Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden

Introduction: Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time.Design: Prospective longitudinal study.Methods: We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time.Results: Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning(B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame(B = 0.90), and negatively associated with positive reframing (B = −0.83) and acceptance (B = −0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping.Conclusions: Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers.Clinical Relevance: Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.Funding for open access charge: Universidad de Jaén/CBUA

The mediating role of sense of coherence on mental health outcomes in carers of older dependent relatives: a longitudinal study

Background: Sense of coherence (SOC) is an important protective factor for carer well‐being but research to date remains cross‐sectional, focusing primarily on the direct effects of SOC on carers’ mental health. The study's aim was to investigate the mediating role of SOC in the longitudinal relationship between caregiver strain and carers’ psychological health, and its stability over time. / Methods: Prospective longitudinal study conducted in Jaén (Spain) with a probabilistic sample of 132 carers of older people, with data collected at baseline and at one‐year follow‐up. We measured SOC, caregiver strain, anxiety and depressive symptoms, and several care recipient characteristics and intensity of care provided. We used multiple linear regression modelling and the Sobel test to analyse mediation effects. / Results: SOC was significantly negatively longitudinally associated with both anxiety (β= ‐0.38, p= 0.001) and depressive symptoms (β= ‐0.28, p= 0.023), after controlling for several confounders. SOC mediated both the relationship between caregiver strain and anxiety and caregiver strain and depressive symptoms (Sobel test; p< 0.001 for anxiety and p< 0.001 for depressive symptoms). Differences between baseline and one‐year follow‐up SOC scores were not statistically significant (p= 0.617). / Conclusions: SOC appears to buffer the impact of caregiver strain on symptoms of depression and anxiety in informal carers of older people. Our data showed that SOC is an important psychological resource for carers that remained relatively stable under non‐experimental conditions over a period of one year in this sample. Findings suggest that interventions aimed at strengthening SOC may protect carer psychological well‐being

The relationship between perceived social support and psychological distress in carers of older relatives: A longitudinal cross-lagged analysis

Background and objectives: Although a large body of research has examined the relationship between social support and psychological health of family carers of frail older people, the exact nature and direction of this relationship is not well understood with most research to date being cross-sectional. This longitudinal study explored the relationship between perceived social support and psychological distress in carers of older relatives. Methods: We used data from two longitudinal cohorts which included a total of 332 family carers of frail older people. We used cross-lagged panel analysis to investigate the longitudinal association between perceived social support and carer psychological distress controlling for a number of covariates over time. Results: Fully-adjusted Generalised Estimating Equations (GEE) and cross-lagged models indicated that higher social support was significantly associated with lower carer psychological distress over time (regression coefficient [B] = -0.178, standard error [SE] = 0.028), with levels of perceived social support exerting an effect on psychological distress rather than vice versa (β = 0.03, p = 0.32). Limitations: All observations were based on self-report data, and there may be other variables that may explain the results that we did not account for. Discussion and implications: Our study finds that the directionality of the relationship appears to be from perceived social support to carer psychological distress suggesting that social support directly affects carer psychological health but not vice versa. This finding has important implications for the provision of social support interventions for carers of frail older people at risk of experiencing psychological distress

The start of caring for an elderly dependent family member: A qualitative metasynthesis

Background: The family often takes care of an elderly person who suddenly becomes dependent. This greatly affects different aspects of the caregivers’ lives. The aim of this study is to explore the initial experiences, during the first year of care, of persons who suddenly become caregivers for elderly dependent relatives. Methods: A search in CINAHL, PsycINFO, WOS, Medline, and Scopus and a metasynthesis of qualitative research were conducted including 19 articles. Results: Three categories were developed to explain the process of becoming a caregiver ‘taking on the role’ (life changes, uncertainty and confusion, and acceptance or resistance); ‘beginning to realise’ (new needs, impact, and appraisal); and ‘implementing strategies’ (seeking help and self-learning, reordering family and social relationships, solving problems, and devising strategies to decrease negative emotions and stress). Conclusions: The synthesis provides a comprehensive understanding of the experience of becoming a caregiver in order to help health-care professionals to adapt care plans to this situation.No proced

