Military Caregivers Research Articles

Elearning for Military Caregivers of Individuals With PTSD, TBI, Depression, and Other Related Injuries

To investigate educational content and training materials useful for an eLearning course for this population, and to identify opportunities for caregivers to connect via eLearning.

Unmet Needs for Information and Support Among Military Caregivers.

In the United States, there are 5.5 million military caregivers, defined as family members, friends, or other acquaintances who provide essential care and support to current or former military service members. This study describes the prevalence and predictors of unmet information and support needs in this unique group of caregivers. Until recently, little research has focused on military caregivers. In 2014, a comprehensive RAND report underscored the specific challenges experienced by military caregivers including greater physical, financial, and emotional strain when compared with civilian caregivers. Of note, compared to civilian caregivers, military caregivers provide care and support for care recipients who are more likely to have complex illness. While this recent research improved our understanding of the increased burden associated with military caregiving, it also identified gaps for future work, including the need for additional studies to better understand unmet information and support needs to inform future interventions. The current study was designed to address this gap. We examined data collected in the Caregiving in the U.S. Survey, a cross-sectional online survey fielded in 2014, by the National Alliance for Caregiving and the American Association of Retired Persons (AARP) for primary caregivers who had been in the role for at least six months. Four outcomes representing unmet caregiver needs were examined measuring caregiver report of needing more help or information to: (1) keep the care recipient safe at home; (2) manage challenging behaviors such as wandering; (3) manage their own emotional and physical stress; and (4) make end-of-life decisions. Survey-weighted logistic regression was used to test associations between military caregiver status (military/civilian) and unmet needs while controlling for key socio-demographic, caregiving and care recipient health variables, with nationally generalizable results. Compared to their civilian counterparts, military caregivers had significantly higher odds of reporting need for information or support to make end-of-life decisions (OR = 2.22; 95% CI: 1.24, 3.97; p = 0.01) and marginally higher odds of reporting need for more information or support to manage physical and emotional stress (OR = 1.64; 95% CI: 0.93, 2.88; p = 0.08). In contrast, military caregivers had significantly lower odds of reporting need for more information or support to keep the care recipient safe compared to civilian caregivers (OR = 0.54; 95% CI: 0.30, 0.95; p = 0.03). Reports of unmet needs related to managing challenging behaviors were similar between military and civilian caregivers. Needs for information and support differ for civilian and military caregivers and may reflect direct or indirect impacts on caregivers arising from differences in TRICARE and Veterans Affairs health insurance coverage and related benefits, services and systems or access to resources that address the unique needs of military populations. Future research is needed to better understand the unique concerns of military caregivers and inform interventions that support end-of-life care decision-making for military service members and their caregivers.

Military and Veteran Caregivers’ Perspectives of Stressors and a Mind-Body Program

There are over one million post-9/11 military caregivers in the United States who face a variety of stressors inherent to caring for an incapacitated loved one. Mind-body interventions, such as the Stress Management and Resilience Training Relaxation Response Resiliency Program (SMART-3RP), have been shown to reduce stress and improve overall health and functioning. The present qualitative study aims to explore stressors experienced by military caregivers in their caregiving role and to assess attitudes towards the virtual delivery of the SMART-3RP. We conducted two focus groups with a total of 13 caregivers [M (SD) age = 41.25 (11.49); 92% female], and participants subsequently completed a survey on their caregiving experiences. Focus groups were conducted remotely via Google Hangouts by two doctoral-level clinicians, transcribed verbatim, and coded using inductive thematic analysis. Themes related to stressors of caregiving included: logistical stressors faced by caregivers, demands of the caregiving role, concerns about children, worries about the future, exacerbation of the caregiver’s physical/mental health concerns, social dynamics, sacrifices made for their veteran in the caregiving role, and relationship dynamics between the veteran and caregiver. Military caregivers found the SMART-3RP logical and felt as though it could be helpful to them. Caregivers expressed interest in a brief, virtual version of the SMART-3RP. Using the findings from the current study, we are adapting the SMART-3RP to be administered virtually as a podcast-based intervention.

Informal Caregivers' Experiences and Perceptions of a Web-Based Peer Support Network: Mixed-Methods Study.

