Caregiver Social Support Research Articles

Caregiver reactions and social provisions among family members caring for home-dwelling patients with cancer in the palliative phase: A cross-sectional study

Objective: Studies focusing on the impact of caregiving for older adult home-dwelling patients with cancer in the palliative phase, particularly the burdens on different family caregiver groups, are limited. The objective of this study was to assess and compare caregiver reactions and social provisions among different family caregiver groups in Norway.Methods: The sample consisted of 58 family members caring for 26 home-dwelling older adult patients with advanced cancer. The Caregiver Reaction Assessment and Social Provisions Scale were used to assess the caregiver reactions and social support, respectively. The analyses were performed using descriptive statistics.Results: Significant differences were revealed between the family caregiver groups in the following three dimensions of the Caregiver Reaction Assessment: impact on schedule, lack of family support and impact on health. Significant differences were revealed between the family caregiver groups in the following two dimensions of the Social Provisions Scale: nurturance and attachment.Conclusions: In our study, children and children-in-law caring for widowed patients and spouses were the most vulnerable family caregivers. We recommend assessing the caregiver situation of all available family members caring for older adult patients with advanced cancer to identify the most vulnerable caregivers.

A systematic review of strategies to increase drinking-water access and consumption among 0- to 5-year-olds.

The objective of this study is to identify promising strategies for improving drinking-water access and consumption among children aged 0 to 5years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer-reviewed, full-text studies from high-income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5years. Twenty-five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non-randomized studies. To date, few high-quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5years.

The mediating roles of caregiver social support and self-efficacy on caregiver burden in Parkinson's disease

BackgroundMost studies in Parkinson's disease (PD) have focused on the direct effects of social support and self-efficacy on caregiver burden. This study aimed to test our prediction that caregiver self-efficacy and social support were two chaining mediator variables on the paths for patient factors affecting caregiver burden, caregiver anxiety, and depression. MethodWe enrolled patients with PD and their caregivers from the First Affiliated Hospital of Shanxi Medical University in China between July and December 2017. Patients completed scales evaluating their cognition, motor function, and depression. Caregivers completed scales evaluating social support, self-efficacy, anxiety, depression, and caregiver burden. We applied Partial Least Squares Structural Equation Modeling (PLS-SEM) to analyze the mediating effects. ResultsCaregiver self-efficacy was a partial mediator on the path of patient motor function effects on caregiver burden (Variance Accounted For, VAF = 0.741), caregiver anxiety (VAF = 0.498) and caregiver depression (VAF = 0.471). Social support for caregivers was a partial mediator on the path for patient motor function effects on caregiver self-efficacy (VAF = 0.247). Caregiver social support and self-efficacy were two chaining mediator variables on the pathway for patient motor function effects on caregiver burden (VAF = 0.768) and caregiver depression (VAF = 0.510). LimitationsOur sample only met the minimum sample size requirement for the PLS-SEM and we only focused on a part of variables we collected. ConclusionsOur prediction has been validated in this study. And this work supports the decision-making of health authorities and policymakers in managing caregiver social support and caregiver self-efficacy with the aim of reducing caregiver burden in PD.

The development of an instrument to identify cancer caregivers at risk for metabolic syndrome.

