Terms Of Caregivers Research Articles

Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review.

Diabetes is a chronic disease associated with numerous complications including diabetic foot disorders, which are associated with significant morbidity and mortality as well as high costs. The costs associated with diabetic foot disorders comprise those linked to care (direct) and loss of productivity and poor quality of life (indirect). Due to the constant increase in diabetes prevalence, it is expected that diabetic foot disorder will require more resources, both in terms of caregivers and economically. We reviewed findings on management, morbidity, mortality, and costs related to diabetic foot disorder.

Developing an occupational telerehabilitation program for caregivers of people with dementia to increase their ability to care and reduce burden

AbstractBackgroundPeople with dementia (PwD) require high levels of care, most of which is provided by either family or informal caregivers. Psychosocial interventions have been demonstrated to reduce caregiver burden and delay nursing home admission. Telemedicine could provide caregivers access to such interventions, increasing their sense of competence and resilience.MethodThrough a co‐design process involving geriatricians, psychologists, neurologists, nurses, occupational therapists and 25 dyads, a telerehabilitation program has been developed and tested through a 12‐months Beta Test protocol. The program comprises a multidimensional clinical assessment and a telerehabilitation plan. Whilst occupational therapists act as care manager interface towards caregivers through a telemedicine platform, a multidisciplinary team including nurses, psychologists and geriatricians, regularly oversees each plan and delivers interventions whenever required.ResultsAlmost all caregivers were spouses or children (22 out of 25). 79% were female and 59% lived with the care recipient in the same household. The average age of caregivers was 63,72 and Zarit index 36,88. On average PwD’s age was 83,75, Barthel Index 61,27, IADL 0,97, NPI Index 24,86 with 4,8 BPSD. The program has required on average 18,8 sessions per caregiver: which comprised of 4,5 sessions for multidimensional evaluation of both PwD and caregiver, 9,1 sessions for the execution of the telerehabilitation plan and 5,2 sessions for follow up. Sessions could range from 45 minutes (clinical scales‐based assessment) to 10 minutes (follow up). 48% of telerehabilitation sessions addressed BPSD, 17% provided emotional support, 14% supported caregivers in ADL activities, 11% addressed comorbidities and 10% addressed other issues (communication and cognition). A self‐developed caregivers' reported outcome questionnaire (24 responders out of 25) reported that 88% of caregivers improved their health literacy, 87% their sense of competence and 97% felt emotionally supported. After at least 6 months, a follow up analysis on 13 PwD and 10 family caregivers, NPI Index has improved on average by 41% while Zarit Index by 16%. Average yearly cost of the program reached 2 euro per day per dyad.ConclusionsThe beta test showed encouraging outcomes in terms of caregivers’ satisfaction that require further investigation in terms of clinical outcomes and cost‐effectiveness.

HeartLogic™: real-world data-efficiency, resource consumption, and workflow optimization.

Heart failure (HF) is a major and still growing medical problem and is characterized by episodes of acute decompensation that are associated with a negative prognosis and a significant burden on the patients, doctors, and healthcare resources. Early detection of incipient HF may allow outpatient treatment before patients severely decompensate, thus reducing HF hospitalizations and related costs. The HeartLogic™ algorithm is an automatic, remotely managed system combining data directly related to HF pathophysiology into a single score, the HeartLogic™ index. This index proved to be effective in predicting the risk of incipient HF decompensation, allowing to redistribute resources from low-risk to high-risk patients in a timely and cost-saving manner. The alert-based remote management system seems more efficient than the one based on scheduled remote transmission in terms of caregivers' workload and alert detection timing. The widespread application of the HeartLogic™ algorithm requires the resolution of logistical and financial issues and the adoption of a pre-defined, functional workflow. In this paper, we reviewed general aspects of remote monitoring in HF patients, the functioning and pathophysiological basis of the HeartLogic index, its efficiency in the management of HF patients, and the economic effects and the organizational revolution associated with its use.

