Reduce Caregiver Stress Research Articles

Feasibility and perception of the impact from aerobic exercise in older adults with Alzheimer's disease.

The subjective experience of participating in aerobic exercise is unknown in Alzheimer's disease (AD). The purpose of this study was to understand the subjective perceptions of the feasibility and impact of a 6-month, moderate-intensity aerobic exercise intervention by older adults with AD and their family caregivers. Ten older adults with AD who completed the intervention and their family caregivers participated in four focus group interviews. Four converging themes were identified: "There was no perceived positive change in cognitive symptoms," "The 6-month exercise program was socially rewarding," "The 6-month exercise program increased physical strength," and "Participation in aerobic exercise was a positive experience." Family caregivers further identified two additional themes: "The exercise program led to improved attitude in older adults with AD" and "The exercise program reduced caregiver stress." Aerobic exercise is a feasible and well-perceived intervention for older adults with AD and their family caregivers.

P02.37. Mindfulness for caregivers

Purpose Caregivers have been shown to be at increased risk of emotional stress, depression, medical illness, and death. Studies of Mindfulness Based Stress Reduction (MBSR) have established its efficacy in reducing stress and physical and psychological concomitants of stress in multiple patient populations. The purpose of this study is to determine the effectiveness of MBSR in reducing caregiver stress, as measured by psychological and biological markers.

Exploring The Molecular Mechanisms Underlying The Efficacy of Mindfulness Based Stress Reduction In Alleviating Psychological Stress in Alzheimer's Disease Caregivers

Caregiving for a dementia patient is associated with an increased risk for emotional distress, depression, dementia, physical health problems and death. Targeting caregivers as the recipients of interventions may greatly improve patient care. Mindfulness Based Stress Reduction (MBSR) is a clinical intervention based on simple meditation practices which have been shown to reduce stress and improve chronic disease outcomes for many different psychological and medical problems. We explored the effectiveness of MBSR at reducing caregiver stress, as measured by psychological and biological markers. We found that MBSR is an effective means to improve the psychological health status of caregivers for dementia patients. Interestingly, we found some of our caregiver participants benefited from MBSR while others did not. Moreover, we identified multiple biomarkers for which contents in the circulating blood were correlated with psychological indices of stress reduction following MBSR and other biomarkers for which baseline blood contents prior to MBSR were predictive of the likelihood of positive response to MBSR. Our observations provide a window into the mechanisms underlying the health benefits of MBSR intervention and provide a logical basis for developing a personalized medicine approach for applying MBSR intervention to a diverse population of caregivers. Supported by discretionary funding to GMP

Stressors of Caregivers of School-Age Children With Epilepsy and Use of Community Resources

Childhood epilepsy causes multiple stressors, difficulty in adjustment, and disruptions in family relations. This study sought to identify stressors of caregivers of school-age children and to assess whether use of community resources alleviates or contributes to caregiver stress. Stressors refer to concern about the child, communication with healthcare providers, changes in family relationships, interaction with school, and support within the community. A caregiver refers to the person who had looked after the child for the past 6-12 months. Support groups, religious or worship groups, counseling services, and traditional and spiritual faith healers were the community resources that were addressed. Face-to-face interviews were conducted on a convenience sample of 46 caregivers. A three-part structured interview schedule was used to describe demographic data, stressors of caregivers, and use of community resources. The top 6 stressors were the inability to get antiepileptic drugs, the deep pain or sadness caused by the child's seizures, caregiving (which was predominantly by mothers), limited help from the extended family, inadequate information on side effects of drugs, and inadequate information on seizures. The most commonly used community resource was religious or worship groups, with epilepsy support groups being least used. To alleviate caregiver stress, it is important that healthcare providers routinely assess the effect of seizures on caregivers and refer those requiring counseling, advocate for more male and extended family involvement in caregiving and provide adequate information on side effects of drugs and on seizures as standard practice. Nurses in developed countries should incorporate religious activities among complementary and alternative medicine interventions to reduce caregiver stress. Spiritual faith healers should be encouraged to refer clients with epilepsy for drug therapy and counseling.

