Positive Aspects Of Caregiving Research Articles

Communicating visit information to family caregivers: How does method matter? A national survey.

The clinic visit is a critical point of contact for family caregivers. However, only 37% of family caregivers are able to accompany patients to visits. When they cannot attend, caregivers receive visit information to assist with their caregiving. However, little is known about how method of receiving information from clinic visits is associated with important caregiver outcomes. This study sought to determine whether mode of receiving clinic visit information (speaking with the patient, attending the visit, or using an after-visit summary [AVS]) was associated with changes in caregiver burden, caregiver preparedness, and the positive aspects of caregiving. Cross-sectional web-based survey of a national sample of adult family caregivers. Multiple linear regression models determined associations between communication modes and caregivers' burden, preparedness, and positive aspects of caregiving, adjusting for sociodemographic covariates. Respondents (N = 340) were mostly male (58%), White (59%), ranged from 18 to 85 years old, and supported patients with conditions including diabetes, dementia, and cancer. Speaking with patients was associated with increases in positive aspects of caregiving (95% CI = 2.01, 5.42) and an AVS was associated with increases in positive aspects of caregiving (95% CI = 0.4, 3.56) and preparedness for caregiving (95% CI = 0.61, 3.15). Using any method of receiving information from visits was associated with the greatest increase in preparedness, compared to not receiving visit information. We did not observe an association between method of communication and caregiver burden. Method of communicating visit information is associated with improvements in caregiver preparedness and the positive aspects of caregiving, though caregiver burden may be unaffected by information exchange. Given the limitations of current communication methods, future work should explore directionality of the associations we found and identify visit communication strategies with caregivers that optimize caregiver and patient outcomes.

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.

Mapping the Caregiver Experience in a Canadian Province: Research Methodology for the Saskatchewan Caregiver Experience Study.

Policies and services for older adults are increasingly focused on living in the community, rather than relying on institutions. A total of 70-80% of community care for older adults is provided by family and friend caregivers. With Canada's aging population, the number of caregivers to older adults is growing. The purpose of this paper is to describe the research methodology that was employed in the Saskatchewan Caregiver Experience Study. The methodology was used to map the experiences and gather perspectives of caregivers in Saskatchewan and to identify their priority support needs. Qualitative description was the approach in this study. An online qualitative survey was administered via SurveyMonkey and distributed via Facebook and community newsletters. The survey collected caregiver demographics and asked three open-ended questions regarding: (1) the challenges that caregivers experience; (2) the positive aspects of caregiving; and (3) the support needs and priorities of Saskatchewan caregivers. A fourth question where caregivers could freely express any other experiences or perspectives was included. Content analysis was the method used for data analysis. 355 individuals met the inclusion criteria for this study. Participants were evenly distributed amongst urban-large, urban-small/medium, and rural settings in Saskatchewan. The average age of caregivers and care recipients were 61 and 83 respectively. This study has implications for research, practice, and policy. By gathering the full spectrum of the caregiver experience in Saskatchewan, this study can help to inform how communities, governments, and our healthcare system can best support caregivers in their role.

The feasibility of a sleep education program for informal dementia care dyads: A pilot randomized controlled trial.

