Spouse Caregivers Of Patients Research Articles

Abstract A036: Female spouse caregivers of patients with glioblastoma want better education and communication from health care professionals regarding what to expect during the disease progression

Abstract The purpose of this study was to understand the challenges and unmet needs of primary spousal caregivers of patients with glioblastoma multiforme (GBM) through a qualitative analysis of letters written by current and former caregivers. GBM is a devastating and terminal cancer that results in memory loss, cognitive declines, personality changes, neuropsychiatric symptoms, and physical impairments that greatly affect quality of life of both the patient with GBM and their primary caregiver, who is often a spouse or partner. Open-ended letters (n=101) written by self-identified female spouse caregivers were analyzed using reflexive thematic analysis (IRB #22-0103). The six phases of reflexive thematic analysis involved 1) data familiarization, 2) systematic data coding, 3) generation of initial themes, 4) development and reviewing themes, 5) refinement and re-naming of themes and 6) writing the report to provide insight into caregiver’s experience. Seven distinct themes were identified from the letters. Three of the themes related to the patient experiences: 1) medical details of the disease trajectory (87%), 2) interactions of the patient/caregiver dyad with health care workers (67%), and 3) the changing patient condition over time (98%). Four themes focused on the caregiver experience: 1) caregiver challenges (80%), 2) caregiver responses (77%), 3) caregiver coping strategies (85%), and description of tangible needs that would help other caregivers in the future (91%). When mapped to the four phases of the caregiving trajectory: acute disease phase, living with disease progression, end of life phase, and the bereavement phase, caregivers needed better communication and support in every phase. The highest caregiver needs were for better education about GBM from health care professionals regarding what to expect and better communication with health care providers about disease progression, treatment options, and anticipated patient, caregiver, and family needs (65%). Caregivers indicated they wanted to be listened to and included in medical decision-making. These findings on the primary caregivers’ experiences provide opportunities to guide more timely and tailored interventions to provide support and improve care for patient/caregiver dyads to help mitigate the burden of this progressive disease and improve quality of life for caregivers and their patients with GBM. Citation Format: Diana L. Coman, Megan P. Chard, Barbara J. Lutz, Laurie A. Minns. Female spouse caregivers of patients with glioblastoma want better education and communication from health care professionals regarding what to expect during the disease progression [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr A036.

Predictors of changes in resilience among spousal caregivers of patients with advanced cancer within the first 6 months after initial treatment.

While previous research has established that resilience is affected by various factors, these studies have primarily focussed on individual variables associated with resilience, without providing insights into how to influence the rate of change in resilience. To examine the trajectory of resilience and identify the factors associated with changes in resilience among spousal caregivers of patients with newly diagnosed advanced cancer receiving treatment during the first 6 months. An observational longitudinal study. A total of 312 spousal caregivers of patients with newly diagnosed advanced cancer were recruited from January 2022 to December 2022 in Yancheng, China. Three data collection points were established, spanning from the first month to 6 months after initial cancer treatment. A latent growth model was employed to depict the resilience trajectory at various time points. A latent growth model with time-invariant covariates was adopted to determine the factors influencing resilience trajectory. The study adhered to the STROBE checklist for proper reporting. Throughout the follow-up period, the participants experienced a significant increase in resilience. Gender, family income, the patient's health status, spirituality and belief in familism were significantly associated with the baseline resilience level. Moreover, family income, the patient's health status, spirituality, caregiver burden and belief in familism were significantly associated with the rate of resilience change over time. Spousal caregivers demonstrated a linear increase in resilience during the first 6 months after initial treatment. Meanwhile, changes in resilience were influenced by multiple factors during the early phase of cancer treatment. Thus, more attention should be paid to early identification and implementation of targeted interventions. Healthcare professionals should understand the change in resilience among spousal caregivers and conduct timely mental health interventions to enhance the resilience of families affected by cancer. The Guidance for Reporting Involvement of Patients and the Public-Short Form reporting checklists were used to improve patient and public involvement.

