Stress Of Family Caregivers Research Articles

“A Fine Line That We Walk Every Day”: Self-Care Approaches Used by Family Caregivers of Persons with Dementia

Individuals living with Alzheimer’s disease and related dementias (ADRD) often exhibit behavioral and psychological symptoms of distress that can contribute to the strain experienced by their family caregivers. This strain can increase levels of stress for family caregivers and reduce quality of life, which can have a negative impact on physical health and wellbeing for both the caregiver and the person with ADRD. This study used blogs written by family caregivers of persons with ADRD to explore self-care strategies practiced by these caregivers. Using a qualitative thematic analysis, seven themes related to self-care approaches used by caregivers of persons with ADRD were identified: (1) health and wellness; (2) altruism and activism; (3) reminiscing and legacy building; (4) social support; (5) information exchange; (6) organization and planning; and (7) spirituality. By understanding the ways in which caregivers for someone with ADRD practice self-care, interventions and services can be developed in an effort to improve caregiver quality of life.

Aerobic exercise lengthens telomeres and reduces stress in family caregivers: A randomized controlled trial - Curt Richter Award Paper 2018

Study designFamily members caring for chronically ill relatives are typically sedentary, chronically stressed, and at high risk of disease. Observational reports suggest caregivers have accelerated cellular aging as indicated by shorter leukocyte telomere lengths. We performed a randomized controlled trial to examine the effect of aerobic exercise on changes in telomerase levels (primary outcome) and telomere lengths (secondary outcome) in inactive caregivers. Methods68 female and male community dwelling dementia caregivers who reported high stress and physical inactivity were randomly assigned to a highly supervised aerobic exercise intervention vs. waitlist control group for 24 weeks. Average leukocyte telomere lengths and peripheral blood mononuclear cells’ telomerase activity were measured pre- and post-intervention. All staff completing blood draws, fitness testing and bioassays were blinded to group assignment. ResultsThe intervention group completed approximately 40 min of aerobic exercise 3–5 times per week, verified by actigraphy. There was high (81%) adherence to 120 min/week of aerobic exercise. Groups did not significantly differ in telomerase activity changes across time, but had significant different telomere length changes across time (67.3 base pairs, 95%CI 3.1, 131.5). There were also significant reductions in body mass index and perceived stress and an increase in cardiorespiratory fitness (i.e., VO2peak) in the exercising caregivers versus controls. ConclusionIn the context of a highly controlled intervention, exercise can induce apparent telomere lengthening, though the mechanisms remain elusive. Our study underscores the importance of increasing participation in aerobic exercise to improve markers of health and attenuate cellular aging in high-risk samples.

Caregivers of elderly and excessive tension associated to care: evidence of the Sabe Study.

Multiple illness and injury classes can cause a functional disability of the elderly, or the right to seek help from another person. Caregiving can be generated without the caregiver functions, leading to burden. to describe the sociodemographic and care profile of caregivers of the elderly and to analyze the factors associated with excessive stress regarding care. This is a cross-sectional study, part of the SABE (Health, well-being and aging) Study, carried out in the city of São Paulo in 2010, with 362 caregivers. The excessive stress associated with care was evaluated by the Zarit Scale, and the load was found to be less than 24 points and the presence of burden was considered, with scores ≥ 24 points. Hierarchical Logistic Regression was used to analyze the factors associated with the stress of family caregivers. Most of the caregivers were family members (91.5%), being female (75.4%), mean age 53.9 years (SD ± 15.5), married (65.3%), lived in the same household with the elderly (68.2%). One-third of them presented burden, which was associated with age (OR = 1.04, p = 0.001), family dysfunction (OR = 5.60, p = 0.000), continuous care (OR = 78, p = 0.030). The data reveal the need to maintain their needs and support to caregivers, especially their relatives and their sources of life and their debts.