Untreated sleep problems in both persons living with dementia (PLWD) and their family care partners (CP) impact their health and quality of life. This pilot study tested a sleep intervention program for both dyad members. Thirty dyads were randomized to a 5-session Care2Sleep intervention (n = 15 dyads) or an information-only control group (n = 15 dyads) delivered in-person or by video-telehealth by trained sleep educators. Care2Sleep is a manual-based program, incorporating key components of cognitive behavioral therapy for insomnia, daily light exposure and walking, and problem-solving for dementia-related behaviors. Adherence with Care2Sleep recommendations was assessed. Sleep outcomes included actigraphy-measured sleep efficiency (SE) and total wake time (TWT) for dyads, and the Pittsburgh Sleep Quality Index (PSQI) for CP. Other outcomes for CP included the Zarit Burden Interview (ZBI) and positive aspects of caregiving (PAC). Outcomes were measured at baseline, posttreatment, and 3-month follow-up. A 2 (group) by 3 (time) mixed model analysis of variance tested treatment effects. Study feasibility was demonstrated, with 13 dyads completing all five sessions of Care2Sleep program and 14 completing the control condition. In the Care2Sleep group, the dyads adhered to recommended sleep schedules of 76% for bedtime and 72% for get-up time for PLWD, and 69% for bedtime and 67% for get-up time for CP. There were several nonsignificant trends in outcomes from baseline to 3-month follow-up between the two groups. For example, SE increased by 3.2% more for PLWD and 3.2% more for CP with Care2Sleep versus control. TWT decreased by 14 min more for PLWD and 12 min more for CP with Care2Sleep versus control at the 3-month follow-up. CP in Care2Sleep also showed improvement in the PSQI, ZBI, and PAC scores. A dyadic approach to sleep improvement is feasible. Larger trials are needed to test effects of this intervention for PLWD and their family CP. gov: NCT03455569.

Translation and cultural adaptation of the Positive Aspects of Caregiving Scale for caregivers of people living with dementia in Brazilian context: a methodological study.

The Positive Aspects of Caregiving (PAC) scale is used to assess psychosocial benefits provided to caregivers by the task of caring. The PAC scale consists of nine items, assessed using a five-point Likert scale, with higher values indicating greater positive perceptions and gains from the caregiving experience. To translate and culturally adapt the PAC scale for informal Brazilian caregivers of people with dementia. A methodological study was conducted at the Federal University of São Carlos. The following stages were carried out: Translation; Synthesis of the translations; Back-translation; Evaluation by an experts' committee; and Pre-test. Two independent professionals translated the PAC scale. The consensus version was obtained by merging both translations, which were back-translated into English by a third translator. The expert committee comprised three specialists in the area and project researchers. All scale items presented a Content Validity Index of 1 (CVI = 1.0), and thus remained in the pre-final version of the instrument. The instrument was pre-tested with seven caregivers of people with dementia, the majority of whom were women (57.1%), with a degree of kinship corresponding to sons/daughters (57.1%) and an average age of 55.2 (± 4.1) years. The caregivers considered it clear and understandable and made no suggestions for changes. The PAC scale was translated and culturally adapted for use by informal caregivers of people with dementia in Brazil. However, a psychometric analysis of the instrument is necessary to provide normative data for this population group.

SUPPORTING CHINESE FAMILY CAREGIVERS OF RELATIVES WITH DEMENTIA——A PILOT INTERVENTION STUDY IN SHANGHAI

Abstract Background Effective interventions are urgently needed to assist dementia family caregivers in China, where limited formal support and services are available. This pilot study aims to test a psychoeducational program that consists of information, skills training, and the use of binaural sound through the Processing Inner Strength toward Actualization Therapy (PISTA) device to alleviate caregiver burden and improve mental health outcomes. Methods Single subject design approach was used. Eight dementia family caregivers in Shanghai, China, were recruited and received a two-stage intervention over 12 weeks: Stage 1 (S1, Six 90-minute weekly sessions: Psychosocial education programs +PISTA) and Stage 2 (S2, Six 90-minute weekly sessions: Psychosocial education only). Caregiver outcomes, including caregiving burden, anxiety, depression, and positive aspects of caregiving (PAC), were assessed through established scales. Paired t-tests and visual analyses were used to compare outcome levels and trends between stages. Results Seven participants completed the entire study, and 1 participant dropped out during S2. Participants showed a decrease in caregiver burden, anxiety, and depression and an increase in PAC during S1. A similar trend was observed during S2 on burden, anxiety, and PAC outcomes, except for depression. Furthermore, the decrease in burden and anxiety scores and the increase in PAC scores were less salient during S2 than during S1, suggesting more effects were observed in S1 with PISTA. Conclusion Evidence is promising that psychoeducational programs combined with PISTA can lead to better psychological outcomes for dementia family caregivers. Findings need to be affirmed in future investigations using an experimental design.