Change in resilience among spousal caregivers of patients with newly-diagnosed advanced cancer over the first six months posttreatment in China

ObjectiveA longitudinal observational study was conducted and aimed to examine the change in resilience among spousal caregivers of newly-diagnosed advanced cancer patients over the first six months after initial treatment. MethodsIn total, 312 Chinese spousal caregivers who were taking care of their patients with newly-diagnosed advanced cancer were recruited. The level of resilience was measured using the Connor–Davidson Resilience Scale at the first month post-initial treatment (T1), three-month post-initial treatment (T2), and six-month post-initial treatment (T3). Latent growth modeling analyses were performed to examine changes in resilience using Mplus 8.3. ResultsThe mean scores of resilience in spousal caregivers were 54.01 ± 7.68 at T1, 56.20 ± 6.38 at T2, and 57.97 ± 6.70 at T3, respectively. Results of latent growth modeling indicated that spousal caregivers showed a significant increase in their resilience scores over the first six months post-treatment (Mean slope = 1.98, p < 0.001). Furthermore, a significant individual variation in the rate of changes in resilience scores allowed spouses to be categorized into two groups: 42.9% participants with fast growth and 57.1% participants with slight growth. ConclusionOur findings highlight the importance that new knowledge about change patterns of resilience in the nursing field is beneficial to reveal different psychosomatic health. Acknowledging that resilience is a dynamic process that changes over time, it is crucial for healthcare providers to monitor the psychological adjustment and focus of vulnerable caregivers, particularly spouses.

Abstract 5540: Spouse caregivers of patients with glioblastoma report unmet needs throughout the disease trajectory

Abstract Glioblastoma (GBM) is a devastating and terminal cancer that results in memory loss, cognitive declines, personality changes, neuropsychiatric symptoms, and physical impairments that greatly affect quality of life of both the patient with GBM and their primary caregiver, who is often a spouse or partner. These caregivers describe feeling unsupported and unprepared to assume the responsibilities associated with addressing the progressive physical, emotional, and psychological support needs of their loved ones with GBM. In this qualitative study, female spouse primary caregivers were recruited through a private Facebook support group to write letters describing their experiences in caring for their loved ones with GBM. Using a reflexive thematic analysis, 101 letters from caregivers were analyzed for unmet needs, challenges, and opportunities for better care and support. Caregivers expressed feeling unsupported and poorly prepared, and described different levels and types of needs and challenges throughout the GBM disease trajectory. The 4 phases of the trajectory included the acute phase (first 2-4 months post diagnosis), living with disease progression, end of life stage, and the bereavement stage. Challenges included difficulties adapting to sudden life changes, the need for more education on what to expect, feelings of sudden loss, relationship strain, and not having enough knowledge about GBM. Associated emotional responses included feelings of fear, lack of control, agony, disappointment, and exhaustion. These challenges and emotional impact were greatest during the acute and living with disease progression phases. Caregivers also described relying heavily on friends, community supports (such as faith groups), peer-support through the Facebook group during this living with disease progression phase, but still experienced high levels of relationship strain and other unmet needs. These findings on the primary caregivers’ experiences provide opportunities to guide more timely and tailored interventions to provide support and improve care for patient/caregiver dyads to help mitigate the burden of this progressive disease and improve quality of life for caregivers. Citation Format: Diana L. Coman, Megan Chard, Lisa Desautels, Barbara J. Lutz, Laurie Minns. Spouse caregivers of patients with glioblastoma report unmet needs throughout the disease trajectory. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5540.