The Hospice Caregiver Support Project: Providing Support to Reduce Caregiver Stress

The vast majority (80%) of care provided to hospice patients is given by informal and unpaid caregivers, who are often family members. They may be responsible for everything from management of the household and finances to medical and personal care. Providing this kind of care to a loved one at the end of life can contribute to increased stress, health problems, and decreased quality of life. Hospice social workers referred caregivers identified as needing additional support into a special project that funded services not covered by hospice and that the family could not afford to purchase. There were no restrictions on the types of services that could be requested. The Pearlin role overload measure (ROM) was administered and the family selected a service provider from an approved list of agencies. Upon completion of the service period, the ROM was re-administered. Use of the hospice respite benefit by any hospice patient during this study was compared with use before the project began. Self-reported caregiver stress, as measured by the Pearlin ROM pre- and post-services, decreased by 52% (t(122) = 10.254; p < 0.0001). Use of the hospice respite benefit requested by any hospice patient caregiver decreased during the project period (χ(2), p < 0.02), and when respite was requested fewer days were used as compared with the same time period prior to the project (χ(2), p < 0.0043). The project results show that offering such services relieved caregiver stress, reduced use of respite, and reduced the number of respite days used.

Community Dementia Care Management

Community Dementia Care Management

Does High Caregiver Stress Predict Nursing Home Entry?

This study estimates how informal care, paid formal care, and caregiver stress or burden relate to nursing home placement. Data came from the 1999 National Long Term Care Survey and were merged with administrative data. Results show that stress is a strong predictor of entry over follow-up periods of up to two years, and physical strain and financial hardship are important predictors of high levels of caregiver stress. The estimates indicate that reducing these stress factors would significantly reduce caregiver stress and, as a result, nursing home entry. We conclude that initiatives to reduce caregiver stress hold promise as a strategy to avoid or defer nursing home entry.

Caregiver factors contributing to psychological elder abuse behavior in long-term care facilities: a structural equation model approach

Identification of caregiver risk factors associated with psychological elder abuse is crucial for preventing and managing such abuse. The aim of this study was to test the most effective model for explaining caregiver factors contributing to caregiver psychological abuse behavior. We hypothesized that caregiver hours worked each day, years of education, age, geriatric care-giving training, gerontological care knowledge, social resources, and self-reported work stress are factors contributing to psychological abuse behavior of caregivers. A cross-sectional study design was used. The sample included a total of 183 caregivers recruited from seven long-term care facilities in southern areas of Taiwan. Instruments included the Caregiver Psychological Elder Abuse Behavior (CPEAB) scale, the Work Stressors Inventory Chinese version (WSI-C), the Personal Resources Questionnaire (PRQ-2000), and Knowledge of Gerontological Nursing Scale (KGNS). The structural equation modeling (SEM) procedure was used to analyze the data. All the model-fit indexes (chi2 = 87.84, df = 70, p = 0.073; CMIN/DF = 1.26; GFI = 0.94, AGFI =0.91, TLI = 0.96, RMSEA = 0.037) of the final model exceeded their respective common acceptance levels except for the normed fit index (NFI) value (0.88). The study results suggest that caregivers who work fewer hours, received fewer years of education, lack social resources, and had more work stress showed higher levels of psychological abuse behavior in caring for the elderly (p = 0.000-0.037). These findings should be incorporated into practice by intervening to reduce caregiver stress and reduce elder abuse behaviors. To help reduce elder psychological abuse, caregivers would benefit from stress management and social resource interventions provided by employers or government programs.

A non-pharmacological intervention to manage behavioral and psychological symptoms of dementia and reduce caregiver distress: Design and methods of project ACT3

Project ACT is a randomized controlled trial designed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia (BPSD) and caregiver distress. The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances. All participants are interviewed at baseline, 4-months (main trial endpoint), and 6-months (maintenance). The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers (communication style, environmental clutter) contributing to behaviors, and instruct in strategies to reduce caregiver stress and manage targeted behaviors. To rule out infection or other potential medical contributors to behaviors, a nurse obtains blood and urine samples from the dementia patient, and conducts a medication review. Participants in the no-treatment control group are offered the nurse arm and one in-home session following trial completion at 6-months. This paper describes the research methods, theoretical and clinical aspects of this multi-component, targeted psycho-social treatment approach, and the measures used to evaluate quality of life improvements for persons with dementia and their families.

