Positive Caregiving Appraisals Research Articles

RECIPROCITY AMONG CARE PARTNER DYADS AND ITS INFLUENCE ON OUTCOMES IN DEMENTIA FAMILY CAREGIVERS

Abstract Dementia family caregiving is a heterogenous experience influenced by multidimensional inter- and intra-personal factors. The interdependence between the well-being of caregivers and care-recipients, and that feelings of mutuality and shared involvement in care responsibilities by both the caregiver (CG) and care-recipient (CR) influence family caregiver outcomes. This presentation will present findings from an analysis that examined the influence of caregiver/care-recipient demographic characteristics, care intensity (functional status, medical/nursing tasks), degree of cognitive impairment, and CR depression and quality of life on CG outcomes including burden, self-efficacy, depression, and positive aspects of caregiving. Baseline data were drawn from 99 family caregiver-care-recipient dyads who participated in the Care Partners intervention, a non-pharmacological intervention for individuals with Alzheimer’s disease and their caregivers. Results showed that CG difficulty in performing medical/nursing tasks, greater distress related to the CR’s functional impairment, CR’s degree of cognitive impairment, lower levels of mutuality, and lower CR ratings of quality of life and depression were significantly related to higher CG burden, depression, and lower CG self-efficacy. Alternatively, being a male CG and greater CG distress related to performing medical/nursing tasks and assistance with activities of daily living was associated with lower positive aspects of caregiving. Having a female CR and reporting higher levels of mutuality and preparedness was subsequently associated with more positive appraisals of caregiving. These findings underscore the importance of reciprocal interactions and the need to target both members of the dyad in interventions aiming to improve quality of life and well-being in dementia care partners.

Influence of medical care tasks on subjective burden and gain among older adults’ family caregivers: structural equation modeling for testing the role of formal and informal support

BackgroundThe number of caregivers performing medical care tasks at home for older adults is expected to increase. Family caregivers, who are not healthcare professionals, are likely to find these activities difficult and burdensome. However, appropriate support may decrease the negative and increase the positive aspects of caregiving. This study investigated direct associations between caregivers providing medical care at home and their negative and positive appraisals of caregiving (burden and gain), indirect associations through healthcare professional support and informal support, and whether the associations between medical care tasks and caregivers’ appraisals of caregiving differed based on the support received.MethodsInterview surveys were conducted in 2013, 2016, and 2019 in a Tokyo Metropolitan Area city with family caregivers of community-dwelling older adults who were certified as requiring care in Japan’s long-term care insurance system. This study analyzed the combined data from each survey (n = 983). Structural equation modeling (SEM) analysis was utilized to examine direct associations between providing medical care and caregiver appraisals and indirect relationships through healthcare professional support and informal support. The modulating effects of these forms of support on the relationship between medical care and caregiver appraisals were assessed using multigroup SEM analyses.ResultsApproximately 9% of family caregivers provided medical care at home. The results of SEM analyses, controlled for care recipients’ physical and cognitive difficulties; caregivers’ age, sex, and economic condition; and survey year, revealed no direct associations between providing medical care and caregivers’ sense of burden and gain. They also did not reveal any indirect effects through either healthcare professional support or informal support. However, the results of multigroup SEM analyses indicated that caregivers providing medical care who used home-visit services by physicians and/or nurses, compared to those who did not, tended to exhibit a greater sense of gain.ConclusionsThese results suggest that family caregivers providing medical care at home can positively change their appraisals of caregiving if they receive appropriate support. Home medical care services provided by healthcare professionals can effectively support caregivers. Developing strategies and policies to make medical care services at home more accessible to caregivers is crucial.

Daily Caregiving Appraisals, Future Self-Views, and Physical Activity Goals Among Adult-Daughter Dementia Caregivers.