BackgroundWeb-based peer support interventions have shown promise in reducing social isolation and social support deficits among informal caregivers, but little research has examined how caregivers use and perceive these interventions.ObjectiveIn this study, we examined utilization and perceptions of a Web-based social support intervention for informal caregivers of wounded, ill, and injured United States military service members and veterans.MethodsThis was a mixed-methods study that used quantitative survey data and qualitative data from focus groups and interviews with informal caregivers enrolled in a Web-based peer support intervention to explore their use and perceptions of the intervention. The intervention was delivered via a website that featured interest groups organized around specific topics, webinars, webchats, and messaging functionality and was moderated by professionally trained peers. This study occurred in the context of a quasi-experimental outcome evaluation of the intervention, where intervention participants were compared with a group of military caregivers who were not enrolled in the intervention.ResultsSurvey findings indicated that caregivers used the website infrequently, with 60.7% (128/211) visiting the website once a month or less, and passively, with a minority (32/144, 22.2%) of users (ie, those who had visited the website at least once during the past 3 months, N=144) posting comments or links to the network. Nonetheless, most users (121/144, 84.0%) endorsed moderate or greater satisfaction with the website on the survey, and focus group and interview participants reported benefiting sufficiently from passive use of the website (eg, reading posts). Quantitative and qualitative findings suggested that users viewed the website primarily as a source of informational support. Among 63.2% (91/144) of users who completed the survey, the most commonly reported network-related activity was obtaining information from the network’s resource library, and focus group and interview participants viewed the network primarily as an informational resource. Focus group and interview participants expressed an unmet need for emotional support and the desire for a more personal touch in the forms of more active engagement with other caregivers in the network and the creation of local, in-person support groups for caregivers.ConclusionsThese findings suggest that Web-based peer support interventions may lend themselves better to the provision of informational (vs emotional) support and may need to be supplemented by in-person peer support groups to better meet caregivers’ needs for emotional support.

Evaluation of a Sesame Street Multimedia Intervention for Families Transitioning Out of the Military

Although transitioning out of the military can be stressful for everyone in the family, the children’s experience has received minimal attention in both clinical lore and research. This study is an evaluation of Sesame Workshop’s multimedia program for families who are transitioning out of the military into civilian life; the program is aimed at improving parents’ confidence and skills in assisting their children with the transition, and at improving young children’s transition-related adjustment. Via a randomized controlled trial design, we evaluated the utilization, acceptability, and impact of this free, online program with 200 military caregivers. Caregivers who received the Sesame program reported increased self-efficacy in helping their child cope with the transition (e.g., making new friends, talking with their child about leaving the military) compared to those assigned to the control condition. Further, caregivers in the intervention condition reported fewer overall child emotional and behavioral problems and a significant reduction in levels of hyperactivity/inattention in their children. Further, the primarily online modality of the Sesame program yielded high caregiver satisfaction and utilization; this approach may warrant further research as an effective means of reaching busy military families.

Critical Care in the Military Health System: A Survey-Based Summary of Critical Care Services.

Critical care is an important component of in-patient and combat casualty care, and it is a major contributor to U.S. healthcare costs. Regular exposure to critically ill and injured patients may directly contribute to wartime skills retention for military caregivers. Data describing critical care services in the Military Health System (MHS), however, is lacking. This study was undertaken to describe MHS critical care services, their resource utilization, and differences in care practices amongst military treatment facilities (MTFs). Twenty-six MTFs representing 38 adult critical care services or intensive care units (ICUs) were surveyed. The survey collected information about organizational structure, resourcing, and unit characteristics at the time of a concurrent 24-h point-prevalence survey designed to describe patient characteristics and staffing in these facilities. The survey was anonymous and protected health information was not collected. We analyzed the data according to high capacity centers (HCCs) (≥200 beds) and low capacity centers (LCCs) (<200 beds). Differences between HCCs and LCCs were compared using Fisher's exact test. Seventeen MTFs (7 HCCs and 10 LCCs), representing 27 ICUs, responded to the survey. This was a 65% response rate for MTFs and a 71% response rate for services/ICUs. HCCs reported more closed vs. open ICUs; more dedicated critical care services (i.e., medical and surgical ICUs vs. mixed ICUs); fewer respiratory therapists available, but more with certification; more total nursing staff and more critical care certified nurses; the use of subjectively more effective protocols (10.5 vs. 6.7 protocols/unit or service); higher utilization of an ICU daily rounds checklist (65% vs. 0%); and less consistency of clinician type participation during multidisciplinary rounds. ICU leadership structure was similar among the institutions. The majority of respondents were unable to provide summary APACHE II scores, but HCCs were more likely to submit this information than LCCs. Most centers perform multidisciplinary rounds daily, but they are more likely to be run by a physician credentialed in critical care at HCCs (85% vs. 59%, p < 0.05). 67% of respondents reported mortality rates <5%. The two services that reported mortality rates greater than 10% were both LCCs. This is the first comprehensive report about MHS critical care services. Despite notable variability in data reporting, an important finding itself, this study highlights notable differences in organizational structure and resourcing between HCCs and LCCs within the MHS. The clinical implication of these differences (i.e., impact on patient outcomes) of these differences require further study. Better understanding of MHS critical care services may improve enterprise decision-making about these services which could ultimately improve care of combat casualties.