Caregiver preference for rivastigmine patches versus capsules for the treatment of Alzheimer disease

Alzheimer disease (AD) has a significant impact on caregivers. Administering and managing medications is one of their many daily tasks. More effective modes of drug administration may benefit patient and caregiver, and may improve compliance. A prospective outcome of the IDEAL (Investigation of TransDermal Exelon in ALzheimer's disease) trial was to evaluate caregiver preference for rivastigmine patches compared with capsules. The 24-week, randomized, double-blind, double-dummy, placebo- and active-controlled IDEAL trial investigated once-daily rivastigmine patches vs twice-daily capsules in moderate AD patients. Caregivers rated patch adhesion throughout. The AD Caregiver Preference Questionnaire (ADCPQ) assessed patch vs capsule from caregivers' perspective, based on expectations, preferences, and satisfaction with treatment. A total of 1,059 caregivers completed the ADCPQ while their respective patients were on study drug. More than 70% of caregivers preferred the patch to capsules overall. The patch was preferred to capsules with respect to ease of use (p < 0.0001) and ease of following the schedule (p < 0.0001). Caregivers indicated greater satisfaction overall (p < 0.0001) and less interference with daily life (p < 0.01) with the patch vs capsules. The preference substudy of the IDEAL trial demonstrated that caregivers of AD patients preferred patches to capsules for drug delivery. Preference for the patch may indicate reduced caregiver stress, substantiated by greater satisfaction and less interference with daily life. These benefits may lead to improved compliance.

Cognitive functioning under stress: evidence from informal caregivers of palliative patients.

Caring for a terminally ill family member can be extremely stressful, and stress is known to have a negative influence on aspects of cognition. In contrast to the well-known physical and mental health risks associated with caregiving, little is known about its impact on cognitive functioning. The primary objective of this study was to explore cognition among caregivers of palliative family members with a battery of neuropsychological tests. A secondary objective was to examine changes in cognition following caregiving by retesting a subset of participants at least 6 months after the death of their care recipient. While caregiving, 27 participants completed an assessment battery measuring attention, learning, and memory, as well as intelligence, mood, and general health; 22 participants completed this battery again post-caregiving. We compared caregivers' cognitive performance to healthy normative samples. Participants who were caring for palliative relatives exhibited significant impairments in attention, including difficulty monitoring their performance and regulating their attentional resources. In contrast, participants' episodic and working memory performance was not impaired while caregiving. A mixed pattern of improvement and worsening of cognitive functioning was evident among caregivers retested after their family member's death. In addition to the well-documented physical and mental health risks associated with caregiving, this study adds to a small body of literature demonstrating impaired cognitive functioning among family members providing end-of-life care. Secondary findings of both improvement and deterioration of cognition post caregiving provide tentative support for the possibility of reversing certain cognitive deficits by reducing caregiver stress.