Investigating the Effect of Stress Management Skills Training On Perceived Stress of Family Caregivers of Patients with Heart Failure: A Semi-Experimental Study

Introduction and Objectives: Heart failure affects not only patients’ lives but also caregivers who are considered as the most important source of care for patients and the health care system. Perceived stress, especially during exacerbations period of disease increased. Furthermore, training the stress management skills increases the ability of individuals to reduce stress and adapt to stressful situations; so this study is conducted with the purpose of determining the effect of training stress management skills on perceived stress of family caregivers of patients with heart failure. Materials and methods: This semi-experimental study (before and after) was conducted on 30 patients with congestive heart failure. The sampling was done by access method. Patients were classified into intervention and control groups. Data were collected using Kuhn’s Perceived Stress Questionnaire completed before and after the intervention. Data were analyzed by SPSS software version 21. Results: The results of the statistical tests showed that there was no significant relationship between the two groups before intervention, but after the intervention, the mean score of perceived stress in the intervention group decreased from 38.46 to 21.53.In the control group, this mean was changed from 37.20 to 35.00, and these changes in the intervention group were statistically significant (p=0.001). Conclusion: the training of stress management skills can be effective through improving self-management ability to reduce perceived stress in caregivers of patients with heart failure. Therefore, it is recommended that this training be considered by the authorities in educational centers.

Development of the Family Stigma Stress Scale (FSSS) for Detecting Stigma Stress in Caregivers of People With Mental Illness.

People with mental illness and their family caregivers often perceive public stigma, which may lead to stigma-related stress (or stigma stress). However, no instruments have been developed to measure this stress for family caregivers of people with mental illness. We modified an instrument that measures the stigma stress of people with mental illness (i.e., the cognitive appraisal of stigma as a stressor) and examined the psychometric properties of the scores of the newly developed instrument: the Family Stigma Stress Scale (FSSS). Primary family caregivers of people with mental illness in Southern Taiwan ( n = 300; mean age = 53.08 ± 13.80; 136 males) completed the FSSS. An exploratory factor analysis showed that the FSSS score had two factors; both factor scores had excellent internal consistency (α = .913 and .814) and adequate test-retest reliability ( r = .627 and .533; n = 197). Significant correlations between FSSS factor scores and other instruments supported its concurrent validity and the ability of the FSSS to differentiate between clinical characteristics, for example, having been previously hospitalized or not. The FSSS is a brief and effective measure of the stigma stress of family caregivers of people with mental illness.

Mindfulness training for psychological stress in family caregivers of persons with dementia: a systematic review and meta-analysis of randomized controlled trials.

Caring for a relative with dementia is extremely challenging; conventional interventions may not be highly effective or easily available on some occasions. This study aimed to explore the efficacy of mindfulness training in improving stress-related outcomes in family caregivers of people with dementia using a meta-analytic review. We searched randomized controlled trials (RCT) through April 2017 from five electronic databases, and assessed the risk of bias using the Cochrane Collaboration tool. Seven RCTs were included in our review. Mindfulness interventions showed significant effects of improvement in depression (standardized mean difference: −0.58, [95% CI: −0.79 to −0.37]), perceived stress (−0.33, [−0.57 to −0.10]), and mental health-related quality of life (0.38 [0.14 to 0.63]) at 8 weeks post-treatment. Pooled evidence did not show a significant advantage of mindfulness training compared with control conditions in the alleviation of caregiver burden or anxiety. Future large-scale and rigorously designed trials are needed to confirm our findings. Clinicians may consider the mindfulness program as a promising alternative to conventional interventions.

The Relationship between Caregiver Burden, and Depression, Anxiety and Stress in Family Caregivers of Cancer Patients Referred to Imam Reza Hospital in Bojnurd City

The Relationship between Caregiver Burden, and Depression, Anxiety and Stress in Family Caregivers of Cancer Patients Referred to Imam Reza Hospital in Bojnurd City

Evaluation of a Video-Based Seminar to Raise Health Care Professionals' Awareness of Culturally Sensitive End-of-Life Care