Spousal caregiver burden in patients with cognitive impairment: Effects on nutrition and other related factors with cognition

AbstractBackgroundWith the rapid aging process, the number of elderly couple househol is increasing. Accordingly, when a patient with cognitive impairment occurs, the elderly spouse tends to take care of patient, and undergoes physical and psychological stress and changes in nutritional status due to the care, which can be a risk factor for cognitive decline.Therefore, this study aims to evaluate the spousal caregiver`s lifestyle, psychosocial factors and nutritional status related with cognition according to the burden of care for elderly couples.MethodFrom May to December 2020, clinical evaluation and blood tests were conducted for patients who visited Chungnam National University Hospital Geriatric Neuropsychiatric Clinic with their spouse. A total of 39 subjects were included in the analysis. As clinical assessment, we evaluated the care burden(Zait burden interview), depression(Geriatric‐Depression‐Scale), sleep quality (Pittsburgh‐Sleep‐Quality‐Index), cognitive function(Mini‐Mental‐state‐exmination) and subjective cognitive decline, physical activity(International‐Physical‐Activity‐Questionnaire), and dietary habits(Mini‐Nutrional‐Assessment). And, serum total protein, albumin, Hemoglobin and Lipid pannel was measured.ResultAs the patient's cognitive function declined, the burden of care increased(p&lt;0.001). In univariate analysis, the spousal caregiver`s burden was significantly associated with the worse the dietary habits(p=0.003) and increased level of depression(p=0.001) and subjective cognitive decline(p=0.038). The spousal caregiver`s burden showed trend level association with sleep quality(p=0.074), but there was no significant relationship with physical activity(p=0.653). When the age, sex, and caring assistant type were adjusted, dietary habits (p=0.002), depression(p=0.003), and sleep quality(p=0.023) worsened as the spousal caregiver`s burden increased.ConclusionEven if cognitive function in the older adult was normal, the higher the burden among spousal caregivers of patients with cognitive decline, the lower the diet habit and sleep quality, and the higher the level of depression. All of these factors could lower cognitive function. Early intervention on these factors is necessary to prevent the cognitive impairment in spouse due to the burden of care.

Factors associated with resilience in spousal caregivers of patients with cancer: An integrative review.

AimTo explore resilience and associated factors in spousal caregivers of patients with cancer.DesignAn integrative review.MethodsThis review used the standardized critical appraisal instruments developed by the Joanna Briggs Institute and was conducted by researching the electronic databases of Cochrane, CINAHL, ProQuest, Science Direct, PubMed, Scopus, EBSCO and Google Scholar. The articles were published in English with full text from January 2010 to January 2020.ResultsAccording to data retrieval, 26 articles were finally selected. From this review, resilience was typically measured by using exact resilience scales (i.e. Connor‐Davidson or Wagnild Resilience Scales) or using other variables to indicate either more positive psychological outcomes or less negative psychological outcomes. For factors associated with resilience, these were classified as individual internal and external factors. Internal factors included caregiver burden, psychological distress, coping strategies and other factors, whereas social support, couple interaction, patient health status and other parameters were considered external factors.ConclusionsResilience plays an important role in promoting positive adaptation in spite of adversity among the spousal caregivers of patients with cancer. Due to the uniqueness of resilience among spousal caregivers, ways to assess resilience and identify its associated factors deserve more attention and careful consideration.

Spousal Caregivers of Patients with Cancer and Its Associated Factors and Resilience

