Social Support, Social Participation, and Depression among Caregivers and Non-Caregivers in Canada: A Population Health Perspective

Caregivers report higher depression levels than non-caregivers. Depression is a major concern because it predicts poor health. Poor caregiver health negatively impacts care provision and increases institutionalization risk for the ill relative. Social support and social participation can influence depressive symptoms in caregivers, with low levels linked to higher depression scores. Previous studies used small, non-Canadian samples. The present study used population-level data from the Canadian Longitudinal Study on Aging to investigate the relationships among social support, social participation, and depression in caregivers and non-caregivers. Analysis of variance assessed differences in the means of the social variables and depression. Path analysis examined the relationship between the social variables and depression. Caregivers reported significantly higher levels of social support and social participation versus non-caregivers. Higher levels of affectionate social support and social participation were associated with lower depression scores. The study identifies the type of social support beneficial for caregivers

Caring near and far by connecting community-based clients and family member/friend caregivers using passive remote monitoring: Protocol for a pragmatic randomized controlled trial

Background: Significant chronic disease challenges exist among older adults. However, most older adults want to remain at home even if their health conditions challenge their ability to live independently. Yet publicly funded home care resources are scarce, private home care is expensive, and family/friend caregivers have limited capacity. Many older adults with chronic illness would require institutional care without the support from family member/friend caregivers. This role raises the risk of physical health problems, stress, burnout, and depression. Passive remote monitoring (RM), the use of sensors that do not require any action by the individual for the system to work, may increase the older adult\u27s ability to live independently while also providing support and peace of mind to both the client and the family member/friend caregiver. Objective: This paper presents the protocol of a study conducted in two provinces in Canada to investigate the impact of RM along with usual home care (the intervention) versus usual home care alone (control) on older adults with complex care. The primary outcome for this study is the occurrence of and time to events such as trips to emergency, short-term admission to the hospital, terminal admission to the hospital awaiting admission to long-term care, and direct admission to long-term care. The secondary outcomes for this study are (1) health care costs, (2) client functional status and quality of life in the home, (3) family/friend caregiver stress, and (4) family/friend caregiver functional health status. Methods: The design for this study is an unblinded pragmatic randomized controlled trial (PRCT) with two parallel arms in two geographic strata (Ontario and Nova Scotia). Quantitative and qualitative methodologies will be used to address the study objectives. This PRCT is conceptually informed by the principles of client-centered care and viewing the family as the client and aims at providing supported self-management. Results: This study is supported by the Canadian Institutes for Health Research. A primary completion date is anticipated in fall 2022. Conclusions: Findings from this real-world rigorous randomized trial will support Canadian decision-makers, providers, and clients and their caregivers in assessing the health, well-being, and economic benefits and the social and technological challenges of integrating RM technologies to support older adults to stay in their home, including evaluating the impact on the burden of care experienced by family/friend caregivers. With an aging population, this technology may reduce institutionalization and promote safe and independent living for the elderly as long as possible

Confronting the Alternate Level of Care (ALC) Crisis with a Multifaceted Policy Lens

Dual demands for increased provision of acute episodic care in hospital and chronic care in the community have contributed to an ALC crisis in Canadian hospitals, where large numbers of patients are boarded in acute-care beds rather than in environments more appropriate for their required level of care. Addressing this crisis will be one of the most profound challenges facing provincial health systems in Canada over the coming decades. This paper outlines the magnitude and complexity of confronting this growing crisis as well as defining a paradigm through which to explore and implement policy solutions along the entire continuum of challenges. ALC as an administrative designation aggregates diverse groups of patients covering a wide spectrum of demographic variables, medical diagnoses, social circumstances, discharge destinations and other characteristics, all of which can affect how and when ALC is coded. It is itself a significant challenge to collect consistent, accurate and adequately granular data to inform the design and implementation of policy reforms. With this in mind, a dominant association between advanced age and markedly higher ALC rates needs to be acknowledged and highlights that solutions to the ALC crisis will be significantly interwoven with addressing previously described challenges for the overall health system with an aging population. Clinically and operationally, ALC is a complex health-system issue that reflects and presents challenges from admission, throughout a patient’s hospital stay and after discharge. This paper outlines a holistic approach to categorizing policy interventions that address obstacles along this continuum, describing potential interventions in each phase. To achieve success, policy approaches must incorporate multi-faceted interventions into the overall context and systematize them to prevent, mitigate the burdens of, and improve the management of ALC