ContextHealth care workers serve diverse communities and face challenges in delivering culturally responsive EOL care, especially when caring for Latino elders. ObjectiveThe objective of this study was to investigate the effect of a newly developed telenovela, or video soap opera, on health care professionals (HCPs)' awareness of caregivers' stress and patients' cultural approaches to end-of-life (EOL) care decisions. MethodsA multicenter cross-sectional study among three communities in New York, Miami, and Missouri. Participants from a convenience sample of multidisciplinary HCPs were randomly assigned to view power point presentation with either a control video or an intervention-telenovela about caregiving as part of a one-hour audiovisual seminar and completed a pre- and post-test questionnaire to evaluate reaction and learning. ResultsParticipants (N = 142) were mostly female (80%) nurses (54%) with a mean age of 44.5 ± 12.4 years and from non-Hispanic white (41%) or Hispanics (37%) ethnicity. In both control and intervention groups, post-test responses demonstrated a high level (87%) of satisfaction with seminar and an increase in openness to discuss EOL issues with culturally diverse patients (P < 0.001). Although both groups reported post-test improvement in awareness of health literacy, cultural competency skills, cultural differences about EOL attitudes, family caregiver stress, and possible interventions, this improvement was significantly higher in the intervention group (P < 0.05) compared with the control group. ConclusionThe telenovela was effective in increasing health care workers' awareness of caregivers stress and cultural approach to EOL decisions. There is need for ongoing efforts to educate HCPs on cultural sensitivity to help ethnically diverse caregivers and their patients benefit from EOL care.

Mindfulness-Based Intervention for Stress Reduction of Family Caregivers of People with Dementia: A Systematic Review and Meta-Analysis

Caring for people with dementia (PWD) poses a lot of challenges to family caregivers. Mindfulness-based intervention (MBI) is a newly adopted psychosocial intervention through an integration of the mind and body to reduce stress of the participants (caregivers). This study aims to determine whether and to what extent MBI for family caregivers of PWD can reduce their stress. Electronic databases including MEDLINE, CINAHL, Cochrane Library, PsycINFO, EMBASE, and the Web of Science were searched for relevant studies published between 1990 and 2016. All randomized controlled trials (RCTs) and quasi-experimental studies evaluating the effects of MBI on reducing stress in family caregivers of PWD were eligible for inclusion in this review. Five studies were included. Of these, three trials involving 144 participants were eligible for the meta-analysis. The analysis showed that stress levels dropped significantly after the MBI. The findings showed a significantly more favorable effect of MBI with the standardized mean difference with a moderate aggregated effect size of 0.57 (95% CI [0.23, 0.92], overall effect Z = 3.25 at p = 0.001). This effect was only found immediately after the MBI but not in the follow-up sessions. In conclusion, the available evidence suggests that MBI seems to be effective at reducing stress among family caregivers of PWD. However, it should be noted that the number of studies involved was small (n = 5), as were the sample sizes, and no sustained effect was found. Multi-center RCTs of the effects of MBI involving larger and more diverse samples of family caregivers of PWD are recommended before any clear conclusion can be reached.

Positive Effects of Cognitive Behavioral Therapy on Depression, Anxiety and Stress of Family Caregivers of Patients with Prostate Cancer: A Randomized Clinical Trial

Background:The family caregivers of patients with cancer mightexperience various physical, mental, and spiritual difficulties, the neglect of which can causeseriousproblems for theentirefamily. If caregivers are left without appropriate treatment and intervention, their level of physical and mental health will substantially decrease-they will, in other words, become “hidden patients.”Materials and Methods:The current study is a clinical trial of 80 family caregivers of patients with prostate cancer, who were allocated to control and experimental groups. The experimental group received 10 sessions of group cognitive behavioral therapy. The 21-item Depression Anxiety Stress Scales were completed before the intervention as well4 and 8 weeks after. Data were analyzed using descriptive statistics (means and standard deviations) andvariousstatistical tests.Results:The results showed thatthecognitivebehavioral intervention reduceddepression, anxiety, and stress among familycaregivers.Conclusion:Because of the positive impact of this intervention, its implementation in clinical care by nurses is recommended.

