Modified Caregiver Strain Index Research Articles

Performance of the Modified Caregiver Strain Index (MCSI) in a sample of Black and White persons living with dementia and their caregivers.

This study examined the performance of the Modified Caregiver Strain Index (MCSI) in a sample of Black and White caregivers of persons living with dementia. Data on 153 dyads enrolled in the Care Ecosystem dementia care management program were analyzed, including sociodemographic variables, dementia severity, and caregiver burden and well-being. Factor structure, item-response patterns, and concurrent validity were assessed across racial groups. Differences between Black and White caregivers included gender, dyad relation, and socioeconomic disadvantage. Factor structure and item loadings varied by racial cohort, with parameters supporting a three-factor model. For Black caregivers, finances and work, emotional and physical strain, and family and personal adjustment items loaded together on individual factors. For White caregivers physical and emotional strain items loaded on separate factors, while personal and family adjustment items loaded with work and financial strain items. Item-level analysis revealed differences between groups, with Black caregivers endorsing physical strain to a greater degree (p=0.003). Total MCSI scores were positively correlated with concurrent measures like the PHQ-9 (White: r=0.67, Black: r=0.54) and the GAD-2 (White: r=0.47, Black: r=0.4,), and negatively correlated with self-efficacy ratings (White: r=-0.54, Black: r=-0.55), with a p<0.001 for all validity analysis. The MCSI displayed acceptable statistical performance for Black and White caregivers of persons living with dementia and displayed a factor structure sensitive to cultural variations of the construct. Our results highlight the inherent complexity and the relevance of selecting inclusive measures to appropriately serve diverse populations.

Abstract TP73: Outcomes in Mexican American Informal Stroke Caregivers and Differences by Ethnicity

Background: Informal home care is the most prevalent type of post-acute care (PAC) in Mexican American (MA) stroke survivors, but data on the impact on caregivers is not available. The objective was to investigate strain, positive aspects of caregiving, familial obligations/support, and depression in stroke caregivers and ethnic differences in a population-based study. Methods: Data are from Brain Attack Surveillance in Corpus Christi PAC Study. Community-dwelling stroke survivors and their caregivers were recruited (n=307). Caregiver eligibility included: 1) residence in study county, 2) not cognitively impaired, 3) not providing care pre-stroke. Caregiver interviews at ~90 days included sociodemographics, dyad characteristics, Modified Caregiver Strain Index (MCSI range 0-26, higher more), PAC scale by Tarlow et al (range 5-45, higher more), familial obligations/support scales by Sabogal et al (range 1-5, higher greater), and PHQ-8 (range 0-30, higher worse). Patient data were from interviews and medical records. Propensity score (PS) methods were used to balance caregiver and patient factors among MA and non-Hispanic white (NHW) caregivers by fitting a model with ethnicity of caregiver as the outcome and predictors being caregiver sociodemographics, patient-caregiver dyad characteristics, and patient sociodemographics and disability. PS were then included as a covariate in regression models considering the association between ethnicity and outcomes. Results: MA caregivers were younger, more likely female, and more likely a child than NHWs. Median MCSI, PAC scale, PHQ-8 were 11 (IQR:6-17), 36 (IQR:30-40), and 11 (IQR:9-15) in MAs and 13.5 (IQR:9-18.3), 30 (IQR:25-36.3) and 13 (IQR:10-16) in NHWS. MA ethnicity was associated with less caregiver strain (β=-2.22, 95% CI:-4.19, -0.26) and depression (β=-2.05, 95% CI:-3.48, -0.63) and more positive aspects of caregiving (β=2.96, 95% CI:0.91, 5.01), but not associated with familial obligations/support. Conclusions: Informal stroke caregivers report moderate levels of strain and depressive symptoms, with NHW caregivers reporting higher levels. MA caregivers report greater positive aspects of caregiving suggesting a possible intervention target to improve outcomes in MAs.