SOCIAL NETWORK AND CAREGIVING EXPERIENCE AMONG SPOUSE AND ADULT-CHILD DEMENTIA CAREGIVERS: A MEDIATION ANALYSIS

Abstract Evidence on differences in social network and their roles in associations between types of family caregivers and caregiving experience is limited. Based on the stress process model (SPM), we aimed to explore the different levels and interactions of social network and caregiving experience among spouses and adult-child caregivers. A questionnaire-based survey was conducted on a total of 146 dementia family caregivers (78 adult-child, and 68 spouses) in China. Data collection comprised four sections: (a) care-related stressors, (b) caregivers’ context, (c) social network using Lubben social network scale, and caregiving experience using short-form Zarit burden interview, and nine-item positive aspects of caregiving (PAC) scale. Linear regression, mediation model analysis, and interactive analysis were performed to explore associations between variables. Spouses experienced lower social network (β= -0.294, P=0.008) and higher PAC (β= 0.234, P=0.003) than adult-child caregivers, whereas no significant difference was found in caregiver burden between two groups. Mediation analysis suggested that associations between caregiver type and caregiver burden were indirect-only mediation effects by social network(β=0.140, 95%CI=0.066 to 0.228). The mediation effect of social network on caregiver type and PAC was the suppressing effect, and the interaction effect was significant (P for interaction =0.025). A higher social network was associated with higher positive aspects of caregiving among the spouse subgroup (β= 0.341, P=0.003). Social networks mediate responses to caregiving experiences among different care provider types and are vital intervention targets, especially for spousal caregivers. Our results can serve as references for identifying caregivers for clinical intervention.

FAMILY MATTERS: CROSS-CULTURAL DIFFERENCES IN FAMILISM AND CAREGIVING OUTCOMES

Abstract The increasing number of minority older adults and subsequent increase in minority individuals needed to provide care highlights the need to understand how the caregiving role is experienced and perceived among racial/ethnic minority groups. Familism, a cross-cultural collectivist value, has been examined as a driving mechanism influencing differential outcomes in family caregivers. However, research examining familism in caregiving has yielded mixed results. Guided by the Sociocultural Stress and Coping Model, the purpose of this study is to examine cross-cultural differences in familism and its influence on caregiving outcomes. Baseline data were collected from 243 family caregivers who participated in the Caring for the Caregiver Network randomized controlled trial, a culturally tailored technology-based psychosocial intervention. Results showed that familism was more highly endorsed by Hispanic and African American participants, when compared to Whites, which was subsequently associated with positive aspects of caregiving, depression, and burden. Exploratory analyses among the Hispanic subgroup were conducted to examine how acculturation, operationalized as number of years living in the US, influences familism and found that a longer length of time spent in the US was negatively associated with familism. When dividing our sample into U.S. natives versus non-natives, non-native Hispanic participants reported higher familism compared to natives. Findings indicate that cross-cultural differences in caregiving appraisals may operate as a function of cultural values, which influence one’s subjective evaluation of the caregiving role and contribute to more optimal outcomes – highlighting the need for culturally congruent interventions to promote positive caregiving outcomes particularly among racial/ethnic minorities.