The Effect of Mindfulness Program on the Perceived Stress of Family Caregivers of Elderlies with Alzheimer’s Disease

The Effect of Mindfulness Program on the Perceived Stress of Family Caregivers of Elderlies with Alzheimer’s Disease

Effectiveness of Group Cognitive-Behavioral Therapy on Strategies for Coping with Stress of Family Caregivers of Patients with Alzheimer’s Disease

Objectives Alzheimer’s disease is a progressive and degenerative disease of the brain that severely damages the thinking and memory functions of human beings. This disease is the most common form of dementia, which comprises a set of signs and symptoms such as loss of memory, judgment, and reasoning that subsequently changes the attitude, behavior, and communication ability. Taking care of people with Alzheimer’s disease can become very stressful for their families. Group cognitivebehavioral therapy has played an important role in teaching how to use compatible coping strategies. Thus, this research aimed to investigate the effectiveness of group cognitive-behavioral therapy on strategies for coping with stress of family caregivers of patients with Alzheimer’s disease. Methods & Materials This research was conducted using a quasi-experimental design. The study sample comprised 32 voluntary caregivers as per Iran's Alzheimer Community Care in 2011. They were selected by convenience sampling method and were randomly assigned into experimental and control groups. We used the questionnaire of coping inventory with stressful situations (CISS), which was completed before group therapy and after the treatment course in 3 stages of pretest, posttest, and follow-up. Data analysis was performed by analysis of covariance, multivariate analysis of covariance, and repeated measures. Results The results showed that the components of compatible strategies (problem-oriented and social enter tainment) in the experimental group were significantly increased compared to pretest and control group due to cognitive-behavioral therapy (P=0.001). However, the components of incompatible strategies (emotionoriented and attention processing) due to cognitive-behavioral therapy was significantly decreased in the ex perimental group compared to the pretest and control group (P=0.001). The results of repeated measuring plan between 3 stages of pretest, posttest, and follow-up showed that the effects of cognitive-behavioral therapy on increasing compatible coping style (problem-oriented and social entertainment) and decreasing incompatible coping style (emotion-oriented and attention processing) as well as the effect of intergroup ac tions and repetition were significant. There was also a significant difference between experimental group and control group. Moreover, the time factor was ineffective in lowering the effect of cognitive-behavioral therapy from posttest to follow-up period. Conclusion Based on the results, the group cognitive-behavioral therapy can increase the use of compatible strategies for coping with stress and decrease the use of incompatible strategies. This issue is related to factors such as complete understanding of Alzheimer’s disease and its effects, creating an atmosphere for presenta tion and an opportunity for social interaction, understanding the importance of sport and allocating time for recreational activities, learning body relaxation in stressful situations, understanding life problems, solving problem techniques, feeling of control, and time management. Thus, we recommend using group cognitivebehavioral therapy as a low-cost treatment for family caregivers of patients with Alzheimer’s and patients with chronic diseases. A B S T R A C T

Problemas en el proceso de adaptación a los cambios en personas cuidadoras familiares de mayores con demencia

ObjectiveTo identify and analyse problems in adapting to change among the family caregivers of relatives with dementia. MethodQualitative study based on the methodology of Charmaz's Constructivist Grounded Theory. Seven focus groups were conducted in different primary health care centres in the province of Jaen (Spain). Eighty-two primary family caregivers of relatives with dementia participated by purposeful maximum variation sampling and theoretical sampling. Triangulation analysis was carried out to increase internal validity. ResultsWe obtained three main categories: ‘Changing Care’, ‘Problems in the process of adapting to change’ and ‘Facilitators of the process of adapting to change’. Family caregivers perform their role in a context characterized by personal change, both in the person receiving the care and in the social and cultural context. The challenge of adaptation lies in the balance between the problems that hamper adaptation of the caregiver to new situations of care and the factors that facilitate the caregiver role. ConclusionsThe adaptation of family caregivers to caring for a person with dementia is hindered by the lack of formal support and under-diagnosis of dementia. The adaptation process could be improved by strengthening formal support in the early stages of care to reduce the stress of family caregivers who must teach themselves about their task and by interventions adapted to each phase in the development of the caregiver role.

Blunted Electrodermal and Psychological Response to Acute Stress in Family Caregivers of People with Eating Disorders.