Caregiver strain among patients of palliative care in Sri Lanka: validation of modified caregiver strain index - Sinhala version

BackgroundCare givers of Palliated patients are at risk of adverse physical, psychosocial and emotional sequelae in varied nature. Efficient and valid assessment tools facilitate early detection to take corrective measures. The Modified Caregiver Strain Index (MCSI), composed of domains associated with caregiver strain is a simple and brief tool that can be used in both clinical and field settings. This study aimed to adapt and validate this in order to cater effective palliative care services in Sri Lanka.MethodsAfter cross-cultural adaptation, 200 primary caregivers in 3 teaching hospitals were recruited. The internal consistency, item-total correlations, of the 13-item S-MCSI were performed. The criterion validity was assessed by Pearson correlation between the total scores of S-MCSI, the Karnofky Performance Scale and the Barthel index. Construct validity was determined by the principal component analysis keeping the Varimax with Keiser normalization as the rotation method. The Kaiser-Meyer-Olkin test (KMO) and Bartlett’s test of sphericity statistics were also performed to determine the adequacy of the sample and correlations between items, respectively. The number of factors was determined by the Scree plot, percentage of variance explained by each component and number of Eigen values over 01 (Kaiser-Guttman rule).ResultsThe total MCSI score ranged 0 to 26. The overall Cronbach’s alpha of the 13-item questionnaire was 0.80 while item-total corrections ranged 0.34 to 0.62, exception of one item (0.11). Inverse correlations were demonstrated in total scores of MCSI and Karnofky Performance Scale (r =- 0.32, p < 0.001) and Barthel index (r =-0.34, P < 0.001). A Kaiser-Meyer-Olkin value of 0.79 (p < 0.001) for Bartlett’s test indicated adequate sampling and nonlinearity of factors. The Scree plot showed a three-factor structure explaining 57% of the variation. Items regarding personal wellbeing of caregiver loaded together while the effects on the family loaded separately. Adjustment of personal concerns and family issues along with time alteration grouped as the third factor.ConclusionsThe study showed that the Sinhala version of MCSI has adequate psychometric properties and reliability to be used as a validated tool to estimate the caregiver burden within a short time period for any health care workers.

Feasibility of the geriatric assessment in older caregivers of older adults with cancer to guide supportive care.

224 Background: Older caregivers of older patients with cancer are at high risk for adverse physical and psychological outcomes. Performing a caregiver geriatric assessment (GA) may help identify caregivers at increased risk of adverse outcomes and guide supportive care strategies. In this study, we aimed to determine the feasibility of a GA to evaluate age-related conditions, and physical and emotional health of both patients and caregivers. Methods: Caregivers aged 65+ and patients aged 65+ with diagnosis of cancer receiving a new line of cancer treatment and caregivers aged 65+ were recruited (Goal 60 dyads; current N=40). Patient and caregiver physical and emotional health was captured using the GA which included assessment of physical function (activities of daily living [ADLs], instrumental activities of daily living [IADLs], Short Physical Performance Battery [SPPB], fall history), comorbidity, psychological health (Geriatric Depression Scale [GDS], General Anxiety Disorder-7 [GAD-7]), cognition (Montreal Cognitive Assessment [MOCA] or Blessed Orientation Memory Concentration [BOMC]), Social Support (Older Americans Resources and Services [OARS] Social Support), polypharmacy, nutrition, caregiver Environmental Mastery, and Modified Caregiver Strain Index. Results: Of 40 dyads who have consented, 17 dyads (42%) completed the GA, 14 dyad GAs are pending (35%), eight have withdrawn (20%), and one was lost to follow-up (2.5%). Mean time for caregivers to complete self-reported GA assessment was 47 minutes (range 20-120 minutes) and return to study staff was 5 days (range 0-22 days). Caregivers had mean age 78 years (range 65-85), 100% white, 94% female, and 94% spouses. Caregivers had high prevalence of age-related conditions, including comorbidities (mean 3.7), impairments in ADLs (24%), IADLs (31%), and physical function (55%). More patients than caregivers screened positive for depression (29% vs 12%) and anxiety (17% vs 6%). Caregivers reported high mastery (Ryff subscale, mean 38, range 26-49) and low strain (4.4, range 0-16). Conclusions: The GA is feasible to use in older cancer caregivers to help identify aging related conditions that may influence caregiving ability. Future work should identify how GA in older cancer caregivers can be used to identify intervention strategies to optimize caregiving abilities and improve outcomes in both older adults with cancer and their caregivers. Clinical trial information: NCT05244915 .[Table: see text]

Evaluating Elements of the Care Partner Experience in Individuals Who Care for People with Alzheimer's Disease Across the Severity Spectrum.