e23174 Background: Cancer caregivers are at increased risk for cardiovascular disease. The aims of the present study were to develop an instrument to identify cancer caregivers at risk for the development of cardiovascular disease. Methods: Cancer caregivers were enrolled in a prospective study examining predictors of metabolic syndrome. Predictors included perceived stress, caregiver stress, depression, hostility, physical activity, diet, alcohol and tobacco use, social support and relationship with the patient. Regression analyses and factor analyses was performed to reduce the number of items to develop an instrument that would identify cancer caregivers at risk for cardiovascular disease. Internal consistency and Area Under the Receiver Operator Curve was also performed to test the new instrument. Results: A total of 111 caregivers were included in the analyses. The mean age of caregivers was 59.6 ( SD= 12.7) and the majority of caregivers were female (74.8%), Caucasian (94.6%), and were the spouse of the cancer patient (65.8%).Using regression analyses, the items from the caregiver stress, hostility, and social support questionnaires were most likely to predict metabolic syndrome. Preliminary findings suggest that a 35-item instrument was predictive of metabolic syndrome [B = 0.067, HR = 1.07, p = 0.001]. The reliability of the instrument was good with a Cronbach Alpha = 0.83. The Area Under the Receiver Operator Curve was also fair (AUROC = 0.703; 95% CI = 0.597-0.808, p = 0.001). Based on the AUROC, the best cut point to detect metabolic syndrome would be a score of 24 (Sensitivity = 0.75 and Specificity = 0.55). Conclusions: Preliminary findings suggest that this 35-item questionnaire may be useful in identifying cancer caregivers at risk for metabolic syndrome, an intermediate endpoint for cardiovascular disease. The questionnaire may be used to screen cancer caregivers for interventions to reduce metabolic syndrome.

Dyadic associations between perceived social support and cancer patient and caregiver health: An actor-partner interdependence modeling approach.

Social support may have a positive impact on health outcomes for patients and caregivers, but the extent to which social support and health outcomes are interrelated for both is unknown. We examine the dyadic interrelationships between social support and health among cancer patients and their caregivers. Lung and colorectal cancer (CRC) patient and caregiver dyadic data were obtained from the Cancer Care Outcomes Research and Surveillance Consortium. Patients and caregivers self-reported sociodemographic, social support, and caregiving characteristics at 5 (n=218 lung; n=222 CRC) or 12months post-diagnosis (n=198 lung; n=290 CRC). Structural equation modeling was used to examine actor-partner interdependence models (APIM) of lung and CRC dyads at 5 and 12months post-diagnosis. At 5months post-diagnosis, no interdependence between patient and caregiver social support was detected for CRC or lung dyads (all P> 0.05). At 12months post diagnosis, no interdependence was detected for CRC dyads (all P>0.70); lung dyads showed complete interdependence, indicating patient social support is associated with better caregiver self-reported health (β=0.15, P<0.001), and caregiver social support is associated with better patient self-reported health (β=0.18, P<0.001). Social support has a positive impact on patient and caregiver perceived health across the cancer trajectory, and these effects may differ by cancer site and time. Future research and translational efforts are needed to identify effective ways to bolster both patient and caregiver social support and to determine critical moments for intervention.

Family caregiver satisfaction with inpatient rehabilitation care.

IntroductionInformal family caregivers play an increasingly important role in healthcare. Despite their role in ongoing management and coordination of care, caregiver satisfaction with the healthcare services care recipients receive has been understudied. We sought to assess what influences caregiver satisfaction with inpatient care provided to their care recipient among caregivers of veterans with traumatic brain injury (TBI) and polytrauma.MethodsData from the Family and Caregiver Experience Survey, a national survey of caregivers of veterans with TBI and polytrauma, was used to explore factors associated with caregiver satisfaction with the care his/her care recipient received while an inpatient at a US Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center. Caregiver and care recipient demographic and injury factors and potential addressable factors including social support, caregiver training received, and caregiver perceptions of being valued by the VA were evaluated for their associations with caregivers’ satisfaction with their care recipients’ healthcare.ResultsThe majority of the 524 caregivers reported being mostly or very satisfied with their care recipient’s inpatient care (75%, n = 393). Higher satisfaction with inpatient care was significantly associated with greater caregiver social support, receipt of training from the VA, and perceptions of being valued by the VA, both on univariate analysis and after controlling for care recipient TBI severity and caregiver’s relationship to the care recipient.ConclusionsResults suggest that supporting a strong social network for caregivers, providing caregiver training, and employing practices that communicate that family caregiving is valued by providers and healthcare organizations are promising avenues for improving caregiver satisfaction.

