The Zarit Burden Interview (ZBI) is believed to be the most commonly used measure of caregiver burden. Originally developed more than 20 years ago for use with informal caregivers of community dwelling persons with Alzheimer disease, it has subsequently been administered to a diverse range of patient populations, formal or paid caregivers, and translated into numerous languages. Given that the ZBI is now used more broadly than it was initially intended and first validated, the current study applies the reliability generalization meta-analytic procedure to examine the psychometric properties of responses to the ZBI across populations. Multiple regression with categorical variables was performed to identify factors associated with error variance in ZBI reliability estimates (N=138 data points). Number of items, residence of the care recipient (community) and the Hebrew version each contributed significantly to prediction of internal consistency. These differences, however, were found to be relatively small and within accepted parameters. Generally, responses to the ZBI appear reliable across populations of caregivers and patients. Only versions of the ZBI with more or less than 22-items (nonstandard formats) reflect both statistical and meaningful differences in reliability. Where feasible, it is recommended that the 22-item version of the ZBI be used in future research and clinical practice.
In this preliminary investigation, we found that referral rates for diagnostic tests and specialist clinics increased independently for board-certified specialists (compared with GPs), for those with higher burnout levels and when objective workload increases. These findings support the conceptualization of referrals rates as objectively measured negative outcomes of burnout. Further replications with other objective outcomes, additional HMOs and bigger samples are warranted.
Our results show that regarding end-of-life preferences for patients, there is moderate agreement between patients and their spouses, but limited evidence for projection of spouses' preferences on patients (i.e. spouse making a prediction based on own wishes). Potential differences in end-of-life preferences between older adults with MCI or mild dementia and their caregivers should be taken into consideration in the preparation of advance care planning.
The objectives of this study were to evaluate caregivers' experiences concerning the care of a terminally ill loved one at home, and to compare the death experiences of caregivers with and without access to homecare programs. The primary caregivers of all the patients who died of cancer 6-18 months before the study period (1999-2001) in the Negev area were contacted. This group included 240 caregivers of patients who died in the home palliative care program and 404 caregivers of patients who died with no access to a home palliative care program. A total of 159 caregivers were interviewed, 76 from the home palliative program and 83 who had no access to a palliative care program. Death at home occurred for 80.3% of patients with access to homecare and 20.5% of those without access. Despite the fact that caring for a loved one at home was a greater financial and emotional burden, there was a greater overall satisfaction with the caring experience of those whose loved ones died at home and had access to the homecare program. Given appropriate professional support systems, home-based care at the end of life is preferable to most caregivers.
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