Factors affecting quality of working life among caregivers in care facilities for the elderly

Theshortage of caregivers in care facilities has become a problem in Japan. Building a comfortable workplace and improving the quality of working life (QWL) of caregivers are essential. However, the factors of QWL that should be prioritized remain unclear. The purpose of this study was to identify the major factors currently affecting the QWL of caregivers in care facilities for the elderly and recognize the priorities that should be addressed. A questionnaire survey targeting administrators and caregivers working in care facilities for the elderly was conducted from October to December in 2018. In total, 1,000 care facilities located throughout Japan were selected via random sampling. Eight caregivers who differed by sex, age, and years of experience were selected from each facility (a total of 8,000 caregivers). A logistic regression analysis was used to analyze the association between QWL and the factors affecting it. Ultimately, data from 504 facilities and 3,478 caregivers were included in the analysis. Human relationships (OR: 3.92, 95% CI: 3.09-4.97) had the highest odds ratio in terms of caregivers' QWL, followed by the number of workers (OR: 3.69, 95% CI: 2.56-5.32), communication (OR: 3.42, 95% CI: 2.66-4.40), support from the facility (OR: 3.37, 95% CI: 2.69-4.23), working hours or time off (OR: 3.20, 95% CI: 2.53-4.04), and discretion of responsibility level (OR: 3.09, 95% CI: 2.46-3.88). In contrast, salary (OR: 2.81, 95% CI: 2.19-3.61) was associated with QWL but the association was lower than that of human relationships and the other factors. Lower back pain among caregivers was also associated with QWL. Findings of this study show that improvement in human relationships is the primary factor for improved QWL among caregivers in care facilities. Thus, it should be prioritized. Secondary factors that affect QWL are the number of workers, communication, support from the facility, working hours or time off, and discretion of responsibility level. Considering the reasons for caregivers' dissatisfaction, improving their QWL requires promoting the exchange of information with superiors and colleagues. It also involves consulting with persons in charge about working hours, time off, and mental health. Salary is related to QWL but is less important than the aforementioned factors. The prevention of lower back pain, however, contributes to improving QWL.

EARLY MALTREATMENT AND CURRENT QUALITY OF RELATIONAL CARE PREDICT SOCIOEMOTIONAL PROBLEMS AMONG INSTITUTIONALIZED INFANTS AND TODDLERS.

The present study is focused on child socioemotional problems 6 months after institutionalization, by considering the putative predictive role of child maltreatment, of developmental functioning at admission and the following months, and of the quality of institutional relational care. Fifty institutionalized infants and toddlers participated in this study. Child developmental functioning (i.e., cognitive, language, and motor development) was assessed at admission to the institution (Wave 0), and 3 (Wave 1) and 6 months (Wave 2) thereafter. The quality of institutional relational care-operationalized in terms of caregivers' sensitivity and cooperation-was measured at Wave 2. Caregivers reported on the presence of disturbed socioemotional behaviors at Wave 2. Child gestational age, birth weight, age, and stunted growth at admission to the institution served as covariates. Results revealed significant associations between socioemotional difficulties and lower levels of motor development at Waves 0 and 1, child maltreatment, and less sensitive caregiving. A logistic regression showed that child maltreatment and caregiver insensitivity were the only significant predictors of disturbed socioemotional functioning by the end of 6 months of institutionalization.

Do adolescents with cerebral palsy agree with their caregivers on their participation and quality of life?

BackgroundIt is important to determine the quality of life (QoL) and level of participation in children with Cerebral Palsy (CP). Previous research has used reports from adolescents or caregivers, but there is no evidence that caregivers' reports accurately reflect the experiences of the adolescents they are interested in. Objective/HypothesisThe aim of this study was to investigate whether a difference was present in the views of the adolescents and their caregivers regarding the participation and the quality of life of adolescents with CP, and to reveal the parameters creating such differences. MethodsThe participation levels and QoL of the adolescents were evaluated separately by the caregiver and the adolescent using the Pediatric Outcomes Data Collection Instrument (PODCI). ResultsA statistically significant difference was found in terms of caregivers and adolescents' scores of PODCI upper extremity (Z = −2,560, p = 0,008), transfer&basic mobility (Z = −3,839, p = 0,000), sports/physical functioning (Z = −3,103, p = 0,002), happiness (Z = −2,420, p = 0,016) and global functioning (Z = −3,639, p = 0,001). The children's scores were statistically significantly higher than caregivers'. It was found that there was a poor consistence in terms of caregivers and adolescents' scores of upper extremity (ICC = 0,373, p = 0,012), transfer/basic mobility (ICC = 0,289, p = 0,016), sport/physical functioning (ICC = 0,359, p = 0,009); moderate consistence in terms of those of global functioning (ICC = 0,421, p = 0,003). ConclusionIt was determined that caregivers and children's answers were not compatible with one another especially in terms of subjective assessments such as happiness and pain, which suggests that the consideration of caregivers or children in the assessment of subjective situations will change the results.