Caring for an offspring with an eating disorder (ED) is associated with high levels of distress, and health problems. Indeed, ED caregivers have to cope with a range of challenges related to their caring role, which represents a chronic stress situation. This tends to alter body homeostasis and caregivers' health status. This study aimed to analyse the electrodermal reactivity and psychological response to acute stress in ED caregivers compared to non-caregivers. As expected, caregivers showed lower electrodermal (p < .001, η2partial = .269 for SCL and p < .01, η2partial = .214 for NSCRs) and psychological response (p < .05, η2partial = .198) to acute stress than non-caregivers. The findings suggest the existence of physiological adaptation to chronic stress in family caregivers of people with EDs.

Effects of Family Support Programs for Caregivers of People with Dementia - Caregiving Burden, Depression, and Stress: Systematic Review and Meta-analysis

The objective of this systematic review was to assess the effects of family support programs on caregiving burden, depression, and stress in family caregivers of people with dementia. A literature search was conducted of electronic databases to identify randomized controlled studies with family support programs done between 2000 and 2014. Studies published in English and/or Korean were included for the analysis with search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. Studies were rated for quality assessment by two independent reviewers using the appraisal checklist developed by Cochrane Reviews and Dissemination. Of 8,334 articles identified in the literature search, full texts of 76 articles that met the inclusion criteria were reviewed and 38 were found to include relevant outcomes. Results from selected studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed using the Chi-square test. Meta-analysis showed that the effect sizes of family caregiver support programs were small to medium for categories of caregiving burden (Hedge's g=-0.17, 95% CI=-0.30~-0.04), depression (Hedge's g=-0.30, 95% CI=-0.40~-0.20), and stress (Hedge's g=-0.39, 95% CI=-0.52~-0.25). The review results indicate that a support programs can assist family caregivers in reducing their psycho-emotional distress.

Psychophysiological correlates of cognitive deficits in family caregivers of patients with Alzheimer Disease

BackgroundThe progressive loss of memory and autonomy of Alzheimer’s Disease (AD) patients, together with their characteristic behavioral and psychological symptoms, subjects their family caregivers to chronic stress. Several studies indicate that these caregivers are predisposed to cognitive impairments, but the physiological correlates of these alterations remain to be elucidated. ObjectiveAnalyze the effects of chronic stress of family caregivers of AD patients on cognition, cortisol/DHEA ratios and BDNF levels and investigate the relation between these variables. Experimental procedureSeventeen family caregivers (64.83±3.64years) of patients with AD and eighteen non-caregivers (58.29±3.16years) completed stress, depression and anxiety inventories. Exclusion criteria were current neurological disorders, major unstable medical illnesses, use of medications that could interfere with cognitive or HPA axis function and dementia. Attention, working memory and executive function were assessed with Digit Span and Trail Making tests, and declarative memory was analyzed with the Logical Memory test. Saliva was collected at 8AM and 10PM and its cortisol and DHEA levels determined by radioimmunoassay. Serum BDNF levels were measured by sandwich-ELISA. Results were analyzed with independent samples t test, covariance analysis and linear regressions. The statistical significance was set at p<0.05 and all p values were adjusted with Holm’s Method. ResultsCaregivers showed more stress, depression and anxiety symptoms than non-caregivers, as well as significantly worse performances on attention, working memory and executive function tests. Caregivers also had higher cortisol/DHEA ratios and lower BDNF levels than non-caregivers. Cortisol/DHEA ratios, especially at 10PM, were negatively related with all cognitive tasks in which caregivers showed impaired performance. On the other hand, the only cognitive task that related with the BDNF level was digit span. ConclusionsThis study showed that caregivers’ cognitive impairment is related with alterations on cortisol/DHEA ratios, and that chronic stress experienced by these subjects has the potential to alter their BDNF levels.

