Informal Caregivers Of Older Adults Research Articles

Validating interRAI Chinese self-reported carer needs (SCaN) assessment and predicting caregiving distress among informal Chinese caregivers of older adults

BackgroundThis study aims to (1) determine the reliability and validity of the interRAI Chinese Self-reported Carer Needs (SCaN) assessment among informal Chinese caregivers of older adults, (2) identify predictors of caregiving distress in Asian regions with long-standing Confucian values of filial piety and family responsibility.MethodsThis cross-sectional study recruited 531 informal Chinese caregivers of older adults in Hong Kong, Shanghai, Taiwan, and Singapore. The scale reliability was examined using Cronbach’s alphas (α) and McDonald’s omega coefficient (ω). The concurrent validity and discriminant validity were assessed using Spearman rank correlations (rho). To examine the predictors of caregiving distress among informal caregivers of older adults, we employed hierarchical linear regression analyses informed by the Model of Carer Stress and Burden and categorized the predictors into six domains.ResultsResults revealed good internal consistency reliability (α = 0.83–0.96) and concurrent validity (rho = 0.45–0.74) of the interRAI Chinese SCaN assessment. Hierarchical linear regression analysis revealed that entering the background factors, primary stressors, secondary stressors, appraisal, and exacerbating factors all significantly enhanced the model’s predictability, indicating that the source of caregiving distress is multidimensional. In the full model, caregivers with longer informal care time, lack of support from family and friends, have unmet needs, experience role overload, have sleep problems, and low IADL functioning are at a higher risk of caregiving distress.ConclusionsThe interRAI Chinese SCaN Assessment was found to be a reliable and valid tool among the Chinese informal caregivers of older adults. It would be useful for determining family caregivers’ strengths, needs, and challenges, and tailoring interventions that address the potentially modifiable factors associated with caregiving distress and maximize support. Healthcare providers working in home and community settings should be aware of the early identification of caregiving distress and routine assessment of their needs and empower them to continue taking care of their needs and providing adequate care to the care recipient.

Low-Fidelity Prototype of a Sensor-Dependent Interaction Platform: Formative Evaluation With Informal Caregivers of Older Adults With Cognitive Impairment.

Unobtrusive sensing technologies developed for monitoring deviant behaviors in older adult care require integration with an interaction platform to facilitate the flow of information between older adults and their caregivers. However, the continuous monitoring capabilities generate a considerable amount of data that must be interpreted, filtered, and personalized before being communicated to the informal caregivers based on their specific care needs and requirements. For the effective implementation of unobtrusive sensing solutions (USSs) in the care of older adults with cognitive impairment, we aimed to explore the expectations and preconditions regarding the implementation of USSs from the perspective of informal caregivers. Subsequently, we designed and evaluated a low-fidelity prototype of an interaction platform for its conceptual workflow and usability, incorporating persuasive system design features based on the needs and requirements of informal caregivers. Overall, 6 informal caregivers of older adults with cognitive impairment living alone participated in this qualitative interview study. We explored the expectation and preconditions regarding implementation through open-ended questions and conducted a formative evaluation (usability study with a think-aloud approach) to evaluate the conceptual workflow and used persuasive system design features in the interaction platform. Overall, a combination of inductive and thematic analyses was used to analyze the interviews. The results of this study present both positive and negative outcome expectations regarding the implementation of USSs, highlighting benefits such as objective decision-making and peace of mind and concerns about information overload and the potential substitution of human contact. Strategic information communication agreements between informal and formal caregivers were deemed crucial for the successful implementation of USSs in care. Overall, informal caregivers had a positive experience with the low-fidelity prototype of the interaction platform, particularly valuing the personalization feature. In conclusion, to achieve successful implementation, a holistic design approach is necessary, and equal consideration should be given to the personalization-privacy paradox to balance users' needs and privacy.