The Impact of Latino Caregiver Acculturation on Treatment Engagement in Children’s Community Mental Health Services

Ongoing treatment engagement is low in children’s community mental health. Although concerns are more pronounced for racial/ethnic minorities, findings have been mixed when comparing racial/ethnic minorities with Non-Hispanic Whites. Within-group variability, such as level of acculturation, may be a more proximal predictor of treatment engagement. The current study aimed to examine the effect of Latino caregivers’ acculturation on ongoing treatment engagement indicators, specifically session attendance, premature treatment termination, and treatment satisfaction. Participants were families of youth, ages 5–15, with a Latino primary caregiver (N = 93) receiving treatment for anxiety/trauma, depression, or disruptive behavior problems in community-based mental health agencies. Caregivers were classified into low and high acculturation groups using latent class analysis based on demographic indicators, such as nativity status and primary language spoken. Groups significantly differed in terms of caregivers’ nativity status, age at immigration, primary language spoken, language of study assessment completion, and language spoken in the home. Families of low acculturation caregivers no showed to significantly fewer planned treatment sessions than families of highly acculturated caregivers. Treatment satisfaction did not differ between groups. Low acculturation families also had lower odds of prematurely withdrawing from treatment. Results of this study highlight the importance of considering family characteristics such as acculturation when engaging families in treatment.

Sometimes Words Will Do

Abstract— Parental embodied mentalizing (PEM) provides an innovative way of characterizing engagement with infants’ internal states in terms of caregivers’ physical or kinesthetic behaviors rather than their verbal comments. In order to ensure that PEM becomes a useful addition to methods of conceptualizing and assessing the quality of infant–caregiver interaction, D. Shai and J. Belsky (2011) must maintain their focus on PEM as a dyadic and relational construct, and consider how caregivers’ verbal recognitions of their infants’ internal states can complement and inform the PEM construct.

Caregivers' Perceptions of a Consumer-Directed Care Program for Adults With Developmental Disabilities

This article examines results from a consumer and caregiver-directed care pilot program for families with adults with developmental disabilities. Surveys were administered to 50 caregivers and three project coordinators, and focus groups were conducted with 44 individuals, including caregivers, consumers, and support coordinators. Significant pre- to posttest changes were seen in terms of caregivers' perceptions of choice, goodness-of-fit of services to needs, and satisfaction with the program. Analysis of focus group discussions yielded three major themes: trust, flexibility, and relief. Although support and program coordinators had some concerns that the program was more caregiver than consumer oriented at times, overall, the program was viewed positively.

Caregiver preferences for pediatric asthma treatment delivery systems

This study was conducted to assess caregiver preferences for pediatric asthma treatment delivery systems. A total of 186 caregivers of children with asthma who ranged in age from 1 to 4 y completed a stated-preference questionnaire to assess the importance of specific treatment attributes in terms of caregivers' preferences, and to determine the percentages of caregivers who preferred specific treatments. Other outcomes assessed included caregivers' likelihood of adhering to pediatric asthma treatment. Most respondents (75%) preferred treatments that have been approved by the US Food and Drug Administration (FDA) in children as young as 12 mo, that require minimal effort in coordination and inhalation on the child's part, and that take up to 10 min to administer. A greater proportion of respondents indicated that they would be able to follow the physician's advice (increased likelihood of adherence) if given this treatment (54%) versus an alternative (35%). This difference did not achieve statistical significance, however. The conjoint analysis method used in this study enabled investigators to assess caregivers' relative preferences for specific attributes of various pediatric asthma treatments. Overall, FDA approval in children as young as 12 mo was the most preferred attribute. Caregiver preference for pediatric asthma treatment alternatives is an important consideration and should be a component of discussions between healthcare professionals and caregivers.