Coping with stress of family caregivers of cancer patients in Turkey

Objective:Cancer is a disease that not only affects the individual's mental and physical integrity but also affects the functionality of the family system. Caregivers experience stress when patients cannot cope with the symptoms they are experiencing. The stress experienced by caregivers gives rise to psychological and physical symptoms. The purpose of this study is to determine the attitude of coping with stress of family caregivers of cancer patients.Methods:This study was conducted as a descriptive research at the Medical Oncology Clinic. The study sample group comprised of 127 family caregivers. In the collection of the data, the Personel Information Form and Attitude of Coping with Stress Inventory were used.Results:The coping attitude used most frequently by family caregivers was active planning, and the least used coping attitude was avoidance isolation (biochemical). There was no significant statistical difference between the coping attitude depending on the descriptive characteristics of the family caregivers (P > 0.05).Conclusion:Results show that family caregivers of cancer patients tend to choose effective coping methods. However, there were still caregivers that displayed ineffective coping attitudes. Therefore, it is important to support the effective coping attitudes of caregivers and intervene in order to change the ineffective coping attitudes.

Comparison of Family Satisfaction in Australian Ethno-Specific and Mainstream Aged Care Facilities

The aim in this study was to identify specific aspects of care that increased satisfaction of family members of Greek and Italian residents with dementia in mainstream or ethno-specific aged care facilities in Australia. Relatives of 83 aged care residents with Greek or Italian backgrounds who were also cognitively impaired were interviewed. They rated their satisfaction with the facility and suggested improvements regarding the care provided. Family members with relatives in ethno-specific care were more satisfied, in terms of the facility's ability to meet the resident's language and cultural needs, social/leisure activities, and the food provided. The presence of a bilingual staff member and greater perceived reduction in family caregiver stress upon admission were associated with higher satisfaction. Results implicate the role of activities programs, catering, resident interaction, supporting caregivers upon admission, and bilingual staff members to increase family satisfaction, with the potential to improve the care provided to residents in mainstream care.

Factors Responsible for Stress among Family Caregivers of Hospitalised Patients in Abeokuta, Nigeria

The study is designed to; evaluate the factors contributing to stress among caregivers, identify the effects of stress among family caregivers of hospitalized patients, to suggest useful coping strategies in dealing with stress during hospitalisation. Family caregiver implies family member, spouse, friend, or neighbour who provides care to an individual during hospitalization. The research design adopted for this study was descriptive survey approach. Purposive sampling technique was used to select the sample of 200 family caregivers. Data was collected using questionnaire. Analysis was done descriptively and inferentially. Care recipient's behaviour and required attention towards siblings do not significantly contribute to stress in family caregivers of hospitalised patients. X2< critical value (P<0.05). Emotional problems are the major effects of caregiver stress. Thorough understanding of patient's medical situation, Stress management and self-efficacy techniques are the useful coping strategies. Therefore, patients and caregivers should be well-informed.

Measuring family caregiver efficacy for managing behavioral and psychological symptoms in dementia: a psychometric evaluation

Caregiver efficacy for managing the behavioral and psychological symptoms of dementia (BPSD) is an important determinant of family caregiver stress and burden. This study aims to develop a measure of caregiver efficacy for responding to BPSD and to evaluate its psychometric properties. The Caregiver Efficacy Scale adds an item for caregiver confidence in managing BPSD to each domain of the Neuropsychiatric Inventory (NPI). The validity, internal consistency, and factor structure of the scale were evaluated in 245 family caregivers. The results provide adequate support for the validity and reliability of the Caregiver Efficacy Scale. The internal consistency was found to be adequate (Cronbach's α = 0.79) and the scale demonstrated good concurrent, construct, and criterion validity. As expected, performance on the Caregiver Efficacy Scale was associated with all dimensions of the NPI, including BPSD frequency (r = 0.869, p < 0.01) and severity (r = 0.883, p < 0.01), and negative outcomes, including negative affect (r = 0.411, p < 0.01), depression (r = 0.362, p < 0.01), anxiety (r = 0.376, p < 0.01), and distress (r = 0.865, p < 0.01). The Caregiver Efficacy Scale might have clinical implications in facilitating the development of improved caregiver interventions for dealing with BPSD, allowing interventions to be tailored according to individual caregiver needs, and also in evaluating the effectiveness of interventions aimed at improving caregiver self-efficacy for managing BPSD.