A Family's Affair: Caring for Veterans with Penetrating Traumatic Brain Injury.

Approximately 1.1 million family members are primary caregivers to post 9/11 veterans. These military caregivers assume a role that requires a long-term commitment that may affect their own health status; however, the impact on health among military caregivers is underestimated and underrepresented. As part of a larger retrospective cohort study that aimed to assess the health-related outcomes of post 9/11 veterans with penetrating traumatic brain injury (pTBI), we examined the health impact of caregiving on caregivers. Caregivers (n = 66) of veterans with pTBI completed a survey that captured the veterans' and their own health-related outcomes. Surveys included veteran and caregiver sociodemographics, caregiver role, tasks, burden, and caregiver-reported measures of veterans' health and quality of life. The participants were spouses (58%) and parents (32%) providing full-time assistance for more than 5 yr (74%). In their caregiver role, they provided assistance with activities of daily living and emotional/social support. Forty-eight percent of these caregivers met the definition of experiencing clinically significant burden. Veterans with pTBI had other comorbidities (e.g., depression, cognitive dysfunction, and anger), which were associated with caregiver burden. The findings further confirm the impact of caregiving on health status of caregivers, specifically when assisting veterans with pTBI.

Operation family caregiver: Problem-solving training for military caregivers in a community setting.

This study, conducted over a 2-year period at 9 sites, describes the outcomes of an evidence-based support program, Operation Family Caregiver, to gain an understanding of how a tailored, problem-solving training could assist military caregivers, who provide care and assistance to those injured, ill, or disabled as a result of war. A pre-post research design was employed to examine caregiver burden, depression, health complaints, satisfaction with life, children's anxiety, and problem solving among a convenience sample of caregivers of 128 military service members and veterans. Analysis revealed a decrease in depression, burden, and health complaints and an increase in satisfaction of life and positive problem-solving skills (p<.001). This program may be beneficial to caregiving families of military service and veterans living with posttraumatic stress, traumatic brain injury, and/or a physical disability.

Why military medical research?

The challenging circumstances that confronted military caregivers during the years of war in Afghanistan and Iraq established the imperative for military-oriented medical research. The burden of injury and illness resulting from this long period of combat operations, and the unique clinical and logistical considerations it engendered provide a compelling rationale for requirement-driven, well-coordinated medical research. Also referred to as “gap” driven and programmed, military trauma research is specifically aimed at providing readily deployable solutions to reduce morbidity and mortality from war-related injury. From a strategic standpoint, the approach taken by military medical research is quite different from that sponsored by other federal research agencies, which typically fund investigator-initiated studies of interest to the scientific community, irrespective of the urgency of the question to society. Importantly, neither these agencies nor private foundations dedicate funding to injury research of the type or severity that can be anticipated in modern warfare including terrorism. Military research has been shown effective in reducing the case fatality rate during combat and has established itself as the centerpiece of the military’s continuously learning health system. 1,2 It has also generated numerous advances that are being translated to improving civilian trauma care. 3 The following paragraphs of this preface and the articles in this supplement provide examples that serve to emphatically answer the question, “Why military medical research?” Between 2005 and 2013, the fatality rate for service personnel injured in Afghanistan decreased by 50% while the severity of injury was increasing. 1,2 The reason for this unprecedented achievement is multifactorial, but two factors stand out. At the height of the wars in Afghanistan and Iraq, the military health system made (1) significant investments in requirement-driven, programmed trauma research, and (2) an extraordinary effort to codify a trauma system that identified emerging needs for research, and rapidly translated results from military research into best clinical practices. The first element was comprised of programmatic research performed by the individual services (Army, Navy, and Air Force) and through the Joint-service, Defense Health Program. The sec