Caregiving dynamics may shape caregivers' views on their own aging in ways that affect their (de)motivation to improve their current and future health and well-being. In this study, we investigated within-person associations of daily positive and negative caregiving appraisals, future self-views (physical functioning, cognitive, and overall health domains), and physical activity goal pursuit among adult-daughter dementia caregivers. Data came from 33 middle-aged caregivers (M = 55.03) who participated in a 30-day microlongitudinal study of caregiving (N of occasions = 855). We used multilevel modeling to analyze within-person associations. Daily positive caregiving appraisals were not associated with daily future self-views. However, on days when caregivers reported higher negative caregiving appraisals, they thought more negatively about their future older selves in all domains. In turn, on days when caregivers thought more negatively about their future older selves in all domains, they reported lower physical activity goal pursuit. Future self-views in all domains mediated the association between negative caregiving appraisals and physical activity goal pursuit. Future self-views did not mediate the association between positive caregiving appraisals and physical activity goal pursuit. However, cognitive future self-views moderated the association between positive caregiving appraisals and physical activity goal pursuit. Results suggest that one pathway through which subjective caregiving experiences, especially negative caregiving appraisals, affect caregivers' physical activity goal pursuit is through future self-views. Thus, this study offers a deeper theoretical understanding of caregivers' self-regulatory health behavior and new empirical information on how caregiving might affect life-span developmental motivation.

DYADIC AND LONGITUDINAL STUDIES OF CLOSE RELATIONSHIPS: NEW INSIGHTS INTO HEALTH AND WELL-BEING ACROSS ADULTHOOD

Abstract This symposium includes 5 papers using intensive, longitudinal, and/or dyadic data on social relationships, revealing novel insights into health and well-being across adulthood. Fruhauf and colleagues conducted a feasibility and acceptability to test their Merging Yoga and self-management to develop Skills (MY-Skills) intervention, which targets caregiving dyads (caregivers and care receivers) dealing with persistent pain. Participants completed group interventions meeting twice a week for eight weeks, with each two-hour session including self-management education followed by yoga. A priori benchmarks for feasibility were met for the dyads, suggesting that these interventions may lead to improved well-being for caregiving dyads. Turner and Hooker conducted a 30-day microlongitudinal study of middle-aged daughters who are caring for their parents with dementia. On days when caregivers had more positive appraisals of caregiving than their own average, they had greater physical activity goal pursuit, independent of that day’s negative appraisals. Luong and colleagues also leverage an intensive longitudinal study spanning 3.5 month that prospectively tracked older adults and their close partners as they transitioned into senior housing facilities. Well-being varied by marital status, and changes over time varied by age. Weidmann & Chopik examined older romantic couples from 36 nations and found that between-partner correlations between depressive symptoms, self-rated health, and cognitive performance diffed across cultures. Finally, Purol et al. found that among middle-aged and older couples, similarity effects of personality facets on health and well-being were relatively small in magnitude, suggesting personality similarity among couples may be overstated in the literature.

POSITIVE APPRAISALS OF CAREGIVING SUPPORT DEMENTIA CAREGIVERS' PHYSICAL ACTIVITY GOAL PURSUIT

Abstract Middle-age daughters caring for parents with dementia have multiple roles and often neglect their own health. In addition to reporting negative appraisals of caregiving dementia caregivers also report positive appraisals, which may support their health behavior. In this study we examine how positive and negative caregiving appraisals interacted to predict physical activity goal pursuit among 27 daughters of parents with dementia who participated in the ACHIEVE Study, an NIH-funded 30-day study on caregiving (Noccasions=622). On days when caregivers had more positive appraisals than their own average, they had higher physical activity goal pursuit, even after controlling for that day’s negative appraisals (β=0.31, SE=0.09, p=0.001). Moreover, the association between positive appraisals and goal pursuit was not dependent on that day’s negative appraisals (p=0.42). Supporting adult-daughter caregivers to feel positively about their role as a caregiver on a day-to-day basis may support them to stay on track with their physical activity goals.