Introduction: Cancer is among the leading causes of morbidity and mortality worldwide and marks a critical life event for the entire family that can cause distress and significant challenges for all involved. Proverbially, cancer impacts not only those diagnosed but also families, especially those spouses who are often the primary caregivers of these patients. Resilience is the ability of individuals to adapt well in the face of adversity. Resilience and its associated factors among spousal caregivers were reviewed and synthesized to obtain better understanding and guidance for further research regarding this phenomenon. Purpose: To explore resilience, and identify the measurement used to assess resilience and associated factors in spousal caregivers of patients with cancer (PWC). Methods: A literature review was performed using electronic database across Cochrane, CINALH, ProQuest, Science Direct, PubMed, Scopus, EBSCO, Google scholar. The articles were published in English with full text from January 2010 to January 2020. Inclusion criteria: (1) resilience in spousal caregivers for cancer patients who were alive; (2) resilience by using resilience scales or measure resilience by using related variables that reflects resilience which were clearly mentioned in the articles; (3) spousal caregivers’ age more than 18-year-old; (4) quantitative, qualitative, and mixed-method research; (5) articles which met the above eligible criteria were included in this review if it was possible to extract the findings. Results According to data retrieval, 26 articles were finally selected including 17 quantitative researches, 6 qualitative researches, and 3 mixed-method researches . Resilience in spousal caregivers of PWC showed an ability to adapt and deal with the challenges of caring for their lovers, which would be those with female gender, younger age, better education, and no child-rearing burden. But other demographic characteristics such as ethnicity, occupation, work status were not associated with resilience. Two types of measurement in resilience were explored across 26 studies. resilience was measured by using exact resilience scales (i.e. Connor-Davidson or Wagnild Resilience Scales) or using other variables to indicate either more positive psychological outcome such as coping and adaptation or less negative psychological outcome such as lower depression and stress etc. For factors associated with resilience, these can be classified as individual internal and external factors. Internal factors include caregiver burden, psychological distress, coping strategies etc., whereas social support, couple interaction, patients’ health status etc. are external factors. Conclusions: The current findings add to our understanding of resilience as a distinct trajectory of adjustment and provide further knowledge on the resilience associated factors. Caring for patients with cancer can be a form of stress and affected spousal caregivers’ health and well-being. Resilience plays an important role in promoting positive adaptation in spite of adversity among the spousal caregivers of cancer patients. With the uniqueness of resilience among these caregivers, ways to assess resilience and identify its associated factors deserve more attention and careful consideration.

Factors Influencing Burden in Spouse-Caregivers of Patients with Chronic-Acquired Brain Injury.

In this cross-sectional study, we assess associated factors of burden in spouse-caregivers of patients with acquired brain injury (ABI) in the chronic phase. 35 spouse-caregivers (71% female, mean age ± SD: 55.7 ± 11.1y) of patients with mild/moderate ABI (29% female, mean age ± SD: 57.5 ± 10.7y), admitted to the intensive rehabilitation unit of the Institute S. Anna (Crotone, Italy) between January 2013 and December 2017, were contacted 2 years postinjury and asked to complete a series of questionnaires. The outcome measure was the Caregiver Burden Inventory (CBI) test, while several demographical and clinical data were considered as predictive factors. Two years after injury, a high level of burden was reported in 34.2% of spouse-caregivers. Stepwise multiple linear regression analyses revealed that caring for a patient with more severe disability (as measured by the Barthel Index scale) and the family life cycle (from the initial phase of engagement to marriage with adult children) explain the vast majority of variance for higher caregiver burden. The functional clinical status and the stages through which a family may pass over time were identified as areas in which the spouse-caregiver of ABI patients experienced high levels of burden in the chronic phase.

Critical points in the experience of spouse caregivers of patients who have suffered a stroke. A phenomenological interpretive study.