Caregiver socioemotional health as a determinant of child well-being in school-aged and adolescent Ugandan children with and without perinatal HIV exposure.

Caregiver socio-emotional attributes are major determinants of child well-being. This investigation in vulnerable school-aged Ugandan children estimates relationships between children's well-being and their caregiver's anxiety, depression and social support. Perinatally HIV-infected, HIV-exposed uninfected and HIV-unexposed Ugandan children and their caregivers were enrolled. Perinatal HIV status was determined by 18months of age using DNA-polymerase chain-reaction test; status was confirmed via HIV rapid diagnostic test when children were 6-18years old. Five indicators of child well-being (distress, hopelessness, positive future orientation, esteem and quality of life (QOL)) and caregivers' socioemotional status (depressive symptoms, anxiety and social support) were measured using validated, culturally adapted and translated instruments. Categories based on tertiles of each caregiver psychosocial indicator were defined. Linear regression analyses estimated percent differences (β) and corresponding 95% confidence intervals (CI) for child well-being in relation to caregiver's psychosocial status. As per tertile increment, caregiver anxiety was associated with 2.7% higher distress (95%CI:0.2%, 5.3%) and lower self-esteem/QOL (β=-1.3%/-2.6%; 95%CI: -5.0%,-0.2%) in their children. Child distress/hopelessness increased (β=3.3%/7.6%; 95%CI:0.4%, 14.7%) and self-esteem/QOL decreased 2.3% (β=-2.3%/-4.4%; 95%CI: -7.2%, -1.3%) as per tertile increment in caregiver depression. Higher caregiver social support was associated with lower distress and higher positive outlook (β=3%; 95%CI:1.4%, 4.5%) in their children. HIV-infected/exposed children had most caregiver depression-related QOL deficit (β=-5.2%/-6.8%; 95%CI: -12.4%, -0.2%) and HIV-unexposed children had most caregiver social support-related enhancements in positive outlook (β=4.5%; 95%CI:1.9%, 7.1%). Caregiver anxiety, depressive symptoms and low social support were associated with worse well-being in school-aged and adolescent children. Improvement of caregiver mental health and strengthening caregiver social support systems may be a viable strategy for improving well-being of vulnerable children and adolescents in this setting.

Status quo of burden on family caregivers of elderly patients with chronic obstructive pulmonary disease and its influencing factors

Objective To explore burden on family caregivers of elderly patients with chronic obstructive pulmonary disease (COPD) and to discuss the influencing factors of caregiver burden. Methods Totally 190 family caregivers of elderly COPD patients treated in a Class III Grade A hospital in a city between January and December 2017 were selected by convenient sampling. The caregiver burden of these elderly COPD patients were investigated with the general information questionnaire, Zarit Burden Interview (ZBI) and Social Support Rating Scale (SSRS) . Multiple linear regression analysis was used to analyze the influencing factors to caregiver burden. Results The total score of caregiver burden of elderly COPD patients was (52.32±7.42) , and the total score of social support was (25.23±5.93) . Multiple linear regression analysis showed that age, occupation, time of daily care, medical service availability and social support were the main influencing factors to caregiver burden (P<0.05) . Conclusions The caregiver burden of elderly COPD patients is at a medium level and is affected by multiple factors. More disease and nursing care related knowledge and information should be provided to the caregivers based on their actual conditions so as to improve the social support for caregivers as well as the caregivers' physiological and mental health and their quality of life. Key words: Aged; Pulmonary disease, chronic obstructive; Family caregivers; Burden; Influencing factors

Process evaluation of a social support platform ‘Inlife’ for caregivers of people with dementia