EFFECT OF SELF-GUIDED INTERVENTIONS ON MENTAL HEALTH OF INFORMAL DEMENTIA CAREGIVERS: A SYSTEMATIC REVIEW

Abstract Informal caregivers of people living with dementia often experience emotional and mental distress due to the demands of caregiving. Self-guided interventions aimed at improving the mental health of these caregivers have emerged, but their effectiveness remains understudied. We systematically examined the effects of self-guided interventions on stress, burden, and mental health of informal caregivers of people living with dementia. PubMed, CINAHL, PsycINFO, Scopus, and Embase databases were searched using relevant search terms for the study aims. Included articles focused on informal caregivers of people living with dementia and self-guided interventions to improve psychological or mental health. Sixteen articles and 1,182 samples were included in this review. Self-guided interventions covered topics on caregiving skills, emotional self-care, and/or information on social or financial resources related to caregiving. Outcomes of each study included stress, burden, depressive symptoms, anxiety, distress, quality of life, self-efficacy, positive aspects of caregiving, and loneliness. Depressive symptoms and burden were the most frequently measured outcomes. Stress was generally reduced after the interventions, whereas the results of burden and mental health from each intervention were inconsistent. Interventions lasting shorter than three months were more likely to be effective compared to longer interventions. Self-guided interventions may be useful for improving mental health of informal caregivers of people living with dementia due to its low time burden, ease-to-access, and affordability. Future research is needed to determine the optimal length and components of self-guided interventions and to collaborate with clinicians for wider distribution to informal caregivers of people living with dementia.

EXAMINING THE PRELIMINARY EFFECTIVENESS OF THE SENIOR COMPANION PROGRAM PLUS FOR AFRICAN AMERICAN CAREGIVERS

Abstract Objectives A culturally informed, peer-led, lay provider model, the Senior Companion Program (SCP) Plus, was implemented to decrease caregiving burden/stress and improve coping skills, and social support for African American ADRD caregivers. This study reported the preliminary effectiveness of this intervention. Methods An explanatory sequential mixed methods design was used in this study and a randomized control trial was conducted for the SCP Plus intervention among participants in three sites (N = 20). A sub-sample of participants (n = 7) consented to a qualitative interview about their experiences with the intervention. The Wilcoxon signed-rank tests, Friedman tests, and one-way repeated measures ANOVA were conducted for quantitative analyses. Thematic analysis was used for the qualitative interviews. Results Results demonstrated that knowledge of AD/dementia (KAD) and preparedness for caregiving were significantly improved for all senior companions in the intervention group. Results also showed that caregivers in the intervention group reported significantly decreased caregiving burden, as well as increased KAD, satisfaction with social support, and positive aspects of caregiving. Themes from the qualitative interviews included: learning new skills about caregiving, gaining knowledge about ADRD, and benefits for the dyad. Discussions: Findings from this study implied that SCP Plus was a promising model for African American family caregivers as it benefits both the SC volunteers and the African American ADRD family caregivers.

Factors Associated With Dementia‐Related Behaviors Among Caregivers Experiencing Poor Sleep

AbstractBackgroundNeuropsychiatric symptoms of dementia are common and have the potential to negatively impact the physical and mental health of family caregivers, hindering their ability to provide care. Such impact may be worse among caregivers experiencing poor sleep. This study aimed to explore factors associated with the frequency of and caregivers’ distress to dementia‐related problematic behaviors.MethodThis was a cross‐sectional study, using data from a clinical trial of dyadic sleep intervention for persons living with dementia (PLWD) and their family caregivers. Dementia‐related behaviors were measured using a 24‐item, Revised Memory and Behavioral Problems Checklist (RMBPC): total scores of frequencies and caregivers’ distress; scores for three subscales (memory‐related, depression, and disruptive behaviors). Caregiver‐related variables included demographic background, Zarit Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), Pittsburgh Sleep Quality Index (PSQI), and Center for Epidemiological Studies of Depression (CESD). Patient‐related variables included activities of daily living (ADLs), instrumental ADLs (IADLs), and Mini‐Mental State Examination (MMSE) scores. A total of 47 dyads were included in the analysis (caregivers: n = 29 spouses, n = 17 non‐spouses; 40% Whites). Pearson correlation analyses were conducted.ResultHigher ZBI and CESD scores were significantly associated with higher RMBPC frequency total (r = 0.41, r = 0.48, respectively; p<0.01) and caregiver distress total scores (r = 0.58, r = 0.43, respectively; p<0.01). Lower PAC (r = ‐0.31, p = 0.04) and higher MMSE scores (r = 0.37, p = 0.03) were also associated with higher caregiver distress total scores. ZBI and CESD scores were associated with RMBPC‐depression subscale scores (frequency/caregiver distress). There were positive associations between CESD and MMSE with RMBPC‐disruptive behaviors (frequency), and ZBI and PAC scores with RMBPC‐disruptive behaviors (caregiver distress). No patient or caregiver‐related factors were associated with RMBPC‐memory subscale scores. There was no significant association between PSQI scores and RMBPC total/subscale scores. Patient factors were not significantly associated with RMBPC frequency total or caregiver distress total scores.ConclusionDementia‐related problems, particularly depressive symptoms and disruptive behaviors of PLWD are associated with both positive and negative aspects of caregiving. Future studies will need to further examine how each RMBPC subscale of behavior contributes to caregiver burden or perceived caregiving experiences among family caregivers.

