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Trends in caregiving intervention research
- Authors:
- TOSELAND W. Ronald, MCCALLION Philip
- Journal article citation:
- Social Work Research, 21(3), September 1997, pp.154-164.
- Publisher:
- Oxford University Press
This article examines trends in the latter part of the 20th century in intervention research designed to support caregivers of chronically ill, older adults. The aims, content, methodology, and outcomes of studies conducted over the past two decades are reviewed and analysed. The article also discusses which trends in caregiving intervention research are likely to continue into the 21st century and suggests promising avenues for future research.
Neuroticism and longitudinal change in caregiver depression: impact of a spouse-caregiver intervention programme
- Authors:
- JANG Yuri, et al
- Journal article citation:
- Gerontologist, 44(3), June 2004, pp.311-317.
- Publisher:
- Oxford University Press
The authors examined the impact of caregiver neuroticism on longitudinal change in depression among spouse-caregivers of individuals with Alzheimer's disease receiving either enhanced psychosocial treatment or usual care. We were interested in whether high levels of caregiver neuroticism would lead to a diminished response to the enhanced treatment and whether neuroticism affected the longitudinal course of caregiver depression regardless of intervention. They analyzed data from the NYU Spouse-Caregiver Intervention Study, which randomly assigned caregivers either to an enhanced treatment group that received a comprehensive intervention with counseling, support, and consultation, or to a usual-care control group. The present study analyzed data from 320 caregivers, 160 in each group, who completed the NEO questionnaire. They used random-effects growth curve modeling to examine changes in depression in the first year after intake, examining possible effects of neuroticism on the course of caregiver depression and on response to intervention. Caregivers high in neuroticism showed a worse longitudinal course of depression compared with those low in neuroticism in both the enhanced treatment and usual-care groups after we adjusted for baseline depression as a covariate. Caregivers showed benefits from the enhanced treatment compared with usual care, regardless of neuroticism score. However, caregivers low in neuroticism responded to treatment with declining levels of depression, whereas caregivers high in neuroticism maintained their baseline level of depression. Caregiver neuroticism is a risk factor for increased caregiver depression over time. High neuroticism does not preclude successful caregiver intervention with a highly individualized intervention, but expectations of outcome should be different than for caregivers low in neuroticism. Future studies should investigate the relationship between neuroticism and response to less individualized interventions and the impact of other personality characteristics on response to treatment.
Validation of the indicators of abuse (IOA) screen
- Authors:
- REIS Myrna, NAHMIASH Daphne
- Journal article citation:
- Gerontologist, 38(4), September 1998, pp.471-480.
- Publisher:
- Oxford University Press
It is important to enable social service agency practitioners to identify cases in which seniors are abused by their caregivers. The Indicators of Abuse (IOA) screening measure provides an abuse screening tool, based on abuse indicators, for use by practitioners. The study supports the validity of the 29-item set of indicators of the IOA, which discriminates abuse cases from nonabuse cases. An abuse-indicator model evolving from the IOA suggests three main type of abuse signals: (a) caregiver personal problems/issues; (b) caregiver interpersonal problems/issues; (c) care receiver social support shortages and past abuse.
Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program: understanding the potential involvement of care partners
- Authors:
- FIELDS Beth, et al
- Journal article citation:
- Health and Social Care in the Community, 30(4), 2022, pp.e1212-e1219.
- Publisher:
- Wiley
Older adults frequently turn to care partners for support to remain in their homes for as long as possible. Yet, many evidence-based home and community programs to support ageing in place do not formally involve care partners. This study sought to understand how to involve care partners in the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program. A qualitative descriptive study was conducted. Framework analysis of multiple sources of data, including descriptions from stakeholders (N = 24) and available CAPABLE resources, provided the basis for understanding how to involve care partners in the program. Considerations for involving care partners when initiating, delivering and following the program were generated; namely, providing older adults’ choices while screening for the program, defining roles and sharing information in a collaborative manner and reinforcing knowledge and skills training. Embracing these considerations in geriatric practice and research efforts is likely to help care partners’ ability to provide assistance, thus enabling older adults to remain in their homes for as long as possible. Providers can use findings to better involve and support care partners in their delivery of programs to older adults. Researchers should further develop and test a care partner-supported CAPABLE program. (Edited publisher abstract)
Supporting an informal care group - social contacts and communication as important aspects in the psychosocial well-being of informal caregivers of older patients in Belgium
- Author:
- JANSEN Leontien
- Journal article citation:
- Health and Social Care in the Community, 30(4), 2022, pp.1514-1529.
