Evaluating the benefits of early rehabilitation intervention for patients with sepsis in the medical intensive care unit: A retrospective study

Purpose: To evaluate the benefits of early rehabilitation intervention for patients with sepsis in a medical intensive care unit (MICU) and to identify the factors associated with positive outcomes at discharge. Methods: A retrospective review of 97 electronic medical records of patients with sepsis admitted to 2 similar-sized MICU pods of an urban tertiary care hospital was conducted. Bivariate analyses were conducted to compare the sociodemographics, length of stay, mobility level, and discharge disposition of 47 patients who received early rehabilitation intervention in MICU pod 1, with 46 patients who received standard rehabilitation intervention in MICU pod 2. In addition, multivariate analysis of the entire sample was conducted to identify the factors associated with positive discharge outcomes. Results: Patients in pod 1 had significantly higher level of mobility at discharge (mean difference = 0.80, P = .009) and a better discharge disposition (λ2 = 25.05, df = 7, P \u3c .001) than those in pod 2. The positive outcomes of increased mobility and return to home at discharge were associated with rehabilitation intensity (F1,91 = 52.30; P \u3c .001, b = 0.82) and rehabilitation initiation (adjusted odds ratio: 0.85, P= .039), respectively. Conclusion These findings provide empirical support for the safety and benefits of providing early intensive rehabilitation for patients in the MICU with sepsis using a therapist-driven model of care

Family Caregiving During the COVID-19 Pandemic

Background: The Coronavirus Disease-2019 (COVID-19) pandemic has taken a disproportionate toll on people with intellectual and developmental disabilities (I/DD) as well as their family caregivers. This is especially true for older family caregivers, many of whom assume dual or compound caregiving roles, and provide care as they undergo their own aging experiences. This research brief presents findings from family caregivers of adults with I/DD to better understand how the COVID-19 pandemic has affected their lives. Method: Thirty family caregivers from across the state participated in a one-hour special COVID-19 virtual discussion group. All participant identifiers were deleted from a session transcript that was examined by two independent researchers to identify common themes using content analysis. The themes were grouped into the area of challenges and unexpected positive outcomes. Results: The most common challenge identified by the participants was limited access to medical services such as cancellation of appointments and obtaining medications. The quick transition to telehealth without adequate training for users or clinicians was also seen as a challenge. The increased use of technology also raised challenges in other areas of life such as education and employment. These challenges were related to inadequate equipment, internet service, having to share the limited equipment, and insufficient experience using technology. Caregivers also reported feeling socially isolated including not being able to leave their homes or see family or friends. They also described frustration of being together all the time. Caregivers also reported several unexpected positive consequences (‘silver linings’). A common theme was that the pandemic slowed life’s pace allowing for more flexibility, more time with their families, and gratitude for everyday things. While technology was discussed as a challenge, it was also mentioned as a positive in that it allowed for social connectedness. Several creative uses of Zoom to connect with family and friends were discussed including virtual game nights, dance parties, cocktail parties, and happy hours. Some shared that their family members were able to make friends more easily online where they had difficulties doing so in-person. Helpful strategies for coping with the quarantine such as physical activity and hobbies were also shared. Conclusion: The duration of COVID-19 and its ramifications are unknown. Many challenges experienced by family caregivers are not new, rather they are intensified due to the pandemic. Family caregivers indicated challenges and needs related to accessing medical services and use of telehealth. Strategies that build on family caregivers’ concerns and strengths are needed to offset the burden posed by COVID‑19. Family Support Navigators (FSNs) and other supportive individuals can play an integral role in helping family caregivers during these unprecedented times

Caregivers’ perceptions of family quality of life of individuals with developmental disabilities comorbid with dementia: A pilot study

