Caregiving as a Dyadic Process: Perspectives From Caregiver and Receiver

Lyons, Karen S.; Zarit, Steven H.; Sayer, Aline G.; Whitlatch, Carol J.

doi:10.1093/geronb/57.3.p195

Cited by 225 publications

(231 citation statements)

References 58 publications

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“…The use of multilevel modeling to control for the interdependent nature of dyadic data has been well-described elsewhere (Lyons et al, 2002). In brief, our approach accounted for measurement error and interdependence of data at the item level, and results in empirical Bayes Table 1 Patient and caregiver determinants of dyadic contributions to heart failure self-care.…”

Section: Discussionmentioning

confidence: 99%

Patterns and predictors of patient and caregiver engagement in heart failure care: A multi-level dyadic study

Lee

Vellone

Lyons

et al. 2015

International Journal of Nursing Studies

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A B S T R A C TBackground: Heart failure is a burdensome clinical syndrome, and patients and their caregivers are responsible for the vast majority of heart failure care. Objectives: This study aimed to characterize naturally occurring archetypes of patientcaregiver dyads with respect to patient and caregiver contributions to heart failure selfcare, and to identify patient-, caregiver-and dyadic-level determinants thereof. Design: Dyadic analysis of cross-sectional data on patients and their caregivers. Setting: Outpatient heart failure clinics in 28 Italian provinces. Participants: 509 Italian heart failure patients and their primary caregivers. Methods: Multilevel and mixture modeling were used to generate dyadic averages and incongruence in patient and caregiver contributions to heart failure self-care and identify common dyadic archetypes, respectively. Results: Three distinct archetypes were observed. 22.4% of dyads were labeled as novice and complementary because patients and caregivers contributed to different aspects of heart failure self-care that was generally poor; these dyads were predominantly older adults with less severe heart failure and their adult child caregivers. 56.4% of dyads were labeled as inconsistent and compensatory because caregivers reported greater contributions to the areas of self-care most insufficient on the part of the patients; patients in these dyads had the highest prevalence of hospitalizations for heart failure in the past year and the fewest limitations to performing activities of daily living independently. Finally, 21.2% of dyads were labeled as expert and collaborative because of high contributions to all aspects of heart failure self-care, the best relationship quality and lowest caregiver strain compared with the other archetypes; patients in this archetype were likely the sickest because they also had the worst heart failure-related quality of life. Conclusion: Three distinct archetypes of dyadic contributions to heart failure care were observed that represent a gradient in the level of contributions to self-care, in addition to different approaches to working together to manage heart failure. Interventions and

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Section: Discussionmentioning

confidence: 99%

Patterns and predictors of patient and caregiver engagement in heart failure care: A multi-level dyadic study

Lee

Vellone

Lyons

et al. 2015

International Journal of Nursing Studies

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“…43 However, the estimates presented here are likely conservative because care recipients usually understate impairment or disability compared with assessments by caregivers. [80][81][82] Furthermore, the self-reported data used in this analysis have also been previously used to estimate informal costs of caregiving for patients with heart failure, stroke, dementia, depression, and diabetes mellitus. 18,19,33,35,83 We did not examine the spillover effects on caregivers; it is well documented that prolonged and intense caregiving effort exerts a devastating toll on caregiver health manifested as burden, depression, reduced quality of life, and increased risk for CVD events and other chronic conditions 14,15 compared with noncaregivers of the same age.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

Dunbar¹,

Khavjou²,

Bakas³

et al. 2018

Circulation

198

102

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INTRODUCTION:In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035. METHODS:We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers' wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant. RESULTS:The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD. CONCLUSIONS:The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers.

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“…In this study, caregivers found it burdensome that the care recipient is often unaware of the burden that the provision of care entails. Although incongruence in the mutual appraisal of caregiving difficulties has been reported (Lyons, Zarit, Sayer & Whitlatch, 2002), interventions seldom focus on this item (Carretero, Garcés, Ródenas, & Sanjosé, 2009). …”

Section: Safety Of Care Recipientmentioning

confidence: 99%

“…Psycho-educational programs might alleviate the emotional discomfort of informal caregivers associated with social-relational issues, and provide them with skills and strategies to face the challenge of caregiving (Lyons et al, 2002). Such programs may also acknowledge and support informal caregivers in the knowledge that the (former) relationship has changed, and that meaningful joint activities have become impossible; this might stimulate informal caregivers to find new ways to achieve joint activities.…”

Section: Safety Of Care Recipientmentioning

confidence: 99%

Problems experienced by informal caregivers with older care recipients with and without cognitive impairment

Bruggen

Gussekloo

Bode

et al. 2016

Home Health Care Services Quarterly

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The care of older persons can have negative impact on the caregiver. The objective of this population-based observational study is to identify problems experienced by informal caregivers, and the extent of related difficulties, in their care of older care-dependent recipients with and without cognitive impairment. Caregivers (n = 2,704) caring for a home-dwelling person aged ≥ 75 years responded to a questionnaire with 23 questions on problems and related difficulties by mail. Prevalence of self-reported problems and related difficulties was calculated. The impact of the problem was estimated by weighing the percentage of problems reported as being difficult against the prevalence of problems. The median number of problems was 12 (range 0-23), with 5 (range 0-23) reported as difficult. Informal caregivers experience a variety of problems, with the impossibility to engage in joint social activities having the highest impact. The impact of problems increased when the care recipient had a cognitive problem.

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Caregiving as a Dyadic Process: Perspectives From Caregiver and Receiver

Cited by 225 publications

References 58 publications

Patterns and predictors of patient and caregiver engagement in heart failure care: A multi-level dyadic study

Patterns and predictors of patient and caregiver engagement in heart failure care: A multi-level dyadic study

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

Problems experienced by informal caregivers with older care recipients with and without cognitive impairment

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