Caregiving Appraisals and Emotional Valence: Buffering Effect of Activity Participation

Caregiving activities often lead to positive and negative appraisal for caregivers. Caregivers may limit social participation due to caregiving activities. Changes in level of activity participation could have profound consequences for caregiver’s valence. However, little is known about how activity participation could moderate the association between these caregiving appraisals and emotional valence. Data came from the National Study of Caregiving (Round 1 and 2), a nationally representative study of caregivers. Referencing Lawton’s two-factor model (1990), we examined both the level and changes in activity restriction interacting with positive and negative caregiving appraisals to predict both valence across two waves. Consistent with two factor models, findings revealed level and changes in activity restriction moderated the relationship between caregiving appraisal and outcomes for both valences. These findings highlight the role of activity restriction as a target to reduce negative valence and improve positive valence for caregivers.

Cross-Cultural Differences in Caregiving: Investigating the Role of Familism and Social Support

Cultural diversity in the United States (US) reflects a demographic shift, with a growing population of minority older adults and a subsequent increase in minority family caregivers providing care to aging adults. Research has demonstrated heterogeneity in the caregiving experience, with increasing focus placed on examining the impact of cultural values on caregiver (CG) outcomes. Familism has been investigated as a driving mechanism of cross-cultural differences in caregiving outcomes, yet prior work examining this relationship has yielded mixed findings. Using the sociocultural stress and coping model as a guiding framework, we examined, in a sample of 243 CGs who participated in the Caring for the Caregiver Network Study, a randomized controlled trial examining a culturally-tailored technology-based psychosocial intervention, the influence of familism and social support on positive aspects of caregiving, depressive symptoms, and caregiver burden. We also examined how these relationships vary as a function of race/ethnicity, the CG’s relationship to the care-recipient, other sociodemographic characteristics (e.g., SES status), and acculturation. Results showed that African American and Hispanic CGs exhibited higher levels of familism compared to Whites. In African Americans, familism predicted higher positive caregiving appraisals, and social support significantly predicted lower burden and depression. In Hispanics, levels of familism varied as a function of acculturation, with lower levels of familism identified among US Hispanic natives. Our findings highlight that cultural beliefs, such as familism, as well as social support may be adaptive in protecting against adverse CG outcomes and point to directions for future culturally congruent, family-centered intervention approaches.

Family Matters: Cross-Cultural Differences in Familism and Caregiving Outcomes.

The increasing number of minority older adults, and the subsequent increase in family members providing care to these individuals, highlights the need to understand how cultural values contribute to differential caregiving outcomes. Using the sociocultural stress and coping model as a guiding framework, the current study examined cross-cultural relationships among familism, social support, self-efficacy, and caregiving outcomes and examines how these relationships vary as a function of caregiver background characteristics. Baseline data were collected from 243 participants in the Caring for the Caregiver Network randomized controlled intervention trial. Participants completed measures assessing familism, social support, self-efficacy, positive aspects of caregiving, depression, and burden. African American and Hispanic participants exhibited higher levels of familism compared to Whites. Compared to White participants, African Americans' endorsement of familism predicted more positive caregiving appraisals. African Americans also reported greater levels of social support, which in turn predicted lower burden and depressive symptoms when compared with Whites. Exploratory analyses demonstrated significant associations between familism and self-efficacy. In the Hispanic subgroup, familism varied as a function of acculturation. Results indicate that greater levels of familism and social support may exert a protective influence against adverse psychosocial caregiving outcomes. These findings can be used to inform intervention efforts targeting culturally congruent, family-centered approaches.

Pediatric Advance Care Planning and Families' Positive Caregiving Appraisals: An RCT.

