Levels Of Caregiver Distress Research Articles

CAREGIVER IDENTITY IN EMERGING ADULTHOOD: HOW IDENTITY DISCREPANCY AND SALIENCE RELATE TO DISTRESS

Abstract As the older adult (age 65+) population grows in the United States, the demographics of caregivers are expanding to include more emerging adults (ages 18-25) who are participating in caregiving tasks. Minimal research has focused on this subgroup of caregivers to older adults, especially with regards to understanding factors that may influence their levels of caregiver distress. Guided by caregiver identity theory, the current study examined 1) the relationship between caregiver identity and caregiver distress, 2) support service utilization as a mediator between caregiver identity and caregiver distress, and 3) the inclusion of ageist attitudes within caregiver identity models. A sample of 259 emerging adult caregivers were recruited through Amazon MTurk. Fit of the hypothesized structural equation model was acceptable and squared multiple correlations (R2) indicated that 73.1% of the variance in caregiver distress, 23.8% of the variance in support service utilization, and 22.7% of the variance in ageist attitudes was explained by this model. Higher caregiver identity salience was significantly related to lower caregiver distress. Support service utilization partially mediated the relationship between identity salience and distress through an inconsistent mediation. The findings of the current study support caregiver identity as a unique, multidimensional process consisting of both identity discrepancy and salience latent constructs. Results showed low-to-moderate caregiver identity discrepancy, possibly due to identity flexibility during this developmental period. High caregiver identity salience was protective against caregiver distress for emerging adults. Ageist attitudes warrant inclusion in future research on caregiving identity development. Implications for support services are discussed.

EXPLORING THE IMPACT OF CHORAL SINGING ON CHANGE IN PERCEIVED DISTRESS FOR CARE PARTNERS OF PERSONS WITH DEMENTIA

Abstract Family care partners (CP) of persons with dementia (PwD) report high levels of psychological distress that impact many facets of their lives. Arts-based interventions have shown promise for improving psychological health. Here, we describe findings from the Voices in Motion (ViM) study, a weekly lifestyle intervention for CP-PwD dyads, with specific emphasis on examining the impact of choral singing on level and change in perceived distress for CP. Data from n=29 CP (Mage=67.7 years, 80% female) were used to examine change in caregiver distress, indexed using the Zarit Caregiver Burden Interview (ZBI). ViM employed an intensive longitudinal design characterized by monthly retests embedded within 3.5-month choral seasons (up to 7 assessments per person). Choral seasons were separated by a 4-month summer break, yielding a naturalistic ABA experimental design optimal for evaluating the impact of choral singing on caregiver distress. Multilevel models of change with piecewise splines were fit; REML was employed due to its advantageous properties for small samples. A significant reduction in caregiver distress (-1.14 units per month, p<.01) was observed across the 3.3-month span of season 1. Following the 4-month summer break, level of caregiver distress at the outset of season 2 had increased back to initial baseline levels (ZBI =19.9 units – a moderate to borderline-high level), thereby underscoring the importance of the choir intervention. These findings suggest that lifestyle engagement may offer an effective complement for lessening the impact of caregiver distress for CP, with implications for the development of dementia care plans.

Modulators of Caregiver Distress and Corresponding Impacts on Persons With Dementia

Extensive literature documents the detrimental effects of caregiver distress (CD) for caregivers. Less is known about the impact that CD exerts upon their care recipients, particularly persons with dementia (PwD). Using multilevel modeling, this study employed dyadic data from the Voices in Motion study to examine time-varying within-person associations between key caregiver and care recipient indicators of psychosocial function. An initial dyadic coupling model indicated that cognitive functioning for PwD and caregiver well-being significantly predicted shifts in CD. A second time-varying dyadic model found that, within dyads, high levels of CD predicted lower positive affect and increased depression scores in PwD. Most sociocognitive interventions target a sole member of a dyad; our results suggest that both dyad members are impacted simultaneously. Caregiver well-being impacts CD, which in turn, impacts well-being in PwD. The symbiotic relationship between care partners and PwD is nuanced, with further research required to understand the interdependencies.

Predictors of caregiver distress among spouses, adult children living with the person with dementia, and adult children not living with the person with dementia.