Introduction: Although individuals with intellectual/ developmental disabilities (I/DD) are living longer than in the past, they also are exposed to age-related changes in health and well-being. They are prone to acquire dementia that often manifests earlier and more frequently than in the general population. However, there is sparse knowledge on the daily challenges that affect the quality of life of the individuals with I/DD and comorbid dementia and their family caregivers. Aim: This pilot study examined strengths and challenges of individuals with dual diagnoses of I/DD and dementia using the family quality of life (FQOL) framework. Method: Cross-sectional data was gathered from a convenience sample of family caregivers using a web-based electronic survey. Objectives: This study aims to identify the common and differential elements of the DLD (SLI) and LD through a quantitative and qualitative analysis. Results: The variables of interest in this study were the levels of importance and satisfaction attributed to the nine FQOL domains, and overall FQOL. The mean level of importance was higher than the associated ratings of satisfaction in eight of the nine domains, with an overall importance mean of 4.15 and satisfaction mean of 3.28. Analysis of the open-ended comments indicated that the negative impact of social isolation, compound caregiving, and dynamically changing caregiving needs on overall FQOL was balanced by participants’ values and beliefs. Results: A statistical analysis (Student’s t test) was conducted in order to compare the children in LD and DLD groups. The data obtained from this analysis along with LSA indicate that the language skills differ between the two groups in the following aspects: lexical, pragmatic, semantic, syntactic, morphological and phonological. Significant differences (p < .05) occur for the start of speech therapy age, phonological disorder, passive vocabulary and language psychological age. Results for active vocabulary did not indicate a statistical difference between LD and DLD children. Implication for practice: The discrepancies in the FQOL domains pertaining to formal and informal services and social supports elucidate a need to empower families with high caregiving needs through research, practice and policy. Conclusion Providers should be cognizant of the needs of individuals with I/DD and dementia comorbid, as well as the needs of their family caregivers

Mediating effects of social support on quality of life for parents of adults with autism

The aim of this study was to examine the mediating effect of formal and informal social support on the relationship of caregiver burden and quality of life (QOL), using a sample of 320 parents (aged 50 or older) of adult children with autism spectrum disorder (ASD). Multiple linear regression and mediation analyses indicated that caregiver burden had a negative impact on QOL and that informal social support partially mediated the relationship between caregiver burden and parents’ QOL. Formal social support did not mediate the relationship between caregiver burden and QOL. The findings underscored the need to support aging parents of adult children with ASD through enhancing their informal social support networks

Family Quality of Life Survey (FQOLS-2006): Evaluation of internal consistency, construct, and criterion validity for socioeconomically disadvantaged families

Aims: The purpose of this study was to test the psychometric properties of the Family Quality of Life Survey (FQOLS-2006) when used with urban families predominantly from socioeconomically disadvantaged backgrounds. Methods: Data gathered from 193 family caregivers using the FQOLS-2006 were subjected to reliability analyses, confirmatory factor analyses, and correlational analyses to test the internal consistency of the scales (reliability), factor structure of the scales (construct validity), and convergence between the long and short versions of the tool (criterion validity). Results: Internal consistency of the 54-item total FQOL scale was excellent (α =.89), while that of the six-item domain subscales ranged from moderate to strong (α =.46–.81). Although the subscale-level FQOL factor structure demonstrated good fit, some of the item-level factor loadings within each of the domains were low. Correlations between scores derived from the long and short versions ranged from moderate to strong (r =.37–.73). Conclusions: Although the internal consistency of the scales ranged from moderate to strong, the FQOLS-2006 had only a moderate degree of construct and criterion validity when used with a sample consisting predominantly of minorities from socioeconomically disadvantaged backgrounds

When more is too much: Compound caregiving, barriers to services, and service support for older families of people with disabilities

Using the theoretical lens of Family Quality of Life, this study evaluated perceptions of older compound caregivers (i.e., caring for more than one family member) regarding their need for services. Quantitative analysis of cross-sectional data collected from 112 caregivers (50 years and older) demonstrated that compound caregivers faced more barriers in accessing services for their families than noncompound caregivers. Although all caregivers shared similar perceptions on the importance, opportunities, initiative, and attainment of service support for their families, compound caregivers had lower stability and satisfaction than noncompound caregivers. Findings highlight the need to develop support programs to equip older caregivers in managing their daily challenges at the individual and family level

Impact of grandchild caregiving on African American grandparents

The aim of this study was to describe the context and impact of caregiving for grandchildren with health concerns on grandparents. The study sample comprised 391 African American grandparents aged 55 or older. Logistic regression analysis indicated that grandparent caregivers of grandchildren with psychiatric or behavioral problems were more likely to experience a negative impact on their health (AOR = 7.86, p =.008) and leisure (AOR = 14.31, p =.024) than grandparent caregivers of grandchildren with no or other types of health problems. The findings underscore the need to support African American grandparent caregivers, particularly those raising grandchildren with mental health problems