Non-professional care partners play an important and often evolving role in the care of persons living with Alzheimer's disease (PLWAD). We investigated two elements of the care partner experience, namely time and strain incurred by care partners providing care to PLWAD across the severity spectrum. Data gathered from the Alzheimer's Disease Patient and Caregiver Engagement (AD PACE) What Matters Most (WMM) study series were analyzed to determine how much time care partners spent providing care to PLWAD based on where the care recipients lived. Additionally, quantitative assessments of weekly hours providing care and the strain experienced by care partners were conducted using the UsAgainstAlzheimer's A-LIST Insights Series survey, which included the Modified Caregiver Strain Index (MCSI). Finally, a targeted literature review was conducted to contextualize findings and characterize the existing literature landscape. Care partners in the AD PACE WMM studies (n = 139) spent significantly more hours providing care for recipients who lived with someone (mean ± standard deviation [SD], 57.3 ± 44.3h/week) than for recipients who lived alone (26.0 ± 12.0h/week) (P = 0.0096) or lived in assisted living/nursing home (23.6 ± 14.4h/week) (P = 0.0002). In the A-LIST Insights Series survey, care partners provided an overall mean (± SD) 58.1 ± 53.0h of direct care each week, with caregiving hours increasing with increasing severity of AD/AD-related dementias(AD/ADRD). Additionally, care partners for recipients with mild (n = 14), moderate (n = 111), and severe AD/ADRD (n = 91) had overall mean MCSI scores of 9.0 ± 3.8 (range 2-14), 13.3 ± 4.8 (range 4-23), and 17.5 ± 5.3 (range 4-26), respectively, with higher scores suggesting greater care partner strain. Persons living with AD require increasing levels of care along the spectrum of disease, and even individuals with early disease need care from partners. Early interventions that slow progression of AD and programs that improve family function may have beneficial impact on the experiences of care partners for recipients with mild, moderate, or severe AD.

Health literacy, quality of life and burden of informal caregivers in Portugal

Abstract Background The process of informal caregiving may have significant impacts on physical, psychological, social and economic conditions of informal caregivers. Worldwide lower levels of health literacy are associated with worse informal care, reduced quality of life and higher burden of informal caregivers. The aim of this study is to assess the correlation between health literacy score (HL), quality of life (QoL) and informal caregiver burden in Portugal. Methods A cross-sectional study was conducted through an online survey directed to informal caregivers. Three validated scales were applied in Portuguese versions: a) European Health Literacy Survey (HLS-EU-PT-Q16); b) European Quality of Life Questionnaire (EQ-5D-5L), c) Modified Caregiver Strain Index (M-CSI). Overall statistical analysis and the Pearsońs correlation test at 5% significance level were performed in SPSS®. Results In total, 760 informal caregivers were surveyed, mean age 57 years (±9.9), 92.5% female, 62.6% married or living with a partner, 41,5% at least university level, 44.4% works full or part-time. Regarding the process of care, 78.9% takes care of one person, 85.2% have been caring for more than 1 year, 54.3% feel that are not supported at all, and 20.3% do not feel competent to care. The mean HL score of informal caregiver (n = 673) was 31.9 (+7.8), QoL (n = 733) was 0.8 (+0.2), and burden (n = 760) was 14.8 (+5.3). HL Score is directly correlated with QoL (r = 0.215; p &amp;lt; 0.001) and inversely correlated with informal caregiver burden (r=-0.150; p &amp;lt; 0.001). Conclusions A higher health literacy score is associated with better quality of life and lower informal caregiver burden. Improving health literacy may be strategic to promote health conditions and quality of life and care for both the informal caregiver and the person being cared for. Key messages • A higher health literacy score is associated with better quality of life and lower informal caregiver burden. • It is crucial to invest on the definition of an integrated strategy, between Health and Social Security, to provide better health conditions to informal caregivers.

Levodopa Carbidopa Intestinal Gel in Advanced Parkinson's Disease: DUOGLOBE Final 3-Year Results.

