Caregiver and Clinician Assessment of Behavioral Disturbances: The California Dementia Behavior Questionnaire

As part of a multicenter project to study noncognitive behavioral disturbances in dementia, the authors developed a comprehensive caregiver-rated questionnaire for these behaviors. The authors determined the reliability of caregiver ratings and compared caregiver ratings with clinician ratings using standard instruments. Caregivers showed good test/retest reliability for ratings of all types of patient behavioral disturbance. Caregiver interrater reliability was highest for depression and lowest for psychosis. The correlation between caregiver reports and professional assessments was highest for agitation, intermediate for psychosis, and lowest for depression. The match between caregiver and clinician assessments of patient behaviors appears to vary significantly by the type of behavior assessed

Frontotemporal dementia: the impact of patient behavioral symptoms on the physical and mental health of family caregivers.

BackgroundProviding informal support to someone with frontotemporal dementia (FTD) could be very stressful. Clarifying the relationship between patient behavioral problems and caregiver health could spur future research on effective symptom management strategies.MethodsSixty-one FTD family caregivers participated in a postal survey.ResultsPatient symptom severity was negatively associated with caregiver mental health (r = -0.26, p < 0.05) but not significantly associated with caregiver physical health. In a regression analysis, caregiver emotional distress from patient behaviors made a statistically significant contribution to caregiver mental health, explaining approximately 10% of its variance.ConclusionThis study underscores the importance of focusing on FTD caregivers' perceived emotional distress from patient behavioral problems and ensuring they are getting the appropriate support they need

A Systematic Review of Telehealth in Palliative Care: Caregiver Outcomes

Objective: Telehealth interventions have proven efficacy in healthcare, but little is known about the results of such interventions in palliative care. We conducted a systematic review to evaluate caregiver outcomes related to palliative telehealth interventions. Materials and Methods: We searched multiple databases for articles published between January 2003 and January 2015 related to telehealth in palliative care. Two hundred twenty-one articles were considered; nine of these met study inclusion criteria. Data on study design, population, interventions, methods, outcomes, conclusions, and methodological quality were extracted and evaluated by three investigators. Results: Of the nine studies, five measured caregiver quality of life, three measured caregiver anxiety, and two measured caregiver burden. All the studies measuring caregiver quality of life showed no significant difference after telehealth interventions. The caregiver anxiety score decreased after the intervention in two studies, and one study reported significantly reduced caregiver burden. Although feasibility of or caregiver satisfaction with the telehealth intervention was not the focus of this review, most studies reported such findings. Of the nine studies, the majority were rated as having moderate quality using the Cochrane Collaboration’s tool for assessing risk of bias. Conclusions: This systematic review suggests there is evidence of overall satisfaction in caregivers who undergo a telehealth intervention, but outcomes reported were often not substantial. Methodological flaws and small sample sizes negatively affected study quality. More rigorous research to test and evaluate such palliative interventions is needed

Developing National In-Home Caregiver Training Standards

This report incorporates discussion by experts on topics of paid in-home caregiver training standards, including curricula, accreditation, certification, career ladder, and caregiver support

Is Helping Really Helping? Health-Related Quality of Life after TBI Predicting Caregiver Depression Longitudinally in Latin America