“It’s a stressful, trying time for the caretaker”: an interpretive description qualitative study of postoperative transitions in care for older adults with frailty from the perspectives of informal caregivers

BackgroundOlder adults with frailty have surgery at a high rate. Informal caregivers often support the postoperative transition in care. Despite the growing need for family and caregiver support for this population, little is known about the experience of providing informal care to older adults with frailty during the postoperative transition in care. The purpose of this study was to explore what is important during a postoperative transition in care for older adults with frailty from the perspective of informal caregivers.MethodsThis was a qualitative study using an interpretive description methodology. Seven informal caregivers to older adults [aged ≥ 65 years with frailty (Clinical Frailty Scale score ≥ 4) who had an inpatient elective surgery] participated in a telephone-based, semi-structured interview. Audio files were transcribed and analyzed using reflexive thematic analysis.ResultsFour themes were constructed: (1) being informed about what to expect after surgery; (2) accessible communication with care providers; (3) homecare resources are needed for the patient; and (4) a support network for the caregivers. Theme 4 included two sub-themes: (a) respite and emotional support and (b) occupational support.ConclusionsTransitions in care present challenges for informal caregivers of older adults with frailty, who play an important role in successful transitions. Future postoperative transitional care programs should consider making targeted information, accessible communication, and support networks available for caregivers as part of facilitating successful transitions in care.

Behavioral activation for family caregiver connectedness: Adaptation of an evidenced based intervention

Informal caregivers of older adults with chronic illness have unique barriers to social connection. As the older adult population increases, individualized interventions are urgently needed to address the social disconnection experienced across generations of informal caregivers. Adapting an evidenced-based intervention to target social connectedness and leverage technology-mediated communication may be a promising approach. This article describes the adaptation of the Brief Behavioral Activation Treatment for Depression-Revised intervention using elements of the Framework for Reporting Adaptations and Modifications-Enhanced. Facilitating the comprehensive documentation of modifications made, we discuss the (a) rationale for modifications, (b) timing and approach to modifications, (c) nature of context and content modifications, and (d) fidelity in modifications. The Behavioral Activation for Family Caregiver Connectedness intervention addresses unique barriers to caregiver social connection with individualized value-based plans. Modifications to content and delivery reflect the goal of improving intervention fit in the context of social connectedness experienced by informal caregivers.

Caregiver burden and health-related quality of life: A study of informal caregivers of older adults in Ghana.

Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghanato date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship between caregiver burden and HRQoL among informal caregivers of older adults in Ghana. We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50years)inthe Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was usedto measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of 0.05 or less. The mean age of the informal caregivers was 39.15years and that of the care recipients was 75.08years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (β = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants withno formal education (β = -1.204, SE=.4085, p value =0.01), those withprimary level of education (β = -2.390, SE=.5099, p value =0.001) orjunior high school education (β = -1.113, SE=.3903, p value= 0.01) hada significantly decreased HRQoLcompared to those with tertiary level of education. Participants who werebetween the ages of 18-24 (β = 2.960, SE=.6306, p value=0.001), 25-34 (β = 1.728, SE=.5794, p value=0.01) or 35-44 (β = 1.604, SE=.5764, p value= 0.01) years significantly had increased HRQoLcompared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the pastyear before the survey significantly had increased HRQoLcompared to those who utilized healthcare services five or more times in the pastyear (β = 4.786, SE=. 4610, p value=0.001). Consistent with our hypothesis, this study reported asignificant negativeassociation between caregiver burden and HRQoL. Our findings partially support the conceptual model of HRQoLused in this study. We recommend that health and social policy measures to improve HRQoL among informal caregivers of older adultsshould consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors.

Development of a short form of the Japanese version of the Caregiver Reaction Assessment (CRA-J-10) among informal caregivers of older adults.