- Publisher:
- Wiley
Background: Increasingly, informal caregivers in Belgium care in group for an older patient. This study aimed to decrease the caregiver burden and to increase the well-being of caregivers and patients by supporting the needs of informal care groups of older patients (≥70 years). Method: Through an online self-management tool, the groups were supported to make informed choices concerning the care for the older patient, taking into account the standards, values, concerns and needs of every caregiver and patient. A pre-post study was performed. Results: Although patients and caregivers considered the self-management tool as useful and supportive, no clear evidence for decreased caregiver burden was found. There was a positive trend in group characteristics such as the distribution of tasks, communication and prevalence of conflicts. Caregivers also stated that they took more time for themselves, had less feelings of guilt and experienced less barriers to ask help. Conclusion: Tailor-made support of informal care groups starts with facilitating and guiding a process to achieve consent within the group to optimise the care for the patient and also for the caregivers. With a shared vision and supported decisions, caregivers can enter into conversations with the professional caregiver to coordinate adjusted support regarding the care needs. (Edited publisher abstract)
What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews
- Authors:
- SPIERS Gemma F, et al
- Journal article citation:
- BMJ Open, 11(9), 2021, Online only
- Publisher:
- BMJ Publishing Group
Objectives: To identify and map evidence about the consequences of unpaid caring for all carers of older people, and effective interventions to support this carer population. Design: A rapid review of systematic reviews, focused on the consequences for carers of unpaid caring for older people, and interventions to support this heterogeneous group of carers. Reviews of carers of all ages were eligible, with any outcome measures relating to carers’ health, and social and financial well-being. Searches were conducted in MEDLINE, PsycInfo and Epistemonikos (January 2000 to January 2020). Records were screened, and included systematic reviews were quality appraised. Summary data were extracted and a narrative synthesis produced. Results: Twelve systematic reviews reporting evidence about the consequences of caring for carers (n=6) and assessing the effectiveness of carer interventions (n=6) were included. The review evidence typically focused on mental health outcomes, with little information identified about carers’ physical, social and financial well-being. Clear estimates of the prevalence and severity of carer outcomes, and how these differ between carers and non-carers, were absent. A range of interventions were identified, but there was no strong evidence of effectiveness. In some studies, the choice of outcome measure may underestimate the full impact of an intervention. Conclusions: Current evidence fails to fully quantify the impacts that caring for older people has on carers’ health and well-being. Information on social patterning of the consequences of caring is absent. Systematic measurement of a broad range of outcomes, with comparison to the general population, is needed to better understand the true consequences of caring. Classification of unpaid caring as a social determinant of health could be an effective lever to bring greater focus and support to this population. Further work is needed to develop and identify suitable interventions in order to support evidence-based policymaking and practice. (Edited publisher abstract)
Non-traditional support workers delivering a brief psychosocial intervention for older people with anxiety and depression: the NOTEPAD feasibility study
- Authors:
- BURROUGHS H., et al
- Journal article citation:
- Health and Social Care Delivery Research, 7(25), 2019, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
Anxiety and depression often coexist in older people. These disorders are often underdiagnosed and undertreated, and are associated with increased use of health and social care services, and raised mortality. Barriers to diagnosis include the reluctance of older people to present to their general practitioner (GP) with mood symptoms because of the stigma they perceive about mental health problems, and because the treatments offered are not acceptable to them. Objectives: To refine a community-based psychosocial intervention for older people with anxiety and/or depression so that it can be delivered by non-traditional providers such, as support workers (SWs), in the third sector. To determine whether or not SWs can be trained to deliver this intervention to older people with anxiety and/or depression. To test procedures and determine if it is feasible to recruit and randomise patients, and to conduct a process evaluation to provide essential information to inform a randomised trial. Design: Three phases, all informed by a patient and public involvement and engagement group. Qualitative work with older people and third-sector providers, plus a consensus group to refine the intervention, training, SW manuals and patient participant materials (phase 1). Recruitment and training of SWs (phase 2). Feasibility study to test recruitment procedures and assess fidelity of delivery of the intervention; and interviews with study participants, SWs and GPs to assess acceptability of the intervention and impact on routine care (phase 3). Setting: North Staffordshire, in collaboration with Age UK North Staffordshire. Intervention: A psychosocial intervention, comprising one-to-one contact between older people with anxiety and/or depression and a SW employed by Age UK North Staffordshire, based on the principles of behavioural activation (BA), with encouragement to participate in a group activity. Results: Initial qualitative work contributed to refinement of the psychosocial intervention. Recruitment (and retention) of the SWs was possible; the training, support materials and manual were acceptable to them, and they delivered the intervention as intended. Recruitment of practices from which to recruit patients was possible, but the recruitment target (100 patients) was not achieved, with 38 older adults randomised. Retention at 4 months was 86%. The study was not powered to demonstrate differences in outcomes. Older people in the intervention arm found the sessions with SWs acceptable, although signposting to, and attending, groups was not valued by all participants. GPs recognised the need for additional care for older people with anxiety and depression, which they could not provide. Participation in the study did not have an impact on routine care, other than responding to the calls from the study team about risk of self-harm. GPs were not aware of the work done by SWs with patients. Limitations: Target recruitment was not achieved. Conclusion: Support workers recruited from Age UK employees can be recruited and trained to deliver an intervention, based on the principles of BA, to older people with anxiety and/or depression. The training and supervision model used in the study was acceptable to SWs, and the intervention was acceptable to older people. (Edited publisher abstract)
Socioecological factors and positive aspects of caregiving: findings from the REACH II intervention
- Authors:
- CHO Jimmyoung, ORY Marcia G., STEVENS Alan B.