PEOPLE NEED PEOPLE: A MIXED METHODS STUDY OF COMPANION CAREGIVERS

Abstract Researchers have found positive aspects of caregiving (PAC) for both formal and informal caregivers, including social connection and sense of purpose. However, few have explored the experience of a novel source of helping individuals age in place: companion caregivers (CC), that is someone who is paid for providing companionship and assistance with everyday tasks that are non-medical. We conducted a descriptive mixed methods study to understand the experience of being a CC. Sixteen CCs who completed 10+ caregiving visits participated in semi-structured interviews and related questionnaires in 2023. Quantitative and qualitative data on CC’s perceptions of the impact of caregiving on their own whole health domains (physical, mental, social, purpose) were analyzed. In addition we examined CC’s perceptions of care recipients’ (CR) unmet social needs, risks in the home, and barriers to CRs achieving improved health domains. Among the cohort, the average age was 53, 63% White, and 31% lived alone. Majority of CCs indicated that they always feel a sense of belonging when with their CRs (n=15) and felt better about themselves after interacting with CRs (n=16). Common PAC across whole health domains emerged, including increased physical activity, improved social connection, and helping others improve CCs’ lives. Common barriers to CRs’ improving their whole health included: decreased social connection, physical limitations, and transportation insecurity. These insights highlight potential benefits for those who might engage in companion caregiving arrangements. More research is needed as new models of caregiving are necessary to meet the demands of our aging population.

Evaluation of the instrument protocol to verify the effects of the iSupport‐Brasil program for caregivers of people living with dementia

AbstractBackgroundThe World Health Organization (WHO) developed iSupport, an online, psychoeducational program for informal caregivers who assist someone who lives with dementia. The iSupport program is being adapted for use in many countries, and in Brazil, we now need to evaluate the effects of this program. However, there are no Brazilian versions of instruments needed to evaluate some of the expected outcomes (self‐efficacy, mastery, and positive aspects of caregiving) and there are no online versions of the instruments. The objective of this study was to evaluate an online protocol to evaluate the effects of the iSupport program, in Brazil.MethodAn online data‐collection form was developed for use in Brazil, based on the protocol suggested by the WHO and considering protocols being used in other countries. Caregivers who were eligible for using the program were accompanied while completing this protocol, to identify their doubts and difficulties. There were seven participants, in two subgroups, so issues identified by one group could be resolved before testing the protocol with the next. Problems were discussed in research team meetings, and solutions were developed.ResultCaregivers indicated problems that resulted in the exclusion of instruments that had similar objectives, the modification of response alternatives to better reflect the diversity of people who are informal caregivers, and wording changes to improve the clarity of instructions or items.ConclusionThis study was important for maximizing the acceptability of the protocol and the usability of the response form we developed for evaluating the Brazilian version of the iSupport program. Thus, community participation in the development of research protocols should help maximize participation rates and the validity of the information gathered, which, in this case, involves the mental health and wellbeing of informal caregivers who assist people living with dementia. Furthermore, this process enabled us to work on cultural and format adaptations of the instruments needed for evaluating the effects of the iSupport‐Brasil program, so that our protocol will be aligned with those being used in other countries to evaluate the effects of the iSupport program.