Little is known about how families respond to pediatric advance care planning. Physicians are concerned that initiating pediatric advance care planning conversations with families is too distressing for families. We examined the effect of family centered pediatric advance care planning intervention for teens with cancer (FACE-TC) advance care planning on families' appraisals of their caregiving, distress, and strain. In a randomized clinical trial with adolescents with cancer and their families conducted from July 2016 to April 2019 in 4 tertiary pediatric hospitals, adolescents and family dyads were randomly assigned at a 2:1 intervention/control ratio to either the 3 weekly sessions of FACE-TC (Advance Care Planning Survey; Next Steps: Respecting Choices; Five Wishes) or treatment-as-usual. Only the family member was included in this study. Generalized estimating equations assessed the intervention effect measured by Family Appraisal of Caregiving Questionnaire. Families' (n = 126) mean age was 46 years; 83% were female, and 82% were white. FACE-TC families significantly increased positive caregiving appraisals at 3-months postintervention, compared with those in the control group (β = .35; 95% confidence interval [CI] 0.19 to 0.36; P = .03). No significant differences were found between groups for strain (β = -.14; 95% CI = -0.42 to 0.15; P = .35) or distress (β = -.01; CI = -0.35 to 0.32; P = .93). Families benefited from participation in FACE-TC, which resulted in positive appraisals of their caregiving for their child with cancer, while not significantly burdening them with distress or strain. Clinicians can be assured of the tolerability of this family-supported model.

Organising Support for Carers of Stroke Survivors (OSCARSS): a cluster randomised controlled trial with economic evaluation

ObjectiveInvestigated clinical effectiveness and cost-effectiveness of a person-centred intervention for informal carers/caregivers of stroke survivors.DesignPragmatic cluster randomised controlled trial (cRCT) with economic and process evaluation.SettingClusters were services, from a UK...

Psychometric properties of the Korean version of the positive aspects of caregiving scale for family caregivers of people with amyotrophic lateral sclerosis.

Many caregivers report finding positive meanings in their caregiving roles and activities. The positive aspects of caregiving (PAC) scale was designed to measure positive appraisals of caregiving. This study assessed the reliability and validity of the Korean version of the PAC for family caregivers of people with amyotrophic lateral sclerosis (ALS). The instrument's content and semantic equivalence were established using translation and back translation of the PAC. A convenience sample of 127 family caregivers of patients with ALS in Korea was recruited. Content, construct, and convergent validity of the Korean PAC were evaluated. Cronbach's α was used to assess reliability. This study used secondary data; the primary study received approval from the Institutional Review Board of H Hospital, from where data were collected. The consent forms did not mention the future use of data. Therefore, we have applied for approval regarding this study's protocol and exemption from informed consent. The Cronbach's α was 0.92, and internal consistency was acceptable. Exploratory factor analysis supported the construct validity with a two-factor solution explaining 74.73% of the total variance. Regarding convergent validity, the Korean PAC score negatively correlated with caregiver burden and depression and positively with self-rated health status. We were unable to evaluate the suitability of the suggested structural dimensionality through confirmatory factor analysis. Furthermore, as we used secondary data, we could not assess retest reliability for the evaluation of the scale's stability. The Korean PAC was found to be an applicable instrument with satisfactory reliability and validity and suitable for further use as a measure for positive appraisals of caregiving for family caregivers of people with ALS. It may be effective for measuring caregivers' psychological resources.

Effect of FAmily CEntered (FACE) advance care planning (ACP) on families’ appraisals of caregiving for their teens with cancer.

e22533 Background: Little is known about how well family caregivers respond to participating in pACP. The research objective was to understand the effect of FAmily CEntered pediatric Advance Care Planning (FACE pACP) for teens with cancer (FACE-TC) on families’ appraisals of caregiving for their child over time. Methods: 126 adolescent/family dyads were randomized to either FACE-TC intervention or treatment as usual control. FACE-TC is three weekly, 60-minute pACP sessions with a trained/certified facilitator. Family Appraisal of Caregiving Questionnaire subscales assessed outcomes. Generalized Estimating equations (GEE) model was used to examine outcome change over time. The effect of intervention on the change was examined by the interaction between time and intervention. Results: 126 adolescent/family dyads completed baseline assessments. 102 dyads completed the 3-month assessment. Adolescents were mean age of 17 years (range 14-20); 57% female; 79% Caucasian. Family participants were mean age 46 (range 19-67); 83% female; 82% Caucasian. Positive caregiving appraisals subscale items are “Caring for __ is satisfying; It is a privilege to care for __; Caring for __ has made me feel closer to him/her; I am able to comfort __ when he/she needs it; I feel confident I can handle most problems in caring for __; I feel useful in my relationship with __; I am committed to caring for __”. FACE pACP significantly increased positive caregiving appraisals at 3 months post-intervention, compared to controls, (β = 0.20, Confidence Interval = 0.03-0.37, p = 0.0189). No significant differences were found between groups for the subscales: burden, distress or family well-being. Conclusions: FACE pACP significantly increased positive caregiver appraisals compared to controls. The family caregiver’s role is critical for the well-being of teens with cancer. Findings identified positive aspects of caregiving in the context of pACP without increasing caregiver burden or distress. Clinical trial information: NCT02693665.