Objective: Studies have shown that functional and psychosocial sequelae of traumatic brain injury (TBI) predict emotional well-being of caregivers (Harris, 2000). Previous research examining the mental health of caregivers and the health-related quality of life (HRQoL) of people with TBI have primarily been in the US (Sander, 2012). Very little research has been conducted to uncover the unique relationships between HRQoL of people with TBI and caregiver mental health longitudinally, or in low-middle income Latin American countries. The aim of this study was to evaluate how HRQoL after TBI predict caregiver depression longitudinally in two countries and three data collection sites in Latin America. Design: Multi-site, multinational longitudinal study. Setting: Three hospitals in Neiva and Cali, Colombia, and Mexico City, Mexico (before hospital discharge), as well as in the homes of individuals with TBI and caregivers in these regions (before discharge, at 2 and 4 months after discharge). Participants: A sample of 109 TBI caregiver-patient dyads (n = 218) was included in the study. Main Outcome Measure(s): Caregiver depression (Patient Health Questionnaire-9) and HRQoL in the person with TBI (Short Form-36). Results: Three multiple regressions were conducted to examine which aspects of patient HRQoL at baseline predicted caregiver depression at baseline, 2 months, and 4 months post-discharge. Eight aspects of patient HRQoL were simultaneously entered into each model as predictors: physical functioning, role limitations (physical and emotional), vitality, mental health, social functioning, pain, and general health. At baseline, the overall model significantly predicted caregiver depression, F(8, 105) = 2.62, p = .012, R 2 = .18. Patient mental health was the only significant unique predictor of caregiver depression at baseline, p = .021, β = -.34. The overall model predicting 2-month caregiver depression was significant, F(8, 101) = 3.21, p = .003, R 2 = .22. Only mental health, p = .016, β = -.36, was a significant unique predictor. The overall model predicting 4-month caregiver depression was significant, F(8, 98) = 2.70, p = .010, R 2 = .19, and no factors uniquely predicted caregiver depression, all ps\u3e.05. Conclusions: Results suggest that TBI patient HRQoL can predict caregiver depression among Latin American caregivers before and during the first 4 months after hospital discharge. Across all three time points (baseline, 2 months, and 4 months), caregiver depression was significantly predicted by patient HRQoL. At baseline, patient mental health was the only domain that uniquely predicted caregiver depression. At 2 months, only physical role limitations uniquely predicted caregiver depression, and no unique predictors were detected at 4 months. These findings suggest that within the cultural framework in Latin America, there is a strong relationship between functional and psychological impairments after TBI and depression outcomes in Latin American caregivers. The results highlight the importance of uncovering these relational distinctions and may infer early detection of mental health needs and psychological intervention considerations for Latin American caregivers.https://scholarscompass.vcu.edu/gradposters/1052/thumbnail.jp

Species-specific differences and similarities in the behavior of hand-raised dog and wolf pups in social situations with humans

In order to reveal early species-specific differences, we observed the behavior of dog puppies (n = 11) and wolf pups (n = 13) hand raised and intensively socialized in an identical way. The pups were studied in two object-preference tests at age 3, 4, and 5 weeks. After a short isolation, we observed the subjects' behavior in the presence of a pair of objects, one was always the subject's human foster parent (caregiver) and the other was varied; nursing bottle (3 weeks), unfamiliar adult dog (3 and 5 weeks), unfamiliar experimenter (4 and 5 weeks), and familiar conspecific age mate (4 weeks). Dogs and wolves did not differ in their general activity level during the tests. Wolf pups showed preference for the proximity of the caregiver in two of the tests; Bottle-Caregiver at the age of 3 weeks and Experimenter-Caregiver at the age of 5 weeks, while dogs showed preference to the caregiver in three tests; conspecific Pup-Caregiver and Experimenter-Caregiver at the age of 4 weeks and dog-caregiver at the age of 5. Compared to wolves, dogs tended to display more communicative signals that could potentially facilitate social interactions, such as distress vocalization, tail wagging, and gazing at the humans' face. In contrast to dog puppies, wolf pups showed aggressive behavior toward a familiar experimenter and also seemed to be more prone to avoidance. Our results demonstrate that already at this early age-despite unprecedented intensity of socialization and the comparable social (human) environment during early development-there are specific behavioral differences between wolves and dogs mostly with regard to their interactions with humans

Exploring the Effects of Caring for Congestive Heart Failure Patients on Caregiver Well-Being: A Descriptive Study

Background: As the incidence of heart failure (HF) quickly becomes the leading cause of disability among older adults, the need for non-professional, in-home caregivers increases as well. Many caregivers are family members who receive no compensation for their efforts, but all are an invaluable tool in the fight against a debilitating disease. Patients with caregivers experience an improved quality of life and lower mortality rates than patients with little social support. The caregiver of a patient with HF may be responsible for everyday activities such as housekeeping and shopping, as well as more complex disease-related necessities as managing medication regimens and fluid restrictions. The stresses associated with caring for a loved one with a progressive and life-altering disease can take a toll on the caregiver, contributing to a decrease in caregiver health and increase in mortality. Purpose: The purpose of this study was to explore how stress factors of caring for an individual with HF impact the emotional health, physical health, social activity, relationships, and lifestyle of the caregiver. Methodology: The study protocol was approved by the University of Arkansas and Washington Regional Medical Center Institutional Review Boards. Patients were accessed through a HF clinic in Northwest Arkansas, the Advanced Nurse Practitioner identifying patients that met the criteria of having an unpaid caregiver as defined in the study. The prospective cohort study was conducted September to December 2016 with 29 individuals identified as friends or family members of a patient with HF who provided care to the HF patient and received no financial compensation for their services. The Caregiver Burden Questionnaire – HF Version 3.0, consists of 26 questions regarding how the caregiver’s experience has been over the past four weeks of caregiving, and was used to measure four domains of physical, emotional/psychological, social, and lifestyle burdens. Results: Summary scores were created for all variables and descriptive statistics used. A Spearman’s rank-order correlation was used to determine the strength and direction of the association between variables. In agreement with previous research findings, physical health of the caregiver was positively correlated with emotional well-being. Discussion: Being a caregiver for a patient with HF can cause strain for the caregiver, but can also be rewarding. The benefits, such as feeling a sense of reward through helping someone else, can provide an emotional buffer that supports the caregiver through times of hospitalization or decline in the patient’s condition. Our findings suggest that interventions implemented to increase the caregiver’s perception of emotional support, perhaps through repeated contact by a healthcare professional, could improve caregiver, and therefore patient, outcomes