AimsTo explore and document the experiences and values of spouse caregivers of stroke survivors. To gain more in-depth knowledge of how the act of caring and the adaption process affects caregiving spouses.Materials and methodsPhenomenological, qualitative study. This study included spouses of stroke survivors who also served as primary caregivers. Individual, semi-structured, in-depth interviews were conducted, transcribed, and analysed using a thematic content analysis as proposed by Giorgi. Data was analysed and managed using Atlas-ti (version 7.0). This study was approved by our institution´s Complejo Hospitalario de Caceres Ethics and Research Committee.ResultsSpouse caregivers of stroke survivors undergo a process of disruption in their private lives and relationships, marked by their caregiving duties. The experiences of spouses caring for stroke survivors is condensed into topics and subtopics: “Caregiving and that´s all” summarizes the sense of having no life horizons and also caregiver impossibility of moving away from caring role. Otherwise, “Breaking the couple´s life together” enlightens the further consequences of stroke in couples shared live biography, which needs to be understood and rebuilt. Finally, “Going through the (non) loss alone” alludes to how spouses reinterpret meaning of loss, which is not appreciated by others and that refers to the balance between stroke survival and any acquired global disability.ConclusionsA comprehensive approach to the couple (family), from a psycho-socio-emotional and relational perspective, is essential for ensuring adequate quality of life for people who suffered a stroke as well as their caregivers. Spouses-caregivers must be considered as individuals living a transition process due to their unexpected disrupting change, which nurses should address through a comprehensive and integrated approach focused on transition care. Care resources must be adapted to the interpretation that the spouses have of their caregiving role and their relationship with the different components of the caregiving process.

Trajectories of mental and physical functioning among spouse caregivers of cancer survivors over the first five years following the diagnosis

ObjectiveIdentify the trajectories of physical and mental functioning among spouse caregivers of patients with cancer over the first five years post-diagnosis and variables associated with low or deteriorating functioning. MethodsCaregivers completed a survey at 6 months and 1, 2, 3.5, and 5 years post-patient diagnosis, including the SF-12 for quality of life (QOL). SF-12 Mental Component Summary (MCS, n=299) and Physical Component Summary (PCS, n=300) scores were analyzed using SAS. ResultsFive trajectories for PCS were identified, the top three were: (a) high PCS (53.0%); (b) steady decline in PCS (17.0%); and (c) steady increase, but remaining below population norm (16.7%). Five trajectories for MCS were also identified, the top two being: (a) high MCS (45.8%) and (b) MCS comparable to population norm (27.8%). Variables associated with low or deteriorating QOL included depression, social support, coping, burden, and/or unmet needs. ConclusionsThis is the first study to document spouse caregivers’ QOL over the first five years post-patient diagnosis. Although many participants experienced high functioning, almost a third reported low or deteriorating mental or physical functioning. Practice implicationsVariables associated with low or deteriorating mental and physical functioning can be targeted in future interventions.

The intensity of caregiving is a more important predictor of adverse bereavement outcomes for adult-child than spousal caregivers of patients who die of cancer.

Increasing attention is being paid to specific difficulties experienced by bereaved family caregivers (FCs). Limited capacity within health and social care structures results in high intensity of informal caregiving. The focus of recent research is the identification of specific predictors of adverse FC outcomes, in order to identify those FCs who will benefit most from intervention and support. Research is challenged by multiple influencing and confounding variables. This study aimed to evaluate factors of care associated with higher grief intensity in bereaved adult-child (AC-FCs) and spousal FCs (S-FCs). Data from the Qualycare study, a mortality follow-back study of bereaved FCs of patients who died of cancer, was analyzed. Four hundred eighty-four patient-FC dyads were included: 246 AC-FCs and 238 S-FCs. S-FCs received more formal (SPC) (p = 0.026), and AC-FCs more informal (p < 0.001), support. AC-FCs were more likely to continue to work while caregiving (p < 0.001). Patients with AC-FCs were more likely to spend time in and die in a nursing home (p < 0.001). Higher grief intensity was associated with higher caregiving intensity (p < 0.001), as well as other factors. AC-FCs whose relative died in NH experienced significantly lower grief intensity (p < 0.001). Intensity of caregiving predicted 11.6% of variance in grief intensity for AC-FCs compared to 0.5% for S-FCs. The 'relief model' of bereavement is relevant for AC-FCs. The support needs of AC-FCs and S-FCs differ. AC-FCs should be targeted for practical supports and interventions, in order to support home-death, if desired by patient and FC, and optimize bereavement outcomes.Copyright © 2016 John Wiley & Sons, Ltd.