The positive and negative appraisals of caregiving (PANAC) scale: A new measure to examine the caregiving experience in Alzheimer's disease and related dementias.

IntroductionDementia caregiving is often examined as a monolithic experience describing the challenges caregivers face, exploring one construct at a time, with little research on the positive experiences of caregiving. To address this, we developed the Positive and Negative Appraisals of Caregiving (PANAC) scale.MethodsPANAC was validated in 253 patient‐caregiver dyads. Factor analyses revealed a two‐factor solution: Positive Appraisals (PAs) and Negative Appraisals (NAs). Psychometric properties were compared with patient and caregiver characteristics and outcomes, disease stage, and etiology.ResultsInternal consistency was good with Cronbach's alpha: 0.82 NA and 0.80 PA (P < 0.001). NA correlated with patient and caregiver characteristics, whereas PA correlated only with caregiver characteristics. The PA/NA ratio could be used to capture change due to an intervention.DiscussionThe PANAC scale is a useful measure of the overall caregiver experience accounting for negative and positive experiences and may be used to tailor support to individual caregivers.

USING A STRESS PROCESS MODEL TO EXAMINE RACIAL DIFFERENCES IN CAREGIVER WELL-BEING AND HEALTH

Current research must utilize nationally-representative samples of older adults and their family caregivers to accurately reflect the growing diversity of the United States. This study aims to use a stress process model to examine potential racial differences in caregiving in a population-based sample of 844 White and 389 Black family caregivers in the United States. We conducted 3 x 2 x 2 (relationship type x race x dementia care status) factorial ANOVAs to examine potential differences in caregiving stressors, appraisals, resources, and mental and physical health outcomes among primary family caregivers. Results indicated significant racial differences in caregiving on several stress process measures. Although Black caregivers reported more caregiving stressors, compared to White caregivers, they tended to report more positive appraisals of caregiving and more caregiving resources. Dementia caregivers tended to report greater caregiving stressors and worse measures of appraisal compared to non-dementia caregivers. There was a significant two-way interaction among relationship type and dementia care status for the caregiving stressor, hours of care. A stress process model can allow researchers to investigate various factors associated with racial differences in caregiving.

Organising Support for Carers of Stroke Survivors (OSCARSS): study protocol for a cluster randomised controlled trial, including health economic analysis