To support informal caregivers, a simple assessment tool capturing the multidimensional nature of caregiving experiences, including negative and positive aspects, is required. We developed a short form of the Japanese version of the Caregiver Reaction Assessment (CRA-J), a multidimensional assessment scale for caregiver experiences. The internet survey involved 934 Japanese informal caregivers aged 20-79 years (mean age = 58.8 years; 50.2% women) who completed questionnaires, including the CRA-J 18 items (CRA-J-18), consisting of five domains, such as impacts on schedule and finances and positive experiences of caregiving. A 10-item short version of the CRA-J (CRA-J-10; 0-50 points), which was prepared by selecting the two items with the highest factor loadings from each domain, was tested for model fit by confirmatory factor analysis (CFA) and was analyzed for correlations with the CRA-J-18, Zarit Burden Interview (ZBI), Positive Aspects of Caregiving Scale (PACS), Patient Health Questionnaire-9 (PHQ-9), and WHO-Five Well-Being Index (WHO-5). The area under the curve (AUC) in the receiver operating characteristic was evaluated as discriminability for depressive symptoms (PHQ-9 ≥ 10 points). The CFA indicated a good model fit in the CRA-J-10. The CRA-J-10 correlated well with the CRA-J-18 and other variables (CRA-J-18, r = 0.970; ZBI, r = 0.747; PACS, r = -0.467; PHQ-9, r = 0.582; WHO-5, r = -0.588) and showed good discriminant performance for the presence of depressive symptoms (AUC = 0.793, 95% confidence interval = 0.762-0.823). The CRA-J-10 allows a simple assessment of caregiver experiences, helping support informal caregivers. Geriatr Gerontol Int 2024; 24: 290-296.

Aging and Caring: Exploring Older Adults' Motivation for Informal Caregiving to Other Aging Individuals in Nigeria.

Because of the global population aging, more informal carers become older adults. In Nigeria, the African country with the largest population of adults aged 60 years and older, self-construal rooted in the African collectivist philosophy generally shapes informal caregiving for older adults. However, there is a general paucity of studies on older adults' informal caregiving roles, particularly about their motivations for caregiving. This study explored older adults' motives for informal caregiving to their care recipients in urban Southeast Nigeria. This study adopted a hermeneutic phenomenological research design. In-depth interviews were conducted with 30 purposively selected older adults aged 54-88 who were the primary carers of other older adults in the family and community. The collected data were analyzed using van Manen's thematic analysis method, using QSR NVivo 12 software. A total of 4 main themes emerged from the participants' responses: reciprocity of kindness, altruism, a sense of moral responsibility, and eagerness for peaceful longevity. The findings generally showed that religion and culture were the latent factors ingrained in these motivations for informal caregiving. Although the African philosophy emphasizes altruism, reciprocity seems more prominent in specific traditional African communities, as observed in Southeast Nigeria. It serves as a means to prioritize family members' needs. The findings indicate the need for the government to establish sustainable programs and policies that support older people in their caregiving role. Doing so will enable carers to derive psychosocial gains from informal caregiving and sustain the caregiving culture of Nigeria.

Effect of Interventions on Informal Caregivers of Older Adults: A Scientific Mini Review

The growing number of older adults with long-term health issues has led to more family members becoming informal caregivers. These caregivers play a crucial role in providing care to their elderly loved ones. However, this caregiving can be physically and emotionally demanding, affecting the caregivers’ own well-being. This scientific mini-review examines various ways, known as “interventions,” that can help ease the challenges faced by informal caregivers and improve their quality of life. These interventions can include things like training programs, support groups, or using technology to assist caregivers. To get the most up-to-date information, we looked at the recent systematic reviews and studies published in the last 5 years. We searched for this information in three widely recognized electronic databases: PubMed, Web of Science, and Scopus with full text. These interventions show promise in making life easier for informal caregivers and improving their quality of life. This mini review intends to offer insights into how these interventions can be beneficial, serving as a resource for healthcare professionals, policymakers, and researchers working to enhance the well-being of both caregivers and the elderly individuals they care for.