Randomized controlled trial of iSupport: Comparison across seven countries

AbstractBackgroundWorld Health Organization (WHO) has developed iSupport for Dementia carers, an online program that aims to improve caregivers’ knowledge and skills, reduce emotional distress and improve the quality of life for both person with dementia and their caregivers. The program has been translated and culturally adapted in 33 countries and randomized controlled trials (RCTs) have been and are being conducted to evaluate effectiveness in Australia and Greater China, Brazil, India, the Netherlands, Portugal, the UK and Japan. We aim to compare and review RCTs protocols and key findings in those countries.MethodProtocols of seven RCTs evaluating the clinical and cost effectiveness of iSupport, and available outcomes data were reviewed and compared.ResultDelivery methods varied across countries ranging from caregivers’ self‐study using iSupport manual to a multicomponent intervention that engaged caregivers in iSupport and provided concomitant support from peers and facilitators. Control conditions also varied allocating the participants to either a waiting list or a control intervention. Sample sizes were between 42 to 390. Data were collected at three time‐points: baseline, three and six or nine months post baseline. The primary outcome was one or a combination of burden, depression, anxiety, health‐related quality of life, and stress. Secondary outcomes included depression, anxiety, quality of life, care recipient outcomes, positive aspects of caregiving, person‐centered attitude, self‐efficacy, mastery, resilience and dementia knowledge. In India, significant improvement was only seen in caregivers' person‐centered attitude towards persons with dementia in the iSupport group. Findings from interim data analysis in Australia and Greater China indicate that the iSupport group significantly improved the mental health component of quality of life, self‐efficacy, and reactions to care recipients’ memory and behavioural problems. The retention rate at 3 months were 36.42% in India, 82% in the UK, 85% in Australia and Greater China and 90.1% in Japan (interim analysis).ConclusionSome of the RCTs are still ongoing and results are expected soon. Preliminary data suggest that iSupport could be beneficial for both caregivers and recipients.

Burden and positive aspects of caregiving: cluster profiles of dementia caregiving experiences

Objectives Although caregiver burden is common in the context of dementia caregiving, the caregiving role is linked to beneficial outcomes too. Individuals reporting higher positive aspects of caregiving tend to exhibit lower burden relative to those reporting few. The goal of this retrospective review of outpatient memory clinic medical records was to demonstrate whether and how constructs of burden and positive aspects of caregiving coexist within individual caregivers, and to explore potential contributors to caregiver profiles created based upon these constructs. Method Cluster analyses were conducted on 1160 caregivers from an initial intake interview meeting criteria on primary measures of Positive Aspects of Caregiving and the Zarit Burden Interview and repeated with 225 caregivers meeting inclusion criteria on all measures. Samples were compared for similarity, and the smaller sample (n = 225) was deemed appropriately representative. Multinomial logistic regressions examined cluster predictors in sample with 225 caregivers. Results Results suggested a three-cluster solution: a High Burden group, a High Positive Experiences group, and a Low-Moderate Experiences group showing low burden and moderate positive experiences. Greater behavioral problems predicted belonging to the High Burden cluster. Greater care recipient dependence predicted belonging to the High Positive Experiences cluster while greater independence predicted the Low-Moderate Experiences cluster. Conclusion Findings suggest that burden and positive aspects of caregiving do not simultaneously present in caregivers at high levels. Supportive caregiver interventions might be tailored to profiles demonstrated here. Future research should investigate other potential contributors to experiences of burden and positive aspects of caregiving.