BackgroundStroke often results in chronic disability, with partners and family members taking on the role of informal caregiver. There is considerable uncertainty regarding how best to identify and address carers’ needs. The Carer Support Needs Assessment Tool (CSNAT) is a carer-led approach to individualised assessment and support for caregiving that may be beneficial in palliative care contexts. CSNAT includes an implementation toolkit. Through collaboration, including with service users, we adapted CSNAT for stroke and for use in a UK stroke specialist organisation providing long-term support. The main aims of OSCARSS are to investigate the clinical and cost-effectiveness of CSNAT-Stroke relative to current practice. This paper focuses on the trial protocol, with the embedded process evaluation reported separately.MethodsLongitudinal, multi-site, pragmatic, cluster randomised controlled trial with a health economic analysis. Clusters are UK services randomised to CSNAT-Stroke intervention or usual care, stratified by size of service. Eligible carer participants are: adults aged > 18 years; able to communicate in English; referred to participating clusters; and seen face-to-face at least once by the provider, for support. The ‘date seen’ for initial support denotes the start of intervention (or control) and carers are referred to the research team after this for study recruitment. Primary outcome is caregiver strain (FACQ - Strain) at three months after ‘date seen’. Secondary outcomes include: caregiver distress; positive caregiving appraisals (both FACQ subscales); Pound Carer Satisfaction with Services; mood (HADs); and health (EQ-5D5L) at three months. All outcomes are followed up at six months. Health economic analyses will use additional data on caregiver health service utilisation and informal care provision.DiscussionOSCARSS is open to recruitment at the time of article submission. Study findings will allow us to evaluate the clinical and cost-effectiveness of the CSNAT-Stroke intervention, directed at improving outcomes for informal carers of stroke survivors. Trial findings will be interpreted in the context of our embedded process evaluation including qualitative interviews with those who received and provided services as well as data on treatment fidelity. OSCARSS will contribute to knowledge of the unmet needs of informal stroke caregivers and inform future stroke service development.Trial registrationISRCTN Registry, ISRCTN58414120. Registered on 26 July 2016.

Caregiving for a Companion Animal Compared to a Family Member: Burden and Positive Experiences in Caregivers.

Introduction: Research in human caregiving shows burden is often present in the caregiver and can be reduced by interventions that increase positive perceptions of caregiving. Recent work suggests burden is also present in owners of a seriously ill companion animal. To help determine if findings from the human caregiving literature are likely to generalize to companion animal caregiving, we undertook a comparison of burden and positive aspects of caregiving in these groups.Material and Methods: Caregivers recruited through social media disease support and information groups completed self-report questionnaires of burden and positive aspects of caregiving in an online research protocol. Owners of a seriously ill companion animal (n = 117) and caregivers of a family member with dementia (n = 252) were cross-sectionally compared. Analyses in the full sample were repeated in a subset (n = 75 per group) of caregivers with blindly matched demographic profiles.Results: Burden was elevated in both dementia and companion animal caregiver groups, though higher overall for dementia caregivers (p < 0.001 for full and matched samples). In contrast, greater positive aspects of caregiving were reported by companion animal caregivers (p < 0.001 for full and matched samples). In both groups, positive aspects of caregiving were negatively associated with burden (full sample p < 0.001; matched sample p < 0.05). Exploratory item analyses suggested the two groups show comparable experiences of fearing the future, guilt, and financial strain (p = ns for full and matched sample).Discussion: Although both groups showed elevated burden, companion animal caregivers reported less burden and a more positive appraisal of caregiving. Elements of burden showing similarities across groups provide a foundation for understanding caregiver burden in the companion animal owner. The inverse correlation between positive aspects of caregiving and burden suggests the impact of positive caregiving experiences should be considered in burden interventions, but because companion animal owners already positively appraise caregiving, enhancing positive aspects of caregiving may not offset burden as it does in human caregiving samples.

Mediators of burden and depression in dementia family caregivers: Kinship differences.

To investigate kinship differences in the caregiver stress process by developing multiple mediation models for two distinct caregiver subgroups (spouses and adult children of older adults living with dementia). The effect of four potential mediating variables (mastery, self-efficacy, satisfaction with social support, positive caregiving appraisals) on the relationship between perceived burden and depression was evaluated. Family caregivers of a person living with dementia were recruited through national dementia and carer organisations. Participants completed a paper-based or electronic version of the study survey. A bias-corrected, accelerated bootstrapping method was used to test the effect of the four proposed mediating variables on the relationship between perceived burden and depression in each caregiver subgroup (spouses and adult children). Perceived burden was directly and significantly related to depression for both spouse caregivers and adult child caregivers. The mediation models explained approximately 50% of the variance in the burden-to-depression pathway for both caregiver subgroups. Mastery and social support (but not self-efficacy, nor positive caregiving appraisals) were found to individually significantly influence the impact of perceived burden on depression in spouse caregivers. All four proposed mediators failed to reach statistical significance as individual mediators of the burden-to-depression pathway in adult child caregivers. These findings demonstrate differences in the dementia caregiver experience according to kinship, and that certain mediating variables are more relevant for some subgroups of caregivers than others. Implications for the design of psychosocial interventions are discussed.