Burden of rhinitis in children with asthma

Although the clinical association of allergic rhinitis and asthma has been recognized for centuries, in recent years the association appears to be stronger than was reported previously. However, data for children are less clear, and some studies indicate that results observed in developing countries may differ from those observed in Western populations. We therefore intended to document the association of rhinitis with pediatric asthma in terms of caregivers' perception, physician practice, and file records. Asthmatic children aged 3-16 years with at least 1-year follow-up in an allergy-asthma outpatient clinic were invited to participate in the study during a 10-month interval. In addition to a face-to-face questionnaire-based interview, file records were evaluated retrospectively to obtain information relating to asthma and rhinitis. Of 396 patients included in the study, 369 with consistent replies were included in the analyses. The mean age of the study group was 10.6 +/- 0.2 (mean +/- SEM) years, and a greater proportion of the respondents were male (63.7%), atopic (78.3%), and mildly asthmatic (50.7%). House dust mite and grass pollens were the most commonly sensitized allergens (50.7% and 46.9%, respectively). Although only 5.4% of our study population regarded themselves as rhinitic and 23.8% had been diagnosed with allergic rhinitis according to the file records, almost 57.7% of patients had required medications for rhinitis within the last year, and 68.8% had findings consistent with allergic rhinitis. Furthermore, 41.2% and 58.8% reported that their rhinitis symptoms caused a significant burden in their daily life and exacerbated their asthma, respectively, and almost 50% felt that their rhinitis had not been given significant consideration by their physician. In conclusion, although we report a large discrepancy between caregivers' perception of rhinitis, documentation in file records, and treatments for rhinitis, the allergic rhinitis prevalence determined in the survey and the medication use for rhinitis appeared to be in agreement. We recommend a greater effort be made to identify, label, and educate children with rhinitis and their families in asthma outpatient clinics.

Family support--a burden to patient and caregiver.

The aim of this paper was to describe family support in terms of the sources as well as the consequences of burden for caregivers, patients and family interaction. Caregivers' sources of burden were related to difficulties in coping with patients' emotional responses, physical complaints and altered life style behaviour as well as future oriented factors. Consequences in terms of caregivers' perceptions of emotional distress and personal losses are elucidated. In terms of family support, when focusing on sources of burden for patients' concerning family support, emotional support is emphasised and related to overprotection. Two different definitions of the overprotection concept are used in order to elucidate different consequences of the phenomenon. Sources and consequences of burden are also related to family interaction. The family is regarded as a system in which a cardiac disease may cause an imbalance. Poor marital quality or poor family functioning is described as a hindrance to a new balance. To summarise, the reviewed literature unanimously shows that the interactive support between family members when dealing with cardiac disease constitutes a considerable emotional burden. Therefore the support for emotional communication within the family should take priority. The knowledge described can provide a foundation for the development of family support in the cardiac area.

Quality of care: relationship between the perceptions of elderly home care users and their caregivers

The aim was to study the relationship between elderly home care users', and their caregivers', perceptions of the quality of care. The sample consisted of 151 matched elderly home care user‐caregiver pairs in a Swedish municipality. The elderly home care users were interviewed and their caregivers filled in questionnaires using an established, theory‐based instrument. Results showed that the elderly home care users evaluated most care components more favourably than their caregivers. On ratings of the various care components' subjective importance to the caretaker, the caregivers consistently scored higher than the elderly home care users. Within the subset of elderly home care users who received help at least twice a day, there were greater similarities between caregivers and caretakers. The results are related to comparable research and discussed in terms of caregivers' needs to legitimize their professional identity and actions.

Skill-specific staffing intensity and the cost of hospital care.

Hospital managers have changed their staffing strategies to reduce the cost of care. Such hospitals may be both understaffed and underskilled in terms of some caregivers. Understaffing and underskilling may have indirect effects that offset the benefits of payroll cost reductions. This article indicates that in 1991 some California hospitals were understaffed in terms of specific bedside caregivers and had higher costs than did hospitals employing more of those caregivers.

Development of a measure of work-related distress: Psychometric properties

A new burnout instrument, the Generalized Work Distress Scale (GWDS) is introduced, which is theoretically more compatible with the concept of work disability than previous instruments that measure job dissatisfaction and burnout. In the present study, the GWDS demonstrated adequate test-retest reliability as well as known group validity in both care-giver and non-caregiver populations. Additionally, the GWDS demonstrated predictive validity in terms of care givers' strong reactions to the need for assistance with their own vocational distress responses, and retrospective validity in terms of non-caregivers' days absent from work. Factor analysis indicated a 2 factor solution involving an internal (distress), and external (support from others) factor. The present test should be useful in the assessment of a common barrier to occupational rehabilitation, especially when rehabilitation involves a musculoskeletal disorder.