- Journal article citation:
- Aging and Mental Health, 20(11), 2016, pp.1190-1201.
- Publisher:
- Taylor and Francis
Objective: Taking a socioecological perspective, this study assessed the relationship of intrapersonal, interpersonal, and organisational factors to positive aspects of caregiving (PAC) for 642 dementia caregivers by racial/ethnic group from the baseline data of the multisite Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) intervention. Methods: Nine intrapersonal indicators, 4 interpersonal indicators, and 12 organisational indicators were used. Blocked-multiple regression analyses by three racial/ethnic groups were computed to examine significant factors related to PAC among caregivers after controlling for memory and behavioural problems. Results: Data showed a significant difference in PAC and significantly different indicators of PAC by racial/ethnic group. Hispanic caregivers reported the highest level of PAC while White participants showed the lowest scores on the measure of PAC. Education, marital status, and using formal transportation services were significant predictors for PAC among Hispanic caregivers; age, education, caregiving duration, and received social support were significant for PAC among African American caregivers; and sex, education, being a spousal caregiver, satisfaction with social support, using help from homemaker and visiting nurse services, and participating in support groups were significant among White caregivers. Conclusion: Findings indicate that PAC varies significantly across the three studied racial/ethnic groups of family caregivers and that intrapersonal, interpersonal, and organizational factors relate uniquely to PAC. Additional investigations of PAC could serve an important role in the development of family caregiving supports and services. (Edited publisher abstract)
A pilot randomized controlled trial of mindfulness-based stress reduction for caregivers of family members with dementia
- Authors:
- BROWN Kirk Warren, COOGLE Constance L., WEGELIN Jacob
- Journal article citation:
- Aging and Mental Health, 20(11), 2016, pp.1157-1166.
- Publisher:
- Taylor and Francis
Objectives: The majority of care for those with Alzheimer's disease and other age-related dementias is provided in the home by family members. To date, there is no consistently effective intervention for reducing the significant stress burden of many family caregivers. The present pilot randomised controlled trial tested the efficacy of an adapted, eight-week mindfulness-based stress reduction (MBSR) programme, relative to a near structurally equivalent, standard social support (SS) control condition for reducing caregiver stress and enhancing the care giver–recipient relationship. Method: Thirty-eight family caregivers were randomised to MBSR or SS, with measures of diurnal salivary cortisol, and perceived stress, mental health, experiential avoidance, caregiver burden, and relationship quality collected pre- and post-intervention and at three-month follow-up. Results: MBSR participants reported significantly lower levels of perceived stress and mood disturbance at post-intervention relative to SS participants. At three-month follow-up, participants in both treatment conditions reported improvements on several psychosocial outcomes. At follow-up, there were no condition differences on these outcomes, nor did MBSR and SS participants differ in diurnal cortisol response change over the course of the study. Conclusion: Both MBSR and SS showed stress reduction effects, and MBSR showed no sustained neuroendocrine and psychosocial advantages over SS. The lack of treatment condition differences could be attributable to active ingredients in both interventions, and to population-specific and design factors. (Edited publisher abstract)
Baby boomer caregiver and dementia caregiving: findings from the National Study of Caregiving
- Authors:
- MOON Heehyul, DILWORTH-ANDERSON Peggye
- Journal article citation:
- Age and Ageing, 44(2), 2015, pp.300-306.
- Publisher:
- Oxford University Press
Background: Previous studies have well documented the characteristics of baby boomers but less is known about the experiences of boomer caregivers (CGs) of people with dementia. Objective: The purpose of this study was to compare the characteristics of boomer CGs of people with dementia with those of boomer CGs for people without dementia and to ascertain factors associated with outcomes. Design: The authors selected baby boomer CGs from the National Study of Caregiving (NSOC) with 650 primary boomer CGs (138 CGs of people with dementia and 512 CGs of people without dementia). Methods: The Stress Process Model (SPM) was used to examine the effects of resources (the use of paid help and informal support) and stressors (primary: level of CG care activities and interrupted sleep; secondary: strain of caregiving on work, other care and social activities) on CGs' down, depressed or hopeless feelings and self-perceived general health. T-tests and chi-square tests were used to compare SPM domain differences and ordinary least-square multiple regression analysis was used to investigate predictors of CGs' outcomes. Results: High blood pressure and arthritis were the most prevalent chronic diseases in both groups. Boomer CGs of people with dementia reported providing more help with daily activities, higher level of caregiving and social activity conflict, experiencing more interrupted sleep and more down, depressed or hopeless feelings than CGs of people without dementia. Different factors predicted boomer CGs' outcomes. Conclusion: The current results yield important information about the considerable differences between two baby boomer CG groups within the caregiving experiences. The findings highlight the need to provide tailored interventions to boomer CGs to help them cope with caregiving stress to improve their physical and mental health. (Edited publisher abstract)