Levodopa-carbidopa intestinal gel (LCIG) improves motor and non-motor symptoms in patients with advanced Parkinson's disease (aPD). To present the final 36-month efficacy and safety results from DUOGLOBE (DUOdopa/Duopa in Patients with Advanced Parkinson's Disease - a GLobal OBservational Study Evaluating Long-Term Effectiveness; NCT02611713). DUOGLOBE was an international, prospective, long-term, real-world, observational study of patients with aPD initiating LCIG in routine clinical care. The primary endpoint was change in patient-reported "Off" time to Month 36. Safety was assessed by monitoring serious adverse events (SAEs). Significant improvements in "Off" time were maintained over 3 years (mean [SD]: -3.3 hours [3.7]; p < 0.001). There were significant improvements to Month 36 in total scores of the Unified Dyskinesia Rating Scale (-5.9 [23.7]; p = 0.044), Non-Motor Symptoms Scale (-14.3 [40.5]; p = 0.002), Parkinson's Disease Sleep Scale-2 (-5.8 [12.9]; p < 0.001), and Epworth Sleepiness Scale (-1.8 [6.0]; p = 0.008). Health-related quality of life and caregiver burden significantly improved through Months 24 and 30, respectively (Month 24, 8-item Parkinson's Disease Questionnaire Summary Index, -6.0 [22.5]; p = 0.006; Month 30 Modified Caregiver Strain Index, -2.3 [7.6]; p = 0.026). Safety was consistent with the well-established LCIG profile (SAEs: 54.9% of patients; discontinuations: 54.4%; discontinuations due to an adverse event: 27.2%). Of 106 study discontinuations, 32 patients (30.2%) continued LCIG outside the study. DUOGLOBE demonstrates real-world, long-term, reductions in motor and non-motor symptoms in patients with aPD treated with LCIG.

Burden of Care among Mothers Having Children with Down Syndrome.

Down syndrome is the most common chromosomal disorder associated with mental retardation. Parents who are the primary caregivers of a child with a disability face numerous challenges in their day-to-day life. The objective of the study was to find out the burden of care among mothers having children with down syndrome. A descriptive cross-sectional study was carried out among 96 mothers having down syndrome children enrolled in the Down Syndrome Society, Nepal. Purposive Sampling technique was adopted for data collection. The Modified Caregiver Strain Index tool was used to collect data through interview. Data were collected from June 14, 2021 to August 1, 2021, which was analyzed by using descriptive and inferential statistics. Findings revealed that majority of the mothers (77.1%) had high level of burden of care. Majority (89.6%) of the mothers involved in the study were always overwhelmed about their child's conditions. More than half (55.2%) of the mothers were always financially strained in care giving, 57.3% had always done work adjustments and 60.4% of mothers always had emotional adjustments to be made. Similarly, 53.1% participants always felt that care giving was a physical strain. Burden of care was significantly associated with the age of delivery (p value= 0.008). The study concludes that mothers having children with down syndrome tend to have high level of burden of care and it is associated with the age at delivery. Therefore, health care providers including concerned authority are recommended to conduct different programs to support the caregivers in order to reduce their burden as well as to raise awareness program related to preventive measures of down syndrome in community.

Redefining caregiver strain for family caregivers in end-of-life care in Hong Kong.

Caregiving for family members at their end of life is stressful. Caregivers' strain, burden, or stress has been measured in various geographical and sociodemographic contexts. The concept of stress, burden, and strain are sometimes used interchangeably. By analysing the factor structure of the Chinese version of the Modified Caregiver Strain Index (C-M-CSI), this study aimed to examine the caregiving strain concept and its demographic correlates. A sample of 453 family caregivers of patients with a terminal illness in Hong Kong was employed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. In addition, generalized linear models (GLM) were used to examine the demographic correlates. The EFA yielded a 3-factor model termed "Perception of Caregiving," "Empathetic Strain," and "Adjustment Demand." This 3-factor model explained 50% of the variance and showed good internal consistency. The CFA confirmed the 3-factor construct with satisfactory internal reliability (χ2 [61, N=226]=108.86, p<0.001, CFI=0.96, TLI=0.95, SRMR=0.04, and RMSEA=0.06). Inspired by this factor structure and concepts of stress and strain from engineering discipline, a new model of caregiver strain is proposed. Additionally, family caregivers of non-cancer patients, who were not living with the patient, or younger were associated negatively with different dimensions of caregiver strain. The results gave insights into the advancement of the conceptualization of caregiver strain, its multidimensional nature, and process of change, which inform directions for future research and practices.