379: Fly me to the moon

The care of the pediatric patient undergoing blood and marrow transplantation is complex and intense. Patients undergoing this type of treatment are often critically ill and many will succumb to their treatment or disease. Patients are often hospitalized for months and parents/caregivers are required to stay with them for the duration of the hospitalization. The stress and burden on both the caregiver and the nursing staff is immense. Numerous studies have now focused on caregiver burnout and compassion fatigue of staff caring for these children. Burnout and turnover rates of staff are often much higher than the National average. The Duke Pediatric Blood and Marrow Program has developed several programs to support caregivers and staff working in this environment. The team adheres to a primary nursing model. The primary nursing team provides continuity and consistency for both the child and family. Additional components for our support program include a Family Support Program and a highly trained social worker staff. The purpose of this abstract is to present the Duke Pediatric Blood and Marrow “Fly Me To The Moon Program”. This program was developed to supplement existing programs that support the emotional and psychosocial needs of the patient and nursing staff. The program incorporates basic principles including bereavement activities, nursing retention strategies and caregiver support. The goals of the program are to reduce caregiver stress and burnout and to support nurses caring for these patients. The presentation will be introduced with a slide show and music, specific tools and activities used in the program will then be discussed. The care of the pediatric patient undergoing blood and marrow transplantation is complex and intense. Patients undergoing this type of treatment are often critically ill and many will succumb to their treatment or disease. Patients are often hospitalized for months and parents/caregivers are required to stay with them for the duration of the hospitalization. The stress and burden on both the caregiver and the nursing staff is immense. Numerous studies have now focused on caregiver burnout and compassion fatigue of staff caring for these children. Burnout and turnover rates of staff are often much higher than the National average. The Duke Pediatric Blood and Marrow Program has developed several programs to support caregivers and staff working in this environment. The team adheres to a primary nursing model. The primary nursing team provides continuity and consistency for both the child and family. Additional components for our support program include a Family Support Program and a highly trained social worker staff. The purpose of this abstract is to present the Duke Pediatric Blood and Marrow “Fly Me To The Moon Program”. This program was developed to supplement existing programs that support the emotional and psychosocial needs of the patient and nursing staff. The program incorporates basic principles including bereavement activities, nursing retention strategies and caregiver support. The goals of the program are to reduce caregiver stress and burnout and to support nurses caring for these patients. The presentation will be introduced with a slide show and music, specific tools and activities used in the program will then be discussed.

Rivastigmine in Vascular Dementia

Vascular dementia (VaD), like Alzheimer's disease (AD), is associated with cholinergic deficits. Rivastigmine provides sustained, brain-selective inhibition of acetylcholinesterase and butyrylcholinesterase. Preliminary data suggest that rivastigmine may provide significant benefits in patients with AD and cerebrovascular disease (mixed dementia), and in patients with VaD. Open-label rivastigmine treatment has been associated with improved cognitive and functional abilities, behavioral symptoms, and reduced caregiver stress in a small pilot study in these patients. Larger, prospective, double-blind studies of rivastigmine in patients with VaD are under way. These studies will confirm whether rivastigmine is an efficacious treatment option for a range of patients for whom, until now, there have been few symptomatic therapies.

Rivastigmine in subcortical vascular dementia: An open 22-month study

Further to recent data indicating that patients with vascular dementia (VaD) show a cholinergic deficit, we aimed to determine whether rivastigmine, a dual inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), has any effects on the symptoms of VaD. Patients aged 65–80, with a diagnosis of dementia and probable VaD, received rivastigmine 3–6 mg/day ( n=8) or cardioaspirin ( n=8) in an open study for 22 months. At 22 months, patients treated with rivastigmine showed significant improvements in executive function and behavioural symptoms (both p<0.05 vs. both baseline and control group), which were reflected in reduced caregiver stress ( p<0.05 vs. baseline and controls). Baseline scores of global response, cognition, word fluency and activities of daily living were maintained in patients receiving rivastigmine, and there was no increase in benzodiazepine or neuroleptic intake. In contrast, the control group showed no improvements in any domain, and significant deterioration in global response and executive function (both p<0.05 vs. baseline and rivastigmine group). Side effects in both groups were tolerable and there were no study withdrawals. Long-term rivastigmine treatment appeared to be safe and effective in this patient population. In particular, improvements in domains particularly relevant to this condition were observed. These benefits may reflect the drug's dual inhibitory effects on the cholinergic system, and its particular activity in frontal areas of the brain. A large, double-blind study of rivastigmine in patients with VaD would be worthwhile.

Nutrition Education May Reduce Burden in Family Caregivers of Older Adults

The chronic, demanding nature of family caregiving for frail older adults creates a high degree of stress for caregivers, called caregiver burden. Caregiver burden compromises caregivers' emotional and physical health and health-promoting behaviors. Deterioration in caregivers' health and nutritional status may put caregivers at risk for chronic disease, diminish the ability of caregivers to provide care, and impair the quality of life experienced by caregivers and care recipients. Nutrition education may help reduce caregiver stress and maintain caregivers' health and well-being. Mediating caregiver stress may allow family caregivers to meet their societal role, which has intensified because of health care cost containment.

