Spousal Caregivers Research Articles

Telehealth Support for Dementia Caregivers During the COVID-19 Pandemic: Lessons Learned From the NYU Family Support Program

ObjectivesIn response to the needs of dementia caregivers during the COVID-19 pandemic, the NYU Langone Alzheimer's Disease and Related Disorders Family Support Program (FSP) quickly transitioned to providing most services online. To understand how dementia caregivers experienced FSP services after the switch to video telehealth, we conducted qualitative interviews of spouse or partner dementia caregivers. ParticipantsTen participants were recruited from a convenience sample of dementia spouse or partner caregivers who used one or more online FSP services offered during the pandemic. DesignCaregivers engaged in semi-structured interviews held via videoconference between May and June 2020. Qualitative analysis of interviews was conducted according to the principles of framework analysis. ResultsCaregivers reported high satisfaction with the FSP pre-pandemic and continued to feel supported when services were provided online. They transitioned to video telehealth services with little difficulty. ConclusionsWhile video telehealth is frequently cited as beneficial for those in rural communities, socioeconomically disadvantaged groups, or homebound individuals, our findings suggest that video telehealth is also advantageous for dementia caregivers, given their unique barriers, including lack of time due to caregiving responsibilities, lack of respite care for the person with dementia, and the additional burdens of travel time to access in-person services.

Predictors of discharge from the VA Caregiver Support Program.

The Department of Veterans Affairs (VA) Program of Comprehensive Assistance for Family Caregivers (PCAFC) is a clinical program providing training, a monthly stipend, and other services to caregivers of qualifying post-9/11 veterans with service-related injuries. Veteran-caregiver discharge from the program occurs when veteran recovery is achieved, participation is no longer in the veteran's best interest, or caregiving ceases. Public scrutiny about potentially inappropriate discharges resulted in a nationwide freeze on all discharges. PCAFC expanded to pre-9/11 veterans in October 2020; thus, lessons learned can continue to inform the expanded program. We pursued 3 objectives: (1) describe the discharge rate, reasons for discharge, and veteran and caregiver characteristics by discharge status; (2) identify factors associated with discharge from PCAFC nationally; and (3) characterize network variation in discharge predictors. Retrospective observational study using VA administrative data from fiscal year (FY) 2011 to FY 2017. Using multivariable Cox proportional hazards regression, we examined factors associated with PCAFC discharge among veterans and caregivers enrolled in PCAFC during FY 2011 to FY 2016. A total of 40.5% of all participants were discharged. Nonspouse caregivers and those applying in later years had the highest rates of discharge; spouse caregivers and those applying in earlier years had the lowest rates of discharge. In 4 of 18 networks, caregivers of Black veterans faced higher rates of discharge compared with caregivers of White veterans, and in 1 network, they faced lower rates of discharge. Substantial variability in rates of discharge was also observed across Veterans Integrated Service Networks. Training on clinically appropriate discharge criteria could improve practice and increase equity.

The impact of care-recipient relationship type on health-related quality of life in community-dwelling older adults with dementia and their informal caregivers.

To assess whether there was an association between care-recipient relationship type and health-related quality of life (HRQL) of older persons living with dementia (PLWD) and their informal caregivers, and whether this association was affected by PLWD' dementia severity. This was a secondary data analysis study. PLWD (n = 1230) and caregivers (n = 1871) were identified from participants in the National Health and Aging Trends Study (NHATS) Round 5 and the National Study of Caregiving (NSOC) II, respectively. A series of bivariate and multivariable regression models examined the associations among relationship type and HRQL in PLWD and caregivers, adjusted for socio-demographic variables and dementia severity. PLWD and caregivers' HRQL outcomes varied by relationship type. PLWD cared for by an adult-child caregiver, or multiple caregivers experienced higher functional limitations than those cared for by a spousal caregiver (β = .79, CI [.39, 1.19]; β = .50, CI [.17, .82], respectively). "Other" caregivers, such as extended family members or friends, had lower odds of experiencing negative emotional burden and social strain than spousal caregivers (β = .79, CI [.39, 1.19]; β = .50, CI [.17, .82], respectively). Lower odds of experiencing negative emotional burden were also found with multiple caregivers. The effect of an adult-child caregiver on social strain was no longer significant when the dementia severity of PLWD was included in the analysis. The type of care-recipient relationship impacts the HRQL in both PLWD and their informal caregivers. Dementia severity of the PLWD appears to affect this association.