Evaluation of the Clinical Outcomes and Disease Burden in Advanced Parkinson’s Disease Patients: PROSPECT Study Preliminary Results (P10-11.009)

Evaluation of the Clinical Outcomes and Disease Burden in Advanced Parkinson’s Disease Patients: PROSPECT Study Preliminary Results (P10-11.009)

The Impact of the COVID-19 Pandemic on Care Partners of People with Parkinson's Disease.

Since the onset of the coronavirus disease 2019 pandemic, the caregiving routine for care partners of people with Parkinson's disease (PwPD) changed substantially. To understand the nature and severity of burden in care partners of PwPD during the ongoing pandemic. We also sought to describe care partners' perceived change in burden and factors associated with increased burden. Cross-sectional online questionnaire-based study among care partners of PwPD, registered in the Fox Insight study. The questionnaire consisted of the Modified Caregiver Strain Index, whether an aspect of strain had changed over the course of the pandemic and additional pandemic-specific infection and lifestyle-related items. Two hundred seventy-three non-paid primary care partners responded to the questionnaire, 73% female with a median age at enrollment of 64 years, 56% reporting a household income greater than 75,000 USD per year, and 61% retired. An increase in burden compared to before the pandemic was prevalent, ranging from 33% to 63% for individual items. Emotional strain increased most frequently (63%). Decreases in burden were uncommon; work adjustments (7%) and time demands (6%) decreased most frequently. PD-related factors and care partner roles in personal care of the PwPD were the factors that were associated with strain in multivariable analysis, whereas social and pandemic-related factors were not. In this affluent and mostly retired cohort, increases in emotional strain during the pandemic were prevalent. Despite this, caregiving roles in personal care and severity of symptoms in the PwPD were more strongly associated with strain than social and pandemic-related factors.

Understanding characteristics of persons with early onset dementia in the UCLA Alzheimer’s and Dementia Care Program

AbstractBackgroundAlthough early onset dementia (EOD) accounts for approximately 5% of persons living with dementia (PLWD), there is limited understanding of their demographic characteristics, behavioral symptoms, and caregiver measures, especially in comparison to persons with older onset dementia (OOD).MethodThe UCLA Alzheimer’s and Dementia Care Program is a comprehensive dementia care management program that has served over 3450 PLWD since 2012. This retrospective study compares baseline visit characteristics of participants with EOD (≤ 65 years of age) to participants with OOD (≥ 80 years of age). Variables include patient and caregiver demographics, Neuropsychiatric Inventory Questionnaire (NPI‐Q) scores, Mini Mental State Exam (MMSE), Modified Caregiver Strain Index (MCSI), caregiver PHQ‐9, and insurance status. Fisher exact tests were used to test differences between age groups.ResultThe attached table presents comparisons of the 177 participants with EOD and 731 with OOD. Compared to OOD, persons with EOD were more likely to be men, college graduates, dually insured, have unpaid caregivers, live alone, and be married. Caregivers for persons with EOD were most often spouses, whereas caregivers for persons with OOD were more often children. Although participants had similar MMSE scores, NPI‐Q severity and NPI‐Q distress scores were higher among persons with OOD compared to EOD.ConclusionThere are important differences in demographic characteristics, caregiving status, and behavioral symptoms among persons with EOD compared to those with OOD. Understanding the unique challenges, needs, and resources of persons with EOD may provide valuable insight to adapt dementia care to better meet their needs.

Effects of an Alzheimer's and Dementia Care Co-management Program on Quality, Clinical Outcomes, and Utilization.