Self-efficacy for controlling upsetting thoughts and positive appraisals of stressors relate to caregiving competence in female family carers

Family carers have high rates of stress, anxiety and depression, but there are also positive aspects of caregiving. The aim of this study is to explore correlates of caregiving competence, a positive aspect of caregiving, in 146 female family carers. Regression analyses identify that self-efficacy for controlling upsetting thoughts, caregiver preparedness and self-reassurance were significantly related to caregiving competence, after controlling for contextual variables. These findings indicate that mental health practitioners working with family carers should target positive psychosocial mechanisms, along with factors directly related to the caregiving situation, to enhance carer well-being and promote sustainable care.

55 The Indirect Effect of Positive Aspects of Caregiving on the Relationship between Dementia Severity and Caregiver Burden

Objective:Caregiver burden tends to worsen as severity of dementia increases, and elevated burden can lead to negative consequences for dementia caregivers. In contrast, positive aspects of caregiving, such as feelings of being useful, needed, or appreciated as a caregiver, are associated with better outcomes. Caregivers reporting fewer positive experiences robustly demonstrate greater burden, suggesting that a lack of positive aspects of caregiving could be a key component of the relationship between dementia severity and burden. This study investigated whether an indirect effect of positive aspects of caregiving would be observed on the association between dementia severity and burden.Participants and Methods:Data were extracted from the medical records of 724 patients enrolled for services at an outpatient memory clinic. Caregiver-care recipient dyads were included based on a clinically supported patient diagnosis on the dementia spectrum following a comprehensive geriatric evaluation and having fully completed assessments from an informal caregiver. Caregivers completed the Zarit Burden Interview (ZBI) and the Positive Aspects of Caregiving (PAC) measures. The Montreal Cognitive Assessment and Mini-Mental State Exam were used to estimate dementia severity, standardized to create a single variable. Multiple potential covariates (e.g., age, gender, education, nature of dyadic relationship) were considered for inclusion in the model. A cross-sectional mediation analysis using the Hayes PROCESS macro explored presence of an indirect effect of PAC on the relationship between dementia severity and ZBI using 5000 bootstrap samples.Results:Of the proposed covariates, only caregiver age was correlated with any of the primary variables; this variable was controlled in subsequent analyses. Significant relationships emerged between dementia severity and ZBI (r=-.12, p<.001), between PAC and ZBI (r=-.23, p<.001), and between dementia severity and PAC (r=-.07, p<.05). An indirect effect of positive aspects of caregiving on the relationship between dementia severity and ZBI was statistically significant (B= .0092, BC 95% CI [.0008, .0185]), accounting for 14.4% of the variance in the model.Conclusions:A small but significant indirect effect of positive aspects of caregiving was observed on the association between dementia severity and burden. Results suggest that as dementia severity worsens, a caregiver who experiences greater positive aspects of caregiving will sustain less burden. Longitudinal examination of these relationships is needed to fully understand causality. Findings may help healthcare providers tailor treatment to alleviate caregiver burden.

Effectiveness of the Stress Process Model-Based Program in Dementia Caregiving (DeCare-SPM) for Family Caregivers: A Study Protocol for a Randomized Controlled Trial.

