Factors related to the quality of life in family carers of people with dementia: a meta- analysis

Objectives: This meta-analysis aimed to (1) quantitatively synthesize evidence of factors related to the quality of life (QoL) of family carers of people with dementia and (2) explore moderating factors that may influence the strength of the relationship between such potential predictive factors and carer QoL.  Methods: Studies that investigated correlations between patient/carer factors and QoL in unpaid family carers of people with dementia and were published in English, Spanish, Portuguese, or Japanese were included.  Results: Thirty-three studies were identified. The pooled correlations with carer QoL (effect size) were significantly large for depression (−0.58), significantly moderate for subjective burden (−0.47), and significantly small for people with dementia’s neuropsychiatric symptoms (−0.24). These results indicated to be robust in the context of publication bias. The results of subgroup analyses demonstrated the social and economic development status of the country where study participants resided did not moderate these effects.  Conclusion: Carer depression, subjective burden, and people with dementia’s neuropsychiatric symptoms may play a critical role in maintaining QoL of family carers regardless of the social and economic circumstances

Hip fracture. Preliminary results supporting significative correlations between the psychological wellbeing of patients and their relative caregivers

Background and aim. Hip fracture is one of the major causes of loss of self-sufficiency in older patients. The associated caregiving rehabilitation task often falls to the lot of a member of the patient’s family. Our study aims at assessing the relationship between the psychological well-being of patients with hip fracture and their caregivers. Methods. The study was carried-out on 53 elderly patients with hip fracture and their primary caregivers. The Mini Mental State Examination (patient), Activities of Daily Living (patient), Instrumental Activities of Daily Living (patient), Geriatric Depression Scale (patient), Psychological General Well-Being Index (patient/caregiver) and the Caregiver Burden Inventory (caregiver) were administered to each participant. Results. The results revealed significant correlations between stress levels and the psychological well-being of hip-fracture patients and relative caregivers. In particular, the Caregiver Burden Inventory’s total score was negatively related to the patient’s Psychological General Well-Being Index score (p < 0.05) and with Anxiety (p < 0.05), Depressed Mood (p < 0.01), Positive Well-being (p < 0.05) and General Health (p < 0.05) subscale scores, as well as with the patient’s Activities of Daily Living (p < 0.05) score. Patients’ Psychological General Well-Being Index scores were related to the caregivers’ General Health subscale (p < 0.01), and negatively related to Caregiver Burden Inventory Time Dependence (p < 0.05) and Social Burden (p < 0.05) subscales, as well as with the Geriatric Depression Scale score (p < 0.05). Conclusion. A mutual relationship seems to exist between a patient’s psychological well-being and his/her caregiver’s burden. These findings highlight the importance of a bio-psychosocial approach to both patients and caregivers

Comparison of anxiety symptoms in spouses of persons suffering from dementia, geriatric in-patients and healthy older persons

Fagfellevurdert, vitenskapelig tidsskriftartikkelObjective:To describe and compare anxiety symptoms in spouses of persons suffering from dementia, geriatric in-patients and healthy controls, and to study possible risk factors associated with anxiety in these groups of older people. Method: The participants were 70 years and above: 1) 76 spouses of persons with dementia recruited from a memory clinic, 2) 98 in-patients without dementia but suffering from one or more chronic diseases, who were admitted to a geriatric department of an acute hospital, and 3) 68 healthy elderly people recruited from day-centres. The State-Trait Anxiety Inventory (STAI-X-1, 12-item) was used to tap anxiety symptoms. Results: Spouses of persons suffering from dementia expressed the same degree of anxiety symptoms as geriatric patients, and anxiety in these two groups differed significantly from the healthy elderly persons. In an adjusted linear regression analysis, anxiety, expressed as a high score on STAI-X-1, was associated with female gender (ß 0.16, p=0.01); being a spousal carer (ß 0.49, p <0.001) and being a geriatric patient (ß 0.57, p<0.001). Conclusion: Spouses of persons suffering from dementia reported as much anxiety symptoms as geriatric in-patients and both groups reported significantly more symptoms of anxiety than healthy older persons without caring obligations. The mental health nurses should include assessment of carers’ anxiety as routine

Depression in the Elderly: Limits and Challenges - A Nursing Perspective

Introduction: There are many difficulties encountered when diagnosing depression in its early stages in the elderly. The role ofthe GP is vital for prompt diagnosis.Aim: The aim of this paper is to provide a critical citation and discussion of the issues involved when diagnosing depression ofthe elderly in the community.Method: For this purpose, a systematic literature review of Greek and international databases were performed seeking referenceson the obstacles encountered when diagnosing depression.Results: Analysis revealed four major themes under which the papers fell: i) General difficulties in diagnosing depression, ii) Thelimitations GPs have when they diagnose depression, iii) The limits patients place on GPs during the diagnostic procedure and iv)The limits GPs and patients set on each other when depression is being consideredConclusions: The findings show that GPs are confronted with numerous detractors which may lead to misdiagnosis especiallywhen depression is mild or moderate. Yet, early recognition can lead to effective treatment. It is suggested that nurses treatinghospitalised patients be alerted to the early warning signs of depression in their patients. In order to support GPs and to make thingseasier for the patient, nurses should be encouraged to use their observation skills during their greater exposure time with thepatient and to advise the patient to discuss these with their GP once discharged so that effective treatment can be initiated ifnecessary