EFFECTS OF ENGAGEMENT IN PHYSICAL ACTIVITY BY INFORMAL CAREGIVERS ON THEIR QUALITY OF LIFE

Abstract Informal caregivers are more likely to have poorer health and wellbeing than non-caregivers. Studies have shown the health benefits of engagement in physical activity (PA) among caregivers. However, little is known about whether and how caregiver engagement in PA promotes or protects caregiver wellbeing. We examined (1) the association of caregiver engagement in PA with caregiver quality of life (QoL) and (2) the moderating effect of caregiver engagement in PA on the relationship between caregiving stressors and QoL. We used data on 278 care-recipient/caregiver dyads from the baseline interview of a longitudinal study of caregivers of older adults in Singapore. Multivariable regression first examined whether caregiver engagement in PA (assessed by number of days in a week with at least 30 minutes of PA, self-reported) was associated with physical, psychological, social, and environmental domains of QoL. Subsequently, interaction terms between caregiving stressors (care-recipient physical, memory, behavioral, and mood impairments) and caregiver engagement in PA were introduced and tested. We found that caregiver engagement in PA had a positive association with psychological, social, and environmental domains of QoL. Furthermore, caregiver engagement in PA mitigated the negative association between care-recipient mood impairment and caregiver QoL in the physical and social domains. Our findings suggest that QoL of informal caregivers of older adults may be improved or protected by their regular engagement in PA, especially if their care-recipients have mood impairments. Providers serving caregivers should encourage caregivers to engage in PA and equip them with the necessary support to do so.

EFFECTIVE SOLUTIONS FOR CAREGIVERS OF OLDER ADULTS: A RAPID UMBRELLA REVIEW

Abstract The negative health impacts confronting over 35 million informal caregivers of older adults in the U.S. are well documented. Although targeted interventions aimed at informal caregivers have demonstrated efficacy in mitigating poor caregiver outcomes, gaps in the literature regarding cost, scalability, and the impact of policy remain. Such knowledge is essential, given the projected growth in the need for caregiving associated with a rapidly aging population coupled with the shrinking of the caregiving workforce. This rapid umbrella review aims to synthesize findings from systematic reviews of randomized clinical trials of interventions that targeted caregivers and specified caregiver outcomes. The National Institute on Minority Health and Health Disparities research framework guided this review to identify gaps in existing intervention research. Databases from diverse disciplinary perspectives, including PubMed, Scopus, APA PsycINFO, ABIM, ATLA, Sociological Abstracts, PAIS, and EconLit, were searched from 2018 to 2023. A total of 52 systematic reviews that met inclusion criteria and were published in English were included in the final review. Reviews described interventions targeting caregivers of older adults with the following conditions: dementia (30), stroke (4), cancer (4), heart disease (1), renal disease (1), mental illness (1), and mixed-diagnoses (11). Major findings reveal varied effects on caregiver burden, quality of life, and mental health, and the growing integration of telehealth interventions. Studies were commonly limited by heterogeneity of interventions and outcomes and small effect sizes. Future intervention development should consider targeting the specific needs of diverse caregivers and scaling effective interventions to broader caregiver populations.

DEVELOPMENT OF AN AI-POWERED EMOTIONALLY INTELLIGENT, INTERACTIVE AGENT PROTOTYPE TO SUPPORT INFORMAL CAREGIVERS

Abstract Long-term informal caregiving for older adults with dementia is exhausting and poses risks to caregivers’ health outcomes. Most informal caregivers are not well prepared for their new role, facing various challenges and receiving limited support. With the advent of artificial intelligence (AI) and information and communication technologies (ICTs), assistive technology is increasingly useful for supporting caregivers. However, limited research assesses the potential for AI to facilitate a privacy-preserving computation environment to provide proactive assistance to caregivers. This project aims to fill this gap by leveraging the tremendous potential of Multimodal Machine Learning and Large Language Models (LLMs) to develop a prototype of an AI-powered emotionally intelligent, interactive agent for informal caregivers. We introduce an effective context-driven instruction tuning technique that enables LLMs to finetune various caregiving-related tasks (tips generation, answering questions, elaborating a specific training module) with instructions. The project will also deliver a first-of-its-kind custom dataset augmented with manualized instructions for relevant caregiving tasks, which is used for finetuning several state-of-the-art LLM models. Our intelligent interactive agent prototype currently has the ability to evaluate caregivers’ unique affective states at query times to provide personalized assistance, addressing various types of caregivers’ situation-specific queries (e.g., managing agitation, wandering, or medications). The prototype is capable of understanding and responding to the user’s natural language queries and designing short, machine-driven persuasive conversations on a pre-defined set of topics. Our prototype has the potential to provide individualized and contextualized support for caregiving tasks which in turn may greatly reduce caregiver burden.