Gendering of care and care inequalities in couple therapy.

Reciprocal partner or spousal caregiving in romantic relationships has been identified as a key determinant of the quality of couple relationships. In this article, we interrogate this premise concerning the presumed reciprocity of caregiving in romantic relationships, focusing on cisgender heterosexual relationships and offering implications for relationships of all genders and sexualities. Looking beyond the conventional focus on individual or dyadic processes, we theorize imbalances in care as gendered. Feminists have repeatedly critiqued gender ideology that devalues caring labor and allocates it to women. Gendered power dynamics can lead to imbalances in care-seeking and care provision. We discuss how the gendering of care and care inequalities can manifest in couple therapy, illustrating with examples from recorded interactions. Implications for therapy practice are discussed.

State-level Medicaid 1915(c) home and community-based services waiver support for caregivers

BackgroundInformal caregivers encounter emotional distress, worsening personal health, and financial strain. The Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver programs provide an array of services including support for caregivers. PurposeThis policy analysis examined Medicaid waiver services offered to persons 65 and older among the 50 states and District of Columbia (DC). MethodsData were obtained from Medicaid waiver applications for adults age 65 and older available at Medicaid.gov. Data elements included number of waiver programs and services for supporting caregivers. Descriptive statistics were applied. FindingsForty-three states including DC (84%) offered a Medicaid waiver for older adults; seven states (14%) offer two waiver programs; eight states (16%) had no Medicaid waiver. Payment to a relative or legal guardian caregiver was the most common service offered in 39 (76%) states. Other services included in-home respite care and adult day health care (35 states; 67%), out-of-home respite care (32 states; 63%), skilled nursing (28 states; 55%), paid spousal caregivers (18 states; 35%), caregiver training (15 states; 29%), and adult day care for socialization (7 states, 14%). DiscussionThis study identifies wide variability in caregiver support across state-based Medicaid waivers. Future research should evaluate effectiveness of the waiver programs in supporting caregivers and inform evidence-based policy advocacy for supporting caregivers.

Course and predictors of psychological distress among colorectal cancer survivors with ostomies: A longitudinal study.

To examined the course and predictors of psychological distress among colorectal cancer survivors with ostomies. 131 survivors were considered in this longitudinal study. Participants were measured at first month (T1), third month (T2), and sixth month (T3) post-operation. Psychological distress, peristomal skin complications and stomal complications were measured. All participants' sociodemographic data were collected one day before discharge. ANOVA with repeated measures was used to compare the course of psychological distress. Generalized Estimating Equations were used to determine the predictors. The prevalence of mild to severe psychological distress in colorectal cancer survivors undergoing colostomy at T1, T2 and T3 was 96.94%, 88.55%, and 29.77%，respectively. The difference of psychological distress in survivors with ostomies at T1, T2 and T3 was statistically significant (F=603.310, P<0.001). Higher level psychological distress was generally differentiated by no religious belief, spouse caregiver, first and third month after ostomy, permanent enterostomy, peristomal skin complications and stomal complications. Survivors generally experience psychological distress, especially at first and third month after surgery. A multidisciplinary collaborative group comprised of Wound, Ostomy, and Continence/Enterostomal Therapy nurses and doctors, as well as psychological counselors, peer educators, and other participants, should be formed to conduct continuous assessments and management of psychological distress. Permanent enterostomies at first and third month after surgery, with spouse caregiver and no religious belief, with peristomal skin complications and stomal complications were being a priority for targeted attention.

Caregiving subsidies and spousal early retirement intentions

AbstractBalancing caregiving duties and employment can be both financially and emotionally burdensome, especially when care is provided to a spouse at home. Caregiving subsidies can play a role in helping caregivers to cope with such duties. This paper demonstrates how providing financial respite for caregivers can influence individuals' decisions to retire early. We investigate the impact of a reform that extended long-term care (LTC) benefits (in the form of subsidies and supports) on the intention of a caregiving spouse to retire early in Spain. We subsequently examine the effect of austerity spending cuts reducing such publicly funded benefits, and we compare the estimates to the effects of an early retirement reform among private sector workers around the same time. Our preferred estimates suggest evidence of a 10pp reduction in early retirement intentions after the extension of LTC benefits even though the effect is heterogeneous by type of benefit. Consistently, austerity spending cuts in benefits are found to weaken retirement intentions. Even more importantly, our estimates suggest that cuts in caregiving subsidies exert a much stronger effect on early retirement intentions than actual early retirement reforms.