DOL: Final FMLA Rule Changes for Military Caregivers and Flight Crews Take Effect; Survey Proposed to Collect Information Concerning Worker Classification • OFCCP: New Directive Issued Concerning Pay Discrimination; EEOC Guidelines on Arrest/Conviction Records Adopted • OSHA: More Whistleblower Regulations Synchronized; Executive Order Regarding Nondisplacement of Qualified Workers under Service Contracts Takes Effect; HIPAA‐HITECH Rules Increase Plan Sponsor Obligations

DOL: Final FMLA Rule Changes for Military Caregivers and Flight Crews Take Effect; Survey Proposed to Collect Information Concerning Worker Classification • OFCCP: New Directive Issued Concerning Pay Discrimination; EEOC Guidelines on Arrest/Conviction Records Adopted • OSHA: More Whistleblower Regulations Synchronized; Executive Order Regarding Nondisplacement of Qualified Workers under Service Contracts Takes Effect; HIPAA‐HITECH Rules Increase Plan Sponsor Obligations

A Rabbit Osteomyelitis Model to Simulate Multibacterial War Wound Infections

A challenge facing military caregivers is the presence of multidrug-resistant infection in extremity wounds. Most frequently identified resistant strains are methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae (KP), Pseudomonas aeruginosa (PA), and Acinetobacter baumannii (AB). We adapted an existing osteomyelitis model to simulate an infected extremity wound for antibiotic testing. New Zealand White Rabbits (n = 95) were divided into 6 inoculation groups for infection with MRSA, KP, PA, and AB alone, and in multibacteria infections. Sodium morrhuate was injected into the left tibia to simulate blast wound trauma, then the respective bacteria or combination of pathogens, and finally sterile saline were injected. Colony-forming units for the mono-organism groups showed that AB, KP, or PA alone at 10(7) colony-forming units per mL (CFUs/mL) was effective for rabbit osteomyelitis induction. Colony-forming units for the multiorganism groups showed that the combination of AB (10(7) CFUs/mL)/KP (10(7) CFUs/mL)/PA (10(7) CFUs/mL)/MRSA (10(5) CFUs/mL) yielded a 100% osteomyelitis induction rate. At 8 weeks, however, only one mono-bacterial group and one multibacterial group showed significant radiographic improvement (p < 0.05). The rabbit model of osteomyelitis can be adapted to study infected blast wounds typical of those seen in veterans. To our knowledge, this is the first demonstration of the model simulating multibacterial infections with multidrug-resistant organisms.

DOL: Final FMLA Rule Changes Issued for Military Caregivers and Flight Crews; Ambitious Regulatory Agenda Announced for 2013 • DC Circuit Court Holds President's 2012 Recess Appointments to NLRB Were Invalid

Employment Relations TodayVolume 40, Issue 1 p. 63-70 Federal Regulations Update DOL: Final FMLA Rule Changes Issued for Military Caregivers and Flight Crews; Ambitious Regulatory Agenda Announced for 2013 • DC Circuit Court Holds President's 2012 Recess Appointments to NLRB Were Invalid Mark G. Kisicki, Mark G. Kisicki kisicki@ogletreedeakins.com Ogletree, Deakins, Nash, Smoak & Stewart P.C.Search for more papers by this author Mark G. Kisicki, Mark G. Kisicki kisicki@ogletreedeakins.com Ogletree, Deakins, Nash, Smoak & Stewart P.C.Search for more papers by this author First published: 16 April 2013 https://doi.org/10.1002/ert.21401AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume40, Issue1Spring 2013Pages 63-70 RelatedInformation

Trauma Spectrum Disorders: Emerging Perspectives on the Impact on Military and Veteran Families

This article summarizes the findings from the Second Annual Trauma Spectrum Disorders Conference, which was held in December 2009 and was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in conjunction with the Department of Veterans Affairs and the National Institutes of Health. The conference covered recent research on the impact of trauma spectrum disorders on military and veteran families and caregivers during deployment, homecoming, and reintegration. Attendees highlighted the need for research studies that examine the needs of warriors with trauma spectrum disorders on a deeper level. Current interventions for trauma spectrum disorders were discussed, as well as recommendations for advancing the quality of care for warriors and their families in the future.