The meaning of preparedness for informal caregivers of older adults: A concept analysis.

To examine the concept of preparedness over time in research with informal caregivers of older adults. Concept analysis. Rodgers' evolutionary method of concept analysis was used to guide this theoretical paper due to the dynamic nature of preparedness, which is influenced by both context and time. Using Rodgers' inductive approach, concept elements were derived from a content analysis of included studies. In the final step, to generate hypotheses and implications regarding the concept, the conceptual structure of preparedness of informal caregivers of older adults was connected to a theoretical problem in the nursing discipline using the Caregiving Stress Process Framework. Four databases (EBSCO CINAHL, Ovid MEDLINE, Ovid PsycINFO and Scopus) were searched in November 2022 and updated in September 2023. No date limits were set for searching, as the intent was to analyse possible variations of the concept over time. The attributes of preparedness include self-confidence, having knowledge, skills and abilities to perform daily tasks, handling emotions and developed over time. These attributes can be compared with the stressors outlined in the Caregiving Stress Process Framework (i.e., the moment the caregiver identifies some 'stressor'; something that prevents them from feeling confident in their preparedness). The concept of preparedness of informal caregivers of older adults is defined as caregiver's self-confidence about their current competence related to the knowledge, skills and abilities to perform daily tasks, and to handle emotions over time. To link the concept to a theoretical perspective, we propose adaptations to a well-known theory, the Caregiving Stress Process Framework. Future research on caregiving preparedness needs to avoid circular definitions and work with the attributes of preparedness to support caregivers. This paper contributes to the development of interventions that focus on the health and preparedness of informal caregivers of older adults. Clarifying the concept of preparedness helps nurses to support caregivers since it is then known which aspects are included in the preparedness of caregivers (e.g., daily tasks and handling emotions). A more fulsome understanding of preparedness supports us to see beyond stressors of caregiving. This study addresses informal caregivers of older adults' preparedness to provide care. We synthesized existing definitions that have been used in research with this population to propose a robust conceptualization of the concept of preparedness, which contributes to better understanding of how preparedness can be supported. We were unable to locate a reporting method related to this kind of work (concept analysis). Not applicable as no new data generated.

Roles and experiences of informal caregivers of older adults in community and healthcare system navigation: a scoping review

ObjectiveInformal caregivers are playing a vital role in improving the degree to which older adults access community and healthcare systems in a more seamless and timely manner, thereby fulfilling their...

Deprescribing bisphosphonates for older adults with dementia: perspectives of caregivers.

The long-term fracture prevention benefits of bisphosphonates may begin to be overshadowed by the potential burden of adverse effects and polypharmacy for older adults living with dementia as the disease progresses. We characterized factors that influence caregiver decision-making for continuing versus deprescribing bisphosphonates for persons living with dementia. We conducted 11 interviews with family or informal caregivers of older adults living with dementia in the community or in long-term care who had been treated with bisphosphonates. Interviews focused on experiences caring for someone who has experienced a fracture, perceived benefits and harms of bisphosphonates, and experiences with deprescribing. Analyses were conducted using a qualitative framework methodology guided by the Health Belief Model. Most caregivers were male (n = 8), younger than 65 (n = 8) and were an adult child caregiver (n = 8). Three caregivers were Black and five were Latino/a. Attempts to maintain functional independence despite high likelihood of falls was frequently discussed as contributing to fracture risk, in this population. Many caregivers perceived fracture prevention treatment as important, while several noted that it may become less important near the end of life. Perceived benefits of fracture prevention treatment for persons with dementia included improved quality of life and maintaining independence. Although most indicated that bisphosphonates were well tolerated, gastrointestinal adverse effects, preference for fewer treatments, and dementia-related behaviors that interfere with medication administration may be reasons for deprescribing. Conversations grounded in caregiver experiences and "what matters most" may help optimize fracture prevention treatment for older adults with dementia.