Behavioral Change Factors and Retention in Web-Based Interventions for Informal Caregivers of People Living With Dementia: Scoping Review.

BackgroundWeb-based interventions aimed at supporting informal caregivers of people living with dementia have the potential to improve caregivers’ well-being and psychological health. However, few interventions are widely implemented for this population, and none of the prior reviews have systematically examined the use of behavior change techniques (BCTs), theories, and agents in web-based interventions for informal caregivers of people living with dementia. To better understand this implementation gap, we reviewed the literature to map behavioral factors (BCTs, theories, and agents) deployed in the studies. Furthermore, because there is an emerging consensus that retention could be shaped by participant characteristics and behavioral factors, we explored relationships between these features and retention rates across studies.ObjectiveWe pursued 3 objectives: to map behavioral factors involved in the web-based interventions for informal caregivers of people living with dementia; to examine the relationship between behavioral change elements and retention in the studies; and to examine the relationship between participant characteristics (gender, age, and spouse or adult children caregiver proportion) and study retention.MethodsWe conducted a literature review using the following keywords and their corresponding Medical Subject Headings terms: dementia, caregivers, and web-based intervention. The time limits were January 1998 to March 2022. Using the BCTv1 taxonomy, which specifies active behavioral components in interventions, 2 coders collected, summarized, and analyzed the frequency distributions of BCTs. Similarly, they abstracted and analyzed participant characteristics, behavior change theories, behavior change agents, and retention rates in the studies.ResultsThe average age was 61.5 (SD 7.4) years, and the average proportion of spousal informal caregivers, adult children informal caregivers, and retention rates were 51.2% (SD 24.8%), 44.8% (SD 22%), and 70.4% (SD 17%), respectively. Only 53% (17/32) of the studies used behavior change theories, but 81% (26/32) included behavior change agents. The most common BCTv1 clusters were shaping knowledge and social support. The median number of BCTv1 clusters was 5 (IQR 3). We observed a negative correlation between the proportion of spousal informal caregivers and the retention rate (r=−0.45; P=.02) and between the number of BCTv1 clusters and retention rates (r=−0.47; P=.01). We also found that the proportion of adult children informal caregivers in the study was significantly and positively correlated with the retention rate (r=0.5; P=.03). No other participant characteristics or behavioral factors were associated with retention rates.ConclusionsWe found that almost half of the studies were not informed by behavior change theories. In addition, spousal involvement and a higher number of BCTs were each associated with lower retention rates, while the involvement of adult children caregivers in the study was associated with higher retention. In planning future studies, researchers should consider matching participant characteristics with their intended intervention as the alignment might improve their retention rates.

"Living Well" Trajectories Among Family Caregivers of People With Mild-to-Moderate Dementia in the IDEAL Cohort.

ObjectivesUnderstanding whether and how caregivers’ capability to “live well” changes over time, and the factors associated with change, could help target effective caregiver support.MethodsWe analyzed 3 time points (12 months apart) of Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort data from coresident spouse caregivers of community-dwelling individuals who had mild-to-moderate dementia at baseline, using latent growth and growth mixture models. Capability to “live well” was derived from measures of quality of life, well-being, and satisfaction with life.ResultsData from 995 spouse caregivers at Time 1, 780 at Time 2, and 601 at Time 3 were included. The mean “living well” score decreased slightly over time. We identified 3 classes of caregivers: one with higher baseline scores declining slightly over time (Stable; 66.8%), one with low baseline scores remaining stable (Lower Stable; 26.0%), and one with higher baseline scores showing marked decline (Declining; 7.2%). Scores on baseline measures differentiated the Lower Stable, but not the Declining, from the Stable class. Longitudinally, the Declining class was associated with care recipient cognitive decline and increasing hours providing care, as well as caregiver stress and depression. Findings were similar when caregivers with other kin relationships were included.DiscussionThe findings indicate the importance of prompt identification of, and support for, caregivers at risk of the declining capability to “live well” and may assist in identifying those caregivers who could benefit most from targeted support.