The Legal Treatment of Informal Caregivers of the Elderly in Canada and Australia: The Importance of Recognizing Relations in Creating Reforms

This thesis examines the policy implications of the legal treatment of caregivers of the elderly in Canada and Australia and how this can inform law and policy reforms in Canada. Legislation and policy on the formal care system and supports for informal caregivers of the elderly in Canada and Australia are described, with a focus on BC and Ontario in Canada. These supports are analyzed and evaluated through the lens of relational autonomy. Australia for the most part has more supports than Canada, although improvements can be made to these supports to make them more effective in supporting informal caregivers in Canada. My policy recommendations include increasing formal care for seniors, recognizing caregivers in legislation, requiring consultation with caregivers, providing a comprehensive and coordinated range of financial and employment supports, providing support for emotional and educational needs of informal caregivers, and increasing government-provided information on caregiving and available supports

Receiving in-home respite when caring for a palliative family member at the end-of-life: family caregivers’ experiences of the eShift model of care

Family caregivers are an important component of home-based palliative care as they provide the majority of unpaid assistance to their palliative family member, during their last days and weeks of life. The demands of caregiving often escalate at the end-of-life, which can result in substantial emotional and physical issues for the family caregiver. In 2010, in London Ontario, the South West Community Care Access Centre (now the South West Local Health Integration Network (SW LHIN)) developed a new model of palliative home care called “eShift” led by an interdisciplinary team of healthcare professionals, that focused care both on the patient and their family caregiver. The eShift model connects personal support workers, called eShift technicians, to a remote registered nurse (via technology) to offer palliative care in a client’s home and simultaneously provide family caregivers with respite. The purpose of this secondary data analysis was to explore the experiences of in-home respite among family caregivers who were caring for a palliative family member receiving eShift palliative home care, at the end-of-life. Overall, the fifteen family caregivers that participated in this study had a positive experience of in-home respite with eShift palliative home care, which enabled them to keep their family member at home until death. Specifically, family caregivers developed trust, had an opportunity for self-care and other activities and felt that the arrangement of services with eShift was comprehensive. This study has implications for public health policy as it offers insights into family caregivers’ experiences of in-home respite with the eShift model of palliative home care. In addition, it serves as a basis for future research on family caregivers’ experiences of in-home respite with eShift and other technology-enabled models of palliative home care

The meaning of home for aging women living alone in North Eastern Ontario

The experience and meaning of home for older, community dwelling women, was investigated. In the world of gerontology there is a paucity of knowledge about those in their eighth and ninth decade, and this becomes more pronounced among older women. With the older demographic expanding and resources being directed at keeping seniors in their home- a solid knowledge base is required. This study built on the knowledge that exists around home, aging at home, formal care, and the vulnerabilities of aging in two ways. First, the literature around home was synthesized with an evolutionary concept analysis which served to focus further research. Secondly, an interpretive description study added to the knowledge of home by bringing to light the precariousness of formal and informal care and the effect this precariousness has on the meaning of home. The knowledge built in this study has the ability to inform policy, organizations, education, and individual providers as well as highlighting areas for further research.Masters of Science (M.Sc.) in Nursin

The Lived Experiences of Formal Caregivers in Communicating with Persons Living with Dementia in Their Own Homes

There is limited literature focused on formal caregivers’ communication with persons living with dementia (PLWD) in home settings. Yet, there is an expected need and demand for formal caregiver support within home care. Thus, the aim of this hermeneutic phenomenological study was to understand better the lived experiences of personal support workers (PSWs) during their communication with PLWD in home environments. Three major themes were identified through thematic analysis of semi-structured interviews (N=15): (1) challenged by dementia-related impairments; (2) valuing communication in care; and (3) home is a personal space. Findings reveal that PSWs experience difficulties communicating with PLWD, despite recognizing the importance of communication in providing optimal care. The findings suggest that while PSWs possess good intentions, they do not possess the skills necessary to ensure effective interactions. Findings have implications for optimizing practice and enhancing quality of care