Balancing competing needs mediates the association of caregiving demand with caregiver role strain and depressive symptoms of dementia caregivers: A cross‐sectional study

Liu, Hsin‐Yun; Yang, Ching‐Tzu; Wang, Yu‐Nu; Hsu, Wen‐Chuin; Huang, Tsui-Chin; Lin, Yueh‐E; Liu, Chin-Yi; Shyu, Yea‐Ing Lotus

doi:10.1111/jan.13379

Cited by 18 publications

(18 citation statements)

References 52 publications

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“…They were also interested in knowing how to manage difficult conversations with their loved ones. This confirms the results of a recent study showing that it is difficult for caregivers to find a balance between the needs of their loved ones and their own needs [ 38 ]. In fact, this factor is associated with the burden of care felt by family caregivers caring for an older adult facing housing decisions [ 39 ].…”

Section: Discussionsupporting

confidence: 90%

Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study

Garvelink

Agbadjé

Freitas

et al. 2020

JMIR Mhealth Uhealth

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Background Older adults desire to stay independent at home for as long as possible. We developed an interactive website to inform older adults and caregivers about ways to achieve this. Objective This study aimed to perform an in-depth exploration among potential end users about how to improve the interactive website to better inform older adults and caregivers about ways to stay independent at home. Methods To complement the results of a quantitative survey on the usability and acceptability of the website before implementation, we conducted a qualitative descriptive study. Using multiple recruitment strategies, we recruited a purposeful sample of older adults (aged ≥65 years) and caregivers of older adults struggling to stay independent at home. We conducted face-to-face or telephonic interviews in either English or French. In addition, we collected sociodemographic characteristics, other characteristics of participants (eg, health, digital profile, and perception of retirement homes), and experiences with using the website (factors facilitating the use of the website, barriers to its use, and suggestions for improvement). Interviews were audio recorded, transcribed verbatim, and thematically analyzed by two researchers. Results We recruited 15 participants, including 5 older adults (mean age 75 years, SD 6) and 10 caregivers (mean age 57 years, SD 14). The mean interview time was 32 min (SD 14). Most older adults had either mobility or health problems or both, and many of them were receiving home care services (eg, blood pressure measurement and body care). Overall, participants found the website easy to navigate using a computer, reassuring, and useful for obtaining information. Barriers were related to navigation (eg, difficult to navigate with a cellphone), relevance (eg, no specific section for caregivers), realism (eg, some resources presented are not state funded), understandability (eg, the actors’ accents were difficult to understand), and accessibility (eg, not adapted for low digital literacy). Suggestions for improvement included a needs assessment section to direct users to the support appropriate to their needs, addition of information about moving into residential care, a section for caregivers, distinction between state-provided and private support services, simpler language, expansion of content to be relevant to all of Canada, and video subtitles for the hearing impaired. Conclusions Users provided a wealth of information about the needs of older adults who were facing a loss of autonomy and about what such a website could usefully provide. The request for less generic and more personalized information reflects the wide range of needs that electronic health innovations, such as our interactive website, need to address. After integrating the changes suggested, the new website—Support for Older Adults to Stay Independent at Home (SUSTAIN)—will be implemented and made available to better assist older adults and caregivers in staying independent at home.

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Section: Discussionsupporting

confidence: 90%

Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study

Garvelink

Agbadjé

Freitas

et al. 2020

JMIR Mhealth Uhealth

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“…The effect of the care receiver's self‐care ability, which can be considered a primary stressor (Pearlin, 1989, 1999), might be mediated by how family caregivers manage the needs of people with dementia, e.g., by how well they balance competing needs (Lethin et al., 2016; Liu et al., 2017; McCabe et al., 2016). On the other hand, the care receiver's self‐care ability might have little or no influence on the process of balancing between competing needs.…”

Section: Discussionmentioning

confidence: 99%

“…Family caregivers of people with dementia who balanced poorly had more depressive symptoms and worse mental health than those who balanced competing needs well (Liu et al., 2014). How well family caregivers balance competing needs in caring for people with dementia mediated the association of caregiving demand with depressive symptoms (Liu et al., 2017). Given that a poor sense of balance is associated in cross‐sectional studies with negative family‐caregiving outcomes, home care nurses should understand how caregivers’ sense of balance changes over time.…”

Section: Introductionmentioning

confidence: 99%

Finding a balance in family caregiving for people with dementia: A correlational longitudinal study