Management of the behavioural symptoms of dementia and the effect on carers

Behavioural disturbance commonly complicates dementia and is associated with carer's psychiatric morbidity. This study hypothesised that behaviours specified by carers as distressing could be managed using individually designed care packages which could reduce such behaviours and improve carer mental health as compared to usual care. People with dementia (PWD) and their carers were recruited. Carers were assessed using the General Health Questionnaire and the Geriatric Mental State (GMS) if over 65, or the Clinical Interview Schedule (from which a DSM IIIR diagnosis was made) if under 65. PWD were assessed using the Mini Mental State Examination and the GMS. The Present Behavioural Examination was completed with each carer, who specified which behaviour(s) they found most distressing. Care Packages for each couple were generated by a Multidisciplinary Team (Psychiatrists, Psychologists, Community Psychiatric Nurse, Occupational Therapist, Social Worker, Pharmacist). Couples were divided into two groups: A and B. Group A care packages were implemented over sixteen weeks. Group B acted as controls. Then both groups were reassessed (reassessment 1) using the initial rating scales. Over the following sixteen weeks Group B Care Packages were implemented. Both groups were then reassessed again (reassessment 2). At reassessment 1, compared to Group B, the behaviour of Group A dementia sufferers improved significantly (p<0.001) as did the mental health of their carers (p<0.001). At reassessment 2, the behaviour of Group A dementia sufferers and the mental health of their carers remained improved. These variables were associated. The intervention received by Group B couples neither improved carer mental health nor dementia sufferer behaviour. In conclusion, behavioural complications of dementia can be reduced and this is associated with an improvement in carer mental health. Since no single intervention was significantly effective, it is likely that care packages succeeded because they were tailored to needs

Seeing the wood for the trees. Carer related research and knowledge: A scoping review

This NIHR-SSCR funded scoping review provides a comprehensive mapping of what is known about carers and caring, and aims to help inform policy, practice and research in relation to carers. The review was undertaken by searching 10 electronic bibliographic databases, supplemented by additional web searches to identify academic research, grey literature and wider knowledge. The analysis adopts a selective thematic approach covering: carer variables - the characteristics of different types of carer and different caring situations; types of care - the nature of needs of the cared for person and the features of the care situation; the impact of caring – resilience and coping, employment and health; and carer support and needs assessment. The final section highlights key messages identified from the review. It found that caring involves all sections and age groups of the population, with people are likely to experience one or more periods of caregiving over their lifetime. The uniqueness of each caring relationship is also highlighted. In relation to types of carers, knowledge about ‘hard to reach’ groups, such as BAME and LGBT carers, remains sparse. Older carers are also relatively invisible in policy and research terms. It found that much of the knowledge about carers identified in the review relates to their characteristics, their lived experience and the nature of their caregiving, with relatively less being known about the effectiveness of interventions to support them. The report concludes by offering suggestions for policy and practice. An appendix provides a bibliography of the 3,434 items identified in review, classified into 17 types of reference

WanderRep : a reporting tool for caregivers of wandering persons with dementia

Wandering behaviour is regarded as one of the most difficult to manage for Caregivers of persons with Dementia. It also results in a lot of stress and burden for all caregivers involved, since this behaviour can result in injuries and getting lost. In this research we are proposing a tool which utilizes the currently available Smart Mobile Technologies to focus on the patients’ wandering patterns whilst identifying any possible dangers pertaining to the patient. A number of findings have been collected from this research tool, through a number of studies with both formal and informal caregivers and patients at the St. Vincent de Paul Elderly Nursing Home. These findings primarily relate to: (1) The benefits which caregivers perceive when being alerted of danger relating to their patients and (2) the need for further understanding this research area through the collected data. Caregivers are also given the opportunity to give their feedback on a patient’s exposure to danger, thus creating a cooperative environment between caregivers of the same patient. Preliminary tests have shown how this system achieves an 89% specificity to danger rate, which defines the statistical performance of a binary classification test, together with showing how caregivers find this system as a positive way of reducing their burden when caring for wandering patients.peer-reviewe

Abuse in the caregiving relationship between older people with memory disorders and family caregivers: A systematic review

Aim To synthesize what is known about elder abuse and relationship factors associated with abuse between caregivers and older people with memory disorders at home. Background Concerns about abuse in the caring relationship between older people with memory disorders and family caregivers have increased. Abuse is associated with negative outcomes on older people's health, quality of life, and zest for life. Abuse in the caring relationship manifests in financial exploitation, neglect, mistreatment, and physical issues. Design Systematic review. Data Sources Databases including Scopus, PubMed/Medline, SveMed+, Cinalh, SonINDEX, and ProQuest were searched using keywords about abuse in the caring relationship between older people with memory disorders and family caregivers at home. Articles published between 2005–2019 were retrieved and underwent data analysis and knowledge synthesis. Review Methods The review was presented under the categories of the dyadic approach of elder abuse in connection with the role of caregiver (risk) and care recipient (vulnerability) by Fulmer et al. (2005). Results The search process led to 12 quantitative studies, including an intervention, a prospective, nine surveys, and a cross‐sectional structural interview. Findings were synthesized and presented under ‘personal’, ‘physical and psychological’, and ‘social’ domains indicating the bilateral roles of caregiver and care recipient leading to abuse. Conclusion This review depicted factors influencing abuse in the caring relationship between older people with memory disorders and their family caregivers at home. They included family caregivers’ psychological issues, knowledge of memory disorders and modifications, previous caring relationship, social support, number of care recipients, and care recipients’ functional level. Impact This review identifies what influences elder abuse by family caregivers using the dyadic approach and explains how abuse can be prevented through suggested strategies. The review findings are relevant to multidisciplinary healthcare providers and can guide the provision of support, screening and assessment, educational programs, and legislative initiatives