Behavioral Interventions and Families: A Medical Rehabilitation Perspective

Behavioral interventions are pertinent to many issues faced by medical rehabilitation patients and their families in late adulthood. Despite their utility in managing chronic illnesses and reducing problematic behaviors related to cognitive impairment, behavioral interventions can be difficult to implement and maintain in a family setting. Problems resulting from countercontrol, caregiver fatigue, conflicting priorities, and impact on family relationships must be anticipated and addressed. These issues are illustrated through references to pertinent research and case examples. Recommendations are offered to reduce caregiver stress and to minimize shifts in relationships when family caregivers act to alter a member's behavior.

Evolving Standards in Patient and Caregiver Support

It has become increasingly clear that family members and others have enormous potential to contribute positively to the care of the patient suffering from Alzheimer disease (AD). Various methods such as respite services and day care as well as counseling and support groups have been shown to reduce caregiver stress and burnout. Moreover, there are many areas in which the informed, trained caregiver can contribute positively to, and even lead, the interdisciplinary ongoing care of AD patients. For example, the caregiver can help with memory aids, behavioral interventions, the maintenance of exercise and nutrition, healthcare proxies and housing arrangements, decisions about intensity of treatment, and the timely implementation of palliative care approaches. Caregivers skilled in such matters will increase the quality of life of the AD patient and reduce their dependency. Many support services and educational activities are known to help caregivers and their patients, yet their availability is variable, and it is unclear whose responsibility it is to organize and finance them.

Comparing the Experiences of Black and White Caregivers of Dementia Patients

Caregivers' capacities to cope with dementia patients are severely challenged as demands for care and impairment levels concomitantly increase. Consequently, the experience can be extremely stressful because it affects many areas of the caregiver's life. Using a conceptual stress development model that treats informal supports and competency as potential mediators, the outcomes of caregiving were examined in samples of black and white caregivers. A perceived lack of informal supports and a sense of incompetency exacerbated stress among the black caregivers but had no effects among the white caregivers. White caregivers were predominantly affected by the impairment of the patient. Cultural differences in caregiver expectations that influence needs are proposed as an explanation for these findings. To be most effective in reducing caregiver stress, social workers must be sensitive to the diversity of values and expectations that can affect the experiences of these individuals.

Needs of family caregivers in chronic schizophrenia.

The goals of the study were to describe (1) the tasks undertaken by people who care for a relative with chronic schizophrenia, according to their level of contact with the patient; and (2) any needs for further help that these caregivers might experience. Interviews and standardized questionnaires were used to collect information from 121 family caregivers whose relatives had been diagnosed an average of 14 years previously. Burden in the sense of interference in caregivers' daily lives was most marked for caregivers in high contact with the patients. Patients whom the caregivers regarded as enjoyable to live with had greater self-care and communication skills. Caregivers preferred that patients low in these skills or high in disruptive behavior live in supervised settings. Caregivers expressed particular support for earlier professional intervention in episodes of illness, information about how to lobby politicians for resources, and information about schizophrenia. These results can be used to plan interventions to reduce caregiver stress.

Post-hospital support program for the frail elderly and their caregivers: a quasi-experimental evaluation.

This paper evaluates the Post-Hospital Support Program for the frail elderly and their caregivers using a quasi-experimental design. The program goals were to reduce stress in the caregivers, improve functioning and reduce mortality in patients, and reduce health service utilization in patients. Subjects were patients at the Johns Hopkins Hospital in Baltimore, Maryland, age 65 or over, who were returning home to the care of a non-paid caregiver and who had extensive post-hospital care needs which were expected to continue for at least one year. The 93 comparison group patient/caregiver pairs were discharged between May 15, 1983 and May 14, 1984. The 98 treatment group pairs were discharged between May 15, 1984 and May 14, 1985. Interviews were conducted with patients and caregivers at 1, 3, 6, 9, and 12 months after discharge. Results showed a slight reduction in caregiver stress and a substantial reduction in hospital days used by the treatment group. When confounding and history effects are taken into consideration, an average difference of 6.5 days per patients remains. The data also suggest that the treatment program may have postponed some deaths and nursing home placements. The results suggest that support services for the frail elderly and their caregivers can be cost efficient by reducing hospital length-of-stay. Savings were estimated at $4,585 per patient per year in this study. However, further work is needed to design programs which more effectively reduce caregiver stress.