The quality of care provided to persons living with dementia (PLWD) and their care partners (CPs) is low, clinical outcomes are poor, and costs are high. Co-management of dementia care by Advance Practice Providers (APPs) has the potential to improve all of these metrics. The UCLA Alzheimer's and Dementia Care (ADC) Program is a health system-based co-management model of APP Specialists (DCSs) working with primary care and specialty physicians that is designed to meet dementia care needs. DCSs approach the PLWD and CP as a dyad, providing support, including community-based resources, to both; behavioral and medication management; and care coordination. The program has provided dementia care for over 3400 PLWD and has a current census of over 750 PLWD who are cared for by 4 nurse practitioner DCSs. Quality of care based on established dementia quality indicators assessed by medical record review was 92%. Based on an analysis of the first 1091 PLWD and their CPs, prior to entering our program, many caregivers were poorly informed about dementia caregiving and felt they were fighting this battle alone. One-third had high stress and more than 10 percent were depressed. By the end of a year in the program, confidence in handling problems and complications of Alzheimer's disease and dementia improved by 72 percent. CP strain (Modified Caregiver Strain Index), distress (Neuropsychological Inventory-Distress), and depression (PHQ-9) were reduced (all P<0.001). Moreover, the program reduced emergency department visits by 20%, days spent in the hospital by 26%, admissions to nursing homes for long-term care by 40%, (all P<0.05) and overall Medicare costs by $2404 per person/year. The ADC Program has been disseminated to 18 sites nationwide and more than 5000 PLWD and their CPs have received ADC care. Dementia co-management with APPs can improve quality and clinical outcomes and reduce health care utilization and costs. The ADC Program can be implemented in diverse health systems indicating the potential for widespread dissemination.

Caregiving strain is associated with cardiac autonomic imbalance in primary oncology caregivers: A cross-sectional analytical study

Objectives: Oncology caregivers often endure a significant amount of psychosocial stress while going through the experience of caregiving for their dependents. Exposure to chronic stress disrupts the cardiac autonomic balance and increases the risk of cardiovascular events. There is a paucity of research on the association between caregiving strain and cardiac autonomic status of primary oncology caregivers. This study aimed to assess the cardiac autonomic balance and its association with the levels of perceived strain and quality of life (QOL) of primary oncology caregivers. Materials and Methods: Forty-six individuals (30 males and 16 females) who have been primary caregivers of patients under the treatment for cancer at the Regional Cancer Centre over the past 3 months–1 year were recruited in this cross-sectional study. Cardiac autonomic status was assessed by heart rate variability (HRV) technique. The level of strain perceived and QOL of the study participants were assessed using the Modified Caregiver Strain Index (MCSI) and Caregiver QOL-Cancer (CQOL-C) questionnaires, respectively. Comparison of study parameters based on MCSI scores (low strain vs. moderate-high strain) was done using the Independent Student’s t-test. Spearman rank correlation coefficient test was performed to assess the correlation between sympathovagal balance (Low frequency [LF]/high frequency [HF]) and other study parameters. Multiple linear regression analysis was performed to predict the LF/HF ratio with independent variables MCSI score and CQOL-C score. P &lt; 0.05 was considered statistically significant. Results: Significantly high blood pressure, LF power, LF nu (LF normalised units) and LF/HF ratio were observed among caregivers with moderate-to-high caregiving strain as compared to those with low strain levels, while significantly low HF nu (HF normalised units) and CQOL-C scores were noted among the moderate-to-high caregiving strain subgroup as compared to the low caregiving strain subgroup. LF/HF ratio revealed a significant positive correlation with the level of caregiving strain (r = 0.563, P &lt; 0.001) and a significant negative correlation with the QOL (r = −0.489, P = 0.001) of caregivers. However, on regression analysis, the level of caregiving strain was found to be a significant predictor of autonomic dysfunction unlike the caregivers’ QOL. Conclusion: Increased caregiving strain is associated with cardiac autonomic imbalance in primary oncology caregivers.

The Modified Caregiver Strain Index in Black and White Dementia Caregivers at Hospital Discharge

ABSTRACT Objectives This study aimed to examine psychometric properties of the Modified Caregiver Strain Index (MCSI) in Black and White caregivers of persons living with dementia at hospital discharge. Methods This was a cross-sectional study using baseline data of 423 family caregivers recruited from a cluster randomized clinical control trial. Factor structure, measurement invariance, and concurrent validity of the MCSI were analyzed. The moderating role of race on the relationship between MCSI score and anxiety, depression, and burden was also examined. Results The two-factor model fits the data best and was invariant across race. Regarding concurrent validity, higher MCSI scores were significantly associated with higher scores on the (HADS-A; anxiety), (HADS-D; depression), and (ZBI; burden). Race moderated the relationship between MCSI score and anxiety, depression, and burden. Conclusions The MCSI is a valid tool to assess caregiver strain in Black and White caregivers of persons living with dementia during hospital discharge. Results suggest that the effect of MCSI score on anxiety, depression, and burden varies by race. Clinical Implications MCSI can be used by clinicians and service providers to help support the needs of Black and White caregivers of people living with dementia during post-hospital transition.