IntroductionInformal caregivers of persons with dementia have an increased risk of facing social isolation. Online social media interventions might offer a new opportunity to increase access to social support. An online social support platform, ‘Inlife’, was developed and launched in the Netherlands to enhance social support, positive interactions and information sharing in informal support networks. ObjectiveA process evaluation was performed to evaluate the internal and external validity of the Inlife intervention. MethodsImplementation, sampling and intervention quality were evaluated by both qualitative and quantitative methods. Analyses were performed using descriptive statistics and inductive content analysis. Analyses were conducted following participants' completion of the intervention after 16 weeks. ResultsThe overall participation rate in the study was 27% (96/351). The Inlife intervention was generally well-received by the primary caregivers. Inlife facilitated empowerment, openness, involvement, and efficient care organization. Still, adherence was not optimal for all Inlife users. Determinants for Inlife use were identified on the level of the Inlife innovation, the users, and the socio-political context. ConclusionsInlife was evaluated as a useful instrument for efficient central care coordination and mutual involvement. This study emphasizes that the personal attitudes of the Inlife users to seek and provide support warrant attention, next to the characteristics of the actual Inlife innovation for optimal intervention uptake. Online and offline support might be integrated to raise awareness of caregiver social support needs and attitudes and provide insight into caregivers' available social capital. Trial registrationDutch trial register NTR6131, Registered on 20 October 2016.

Psychosocial Factors Related to Adverse Outcomes in Caregivers of Heart Failure Patients: A Structural Equation Modeling Analysis

Background HF caregivers often experience caregiving burden, impacting their physical and psychological well-being. Social support and social problem-solving, as coping resources, may influence the effect of caregiving burden on self-care, depressive symptoms, and quality of life. Yet, studies examining these coping resources on HF caregiver outcomes are lacking. Purpose To investigate whether social support and social problem-solving mediate the relationships among caregiving burden, self-care, depressive symptoms, and quality of life in HF caregivers. Methods Using a descriptive, cross-sectional, correlational design, HF caregivers (n=530) completed online surveys, including the Dutch Objective Burden Inventory, the Interpersonal Support Evaluation List-12, the Social Problem-Solving Inventory Revised-Short, the Center for Epidemiological Studies - Depression scale, the Denyes Self-care Practice Instrument, and the Bakas Caregiving Outcomes Scale. Path analytic methods were used to examine a hypothesized mediating role of social support and social problem solving in the relationships between caregiving burden and caregiver self-care, depressive symptoms, and quality of life. The analysis proceeded in two phases: 1) a model-development phase with ∼62% of the sample (n=329) used to make data-based decisions on measurement indicators and structure of the path model; and 2) a confirmatory phase with ∼38% of the sample (n=201) used to provide unbiased inference on the model structure resulting from the initial phase. Results Participants were 41.39 (± 10.38) years old, Caucasian (78.3%), men (50.9%) caring for their spouse with HF (44.9%). Perceived caregiver burden was a predictor of caregiver social support (standardized effect B= -.4), self-care (Total B= -.39), depressive symptoms (Total B= .45), and quality of life (Total B= -.33). Higher level of caregiver burden was associated with less social support, worse self-care, more depression and decreased quality of life. Social support mediated the relationship between caregiving burden and depression (56% of Total effect), but did not appear to relevantly mediate the relationship between caregiving burden and self-care (11% of Total effect) or quality of life (0% of Total effect). When considered simultaneously with social support, social problem-solving was not a relevant mediator between caregiving burden and outcomes. Conclusions Caregiving burden negatively impacts caregiver outcomes. Social support appears more beneficial in mediating the effects of caregiving burden on depression, but has little mediational effect on caregiver self-care or quality of life.

Caregiver burden in Alzheimer's disease: Moderation effects of social support and mediation effects of positive aspects of caregiving.