The caregiving situation differs according to the type of relationship between the patient caregiver, and among dementia caregivers, living with the person with dementia can contribute to caregiver distress. This study aimed to identify the predictors of caregiver distress based on caregiver profile: spouse, adult child living with the person with dementia, and adult child not living with the person with dementia. In total, 213 caregivers participated in this study. Their responses to questionnaires helped identify the positive and negative implications of the caregiving situation and the level of caregiver distress. The analyses consisted of univariate and multiple linear regression models using a forward method. Based on the standardized beta scores, the variables that are the most significant in predicting spouse caregiver distress are the impact on health and impact on schedule. The variable that is the most significant in predicting the distress of adult child caregivers living with the person with dementia is the impact on health. The variables that are the most significant in predicting the distress of adult child caregivers not living with the person with dementia are the impact on health, impact on schedule, and impact on finances. The results make it possible to consider different approaches to providing support, including evaluating the health of all caregivers, giving guidance on accepting help and focusing caregivers' actions on their values for spouse caregivers, providing family mediation for adult child caregivers living with the person with dementia, and offering information and assistance on the available aids for adult child caregivers not living with the person with dementia.

Validation of the distress thermometer for caregivers of children and adolescents with schizophrenia.

To develop and psychometrically test the distress thermometer for caregivers (DT-C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia. A validation diagnostic accuracy study and descriptive cross-sectional survey. DT-C was adopted based on Harverman's distress thermometer for parents. The cut-off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale-21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018. One-item DT of DT-C indicated a good retest reliability (r=0.86) and one-item DT and the Problem List (PL) indicated good convergent validity (r=0.67-0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70-0.90). Setting seven as the cut-off score, the values of sensitivity (0.72-0.81), specificity (0.86-0.90), Youden's index (0.61-0.70), positive predictive value (0.67-0.74), and negative predictive value (0.84-0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88-0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut-off. Caregivers above the cut-off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains. The DT-C, with six domains containing 35 items in Problem List and with the cut-off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers' distress. This study adapted a reliable DT-C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals.

Effects of Home Care Services Use by Older Adults on Family Caregiver Distress

The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress. A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, χ² test, t-test, and Heckman selection model analysis were conducted using SAS 9.3. Presence of family caregiver distress was significantly associated with days of nurse visits (β=-.89, p=<.001) and home helper visits (β=-.53, p=.014). Level of caregiver distress was also significantly associated with days of nurse visits (β=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult. The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.

Concurrent Validity of Neuropsychiatric Subgroups on Caregiver Burden in Alzheimer Disease Patients

In a previously published study, the authors conceptualized neuropsychiatric symptoms in Alzheimer disease (AD) patients as distinct symptom profiles with differential outcomes. In the present study, our aim was to further examine the validation of the classification by considering its concurrent validity on caregiver burden. As described previously, neuropsychiatric symptoms, as assessed by the Neuropsychiatric Inventory, in 122 patients with AD were categorized, using cluster analysis. The presence as well as the severity and frequency of symptoms were both used in the classification. After the classification, group differences in caregiver burden, as measured by Screen for Caregiver Burden, were tested using analysis of covariance. The effects of important covariates, such as functional impairment, comorbid medical conditions, parkinsonism, age, and cognitive functioning, were examined. Based on the presence of symptoms, subgroups differed in the level of caregiver distress in that caregivers of the "minimally symptomatic" and the "affective/apathetic" subgroups experienced less distress than the caregivers of the "highly symptomatic" subgroup. Based on the severity and frequency of symptoms, subgroups differed in such a way that caregivers of the "minimally symptomatic" and the "predominantly apathetic" subgroups endorsed less distress than the caregivers of the "affective" and the "highly symptomatic" subgroups. Neuropsychiatric subgroups were able to differentially predict caregiver burden. The findings appear to lend further support to the validity of classifying neuropsychiatric symptoms in AD patients using cluster analysis.

Caregiver burden in multiple sclerosis: the impact of neuropsychiatric symptoms

Background:We studied the level of distress in caregivers of patients with recently diagnosed multiple sclerosis (MS), and their relation to clinical characteristics.Methods:Caregivers of patients with MS and Parkinson’s disease completed...

Infant massage: A strategy to promote self-efficacy in parents of blind infants

For successful communication to exist between a caregiver and infant, the caregiver must feel confident about her/his ability to parent and also have specific and accurate knowledge about the behaviours required for optimal care-giving; lack of this knowledge may lead to feelings of uncertainty and less than optimal communication. Studies indicate that the highest levels of caregiver distress were experienced by caregivers who had low feelings of self-efficacy and infants with functional limitations. Many caregivers of blind infants have high levels of distress and low selfefficacy due to lack of information, resources, and support. Research indicates that a majority of care givers of atypically developing infants are able to ‘bring the best’ to their infants when appropriately supported by a professional or intervention. Infant massage is an inexpensive and easily utilized intervention which may help increase caregiver self-efficacy and promote sensitive communication in dyads where the infant is blind.