Influence of Patient Functional Status and Depression on Strain in Caregivers.

Individuals who provide care to older adult women with breast cancer can experience distressing caregiver strain. The purpose of this study was to determine whether functional status and depression in older adult women with breast cancer relates to strain in their caregivers. Relationships among caregiver characteristics and strain were also evaluated. This multivariate, cross-sectional study used activities of daily living, instrumental activities of daily living, Timed Up and Go Test, Geriatric Depression Scale, and Modified Caregiver Strain Index (MCSI). Statistical analyses included Wilcoxon rank-sum tests and Spearman rank correlations. Logistic regression was used to predict MCSI scores. Patient Timed Up and Go Test and Geriatric Depression Scale scores had the greatest impact on MCSI, with lower function and greater depression associated with increased caregiver strain. Advanced disease was associated with increased caregiver strain. When cancer stage is controlled for, caregiver employment is associated with increased strain.

The relationship of caregiver strain with resilience and hardiness in family caregivers of older adults with chronic disease: a cross-sectional study

BackgroundProviding long-term home care to older adults with chronic diseases may endanger the physical, mental, social, and spiritual health of caregivers and lead to care strain.ObjectiveThis study aimed to assess the relationship of caregiver strain with resilience and hardiness in family caregivers of older adults with chronic disease.MethodologyThis cross-sectional correlational study was conducted in 2020–2021 in Tehran. Participants were 230 family caregivers randomly recruited from 8 urban health care centers. Data were collected using a personal characteristics questionnaire, the Modified Caregiver Strain Index, Connor-Davidson Resilience Scale, Family Hardiness Index, and the data were analyzed by using SPSS 22 version. Pearson’s correlation coefficient was applied for data analysis. P-values ≤0.05 were considered significant.ResultsA total of 230 caregivers participated in the study. The mean age of participants was (46.65 ± 13.63) years and most of them were female (73.9%). Mean scores of caregiver strain, resilience, and hardiness in family caregivers were 16.23 ± 4.5, 39.89 ± 10.9, and 31.21 ± 7.79, respectively. Pearson correlation showed a significant and inverse correlation between caregiver strain and resilience (r = -0.310, P = 0.002), and also a significant and inverse relationship between caregiver strain and hardiness (r = -0.276, P = 0.001).ConclusionIn this study, family caregivers had moderate caregiver strain, low resilience, and high hardness. Caregiver strain in family caregivers of older adults with chronic disease is an important health issue associated with resilience and hardiness. To promote health, effective adaptation to long-term care, and reduce caregiver strain, designing effective interventions to increase resilience and hardiness in family caregivers seems necessary.

Prevalence and Correlates of Caregiver Anxiety in Family Caregivers of Patients With Advanced Cancer: a Cross-Sectional Study in a Palliative Care Unit in Hong Kong.