Although there are many studies on the relationship between patient-related factors and negative caregiver outcomes, the specifics of this relationship are poorly understood. We aimed to examine whether caregiver social support moderated the relationship between patient factors and negative outcomes for caregivers of community-dwelling older adults with Alzheimer's disease (AD), and whether positive aspects of caregiving mediated this relationship. We conducted a cross-sectional study of patients diagnosed with AD from 2 hospitals and 3 communities in Taiyuan, China, and their caregivers. Latent moderated structural equations and the bias-corrected percentile bootstrap method were used to estimate the parameters of moderating and mediating effects, respectively. Social support significantly moderated the effects of AD patient cognitive function (P<0.001) and depression (P=0.001) on caregiver burden. Positive aspects of caregiving completely mediated the association between patient depression and caregiver burden (P=0.006), caregiver anxiety (P=0.007), and caregiver depression (P=0.034). The findings identify social support as a moderator and positive aspects of caregiving as a mediator of the relationship between patient-related factors and negative caregiver outcomes. The results suggest that health care providers must offer more effective social support for caregivers. In addition, prompt identification of patient and caregiver emotional states could help to improve quality of life.

Social support and subjective burden in caregivers of adults and older adults: A meta-analysis.

BackgroundDespite the generally accepted belief that social support improves caregiver adjustment in general and subjective burden in particular, the literature shows mixed findings, and a recent review concluded that the predictive strength of caregiver social support in determining caregiver burden is less evident, due to the conceptual diversity of this determinant.ObjectiveThe purpose of this review is to analyse the relationship of perceived and received social support with subjective burden among informal caregivers of an adult or older adult.MethodsA systematic search was carried out up to September 2017 in the following databases: MEDLINE (PubMed), CINAHL, EMBASE, PsycINFO), Scopus and ISI Proceedings, and a meta-analysis was performed with the results of the selected and included studies.ResultsFifty-six studies were included in the meta-analysis, which provided 46 independent comparisons for perceived support and 16 for received support. Most of these studies were cross-sectional. There was a moderate, negative association of perceived social support on subjective burden (r = -0.36; CI 95% = -0.40, -0.32) and a very small, negative association of received support on subjective burden (r = -0.05; CI 95% = -0.095, -0.001).Conclusions1) perceived and received support are not redundant constructs, 2) the relationships between social support and subjective burden depend on whether the social support is measured as perceived or received, 3) the relationship of perceived social support with subjective burden has a bigger effect size than that of received social support, the relation between received support and subjective burden being clinically irrelevant, 4) perceived social support may be a good predictor of subjective burden.Implications of key findingsOur findings broadly support interventions promoting social support in caregivers to prevent or alleviate subjective burden, and specifically, to intervene on the promotion of perceived social support more than on the promotion of received social support when preventing or alleviating burden.

Caregiver social support quality when interacting with cancer survivors: advancing the dual-process model of supportive communication.

Cancer caregivers often experience significant challenges in their motivation and ability to comfort cancer survivors, particularly in a spousal or romantic context. Spousal cancer caregivers have been known to report even greater levels of burden and distress than cancer sufferers, yet still take on the role of acting as an informal caregiver so they can attend to their partner's needs. The current study tested whether a theoretical model of supportive outcomes-the dual-process model of supportive communication-explained variations in cancer caregivers' motivation and ability to create high-quality support messages. The study also tested whether participant engagement with reflective journaling on supportive acts was associated with increased motivation or ability to generate high-quality support messages. Based upon the dual-process model, we posited that, following supportive journaling tasks, caregivers of spouses currently managing a cancer experience would report greater motivation but also greater difficulty in generating high-quality support messages, while individuals caring for a patient in remission would report lower motivation but greater ability to create high-quality support messages. Findings provided support for these assertions and suggested that reflective journaling tasks might be a useful tool for improving remission caregivers' ability to provide high-quality social support to survivors. Corresponding theoretical and applied implications are discussed.

End-of-Life Caregiver Social Support Activation: The Roles of Hospice Clinicians and Professionals.

