 66.6% reported little caregiver burden, 16.6% reported mild to moderate burden, and 16.6% reported moderate to severe burden. Additional patients are being interviewed in the ECT suite and further data collected will be presented at the 2021 IPA Virtual International Congress.ConclusionAs the world adjusts to life in the COVID-19 era, caregivers face new challenges in providing care for vulnerable, at-risk populations. Caregivers of patients receiving ECT facilitate frequent COVID testing and limited visitation policies while continuing to provide care and emotional support to patients with advanced age and a mental illness. Administrating the Zarit Caregiver Burden Interview can help providers look at the degree of burden in caregivers of patients receiving ECT for depressive symptoms and provide better caregiving strategies during and post pandemic.

Caring for Older Adults with Depression Receiving Electroconvulsive Therapy (ECT) During the 2020 Pandemic

<h3>Introduction</h3> Caregivers are essential in providing valuable patient information to medical providers, such as recent changes in health, family history, previous hospitalizations, and medication reactions. Caring for elderly patients with a mental illness, in particular, is a unique and challenging job that may lead to caregiver stress and inability to provide proper care. As a result, patients with stressed caregivers are at increased risk of elder neglect and abuse. With limited available research investigating caregiver burden among those caring for patients receiving ECT and the new life challenges presented by the 2020 pandemic, it is more important than ever to take a closer look at the caregivers' experiences. <h3>Methods</h3> Emory's Wesley Woods Geriatric Hospital is one of the busiest ECT services in the country with around 2000 treatments completed every year. In this study, researchers are expecting to enroll and interview 25 caregivers of patients receiving ECT using the Zarit Caregiver Burden Interview. This assessment includes 22 questions assessing the nature and frequency of caregiver emotions when caring for their dependents in order to examine the impact of the patient's condition on caregiver wellbeing. The score ranges from 0 (no burden) to 88 (severe burden) and the questions cover information about the caregivers' current emotional state and struggles. Other objective assessments completed with ECT patients are BDI (Beck Depression Inventory), BDI Suicide, Sheehan Disability Scale, ECCA (Electrocompulsive Cognitive Assessment), GAD-7 (Generalized Anxiety Disorder Scale), and CGI (Clinical Global Impression). The purpose of these interviews is to investigate whether the higher severity of depression in patients correlates with higher levels of caregiver burden and whether the pandemic contributed to caregiver burden. <h3>Results</h3> The Zarit Caregiver Burden Interview has been administered on five patients (n=5) currently undergoing ECT for depressive symptoms. Additional patients are being interviewed in the ECT suite and further data collected will be presented at the 2021 AAGP Annual Meeting. <h3>Conclusions</h3> As the world adjusts to life in the COVID-19 era, caregivers face new challenges in providing care for vulnerable, at-risk populations. Caregivers of patients receiving ECT facilitate frequent COVID testing and limited visitation policies while continuing to provide care and emotional support to patients with advanced age and a mental illness. The main focus of the medical team is typically on patients; however, caregivers fill an essential role in the care of our geriatric patients receiving ECT and it is equally as important to be mindful of caregivers' experiences in order to catch and potentially prevent serious consequences resulting from caregiver burnout. Administrating the Zarit Caregiver Burden Interview can help providers look at the degree of burden in caregivers of patients receiving ECT for depressive symptoms and provide better caregiving strategies during the 2020 pandemic. <h3>Funding</h3> Not Applicable

Perceived stress and depressive symptoms not neuropsychiatric symptoms predict caregiver burden in Alzheimer\u2019s disease: a cross-sectional study

BackgroundCaregiver burden affects the caregiver’s health and is related to the quality of care received by patients. This study aimed to determine the extent to which caregivers feel burdened when caring for patients with Alzheimer’s Disease (AD) and to investigate the predictors for caregiving burden.MethodsA cross-sectional study was conducted. One hundred two caregivers of patients with AD at Maharaj Nakorn Chiang Mai Hospital, a tertiary care hospital, were recruited. Assessment tools included the perceived stress scale (stress), PHQ-9 (depressive symptoms), Zarit Burden Interview-12 (burden), Clinical Dementia Rating (disease severity), Neuropsychiatric Inventory Questionnaires (neuropsychiatric symptoms), and Barthel Activities Daily Living Index (dependency). The mediation analysis model was used to determine any associations.ResultsA higher level of severity of neuropsychiatric symptoms (r = 0.37, p < 0.01), higher level of perceived stress (r = 0.57, p < 0.01), and higher level of depressive symptoms (r = 0.54, p < 0.01) were related to a higher level of caregiver burden. The direct effect of neuropsychiatric symptoms on caregiver burden was fully mediated by perceived stress and depressive symptoms (r = 0.13, p = 0.177), rendering an increase of 46% of variance in caregiver burden by this parallel mediation model. The significant indirect effect of neuropsychiatric symptoms by these two mediators was (r = 0.21, p = 0.001).ConclusionCaregiver burden is associated with patients’ neuropsychiatric symptoms indirectly through the caregiver’s depressive symptoms and perception of stress. Early detection and provision of appropriate interventions and skills to manage stress and depression could be useful in reducing and preventing caregiver burden.