Factors of resilience in informal caregivers of people with dementia from integrative international data analysis

Background/Aims: Although caring for a person with dementia can be stressful, some caregivers appear to experience few negative consequences to their well-being. This study aimed to examine what proportion of caregivers demonstrates resilience under different challenging circumstances and to identify factors related to their resilience. Methods: Baseline data from 4 studies from the Netherlands and UK among informal caregivers of people with dementia were harmonized and integrated. Caregiver resilience was defined as high levels of psychological well-being despite different types of high caregiving demands. Multivariate regression analyses identified factors significantly related to caregiver resilience. Results: The integrated data set included 15 harmonized variables with data from 1,048 caregivers facing a high care demand. The prevalence of resilience varied between 35 and 43%, depending on the demand for high care. Being a male caregiver, caring for a female, living apart from your relative, and low caregiver burden were positively related to caregiver resilience. Conclusion: Caregivers have the capacity to demonstrate resilience despite significant challenges. This study demonstrates how harmonization of data from multiple existing studies can be used to increase power and explore the consistency of findings. This contributes to a better understanding of which factors are likely to facilitate caregiver resilience and offers insights for developing services

Mom-it helps when youre right here! Attenuation of neural stress markers in anxious youths whose caregivers are present during fMRI.

Close proximity to an attachment figure, such as a caregiver, has been shown to attenuate threat-related activity in limbic regions such as the hypothalamus in healthy individuals. We hypothesized that such features might be similarly attenuated by proximity during a potentially stressful situation in a clinically anxious population of youths. Confirmation of this hypothesis could support the role of attachment figures in the management of anxiety among children and adolescents. Three groups were analyzed: anxious children and adolescents who requested that their caregiver accompany them in the scanner room, anxious children and adolescents without their caregiver in the scanner room and healthy controls (each of N = 10). The groups were matched for age and, among the two anxious groups, for diagnosis (mean age 9.5). The children and adolescents were exposed to physical threat words during an fMRI assessment. Results indicate that activity in the hypothalamus, ventromedial, and ventrolateral prefrontal cortex were significantly reduced in anxious children and adolescents who requested that their caregiver accompany them in the scanner room compared to those without their caregiver in the scanner room. Mean activity in these regions in anxious children and adolescents with their caregiver in the scanner room was comparable to that of healthy controls. These data suggest links between social contact and neural mechanisms of emotional reactivity; specifically, presence of caregivers moderates the increase in anxiety seen with stressful stimuli. Capitalizing on the ability of anxious youths to manifest low levels of anxiety-like information processing in the presence of a caregiver could help in modeling adaptive function in behavioral treatments

Decreasing Caregiver Stress

Stress is both critical and personal experience and has significant effects on caregivers’ physical, mental, and social well-being. The nature of caregiving and the responsibility to work and serve individuals at their illness conditions are very personal encounters that often result in adverse effects on the health and well-being of caregivers (Frederick, 2016). A decrease in stress experience can lead to the satisfaction of caregiver roles and improvement of patient’s quality of life (Choi, Jisun & Boyle, Diane, 2013; Yada, Nagata, & Inagaki, 2014). This scholarly project determined that evidence-based stress management interventions have decreased the perceived stress in caregivers. The scholarly project identified low levels of stress among research participants, and how evidence-based interventions decreased caregiver stress by increasing their knowledge and awareness of evidence-based stress management interventions. The results of this scholarly project agree with the literature that caregiver stress experience can be decreased through the implementation of evidence-based stress management interventions (Blom, Zarit, Groot Zwaaftink, Cuijpers, & Pot, 2013). It is significant to implement evidence-based stress management interventions to decrease perceived stress among caregivers