Effect of Perceived Stress on Health-Related Quality of Life among Primary Caregiving Spouses of Patients with Severe Dementia: The Mediating Role of Depression and Sleep Quality.

Recently, there has been a rise in the number of spouses becoming primary caregivers to patients with dementia. This study identifies the mediating effects of depression and sleep quality on the relationship between perceived stress and health-related quality of life (HRQoL) among primary caregiving spouses of patients with severe dementia through a secondary data analysis of the 2018 Korea Community Health Survey by the Korea Disease Control and Prevention Agency. Data from 229 primary caregiving spouses of patients with severe dementia were analyzed using descriptive statistics, Spearman’s rank correlation or Pearson’s correlation analysis, and the lavaan R package, version 0.6-9. The association between perceived stress status (PSS) and the European Quality of Life Five Dimension (EQ-5D) index was highly significant. The direct effect of PSS observed in the model was nullified with both the Patient Health Questionnaire-9 and the Pittsburgh Sleep Quality Index as mediators, which implies that they mediate the effect of PSS on caregivers’ EQ-5D indexes. The mediation model accounted for 33.2% of the variance in the EQ-5D index of caregivers. The results suggest the need to develop an intervention to improve sleep quality and manage depression to mitigate a decline in HRQoL for these caregivers.

Factors influencing the burden on spousal caregivers of breast cancer survivors.

PurposeTo examine the status of spouses’ burdens of caring for breast cancer survivors and explore the relationships between social support, family resilience, breast cancer survivors’ individual resilience, and caregiver burden.MethodsA cross-sectional study on 315 young and middle-aged breast cancer survivors and their spousal caregivers was conducted at eight comprehensive Southwest China hospitals. The caregivers completed the Chinese Version of the Family Resilience Assessment Scale, the Perceived Social Support Scale, and the Zarit Caregiver Burden Interview, while breast cancer survivors completed the shortened Chinese version of the Connor-Davidson Resilience Scale. Structural equation modeling was used to evaluate the relationships among social support, family resilience, survivors’ individual resilience, and caregiver burden.ResultsCaregiver burden (45.76 ± 14.66) was found to be severe. Social support, family resilience, and individual resilience were significantly negatively associated with caregiver burden (β = − 0.421, P < 0.001; β = − 0.208, P < 0.001; and β = − 0.444, P < 0.001, respectively). Individual resilience not only partially mediated the relationship between family resilience and caregiver burden (b = − 0.052; 95% confidence interval, − 0.110, − 0.018), but also partially mediated the relationship between support and caregiver burden (b = − 0.045; 95% confidence interval, − 0.102, − 0.011).ConclusionsThe findings suggest that higher social support, family resilience, and individual resilience tend to ease caregivers’ burden. Healthcare workers should have an in-depth understanding of the care needs of survivors, actively contact social security departments and social organizations to provide financial, technical, and emotional support, and provide family-based care-skills training and psychological counseling to reduce spousal caregivers’ burdens.

Biweekly fluctuations of neuropsychiatric symptoms according to the Neuropsychiatric Inventory: Erratic symptoms or scores?

ObjectivesThis study investigates the stability of neuropsychiatric symptoms (NPS) assessed biweekly using the Neuropsychiatric Inventory (NPI) in a memory clinic population during a 6 week period.MethodsTwenty‐three spousal caregivers (mean [SD] age = 69.7 [8.8], 82.6% female) of 23 patients (43.5% had dementia) completed all assessments. The NPI was assessed four times during 6 weeks. We examined whether NPI domains were present during all four assessments, studied within‐person variation for each NPI domain, and calculated Spearman's correlations between subsequent time‐points. Furthermore, we associated repeated NPI assessments with repeated measures of caregiver burden to examine the clinical impact of changes in NPI scores over time.ResultsThe course of NPS was highly irregular according to the NPI, with only 35.8% of the NPI domains that were present at baseline persisted during all 6 weeks. We observed large within‐person variation in the presence of individual NPI domains (61.3%, range 37.5%–83.9%) and inconsistent correlations between NPI assessments (e.g., range r s = 0.20–0.57 for agitation, range r s = 0.29–0.59 for anxiety). Higher NPI total scores were related to higher caregiver burden (r s = 0.60, p < 0.001), but changes in NPI total scores were unrelated to changes in caregiver burden (r s = 0.16, p = 0.20).ConclusionsWe observed strong fluctuations in NPI scores within very short time windows raising the question whether this represents erratic symptoms and/or scores. Further studies are needed to investigate the origins of these fluctuations.