Engagement in Physical Activity and Quality of Life Among Informal Caregivers of Older Adults

Objectives This study examined (1) the association of caregiver engagement in physical activity (PA) with their quality of life (QoL) and (2) the moderating effect of caregiver engagement in PA on the relationship between several caregiving stressors and their QoL, among informal caregivers of older adults. Methods Multivariable regression was applied to data from 278 adult caregivers, aged 23–90 years, in Singapore. Results Engagement in PA by caregivers was positively associated with psychological, social relationships, and environment domains of their QoL. Caregiver engagement in PA also mitigated the negative association between care-recipient mood impairment and QoL of caregivers in the physical health and social relationships domains. Discussion QoL of caregivers may be improved or protected by their regular engagement in PA, especially when their care-recipients have mood impairment. Policymakers and practitioners should encourage caregivers to engage in PA and provide them with the necessary support to do so.

Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study.

With the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. This comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. A multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. Informal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. From the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users.

Healthcare utilization among informal caregivers of older adults in the Ashanti region of Ghana: a study based on the health belief model

BackgroundExisting global evidence suggests that informal caregivers prioritize the health (care) of their care recipients (older adults) over their own health (care) resulting in sub-optimal health outcomes among this population group. However, data on what factors are associated with healthcare utilization among informal caregivers of older adults are not known in a sub-Saharan African context. Guided by the Health Belief Model (HBM), the principal objective of this study was to examine the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.MethodsData were extracted from a large cross-sectional study of informal caregiving, health, and healthcare survey among caregivers of older adults aged 50 years or above (N = 1,853; mean age of caregivers = 39.15 years; and mean age of care recipients = 75.08 years) in the Ashanti Region of Ghana. Poisson regression models were used to estimate the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults. Statistical significance of the test was set at a probability level of 0.05 or less.ResultsThe results showed that 72.9% (n = 1351) of the participants were females, 56.7% (n = 1051) were urban informal caregivers and 28.6% (n = 530) had no formal education. The results further showed that 49.4% (n = 916) of the participants utilized healthcare for their health problems at least once in the past year before the survey. The final analysis showed a positive and statistically significant association between perceived susceptibility to a health problem (β = 0.054, IRR = 1.056, 95% CI = [1.041–1.071]), cues to action (β = 0.076, IRR = 1.079, 95% CI = [1.044–1.114]), self-efficacy (β = 0.042, IRR = 1.043, 95% CI = [1.013–1.074]) and healthcare utilization among informal caregivers of older adults. The study further revealed a negative and statistically significant association between perceived severity of a health problem and healthcare utilization (β= − 0.040, IRR = 0.961, 95% CI= [0.947-0.975]) among informal caregivers of older adults. The results again showed that non-enrollment in a health insurance scheme (β= − 0.174, IRR = 0.841, 95% CI= [0.774-0.913]) and being unemployed (β= − 0.088, IRR = 0.916, 95% CI= [0.850-0.986]) were statistically significantly associated with a lower log count of healthcare utilization among informal caregivers of older adults.ConclusionThe findings of this study to a large extent support the dimensions of the HBM in explaining healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. Although all the dimensions of the HBM were significantly associated with healthcare utilization in Model 1, perceived barriers to care-seeking and perceived benefits of care-seeking were no longer statistically significant after controlling for demographic, socio-economic and health-related variables in the final model. The findings further suggest that the dimensions of the HBM as well as demographic, socio-economic and health-related factors contribute to unequal healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.