Liu

Hsu

Shyu

et al. 2021

Journal of Advanced Nursing

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Aims The “Finding a Balance Point” framework was used to explore the caregiving process over time for family caregivers of people with dementia in Taiwan. This study aimed to: (a) identify Taiwanese caregivers’ different balance trajectories; (b) explore predictors of trajectory group membership; and (c) examine associations of different balance trajectories with caregiving outcomes. Design A correlational longitudinal design was used. Methods Data were collected from 200 family caregivers’ self‐completed questionnaires and they were followed over 2 years (June 2015–May 2017). Discrete balance trajectories were identified by group‐based trajectory modelling. Predictors of trajectory group membership were identified from potential predictors of caregiving characteristics and caregiving factors using multivariate logistic regression. Associations of trajectory groups with caregiving outcomes (depressive symptoms and health‐related quality of life) were explored using the generalized estimating equation. Results Balance trajectories best fit a two‐group trajectory model (poor and good). Caregivers with a poor sense of balance between competing needs were more likely to have more depressive symptoms (b = 11.71, 95% CI [9.04, 14.38], p < .001), worse physical health (b = −6.22, 95% CI [−8.71, −3.74], p < .001), and worse mental health (b = −11.1, 95% CI [−13.58, −8.63], p < .001) than caregivers with a good sense of balance. Caregivers experiencing lower role strain (b = −1.45, SE = 0.48, p = .003) or higher predictability (b = 2.83, SE = 0.76, p < .001) were more likely to belong to the good‐balance group. Conclusions Caregivers with poor balance between competing needs are more likely to have worse caregiving outcomes. Role strain and predictability significantly predicted balance trajectory groups. Family caregivers with lower caregiving task difficulty and/or better knowledge of the care receiver were more likely to be in the good balance trajectory group. Impact Our findings support the framework, “Finding a Balance Point,” and clarify the family caregiving process for people with dementia. This framework could be used to tailor interventions for home care nurses to improve family caregivers’ caregiving outcomes.

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“…19 For many caregivers, care does not mean giving attention, being willing with the elderly, but living in a constant state of concern about them, which brings disharmony and difficulty in maintaining the balance in the care, contributing, on the long-term, that CRS may be settled. 26 This is probably due to the responsibility of caring for the elderly that the caregiver attributes to themselves. This accountability is often tied to a moral duty conditioned in part on the family bond.…”

Section: Discussionmentioning

confidence: 99%

“…This accountability is often tied to a moral duty conditioned in part on the family bond. 26 In this emotional connection, the caregiver tends to see the care for the elderly as a mission, considering himself the only person able to do it, which can generate a state of constant concern and being hard on themselves. 27 Thus, the closer the relationship between caregiver and care recipient is, the greater the impact on the caregiver's mental health.…”

Section: Discussionmentioning

confidence: 99%

Caregiver Role Strain in Informal Caregivers for the Elderly

Vechia

Mamani

Azevedo

et al. 2019

Texto contexto - enferm.

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Objective: to analyze the frequency of the “caregiver role strain” nursing diagnosis in informal caregivers for the elderly, the defining characteristics and the related factors. Method: a cross-sectional, descriptive study carried out with 99 informal caregivers for elderly residents living in the areas covered by five units of the Family Health Strategy of Cuiabá, Mato Grasso, Brazil. Data collect took place between July and September 2017, through home interviews. A questionnaire elaborated from the literature on the diagnosis A questionnaire elaborated from the literature on the diagnosis caregiver role strain established by NANDA-International taxonomy II was used. A descriptive analysis with relative and absolute frequency was accomplished. Results: the frequency of the “caregiver role stress” nursing diagnosis found in caregivers was 98.0%. The most common defining characteristics were: difficulty in seeing the care receiver with the disease (69.1%); apprehension about the future health of the care recipient (66.0%); apprehension about the welfare of the care recipient, if the caregiver is unable to offer it (61.9%); apprehension about the future ability to provide care (60.8%); apprehension about the possible institutionalization of the care recipient (55.7%); concern with the routine care (55.7%) and social isolation (51.5%). The related factors most frequently found were: duration of care (92.8%); 24-hour a day care responsibilities (75.3%); dependence (77.3%) and alteration in the cognitive function was (73.2%) in the elderly; physical conditions (73.2%) and codependency of the caregiver (61.9%). Conclusion: the frequency of the “caregiver role strain” nursing diagnosis found in this study is high, its defining characteristics concerning mainly the caregiver's apprehension with the elderly and the related factors refer to the demands of the care provided. The nurse and other team’s professionals must pay attention to the caregivers as well as to the elderly being cared of in the health units, helping them to overcome the difficulties involved in performing their role.

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Balancing competing needs mediates the association of caregiving demand with caregiver role strain and depressive symptoms of dementia caregivers: A cross‐sectional study

Cited by 18 publications

References 52 publications

Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study

Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study

Finding a balance in family caregiving for people with dementia: A correlational longitudinal study

Caregiver Role Strain in Informal Caregivers for the Elderly

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