application/pdfJournal of Nutrition, Health and Aging. 2022, 26 (2), P.157-160journal articl

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Kimura, Yosuke

Kojima, Iwao

Koyama, Shingo

Otobe, Yuhei

Suzuki, Mizue

Yamada, Minoru

音部, 雄平

The journal of nutrition health & aging

English

Osaka Metropolitan University Repository Education and Research Archives

Factors Associated with Increased CaregiverBurden of Informal Caregivers during theCOVID-19 Pandemic in Japan言語: English出版者: 公開日: 2022-11-09キーワード (Ja): キーワード (En): 作成者: Otobe, Yuhei, Kimura, Yosuke, Suzuki, Mizue,Koyama, Shingo, Kojima, Iwao, Yamada, Minoruメールアドレス: 所属: メタデータhttp://hdl.handle.net/10466/00017835URL 1 Title: 1 Factors associated with increased caregiver burden of informal caregivers during the COVID-19 2 pandemic in Japan 3  4 Yuhei Otobe1), Yosuke Kimura1,2), Mizue Suzuki1) Shingo Koyama1), Iwao Kojima1), Minoru Yamada3) 5  6 1) Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan 7 2) Department of Electrical Engineering, Health and Sports Technology Course, Kanto Gakuin 8 University 9 3) Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan 10  11 Running Title 12 Caregiver burden and COVID-19 13  14  15 Corresponding author:  16 Yuhei Otobe 17 Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan 18 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan 19 Tel: +81-29-853-2111 20 E-mail: otobeyuhei@gmail.com 21  22  2 Abstract: (150/150 words) 23 This study’s objective was to explore the association between various factors and the increased 24 caregiver burden of informal caregivers during the COVID-19 pandemic. On February, 2021, 700 25 informal caregivers completed an online survey. We assessed the change in caregiver burden during the 26 COVID-19 pandemic. Among all caregiver participants, 287 (41.0%) complained of an increased 27 caregiver burden due to the COVID-19 pandemic. The factors associated with increased caregiver 28 burden were depressive symptoms in caregivers [odds ratio (OR), 2.20; 95% confidence interval (CI), 29 1.50-3.23], dementia (OR, 2.48; 95%CI, 1.07-5.73) and low Barthel Index scores (OR, 2.01; 95%CI, 30 1.39-2.90) in care receivers, care days (OR, 1.09; 95%CI, 1.01-1.17) and times (OR, 1.06; 95%CI, 1.01-31 1.10), and use of home care service (OR, 1.46; 95%CI, 1.01-2.10) and visiting care service (OR, 1.71; 32 95%CI, 1.20-2.45). These findings suggest we need to pay attention to the physical and mental health 33 of both the care receivers and caregivers. 34 Key words: COVID-19, caregiver burden, informal caregivers, factors 35  36  37  38  39  40  41  3  42 Introduction 43     The coronavirus disease 2019 (COVID-2019) pandemic has restricted a variety of social activities 44 and has also seriously affected geriatric care and welfare. In this context, the growing caregiver burden 45 of informal (family) caregivers has become increasingly serious. Several studies have reported that the 46 caregiver burden of informal caregivers increased as a result of the COVID-19 pandemic1-3). The causes 47 of increased caregiver burden during the COVID-19 may not only be related to a decline in cognitive 48 function, physical function, and activities of daily living (ADL) in older care receivers2-4), but in addition 49 it has become difficult to make use of home care and/or visiting care services because of the pandemic. 50 However, the main cause of the increase in caregiver burden is still unclear, even after considering a 51 variety of factors, including those related to caregivers, care receivers, and care information. The aim 52 of this study was therefore to explore the association between various factors and the increased caregiver 53 burden of informal caregivers during the COVID-19 pandemic in Japan. 54  55 Methods 56 Participants 57     From February 4 to 7, 2021 during the third wave of COVID-19 in Japan, an online survey was 58 completed by 700 informal caregivers who were 20 to 89 years old and had a familial relationship with 59 a care receiver who was a spouse, parent or parent in-law. The participants of this study were recruited 60 through convenient sampling by online research agency. This study was conducted in accordance with 61 the guidelines proposed by the Declaration of Helsinki, and the study protocol was reviewed and 62  4 approved by the Ethics Committee of the Faculty of Human Sciences, University of Tsukuba. Electronic 63 informed consent was obtained from all participants.  64  65 Change in caregiver burden 66     We assessed changes in caregiver burden during the COVID-19 pandemic. The caregivers were 67 asked, “Has your caregiver burden increased as a result of the COVID-19 pandemic?”, to which they 68 answered with “Yes” or “No.” 69  70 Characteristics 71     We assessed the demographic characteristics of both caregivers and care receivers. For caregivers, 72 the following items were assessed: age, sex, body mass index (BMI), presence of depressive symptoms, 73 and frailty. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-74 15)5) in caregivers aged over 65 years, and using the Self-Rating Depression Scale (SDS)6) in caregivers 75 aged less than 65 years. We defined caregivers with GDS ≥ 5 or with SDS ≥ 40 as showing depressive 76 symptoms7,8). Frailty status among caregivers was assessed using the Kihon checklist9), and we defined 77 scores of 8 or more as frailty, according to a previous study10). Similarly, we assessed data across several 78 characteristics for care receivers, including age, sex, BMI, relationship to caregiver (spouse, parent, 79 parent-in-law), comorbidities (cancer, heart failure, stroke, diabetes, falls and fractures, neurological 80 disorder, and dementia), and Barthel index (BI) score. The higher BI scores represent better ADL.  81 Additionally, we investigated care information such as care period [year(s)], care days [day(s) per week], 82 care times [hour(s) per day], use of home and visiting care services (including nursing, rehabilitation, 83 and day service). All questions were answered by caregivers. 84  85 Statistical analysis 86     We examined the factors associated with the change in caregiver burden during the COVID-19 87 pandemic using univariate and multivariate logistic regression analyses with a stepwise forward 88  5 selection method. The data were analyzed using IBM SPSS Statistics for Mac (version 27.0; IBM Japan, 89 Tokyo, Japan). A P-value of less than 0.05 was considered to indicate statistical significance for all 90 analyses. 91  92 Results 93     The characteristics are presented in Table 1. Among the total caregivers, 287 (41.0%) and 413 94 (59.0%) were in the increased and unchanged caregiver burden due to COVID-19 pandemic groups, 95 respectively. The results of the univariate logistic regression analysis and stepwise forward selection to 96 determine the factors associated with increased caregiver burden due to the COVID-19 pandemic are 97 summarized in Table 2. All indicators in this study were entered into the stepwise forward selection and 98 several factors were chosen, as follows: caregivers with depressive symptoms (odds ratio [OR]: 2.20, 99 95% confidence interval [CI]: 1.50-3.23), care receivers with dementia (OR: 2.48, 95%CI: 1.07-5.73), 100 care receiver’s with BI scores of less than 85 (OR: 2.01, 95%CI: 1.39-2.90), care days (OR:1.09, 101 95%CI:1.01-1.17), care times (OR:1.46, 95%CI: 1.01-2.10), use of home care service (OR:1.46, 102 95%CI: 1.01-2.10), and use of visiting care service (OR:1.71, 95%CI: 1.20-2.45). 103  104 Discussion 105  106     In this study, 41% of caregivers complained of an increase in caregiver burden due to the COVID-107 19 pandemic. We found that factors associated with increased caregiver burden during the COVID-19 108 pandemic were caregivers with depressive symptoms, care receivers with dementia and low BI scores, 109  6 care days and times, and use of home care and visiting care services.  110 These results might be caused by increased caregiving intensity in the pandemic situation; however, 111 the risk of increasing caregiver burden has been present from before the onset of the pandemic. Previous 112 studies conducted before the pandemic reported that caregivers with depressive symptoms and who 113 cared for individuals with dementia and low ADL were more likely to experience increased caregiver 114 burden than caregivers who did not experience these factors11-14). Therefore, caregivers whose caregiver 115 burden increased during the COVID-19 in this study may have had pre-existing risk factors for high 116 caregiver burden before the pandemic. Additionally, Cohen et al. reported that caregiving intensity 117 increased significantly as a result of the COVID-19 pandemic15). Caregivers who had increased 118 caregiving intensity were more likely to complain of feelings of depression and anxiety than those who 119 did not have increased caregiving intensity16). This would be caused by not only the health condition of 120 care receivers, such as worsening of cognitive symptoms17), but also by changes in the care situation 121 with little external support. Hence, various factors before and during the pandemic may have had 122 complex interactions and influenced the increased caregiver burden. 123 Moreover, care information such as care days, care times, and use of home care and visiting care 124 services were associated with increased caregiver burden during the COVID-19 pandemic, as well as 125 caregiver and care receiver characteristics. An increase in care days and care times, together with the 126 use of home care and visiting care services, may mean higher care dependency among care receivers. 