This paper aims to describe a randomized controlled trial protocol evaluating the effectiveness, cost, and process of a stress process model-based program in dementia caregiving (DeCare-SPM) for family caregivers. Family caregivers of individuals with dementia will be recruited from memory clinics and community settings and randomly assigned to either DeCare-SPM or usual care. DeCare-SPM comprises three face-to-face sessions (ie, problem-based coping, emotion-based coping, meaning-based coping), and a fourth session (ie, social support) including weekly telephone-based consultation for four weeks and then monthly face-to-face boosters. Outcomes will be measured at baseline (T0), and at one (T1), three (T2), and six months (T3). The primary outcome is positive aspects of caregiving and secondary outcomes are caregiving (ie, sense of competence, caregiver burden, social support, anxiety, depression, and quality of life), dementia-related (ie, care dependency, neuropsychiatric symptoms, and quality of life), and stress-related biomarkers of blood and saliva. In addition, process and economic evaluations will be performed. Mixed-effects models will be used to assess intervention effects. Content analysis will be performed on the qualitative data. This paper described the protocol for comprehensive evaluation of the effectiveness, cost, and process of the theory-driven DeCare-SPM to inform how and why interventions work. It highlights the need to reduce challenges and enhance the positive aspects of dementia care. The DeCare-SPM will provide evidence-based insights into how to support and empower family caregivers in their important roles, thereby, leading to improved dementia care.

A - 55 Boosting Positive Emotion in Caregivers: Moderators of a Positive Psychological Intervention.

There are numerous negative health effects associated with dementia caregiving, including increased stress and depression. Positive emotion interventions could improve health and psychological outcomes for caregivers. The present study was a secondary analysis of data from the Life Enhancing Activities for Family Caregivers (LEAF) trial (R01NR014435). LEAF is an evidence-based intervention designed to increase positive emotion in caregivers. Using multiple linear regression, data from the LEAF trial (n = 170 community-dwelling caregivers) were examined to identify which caregiver characteristics moderated LEAF outcomes (positive emotion, negative emotion, positive aspects of caregiving) over time. Length of time caregiving significantly moderated the effect of positive emotion from baseline to post-intervention, such that longer-term caregivers in the LEAF intervention group experienced greater increases in positive emotion compared to longer-term caregivers in the emotion-reporting waitlist control group (B = 0.119, t = 2.1, p < 0.05). Moreover, gender moderated positive emotion, such that males in the intervention group and females in the waitlist control group experienced greater increases in positive emotion over time than males in the waitlist control group and females in the intervention group, respectively (R2 = 0.06, F[3, 139] = [2.75], p = <0.05). No other effects were found. Results suggest that length of time caregiving and gender play an important role in the extent to which dementia caregivers benefit from positive emotion interventions. This study assists in identifying caregivers for whom positive emotion interventions work best, suggests ways that the intervention should be tailored to match caregiver characteristics, and targets outcomes most impacted according to caregivers' individual differences.

Feasibility and Efficacy of Life Review Delivered by Virtually-Trained Family Caregivers.

Due to the high prevalence of depressive symptoms and Alzheimer's disease and related dementias in older Americans (≥65 years), we developed a six-week depression intervention, Caregiver-Provided Life Review (C-PLR) for care recipients (CRs) with early-stage dementia and mild depression. The objective of the study was to examine the feasibility and efficacy of C-PLR delivered by virtually-trained caregivers (CGs) on CRs who live with dementia and depression in community and long-term care settings (N = 25 CG-CR dyads). We used fidelity scores as a measure of CG's feasibility to provide C-PLR. We collected the pre- and post-measures on CRs' depression (primary outcome), life satisfaction, CGs' burden, positive aspects of caregiving, and CG-CR relationship quality (secondary outcomes) and compared them using paired t-tests. We evaluated if the effect differed by race/ethnicity, residential setting, or living alone. The average fidelity check-in score was 14.8±0.78 indicating high feasibility. CGs were 52 years old (mean), 88% female, 64% working, 72% college-educated, and 72% in good-excellent health. CRs were 81 years old (mean), 84% female, and 56% in poor-fair health. CRs' depression significantly improved (p < 0.001), and this effect was found in CRs who were Asian (p = 0.017), White (p = 0.040), community-dwelling (p < 0.001), lived alone (p = 0.045), or with others (p = 0.002). This study demonstrated that the C-PLR can be successfully taught to CGs virtually and is effective in reducing CR's depressive symptoms. C-PLR could be implemented more broadly to improve symptoms among CRs in community and residential settings, as well as among a diverse population of CRs.