Personality and Perceived Health in Spousal Caregivers of Patients with Lung Cancer: The Roles of Neuroticism and Extraversion.

Purpose. Family members' responsibilities for patients with cancer have increased dramatically over the past decade and will likely continue to rise. Given that caregiving is associated with declines in self-care, there is a need for research on caregivers' perceptions of their own health. The purpose of this study was to examine whether personality is associated with four self-report perceived health items from the SF-36. Methods. The sample consisted of 114 spouses of lung cancer patients who completed cross-sectional measures as part of a larger cohort study on adjustment to the diagnosis and treatment of lung cancer. Predictors of interest were Neuroticism and Extraversion scores from the NEO-FFI. Covariates were age, gender, conscientiousness, depressive symptoms, and objective illness burden. Results. Multivariate analyses revealed that caregivers with higher Extraversion scores were less likely to respond affirmatively to the item “I expect my health to get worse” (OR = 0.90, p < 0.05). Neuroticism was associated with poorer perceived health (ORs from 1.11 to 1.12, p's < 0.05). Conclusions. The present cross-sectional findings suggest that personality is associated with responses to SF-36 perceived health items beyond what can be accounted for by objective illness burden and other covariates. The potential overestimation of health among extraverted caregivers may have implications for their health outcomes.

Feasibility of a pocket-PC based cognitive control intervention in dementia spousal caregivers

Objectives: Spousal caregivers of patients with dementia are in need of interventions to bolster their quality of life. Computer-based, self-administered cognitive training is an innovative approach to target spousal caregiver distress and coping. We tested the feasibility of administering one such intervention with minimal clinician intervention.Methods: Twenty-seven elderly adults (>64 years old), who each were the primary caregiver for a spouse with dementia, were recruited through the Memory Disorders Clinic of the Alzheimer Disease Research Center in Pittsburgh, PA. Spousal caregivers were instructed to use a handheld computer version of the Adaptive Paced Visual Serial Attention Task (APVSAT) at least three times per week for four weeks as part of a larger caregiver intervention trial (P01 AG020677). Feasibility was explored by examining the frequency of APVSAT usage.Results: Results suggest that self-directed cognitive training is feasible for spousal caregivers of dementia patients. The mean usage of the APVSAT was 42 (SD = 28.58). Performance increased from the beginning to the end of the trial, and usage was not affected by stress, worry, or poor sleep quality.Conclusion: Findings suggest the potential utility of cognitive training via handheld computer for spousal caregivers of dementia patients to improve problem solving, coping and adaptation, planning, and persevering with goal-directed tasks.

Personality Change Pre- to Post- Loss in Spousal Caregivers of Patients With Terminal Lung Cancer

Personality is relatively stable in adulthood but could change in response to life transitions, such as caring for a spouse with a terminal illness. Using a case–control design, spousal caregivers (n = 31) of patients with terminal lung cancer completed the NEO Five-Factor Inventory (NEO-FFI) twice, 1.5 years apart, before and after the patient’s death. A demographically matched sample of community controls (n = 93) completed the NEO-FFI on a similar time frame. Based on research and theory, we hypothesized that bereaved caregivers would experience greater changes than controls in interpersonal facets of extraversion (sociability), agreeableness (prosocial and nonantagonistic), and conscientiousness (dependability). Consistent with hypotheses, bereaved caregivers experienced an increase in interpersonal orientation, becoming more sociable, prosocial, and dependable (Cohen’s d = .48–.67), though there were no changes in nonantagonism. Changes were not observed in controls (ds ≤ .11). These initial findings underscore the need for more research on the effect of life transitions on personality.