127 During the pandemic, many informal caregivers had difficulty obtaining adequate care from outside the 128  7 household because of reduced availability of paid services and care support, and/or they requested a 129 break in such services because of COVID-19-related infection control measures16,18). Therefore, 130 informal caregivers had to had to compensate for insufficient provision of home-based care by 131 themselves, which might have contributed to their increased caregiver burden during the COVID-19 132 pandemic.  133 The present study has some limitations. First, this study is cross-sectional in nature and, therefore, 134 the longitudinal causal relationship between the COVID-19 pandemic and increased caregiver burden 135 remains unclear. Second, this study was conducted only in Japan; however, the situation of the COVID-136 19 differs by country and region. Therefore, further research is needed to generalize our findings in 137 other countries.  138     In conclusion, many informal caregivers complained of an increase in caregiver burden due to the 139 COVID-19 pandemic. In addition, caregivers with depressive symptoms, care receivers with dementia 140 and low BI scores, care days and times, and use of home care and visiting care services were associated 141 with an increase in caregiver burden. These results suggest that we need to pay attention to the physical 142 and mental health of not only care receivers but also caregivers under the “new normal” conditions of 143 the COVID-19 pandemic.  144  145  146 Disclosures: The authors have no potential conflicts of interest to disclose. 147 Conflict of interest: None 148  8 Ethical Standards: The ethics committee approved the study. 149  150  151 Table 1. Characteristics      Increased burden  group (n= 287) Unchanged burden group (n= 413) Caregiver  characteristics Age (years) 54.0 (41.0-65.0) 59.0 (42.0-68.0) Female, n (%) 147 (51.2) 203 (49.2) Body Mass Index (kg/m2) 21.6 (19.6-24.0) 22.0 (19.8-24.2) Depressive symptom, n (%) 232 (80.8) 270 (65.4) Frailty, n (%) 141 (49.1) 156 (37.8) Care receiver characteristics Age (years) 80.0 (70.0-88.0) 80.0 (70.0-88.0) Female, n (%) 162 (56.4) 245 (59.3) BMI (kg/m2) 21.7 (19.2-23.9) 21.6 (19.4-24.2) Relationship to caregiver, n (%)   Spouse 89 (31.0) 183 (44.3) Parent 155 (54.0) 190 (46.0) Parent-in-law 43 (15.0) 40 (9.7) Comorbidities, n (%)   Cancer 15 (5.2) 9 (2.2) Heart failure 23 (8.0) 15 (3.6) Stroke 17 (5.9) 13 (3.1) Diabetes 28 (9.8) 37 (9.0) Falls and fractures 21 (7.3) 16 (3.9) Neurological disorder 2 (0.7) 5 (1.2) Dementia 23 (8.0) 9 (2.2) BI, n (%)    < 85 211 (73.5) 190 (46.0) ≥ 85 76 (26.5) 223 (54.0) Care information Care periods [year(s)] 3.0 (2.0-5.0) 2.0 (1.0-5.0) Care days [day(s)/week] 5.0 (3.0-7.0) 3.0 (1.0-7.0) Care times [hour(s)/day] 3.0 (2.0-6.0) 2.0 (1.0-4.0)  9 Use of home care service, n (%) 168 (58.5) 148 (35.8) Use of visiting care service, n (%) 183 (63.8) 168 (40.7) All indicators are expressed in median (IQR) aside from the categorical data. BMI, body mass index; BI, Barthel index                                     10 Table 2.  Univariate and multiple logistic regression analysis with stepwise forward selection to determine the factors associated with increased caregiver burden during the COVID-19 pandemic    Univariate  Stepwise forward selection  Variables Units of Increase OR 95%CI  OR 95%CI Caregiver characteristics Age 1year 0.99 0.98-0.99     Sex (ref: male) ― 1.09 0.80-1.47     BMI 1kg/m2 0.97 0.93-1.02     Depressive symptom ― 2.23  1.56-3.19  2.20  1.50-3.23  Frailty ― 1.59  1.17-2.16    Care receiver characteristics Age 1year 1.00  0.99-1.01     Sex (ref: male) ― 0.89  0.66-1.21     BMI 1kg/m2 1.01  0.97-1.05     Relationships (ref: spouse)        Parent ― 1.68  1.21-2.33     Parent-in-law ― 2.21  1.34-3.64     Comorbidities        Cancer ― 2.48  1.07-5.74     Heart failure ― 2.31  1.18-4.51     Stroke ― 1.93  0.93-4.05     Diabetes ― 1.10  0.66-1.84     Falls and fractures ― 1.96  1.00-3.82     Neurological disorder ― 0.57  0.11-2.97     Dementia ― 3.91  1.78-8.58  2.48  1.07-5.73  BI (ref: ≥ 85) ― 3.26  2.35-4.51  2.01  1.39-2.90 Care information Care periods 1year 1.00  0.98-1.02     Care days 1day 1.18  1.11-1.26  1.09  1.01-1.17  Care times 1hour 1.12  1.08-1.17  1.06  1.01-1.10  Use of home care service ― 2.53  1.86-3.44  1.46  1.01-2.10  Use of visiting care service ― 2.57  1.88-3.50  1.71  1.20-2.45 OR, odds ratio; CI, confidence interval; BMI, body mass index; BI, Barthel index  11  152 References  153 1) Cohen G, Russo MJ, Campos JA, Allegri RF. 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Factors Associated with Increased Caregiver Burden of Informal Caregivers during the COVID-19 Pandemic in Japan

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Factors Associated with Increased Caregiver Burden of Informal Caregivers during the COVID-19 Pandemic in Japan

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