Influence of spousal caregiving and living arrangement on depression among husband caregivers in rural China

Objectives With sociodemographic changes, men are increasingly taking responsibility for spousal caregiving. Previous studies have described gender differences in the psychological outcomes of caregiving; however, few have focused exclusively on husband caregivers. This study investigates the influence of starting spousal caregiving on the psychological well-being of older husbands in rural areas and examines whether living arrangements can moderate this relationship. Methods A total of 1,167 baseline non-caregiver husbands aged 60 and above in rural areas were taken from the 2011–2015 China Health and Retirement Longitudinal Study (CHARLS). The generalized estimating equation (GEE) was employed to examine the effects of spousal caregiving transitions and living arrangement changes on depressive symptoms over four years. Results Compared with rural husbands who remained non-caregivers, those transitioning into activities of daily living (ADL) caregiving reported higher depressive symptoms at follow-up (B = 1.67, p < 0.05). Moreover, the increase in depressive symptoms when transitioning into ADL caregiving was significantly lower among participants who changed from living with spouse alone to living with spouse and other family members together (B = − 5.37, p < 0.05). Conclusion There was an association between transitioning into ADL caregiving and an elevated level of depression over four years among older husbands, which could be alleviated by living with family members. Co-residence with family members could serve as a natural support resource, buffering adverse mental health outcomes when older husbands start a demanding caregiving role.

Dyadic effects on depressive symptoms of spouse caregivers and their care recipients: evidence from China

Objectives The likelihood of providing care to a spouse in middle and older ages has increased as life expectancy increases, but knowledge about how the caregiver and care recipient influence each other’s mental health is limited. This study examined whether a partner’s physical, cognitive, and mental health in a spousal caregiving dyad are associated with the other partner’s depressive symptoms in China and whether the dyadic effects vary by gender. Methods This study used data from Wave 3 (2015) and Wave 4 (2018) follow-up surveys of the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample featured 1,245 dyads of care recipients aged 45 or older and their spouse caregivers. The Actor-Partner Interdependence Model was used to test the dyadic effects among all couples in the analytic sample, couples with wife caregivers and couples with husband caregivers, respectively. Results We found that caregiver’s depressive symptoms at Wave 3 were significantly associated with care recipient’s depressive symptoms at Wave 4 in the full sample. Regardless of caregiver or care recipient roles, wives’ mental health was impacted by their husbands’ depressive symptoms, but not vice versa. Wife recipient’s cognitive impairment was associated with husband caregiver’s lower depressive symptoms. Conclusion This study sheds light on the mental health of couples in the context of caregiving in China. The findings indicate that interventions to support couples in a caregiving dyad need to consider the influence they have on each other, and the gender and health conditions of each in the dyad.

Psychosocial Well-Being of Older Spouses During End-of-Life Caregiving for Their Partners With Cancer: A Phenomenological Study.

Specific burdens of older spousal caregivers often remain invisible, and spousal caregivers rarely receive the support they need to perform their role. To provide suitable support for spousal caregivers, it is crucial to develop a comprehensive understanding of their well-being, particularly during end-of-life caregiving. The aim of the current study was to gain more insight into the psychosocial well-being of older spouses engaged in end-of-life caregiving for their partners with cancer. This qualitative study uses a phenomenological approach with in-depth interviews conducted with older (aged ≥65 years) spousal caregivers of individuals who died of cancer. Eleven spouses participated in the study. Strains on psychosocial well-being during end-of-life caregiving fell into four major themes: The Disease Itself, The Caregiving Process, The Partner Relationship, and Support From Others. Results suggest that older spousal caregivers are experiencing issues that might be more pronounced due to their older age, for example, physical and emotional exhaustion and loneliness. Providing care is time-consuming and often leads to a reduced social network, which enhances loneliness. Moreover, as relationships with ailing partners changed and communication deteriorated, participants reported feeling more like a caregiver rather than a partner. [Journal of Gerontological Nursing, 48(6), 33-39.].