The role of frailty among the predictors of depression on informal caregivers of older adults: a mediation analysis.

Providing care for older adults has been associated with the presence of depressive symptoms among their informal caregivers. Numerous caregivers and older adults' characteristics have been mentioned as predictors of caregivers' depression. However, studies dealing with the impact of older adults' frailty status on caregivers' depression are scarce. This study was conducted to clarify the precise relationship between caregivers' depression, caregivers' burden, caregivers' characteristics and patients' characteristics, including frailty, among the variables that may have an impact on caregivers' depression. In this cross-sectional study, patients and caregivers' characteristics were recorded for 311 patient-caregiver dyads, when the patient was admitted to the hospital. For the purpose of the study, a mediation analysis was used with patients and caregiver characteristics considered to be predictors, subjective caregivers' burden as the mediator, and caregivers' depression as the outcome variable. Only patients' frailty and caregivers' subjective burden had a direct effect on caregivers' depression. Moreover, caregivers' gender, patients' frailty status and comorbidity, duration of caregiving, and the relationship with the patient, had an indirect effect through caregivers' burden that acted as mediator. Regarding total effects, caregivers burden followed by patients' frailty status had the greater impact on caregivers' depression. By organising interventions to reduce caregivers' depression, patients' frailty status could be among the targets of those interventions considering that frailty might be delayed or reversed.

Effect of a telecare-based intervention on stress levels in informal caregivers of older adults: protocol for a randomized controlled trial.

Due to caregiving commitments, caregivers of older adults may not have the time to make use of the onsite community services available to them during the day. With the support of advanced technology, telecare could be a convenient and easily accessible channel for providing individualized caregiving advice to caregivers. The aim of the study is to describe a research protocol that highlights the development of a telecare-based intervention program for reducing stress levels in informal caregivers of community-dwelling older adults. It is a randomized controlled trial. The study is supported by two community centers. The study participants will be randomly assigned to either the telecare-based intervention group or the control group. The former will receive a 3-month program comprised of three components: online nurse case management supported by a health and social care team, an online resource center, and a discussion forum. The latter will receive the usual services that provided by the community centers. Data will be collected at two time points - pre-intervention (T1) and post-intervention (T2). The primary outcome is stress levels, while secondary outcomes include self-efficacy, depression levels, quality of life, and caregiving burden. Besides taking care of one or more older adults, informal caregivers have to deal with work, chores, and take care of their children. This study will add valuable information to the knowledge gap on whether telecare-based interventions with the support of an integrated health-social team can alleviate the stress levels of informal caregivers of community-dwelling older adults. If successful, policymakers and healthcare professionals should consider incorporating telecare modalities in a primary health setting for informal caregivers to correspond with them, to relieve their caregiving stress and promote a healthy life. https://www.clinicaltrials.gov/, NCT05636982.

"She is My Work": Caregiving for Older Adults With Hypertension and Diabetes Mellitus.

To explore the lived experiences of informal caregivers of older adults with hypertension and/or diabetes mellitus in Kumasi, Ghana. A qualitative research approach was used to conduct the study using informal caregivers of older adults with hypertension and/or diabetes mellitus at a teaching hospital in Ghana. In all, 20 participants were purposively sampled, interviewed, and data were analyzed using thematic analysis. Three main themes emerged: "Experience with care demands," "Coping with care demands," and "Motivation for caregiving." Older adults with hypertension and/or diabetes mellitus had needs that placed a burden on informal caregivers' work life, health, and social life. Informal caregivers of older adults with hypertension and/or diabetes mellitus are under strain. Caregiving is a difficult task, requiring a lot of time, effort, attention, and devotion. Nurses should plan the care of older adults with hypertension and/or diabetes mellitus in collaboration with their informal caregivers.