Caregiving Appraisal by Family Caregivers of Stroke Survivors in Nigeria.

Introduction: Attending to caregiving experiences of family caregivers of stroke survivors is important in person-centered stroke rehabilitation. This study explored caregiving appraisals by family caregivers of stroke survivors in Nigeria. Methods: A cross-sectional survey of family caregivers’ negative and positive appraisals of caregiving was conducted using the 24-item 4-domain revised Caregiving Appraisal Scale (rCAS). Mann Whitney U and Kruskal-Wallis tests were used to identify differences in caregiving appraisals based on specific caregiver and stroke survivor variables. Results: Seventy-three caregiver and care recipient dyads participated in the study. Mean age of the caregivers was 31.51 (9.82) years. From a score of 5, and higher scores depicting higher appraisal, mean (SD) score for caregiving satisfaction and caregiving mastery (positive appraisal domains) was 4.23 (0.97) and 4.04 (0.92) respectively while 2.29 (0.98) and 2.11 (0.93) were respectively recorded for caregiving burden and environmental impact (negative appraisal). Caregivers’ gender, age, and employment status resulted in significantly different appraisals with female caregivers having higher caregiving mastery (U = 446, P<0.05), caregiving satisfaction (U = 384.5, P<0.01), and also caregiving burden (U = 382.5, P<0.01) compared to their male counterparts; while older (U = 330; P<0.05) and employed (U = 437.5, P<0.05) family caregivers reported higher caregiving satisfaction and burden respectively than younger and unemployed family caregivers. Conclusion: Given the comparatively higher positive caregiving appraisal, and the documented benefits of positive caregiving appraisal, efforts should be geared towards identifying effective means of reinforcing positive appraisal, and reducing negative stroke caregiving appraisal, especially for female, older and employed family caregivers.

Changes in caregiving appraisal among family caregivers of persons with dementia: A longitudinal study over 12 months

The main purpose of this study was to identify changes in both caregiver burden and positive caregiving appraisal over time, as well as factors affecting these variables. This analysis included 41 in-home family caregivers who had completed questionnaires at baseline, 6 months, and 12 months. We assessed various caregiver and care recipient characteristics, caregivers' positive appraisal of caregiving, caregiver burden, desire to continue caregiving, severity of care recipients' cognitive impairment, and behavioural and psychological symptoms of dementia. We observed no significant differences in caregiver burden, positive caregiving appraisal, or behavioural and psychological symptoms of dementia across the three measurement times. However, we did find differences in the desire to continue caregiving and in the personal strain and role strain dimensions of caregiver burden. Overall, our study suggests that caregiving service providers should consider support that focuses on improving the subjective caregiving appraisals of caregivers.

The roles of unmet needs and formal support in the caregiving satisfaction and caregiving burden of family caregivers for persons with dementia.

The stress process model and a two-factor model were used as the conceptual framework for this study. Data for 320 family caregivers from a large cross-sectional survey, the Seoul Dementia Management study, were analyzed using structural equation modeling. In the hypothesized model, the exogenous variables were patient symptoms, including cognitive impairment, behavioral problems, and dependency on others to help with activities of daily living and with instrumental activities of daily living. The endogenous variables were the caregiver's perception of the unmet needs of the patient, formal support, caregiving satisfaction, and caregiving burden. The adjusted model explained the mediating effect of unmet needs on the relationship between patient symptoms or formal support and caregiving satisfaction. Formal support also had a mediating effect on the relationship between patient symptoms and unmet needs. Patient symptoms and caregiving satisfaction had a significant direct effect on caregiving burden. The level of unmet needs of persons with dementia and their family caregivers must be considered in the development of support programs focused on improving caregiving satisfaction.