Illness perception and concordance between prostate cancer survivors and caregivers and adherence to self-management behaviors.

e24002 Background: Illness beliefs are important determinants of self-management behaviors (SMBs). Spousal or informal caregiver involvement improves clinical outcomes in non-cancer survivors with chronic diseases. However, very little is known about the influence that caregivers have on comorbid disease SMBs in cancer survivors. In this study, we aim to understand and identify concordance in illness beliefs and perceptions between caregivers and prostate cancer survivors and to determine their impact on hypertension (HTN) SMBs. Methods: Survivors and their caregivers completed surveys assessing their beliefs and perceptions and SMBs regarding survivors’ HTN. Both survivors and caregivers answered the Brief Illness Perception Questionnaire (BIPQ) to assess beliefs and perceptions of survivors’ HTN. The BIPQ score is a sum of eight questions with a higher sum score indicating a more threatening view of the illness. Survivors reported adherence to SMBs using the Medication Adherence Report Scale (MARS) and Hypertension Self-Care Activity Level Effects (HSCALE). MARS scores &gt;4.5 were considered adherent. The HSCALE isdivided into five sub-scores – diet, physical activity, smoking behavior, weight management and alcohol intake and each was score was dichotomized. Cohen’s Kappa statistic assessed concordance between survivor and caregiver dyad responses to the BIPQ. Logistic regression assessed associations between survivor and caregiver BIPQ scores and odds of SMB adherence. Results: This analysis included 55 dyads. Mean age of survivors was 70.4 years ± 9.6; 12 (22%) were Black, 36 (65%) were White, 2 (4%) were Asian and 3 (5%) were other race. Mean age of caregivers was 64.4 years ± 10.5, 9 (16%) self-identified as Black, 35 (64%) White, 2 (4%) Asian and 3 (5%) other race. Survivors and caregivers had fair agreements about how much HTN affected survivors’ lives (k = 0.147, p = 0.008), how concerned survivors are about their HTN k = 0.130, p = 0.014), and HTN’s emotional impact on survivors (k = 0.185, p = 0.002). However, survivor-caregiver concordance about HTN had no significant impact on survivors’ SMBs. In contrast, caregivers’ beliefs about HTN was associated with survivors’ SMB such that a 1-point increase in caregiver’s BIPQ score was associated with 8% increase in the odds of survivors’ self-reported weight adherence (p = 0.0314). Survivors’ HTN beliefs were not associated with adherence to SMBs. Conclusions: Caregivers have a significant influence on prostate cancer survivors’ adherence to weight-related SMB, demonstrating that it is important to also educate caregivers who support cancer survivors with chronic comorbidities. Future analysis will include a larger cohort to better understand the interrelationship between caregivers’ illness beliefs and survivors’ SMBs and may help clinicians better direct interventions to improve survivorship outcomes.

Factors influencing family function in spousal caregivers of head and neck cancer patients within 6months posttreatment.

Spousal caregiving of head and neck cancer (HNC) patients challenges relationship quality and may negatively impact family function. Our purpose was to identify factors associated with family dysfunction in spousal caregivers (SCs) of HNC patients within the first 6months after treatment. We explored whether patient or SC characteristics differ by level of family dysfunction. We conducted a cross-sectional study of HNC patient-SC dyads in Taiwan from July 2020 to January 2022 using patient-reported outcomes. Patients were assessed using a set of structured questionnaires to measure performance status, demographic and clinical characteristics, physical function, and social-emotional function. SCs were measured on their hardiness, coping styles, spousal relationship, quality of life, and family function. Of the 132 dyads surveyed, 62.1% of SCs reported a functional family, 34.8% reported a moderately dysfunctional family, and 3.0% reported a highly dysfunctional family. Patient factors associated with family dysfunction (highly dysfunctional or moderately dysfunctional) included lower family annual income and worse social-emotional function. Associated SC factors were lower hardiness, less use of active coping, and worse spousal relationships. Lower family annual income, less patient social-emotional function, less SC hardiness, less SC active coping, and worse SC perceived spousal relationship were associated with perceived family dysfunction. Providing patient-SC dyads with sufficient social resources and problem-solving training may help them positively cope with cancer and enhance family function.