To assess the prevalence of caregiver anxiety and to identify correlates of caregiver anxiety in family caregivers of patients with advanced cancer in a palliative care unit in Hong Kong. Family caregivers of patients admitted to the palliative care ward for the first time between July 2019 and September 2019 were screened for recruitment. Caregiver demographics (age, sex, marital status, occupation, education level, housing condition, relationship with the patient, known diagnosis of anxiety or depression, and Charlson comorbidity index) were collected, as were caregiver understanding of patient's diagnosis and prognosis, perceived patient's distress, frequency of witnessing confusion or delirium of patients in past month, perceived adequacy of psychological support (other than general social support), and perceived anxiety towards patient's approaching death. Caregiver anxiety was assessed using the 7-item Generalised Anxiety Disorder scale (GAD-7). Caregiver depression status was assessed using the 9-item Patient Health Questionnaire (PHQ-9). Caregiver psychological well-being was assessed using the 11-item Psychological Well-being Scale for Family Caregivers (PWS-C). Caregiver overall burden was assessed using the Chinese version of the 13-item Modified Caregiver Strain Index (C-M-CSI). 70 caregivers (of 66 patients) were included, with a response rate of 98.6%. 16 (22.9%) caregivers had moderate to severe anxiety (GAD-7 score of ≥10). The GAD-7 score was higher in female caregivers than in male caregivers (mean rank: 39.26 vs 27.83, p = 0.026). 26 (37.1%) caregivers had depression (PHQ-9 score of ≥7). The GAD-7 score of caregivers was associated with the PHQ-9 score (rs = 0.834, p < 0.01), the four subscales of PWS-C: social support (rs = -0.308, p = 0.01), life meaning (rs = -3.30, p < 0.01), emotional distress (rs = 0.615, p < 0.01), and caregiver inadequacy (rs = 0.41, p < 0.01), and the C-M-CSI score for caregiver overall burden (rs = 0.332, p < 0.01). In multiple linear regression, predictors for GAD-7 score were the PHQ-9 score, caregiver's feeling of anxiety towards patient's approaching death, and caregiver sex. 22.9% of family caregivers of patients with advanced cancer have moderate to severe anxiety. Anxiety of caregivers was associated with depression, caregiver's feeling of anxiety towards patient's approaching death, psychological support, and life meaning. All these are potentially amendable by interventions. A structured screening of anxiety in family caregivers of patients with advanced cancer should be considered as routine practice.

Use of mobile app to enhance functional outcomes and adherence of home-based rehabilitation program for elderly with hip fracture: A randomized controlled trial.

Mobile app has been used to improve exercise adherence and outcomes in populations with different health conditions. However, the effectiveness of mobile app in delivering home-based rehabilitation program to elderly patients with hip fracture is unclear. The aim of this study was to test the effectiveness of mobile app in delivering home-based rehabilitation program for improving functional outcomes and reducing caregiver stress with enhancing adherence among the elderly patients with hip fracture. A randomized controlled trial with an intervention period of two months was performed. Eligible participants were randomized into either experimental group with home-based rehabilitation program using a mobile app or control group with home-based rehabilitation program using an exercise pamphlet. Primary outcomes were Modified Functional Ambulatory Category (MFAC), Elderly Mobility Scale (EMS) and Lower Extremity Functional Scale (LEFS). Secondary outcomes were exercise adherence and Modified Caregiver Strain Index (M-CSI). The outcomes were collected at pre-discharge training session, one month and two months after hospital discharge. A total of 50 participants were enrolled, with 19 participants in the experimental group and 20 participants in the control group. Eleven participants had withdrawn from the study. The experimental group showed higher exercise adherence than the control group in first month (). There were no between-group differences in MFAC, EMS, LEFS and M-CSI at the first month and second month. Use of the mobile app improved exercise adherence, yet it did not improve physical performance, self-efficacy and reduce caregiver stress when compared to a standard home rehabilitation program for elderly patients with hip fracture. Further studies to investigate the benefits of mobile apps are required. (ClinicalTrials.gov ID: NCT04053348.).

Caregiver Strain in Community Care

The paper focuses on the identification of areas of strain in caregivers who, on a non-professional basis, provide care to a person with a neurological disease in a community care-based setting. The aim of the survey was to validate the nursing diagnosis Caregiver Role Strain. Through a group of experts, we found out which determining features and related factors of the aforementioned nursing diagnosis occur most often in clinical practice while caring for patients with a neurological disease. Furthermore, for assessing caregivers we used the Modified Caregiver Strain Index to find out which neurological diseases cause the greatest strain for them, and which gender and age group of caregivers are most predisposed to strain. The survey took the form of online questionnaires fromApril 2021 to September 2021. Caregiver strain occurs most often in caregivers who care for neurological patients. By analyzing the data, we came to the conclusion that the experts in our survey identified fatigue as the most important determinant. The group of experts identified the most important related factor - inexperience in providing care. Due to the demanding position of the caregiver, it is important for care providers to correctly and quickly identify potential stressors, and thus relieve the caregivers from their difficult mission