Caregivers of those with life-limiting illness face many complicated tasks, including providing direct patient care, communicating with professionals, and managing the logistical demands of daily activities. To assist with caregiving responsibilities, caregivers require social support from social network members at all points in the illness process. This study analyzes themes from interviews with 61 caregivers of patients enrolled in hospice services to identify the types of support caregivers mobilize from new social network members for social support during the end-of-life care process. Themes indicate that caregivers receive accessible, immediate, caregiver-centered emotional support from hospice health care professionals, and situationally tailored, understandable informational support from other types of professionals. In addition, caregivers received overlapping emotional and informational support from hospice health care professionals. Findings enhance the understanding of how caregivers receive tailored emotional and informational support.

Psychological Distress Among Caregivers of Individuals With a Diagnosis of Schizophrenia or Schizoaffective Disorder.

The aim was to quantify caregiver distress among informal caregivers of individuals with schizophrenia or schizoaffective disorder and identify its correlates. From December 2014 through April 2015, ads posted with mental health advocates and the media recruited informal caregivers, age ≥21 years, to complete an online questionnaire. It included the ten-item Perceived Stress Scale (PSS) (0, no distress; 39, highest) and hypothesized distress correlates in four groups: caregiver and care recipient characteristics; caregiver role demands; caregiver social supports; and caregiver cognitive appraisals of caregiving. Three hypotheses were tested: first, distress is significantly related to variables from each group; second, social supports moderate the effects of role demands on distress; and third, cognitive appraisals mediate the effects of role demands on distress. Hypotheses were tested with multiple linear regression equations and structural equation models (SEMs). Of 2,338 Web site "hits," 1,708 individuals consented, 1,398 were eligible, and 1,142 had complete data. Most caregivers were women (83%), white (89%), and college educated (59%), with a mean±SD age of 55.6±13.0. Compared with U.S. norms on the PSS (13.4±6.5), mean caregiver distress was high (18.9±7.1). According to SEMs, variables from each group were associated with distress. Contributing most to greater distress were caregiver health problems, providing frequent caregiving assistance, monitoring medication, having limited social support, and appraising caregiving negatively. Cognitive appraisals mediated the effects of demands on distress. Social support had a significant direct effect only. Caregiver distress was relatively high and related to multiple variables, some of which are potentially modifiable.

Psychosocial Needs and Facilitators of Mothers Caring for Children with Duchenne/Becker Muscular Dystrophy.

Care guidelines for Duchenne/Becker muscular dystrophy (DBMD) include recommendations for assessment of caregivers of patients with DBMD followed by proactive psychosocial interventions. To inform clinical assessment, this study described appraisals of psychosocial needs and caregiving facilitators of mothers of individuals with DBMD. Two hundred and five mothers completed an online survey. More than 50% endorsed unmet needs for managing uncertainty about the future and managing DBMD fears. Higher levels of unmet need were associated with less disease progression/earlier stage of DBMD (rho=-0.166 p=0.02). Twenty-one percent regularly used respite care and 57% worried about allowing others to care for their child. Highly-endorsed care facilitators included partner relationships (63%), child's approach to life (59%), and family relationships (49%). Our findings highlight the importance of psychological and social support for caregivers. Starting when children are young, clinicians should assess caregivers' unmet psychological needs, particularly uncertainty and fear. Exploring needs and facilitators may allow clinics to target and customize interventions that build upon existing strengths and supports. Our findings have implications for efforts to promote early diagnosis and newborn screening, in that increased needs in mothers of younger children should be anticipated and built into counseling. Further research can assess whether and how unmet needs change as new therapies become available.