Spousal Caregiver Resilience in A Nutshell: A Directed Content Analysis in the Context of Dementia Caregiving in Vietnam

This study aims to define resilience of spousal family caregivers for older adults living with dementia in the Vietnamese context. A directed content analysis was conducted on 22 interview transcripts, including nine follow-up interviews, of a sub-sample of 13 spousal caregivers, drawn from a larger study with family caregivers for relatives with dementia in a hospital in Vietnam. The study started with key categories from the theory of the unifying model of resilience in dementia caregiving to guide the analysis process, while new codes and categories were identified during this process. The study results show a revision and extension of this model by introducing a revised model with newly developed sub-categories under the five revised key categories of adversity, resilience processes, outcomes, internal resources, and external resources. The results provide evidence for the development of resilience-based interventions and services for spousal caregivers in their contexts.

Discrepancy between self-reported and objective sleep duration among dementia caregivers and noncaregivers.

Poor sleep, including short sleep duration, is common among caregivers of persons with dementia. However, it is unclear whether poor sleep is consistent across both self-reported and objective measures of sleep in caregivers. This study aimed to test the role of caregiving status (caregivers vs noncaregivers) on the discrepancy between self-reported and objective sleep duration. This was a cross-sectional study. Study participants were community-dwelling caregivers of spouses with dementia (n = 122) and noncaregivers (n = 53). A sleep duration discrepancy index was created by subtracting objective sleep duration measured with 3 consecutive 24-hour periods of actigraphy from self-reported sleep duration measured with the Pittsburgh Sleep Quality Index. Covariates included participants' demographic characteristics, depressive symptoms, positive and negative affects, personal mastery, and caregiving-role overload. Caregivers showed a greater discrepancy in sleep duration than did noncaregivers (-0.46 hour vs 0.22 hour, respectively; P = .003). In a regression model, however, caregiving status was no longer associated with this sleep duration discrepancy, when covariates were accounted for. Higher positive affect was significantly associated with less sleep duration discrepancy (R2 = 11.3%, P = .014). The Sobel test of mediation showed that 26% of the effect of caregiving on this sleep discrepancy was attributable to caregivers with low positive affect. The findings suggest a potential mediating role of positive affect on the relationship between caregiving status and sleep duration discrepancy. As an aid for understanding the role of lower positive affect, use of actigraphy may help address sleep discrepancy in caregivers. Song Y, Moore RC, Jeste DV, et al. Discrepancy between self-reported and objective sleep duration among dementia caregivers and noncaregivers. J Clin Sleep Med. 2022;18(8):1945-1952.

Systematic Review and Meta-Analysis of Prevalence of Depression Among Caregivers of Cancer Patients

BackgroundCaregivers of cancer patients commonly experience depressive symptoms due to the heavy burden of caregiving responsibility.ObjectiveThis meta-analysis examined the prevalence of depression among caregivers of cancer patients.MethodsWe included 85 studies covering 23,317 participants published between 2001 and 2021 (25 countries) that reported the prevalence of depression among caregivers of cancer patients. We examined the pooled prevalence of depression and hypothesized moderators, including year, age, sex, geographic regions, percentage of spousal caregivers, depression measures, and cancer stage.ResultsAll 85 effect sizes included 6,077 caregivers of patients with depression. The weighted average prevalence of depression was 25.14% (95% CI, 21.42–29.27%) among caregivers. The prevalence rates were moderated by geographic region, patients' cancer stage, and measures for depression. The prevalence rates also varied among the different measures assessing depression. The prevalence rate decreased with the mean age of the caregivers and the percentage of spousal caregivers.ConclusionsThis study revealed a high prevalence of depression among caregivers of cancer patients. The prevalence rates also varied with the study design, demographics of caregivers, and patients' medical information. These findings highlight that psychological support and intervention may be crucial for patients and their caregivers in clinical practice.