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

ResumenObjetivoIdentificar y analizar los problemas que surgen en el proceso de adaptación de la persona cuidadora a los cambios durante el cuidado familiar a una persona afectada por demencia.MétodoEstudio cualitativo basado en la metodología de la teoría fundamentada constructivista de Charmaz. Se realizaron siete grupos focales en diferentes centros de atención primaria de salud en la provincia de Jaén (España). Participaron 82 personas cuidadoras principales familiares de mayores con demencia, seleccionadas por muestreo propositivo de máxima variación y teórico. Se llevó a cabo una triangulación del análisis para favorecer la validez interna del estudio.ResultadosSe obtuvieron tres categorías centrales, que fueron «Cuidados cambiantes», «Problemas en el proceso de adaptación a los cambios» y «Factores facilitadores del proceso de adaptación a los cambios». La persona cuidadora desempeña su rol en una realidad caracterizada por el cambio, tanto personal como de la persona a la que cuida y su contexto social y cultural. El reto adaptativo está en el balance entre los problemas que dificultan la adaptación a los cambios de la persona cuidadora a las nuevas situaciones de cuidado y los factores que facilitan su labor cuidadora.ConclusionesLa escasez de apoyo formal y el infradiagnóstico de la demencia dificultan la adaptación de la persona cuidadora al cuidado de una persona afectada por demencia. El proceso de adaptación podría mejorar reforzando el apoyo formal en las primeras fases del cuidado para reducir el estrés del proceso de aprendizaje autodidacta de las familias cuidadoras, así como adaptando las intervenciones a cada fase de la evolución del rol cuidador.AbstractObjectiveTo 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

Perceptions, Motivations, and Empowerment Strategies of Midwives in Rural and Remote Areas of Northern Morocco

The shortage of midwives is a problem in rural and remote areas. This is mainly the consequence of job insecurity and difficult living conditions. The present study aimed to identify and analyse the perceptions and motivations of midwives in rural and remote areas of northern Morocco on the quality of their working life and the motivational factors and empowerment strategies they use to maintain and develop their work. It is a qualitative study that follows Van Manen’s hermeneutic phenomenology approach. Three focus groups and in-depth interviews were conducted with 15 midwives from rural and remote areas. The results indicate that midwives in rural and remote areas have a negative perception of the quality of the work and their personal life because of the scarcity of basic resources, unfavourable working conditions, and the personal sacrifices they have to make to support themselves. However, some factors favour their efforts. Therefore, there is a need to promote intersectoral policies that focus on improving material and human resources, as well as the working and personal conditions of midwives and the factors that support and empower them

Perceived needs of the family caregivers of people with dementia in a mediterranean setting: A qualitative study

The purpose of this study was to identify, classify and analyze the perceived needs of caregivers of elderly people with dementia during the care process. A descriptive phenomenological qualitative study using seven focus groups was conducted in different primary health care centers in the province of Jaén (Spain) between July 2012 and February 2013. Eighty-two family caregivers who were caring for people with dementia in different stages of the disease were selected by purposeful maximum variation sampling. Data were analyzed and organized thematically, considering the semantic and pragmatic content and field notes. Two main categories of the perceived needs of caregivers were identified. The first was related to the management of caring for a relative with dementia, and the second was related to the management of the caregivers’ own care. Our findings support the provision of comprehensive interventions for the improvement of caregivers’ emotional health that encompass more than one care need. This is where psycho-educational interventions aimed at managing the various aspects of dementia and self-care in caregivers can be accommodated. In addition, proactive interventions to develop important skills to care for a relative with dementia, which are not perceived as needs by the caregivers, are needed. These include skills in family negotiation, planning and searching for resources outside the family

Relationship between sense of coherence and health-related behaviours in adolescents and young adults: a systematic review

Background: The sense of coherence is developed through the learning process and contributes to the positioning of individuals in the health-disease continuum, facilitating successful and adaptive personal outcomes. Health-related behaviours represent a health determinant of utmost importance for public health and the development of adolescent and youth health promotion policies, as they are related to the main risk factors and problems of morbidity and mortality in our society. Previous studies have analysed the relationship between sense of coherence and only some individual health outcomes such as oral health, the relationship of sense of coherence with smoking and alcohol consumption, concluding that salutogenic factors are related to quality of life and preventive behaviours. The aim of this systematic review was to describe the relationship of sense of coherence with different health-related behaviours investigated so far in the adolescent and youth population. Methods: A systematic review was carried out in databases (PubMed, CINAHL, Scopus and PsycInfo) and in the bibliographies of the retrieved articles, without limitation of time or language. Associations between sense of coherence and health-related behaviours have been assessed. Results: A total of 1214 investigations were reviewed and 21 of them were included in this systematic review. The relationship between sense of coherence and eight health-related behaviours were identified (alcohol use, physical activity, tobacco use, eating habits, rest periods, use of illegal substances, behaviours related to oral health and time spent in games on the computer). Conclusions: Our results increase the available evidence and support the solid relationship of the sense of coherence with health behaviours both as a protective factor against risk behaviours and for its positive association with preventive and health promoting behaviours of adolescents, young adults and university students