A Mixed-Method Approach to Understanding the Experiences of Non-Deployed Military Caregivers

Given the unprecedented operational tempo of the Afghanistan and Iraq wars and the heavy involvement of the Reserve and National Guard, the stress that military families are exposed to is distinct from stress in earlier conflicts, with little empirical data to inform the impact on non-deployed military caregivers or "home caregivers." The study seeks to examine the experiences of home caregivers during deployments, with a focus on the impact of deployment on the caregiver's well-being. We conducted 50 qualitative interviews and 1,337 survey interviews with home caregivers who experienced at least one deployment. The structured qualitative interview focused on caregiver experiences during deployment. The quantitative data centered on caregiver well-being and household and relationship hassles. The qualitative interview notes were the unit of analysis and traditional methods were used to analyze the data. The quantitative data were analyzed using regression models. The qualitative data revealed key deployment-related household challenges that caregivers experience and the effect of those challenges on caregivers. Multivariate analyses of the quantitative data explored differences in caregivers' emotional well-being, household and relationship hassles. The results showed important component and deployment experience differences. Caregivers affiliated with the National Guard and those with more months of deployment reported significantly poorer emotional well-being, and more household and relationship hassles. Given the important role that maternal well-being has on child and family functioning, it is critical to understand how the stress of deployment is affecting mothers in their daily routines, especially during potentially high stress periods.

Secondary Trauma and Military Veteran Caregivers

The article focuses on the secondary trauma stressors experienced by those who care for members of the military with special attention to the caregivers of war fighters seeking help from combat stress. Consistent with the theme of the special issue of understanding and preparing for the challenges of combat stress, the authors suggest that military caregiver stress and resilience require attention. The article calls for more attention to this area by researchers, practitioners, and policy makers given the growing combat stress injuries due, in large part, to recent multiple and lengthy deployments. The first section of the article describes secondary traumatic stress (STS) conceptually by identifying and defining STS and related constructs and the relevant theories and the prevalence estimates. The middle section of the article discusses the risk and protective factors for STS. The latter section provides an overview of very underdeveloped literature on military veteran caregivers by first describing this population, the most promising approaches to mitigating and preventing STS, and several model programs that may be useful for units of military caregivers.

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

Mortality from battlefield wounds has historically declined, thanks to better surgical management, faster transport of casualties, and improved antibiotics. Today, one of the major challenges facing U.S. military caregivers is the presence of multidrug-resistant organisms in orthopaedic extremity wounds. The most frequently identified resistant strains of bacteria are Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter calcoaceticus-baumannii complex. Overuse of broad-spectrum antibiotics may be an important factor in building resistant strains. Acinetobacter infections appear to hospital-acquired and not from an initial colonization of the injury. More research is required to give military physicians the tools they require to reduce the infection rate and defeat multidrug-resistant organisms.

Experience of Strain Among Types of Caregivers Responsible for Children With Serious Emotional and Behavioral Disorders

Parents and relative caregivers of children with severe emotional and behavioral disorders (EBD) often report high levels of strain associated with the care of that child.This study compares how parents and other relative caregivers, and different family caregiver groups, experience strain. Overall, we found that Medicaid caregivers ( n = 648) reported high levels of objective strain, whereas military caregivers ( n = 978) had high scores on the subjective internalized and externalized subscales of the Caregiver Strain Questionnaire (CGSQ). An exploratory common factor analysis showed that overall,the CGSQ performed similarly for the Medicaid and the military caregivers and was generally consistent with previous research showing three factors. However, among Medicaid caregivers, other relatives ( n = 109) reported two rather than one type of objective strain, and emotionally based items had lower correlations with the latent factor among other relatives as compared with parents ( n = 539).These findings suggest the need to tailor approaches to assisting different groups of caregivers in coping with their strain.