Psychosocial Adjustment of Spousal Caregivers of Patients With Chronic Pain

This conceptual article aims to propose a framework of understanding the risk and resistance factors that contribute to the adjustment of spousal caregivers of chronic pain patients (SCCPP). A comprehensive review of literature related to caregivers of patients with chronic pain was performed. Findings from the review were applied to the Wallander et al.’s Risk and Resistance Model of Adjustment, specifically examining outcomes among SCCPP. No statistical results are presented in this conceptual article. We advocate for the need to study and test the adjustment process of SCCPP in a systematic, comprehensive, and theory-driven manner to further understand caregivers’ strengths and challenges. This will allow for further rehabilitation interventions to address risk factors and promote resistance factors, allowing for more inclusive mental health care for SCCPP.

Care for Alzheimer's Disease

Cognitive impairment due to dementia deprives those afflicted with the disease of their autonomy and ability to take care of themselves, making them dependent on care provided by formal and informal resources. Moreover, as the disease progresses, behavioral and psychological symptoms of dementia (BPSD) may occur. BPSD are often troublesome to both caregivers and the patients themselves. The care burden is often heavy and disrupts the lives of family members surrounding the patient. Early screening and identification of cognitive decline will help those with the disease and family members prepare for better care and may reduce the patients' BPSD. Effective screening for dementia, which can be administered at ambulatory care facilities, is warranted. Vascular risk factors, especially type 2 diabetes mellitus, have been found to increase the risk of developing Alzheimer's disease (AD). The prevalence of type 2 diabetes mellitus is increasing in Japan. In this special issue, T. Matsuzawa et al. describe an index for screening for mild or moderate AD cases among the elderly with type 2 diabetes mellitus. The index includes self-reported answers to a questionnaire regarding subjective memory complaints and daily functioning and information on vascular risk factors obtained from clinical charts. The index had satisfactory discriminatory ability to identify those with AD among patients with diabetes. This may contribute to an effective screening for AD among those with diabetes, that is, known high-risk populations. Current treatments for AD are limited to alleviating symptoms, but not reversing the pathological progress. Pharmacological treatments for BPSD, which are critical for the well-being of both patients and caregivers, are also limited in their effectiveness. The study by H. Fukui et al. examines changes in sex hormones associated with the pathogenesis of AD before and after music therapy among patients with AD. They show that music therapy modified the secretion of sex hormones, and the results also suggest that problematic behavior may be reduced this way. The therapy has the potential to become a safe alternative treatment that is as effective as hormone replacement, but with fewer side effects. The underlying biological mechanism of effects shown in this study is convincing and a welcome addition to the field. The number of those suffering from dementia is increasing worldwide. Effective caregiving strategies and targeted care management programs are urgently needed to enhance the well-being of those with AD and their caregivers. T. Passos et al. examined the met and unmet needs of the elderly with mental health problems and their care in Portugal. The main unmet needs identified were daytime activities, social benefits, company, psychological distress, and incontinence. Some of these unmet needs may be universal across countries worldwide, but others may differ depending on specific health care systems and cultures. A comparison with similar surveys in other countries may help identify common unmet needs for patients and caregivers. M. M. Poysti et al. compare the characteristics and burdens of male and female spousal caregivers of patients with dementia in Finland. This is an important issue because the proportion of male caregivers is rapidly increasing in many countries. In the study, male caregivers experienced a lower burden than female caregivers even though female caregivers were responsible for more severe cases. The finding should be confirmed, and the reasons behind it should be explored further, so that factors that may reduce high caregiver burden can be identified. Finally, the economic and social costs for caring of the demented are of significant importance as the at-risk population grows rapidly around the globe. Japan has one of the fastest growing elderly populations, and in 2000 it launched a new public long-term care insurance system [1]. S. Shinagawa et al. report that the requisite costs in the Japanese long-term care insurance are different between AD and vascular dementia (VD). In this special issue, we highlight several important themes in the care for dementia. We hope that the results presented contribute to developing and providing better care of the demented and increase awareness of the importance of international studies of dementia caregiver issues. Hiroyuki Umegaki Hajime Takechi Hiroko H. Dodge