Linoleic acid-derived oxylipins and isoprostanes plasma levels are influenced by 1,25-Dihydroxyvitamin D levels in middle-aged sedentary adults: The FIT-AGEING study

Introduction: Vitamin D – concretely its active form 1,25-dihydroxyvitamin D (1,25(OH)2D) – maintains several physiological processes. Oxylipins are oxidized lipids derived from ω-6 and ω-3 polyunsaturated fatty acids involved in inflammation. Little is known about the association of 1,25(OH)2D with inflammatory parameters in middle-aged populations – who could be at risk of vitamin D deficiency –. The aim of this study was to investigate the relationship between 1,25(OH)2D plasma levels with circulating white blood cells, platelets counts and oxylipins levels. Materials and methods: A total of 74 (53 % women) middle-aged (40–65 years old) adults were recruited for this cross-sectional study. 1,25(OH)2D plasma levels were measured using an immunochemiluminometric assay. White blood cells and platelets were analyzed by hemocytometry. ω-6 and ω-3 oxylipins plasma levels were measured using liquid chromatography - tandem mass spectrometry. Simple and multiple linear regression models, and Pearson correlation analyses, were performed to study the association of 1,25(OH)2D levels with WBC and platelets counts, and oxylipins, respectively. Results: 1,25(OH)2D plasma levels were positively related with linoleic acid-derived oxylipins and isoprostanes plasma levels, whereas an inverse relationship with dihomo-γ-linolenic acid/linoleic acid and arachidonic acid/ linoleic acid ratios was unveiled. No significant associations were observed for circulating ω-3 oxylipins, white blood cells levels or platelets count. Conclusions: Linoleic acid-derived oxylipins and isoprostanes plasma levels may be influenced by 1,25(OH)2D plasma levels. Further investigations are needed to elucidate the impact of other vitamin D forms upon circulating oxylipins levels.Spanish GovernmentChina Scholarship Council 201607060017 20170706001

Primary care nurses’ difficulties in advance care planning processes: A qualitative study

©2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the Accepted, version of a Published Work that appeared in final form in Atención Primaria. To access the final edited and published work see http://dx.doi.org/10.1016/j.aprim.2016.01.008Objetivo: Conocer las dificultades que encuentran las enfermeras de atención primaria para promover procesos de planificación anticipada de las decisiones con personas en el final de la vida. Diseño: Estudio cualitativo fenomenológico. Emplazamiento: Área de Gestión Sanitaria Norte de Jaén. Participantes: Enfermeras de atención primaria. Método: Muestreo intencional. Realización de 14 entrevistas en profundidad hasta la saturación de los discursos. Análisis de contenido en 4 etapas: transcripción de datos, codificación, obtención de resultados y verificación de conclusiones. Uso de N-Vivo como apoyo al análisis. Triangulación de resultados entre investigadores. Resultados: Dificultades referidas a los profesionales: falta de conocimiento sobre el tema, falta de habilidades de comunicación o de experiencia y presencia de emociones negativas. En la institución sanitaria, la falta de tiempo y las interferencias con otros profesionales suponen una barrera. También la actitud del propio paciente o su familia es vista como una traba ya que pocos hablan sobre el final de la vida. Finalmente, nuestra sociedad evita las conversaciones abiertas sobre temas relacionados con la muerte. Conclusiones: Es necesario el aprendizaje de los profesionales sobre planificación anticipada de decisiones, su entrenamiento en habilidades comunicativas y su educación afectiva. Los gestores sanitarios han de tener en cuenta el hecho de que las intervenciones para planificar anticipadamente decisiones sanitarias precisan formación, tiempo y atención continuada. En tanto no acontezca un cambio cultural, persistirá un modelo evasivo para afrontar el final de la vida.----------------------------------------Objective: To know the primary care nurses’ difficulties to promote advance care planning process with patients in the end of life. Design: Phenomenological qualitative methodology. Location: Health Management Area North of Jaén. Participants: Primary care nurses. Method: Purposive sampling. Fourteen in-depth interviews were conducted until the speeches saturation. Content analysis in four steps: transcription, coding, obtaining results and conclusions verification. Supported whit the software Nvivo 8. Triangulation of results between researchers. Results: Professionals’ difficulties: Lack of knowledge about the topic, lack of communication skills, lack of experience and presence of negative emotions. In the health institution lack of time and interference with other professionals is a barrier. Also the patient’s attitude and the family are identified as an obstacle because few people speak about the end of life. Finally, our society prevents open discussion about issues related to death. Conclusions: Professional learning about advanced care planning, training in communication skills and emotional education are necessary. Health managers should consider the fact that early interventions for planning health decisions require training, time and continued attention. If a cultural change does not happen, an evasive way to face the end of life will persist