Perceptions of Social Support as Experienced by Caregivers of Children With Special Needs

Abstract Date Presented 3/30/2017 Perceived social support of caregivers of a child with special needs was analyzed through use of the Medical Outcomes Study Social Support Survey. Results indicate that education level, employment status, marital status, and location of residence impact social support, broadening the scope of practice in occupational therapy. Primary Author and Speaker: Sarah Polito Additional Authors and Speakers: Kerri Golden

Policy and advocacy for informal caregivers: How state policy influenced a community initiative

With a growing proportion of elderly in the global population, the role of 'informal caregivers' gains importance. Informal caregivers are unpaid family members or friends who provide assistance to home-dwelling adults with health-related needs or limitations. Internationally, informal caregivers provide important medical support to those with a variety of diseases. While informal caregivers will remain vital to the growing aging population's pursuit of healthy aging, they often suffer from 'caregiver burnout,' a state of physical, emotional, and mental exhaustion caused by their caregiving work. Policy and legislation are needed to diminish the burden on caregivers and to help assure that resources are allocated for these caregivers. We describe an initiative aimed at providing appropriate social support for caregivers by partnering among local organizations, hospitals, and health authorities.

El efecto del envejecimiento para la carga de cáncer en Colombia: proyecciones para las primeras cinco localizaciones por departamento y sexo en Colombia, 2020 y 2050

ObjectiveTo demonstrate the effect of demographic changes envisaged by the Economic Commission for Latin America and the Caribbean (ECLAC) on the burden of cancer in Colombia. MethodThe number of new cases of cancer was established in the top five locations in patients>15 years-old, using the incidence rates of cancer for each Department, Bogotá, and the Amazonas group, estimated by the National Cancer Institute of Colombia and the population projections for 2020 by the National Administrative Department of Statistics (NADS), and 2050 by ECLAC. ResultsThe number of these new cases could increase by 28% in men and 25% in women by 2020, but by 2050 the increase would be 58% in both sexes. The disease in these locations would be concentrated much more in people over 65 in 2050, from 62% to 75% in men and 33% to 53% in women. More than three-quarters of them would be prostate, stomach, and lung cancer in men, and in women breast, cervical and colorectal cancer in most Departments of the country. ConclusionsIt is necessary to reflect on the construction of public policy on cancer health care, by measuring, comparing and disseminating the results of prevention and timely detection by health providers. Reflection is also required on the diagnostic and treatment services available in all regions and in the meaning of cancer care in the elderly, palliative care at all levels with a focus on public health, and social support for caregivers.

Abstract TMP40: Sociodemographic Predictors of Return to Home after Inpatient Stroke Rehabilitation

Background: Interpersonal relationships are understudied components of the stroke treatment paradigm, which become important when patients require long-term care. In this study, we analyzed sociodemographic factors that impact return to home after inpatient rehabilitation (IR). Methods: Stroke patients were identified by ICD9/10 code from a prospective multicenter rehabilitation registry between Jan 2005 &amp; July 2016 (n=6447). Patients were analyzed based upon "Home" vs "Not Home" or "Married" vs "Not Married" groups. Descriptive statistics were provided for all patients. Marital status was used as a proxy for caregiver support. We hypothesized that increased discharge functional independence measure (FIM), ambulation and no insurance predicted return to home. A “return home model” was developed using multivariable regression with a stepwise approach. Odds ratio &amp; 95% CI were calculated. Results: 5378 patients returned Home, 1069 did not return Home. Home patients tended to be younger, married, ambulatory and minorities, with a discharge FIM&gt;75 (p&lt;0.0001). Aphasia, dysphagia and UTI were significantly higher in the “Not Home” group (p&lt;0.0001). Married patients had more stroke risk factors and impairments, indicating increased caregiver needs (Figure). In the model, being a minority and being a woman increased the odds of returning home. Advancing age, being widowed, divorced, separated or never married decreased the odds of returning home. We confirmed that ambulation, increasing discharge FIM and no insurance predicted return to home (Figure). Conclusions: Being married, a woman or a minority increases the odds of returning home after inpatient rehabilitation. Caregiver training and social support for unmarried and male patients are important areas of improvement. Strategies to ensure the successful transition of stroke rehabilitation patients to home are needed, including prospective studies of non-spousal caregiver support.