Spouses of Patients With Cancer Have an Increased Risk of Cardiovascular Disease

The article by Ji, Zoller, Sundquist, and Sundquist1 found that, after a cancer diagnosis in husbands or wives, the risks of coronary heart disease and ischemic and hemorrhagic stroke were each significantly increased in affected versus nonaffected spouses. This analysis used several Swedish national data registries, including the Swedish Cancer Registry, the Swedish National Population and Housing Census, and the Swedish Multi-Generation Registry, which cover close to 100% of the population and include substantial individual-level information. Such a comprehensive and integrative system made it possible systematically and objectively to assess the association between being a cancer caregiver and the elevation in the risk of cardiovascular disease. Thus, the study found that the spousal caregivers of patients with cancer in comparison with a matched reference group, experienced an excess risk of coronary heart disease and stroke of 13% to 29% when assessed for up to 20 years after their spouse's cancer diagnosis. Article see p 1742 An important contribution provided by Ji and colleagues in their analysis is that they were able to provide insight into the relative contribution to excess cardiovascular risk attributable to preexisting lifestyle factors versus possible stress-related psychosocial variables affecting the spousal caregiver following the diagnosis of cancer.1 However, the extent to which the …

The Factors Associated with the Quality of Life of the Spouse Caregivers of Patients with Cancer: A Cross-Sectional Study

It is well known that cancer greatly affects not only patients but also their families. However, few studies on caregivers' quality of life have been conducted within the Asian population. We carried out a survey using well-constructed, self-administered questionnaires that were answered by pairs of patients with cancer and their spouse-caregivers (n=100 pairs) who were visiting the cancer daycare center at Seoul National University Hospital. The caregiver's quality of life (QOL) was assessed by the Korean version of the Caregiver Quality Of Life Index-Cancer (CQOLC), which contains four domains along with other items. Possible determinants of caregiver QOL were categorized according to sociodemographic factors, caregiver burden, health risk factors, spirituality, and family function. Multiple linear regression analysis was used to identify the factors associated with spouse-caregivers' QOL. Having a reason or purpose for living was associated with the total CQOLC score (β=3.408, p=0.025) and positive adaptation (β=1.035, p=0.009). Family function was associated with total CQOLC and all the domains except burden, and caregivers' religion was associated with total CQOLC. Monthly household income and cigarette smoking status were associated with financial concern. Having a reason and purpose for living, which is an aspect of spirituality, was a relevant factor in the spousal caregivers' QOL. Future research is needed to confirm the association between spirituality and caregivers' QOL and whether interventions supporting spirituality could improve their QOL.

Multiple mediators of the relations between caregiving stress and depressive symptoms

Objective: This study tested a model for explaining how stress is associated with depressive symptoms in a sample of spouse caregivers of patients with Alzheimer's disease. It was hypothesized that more depressive symptoms would be significantly correlated with both ‘primary’ caregiver stressors (i.e., care recipient problem behaviors) and ‘secondary’ stress (i.e., role overload), but that this relationship would be significantly mediated by four variables: (1) personal mastery, (2) coping self-efficacy, (3) activity restriction, and (4) avoidance coping. Method: We used an asymptotic and resampling strategy for simultaneously testing multiple mediators of the stress-to-depressive symptoms pathway. Results: Greater stress was significantly related to more depressive symptoms. Increased stress was also associated with reduced personal mastery and self-efficacy, as well as increased activity restriction and avoidance coping. Finally, these four mediators accounted for a significant amount of the relationship between stress and depressive symptoms. Discussion: These results suggest multiple pathways by which both primary and secondary caregiver stresses may be associated with increased depressive symptoms, and may argue for multiple treatment targets for caregiver interventions.

Palliative Needs of Spousal Caregivers of Patients With Heart Failure Followed Up at Specialized Heart Failure Centers

Palliative Needs of Spousal Caregivers of Patients With Heart Failure Followed Up at Specialized Heart Failure Centers