Detecting pre-death grief in family caregivers of persons with dementia: measurement equivalence of the Mandarin-Chinese version of Marwit-Meuser caregiver grief inventory

Liew, Tau Ming; Yap, Philip; Luo, Nan; Hia, Soo Boon; Koh, Gerald Choon‐Huat; Tai, Bee Choo

doi:10.1186/s12877-018-0804-5

Cited by 16 publications

(17 citation statements)

References 45 publications

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“…Figure 1 exploring the various aspects of loss related to the past, present, and future; and encouraging adaptive ways of coping with the losses (such as not avoiding grief reactions, finding new ways to remain connected with the PWD, and involving other family members in the grieving process). This approach bears much resemblance to the key strategies that have been employed in previous intervention studies for PDG, [39][40][41] which included 22,39,[41][42][43] (1) This study has several limitations. First, the participants were recruited from tertiary centers and may not fully represent community samples.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, total scores >175 were reported to indicate high PDG which may require clinical attention. MM-CGI 9,22,23 and ZBI 24 have previously been validated in our local population. 19 The items are rated on a 5-point Likert scale and summed to generate a total score ranging from 0 to 88.…”

Section: Methodsmentioning

confidence: 99%

“…In a more recent study, 21 scores ≥34 were reported to indicate significant burden that may require clinical attention. MM-CGI 9,22,23 and ZBI 24 have previously been validated in our local population.…”

Section: Methodsmentioning

confidence: 99%

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Contrasting the risk factors of grief and burden in caregivers of persons with dementia: Multivariate analysis

Liew

Tai

Yap

et al. 2018

Int J Geriat Psychiatry

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Background Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of the person. While such phenomenon of pre‐death grief (PDG) has been increasingly described, we are uncertain how it can be distinct from the well‐studied construct of caregiver burden. Objective To determine whether there are differences in the risk factors of PDG and caregiver burden to aid in our understanding of the relationship between the two constructs. Methods Spouses or children of community‐dwelling PWD were consecutively sampled from two tertiary hospitals. They completed questionnaires containing a PDG scale, a caregiver burden scale, and information related to the caregiver and PWD. Risk factors of PDG and caregiver burden were identified using multivariate regression, within which PDG and caregiver burden scores were jointly included as two separate dependent variables. Results We recruited 394 caregivers with a mean age of 53.0 years (SD 10.7), majority were Chinese (86.6%), children caregivers (86.3%), and primary caregivers (70.8%). In the regression analyses, we identified three risk factors which were shared by both PDG and caregiver burden (later stage of dementia, behavioral problems in PWD, and primary caregiving role) and three other risk factors which were unique to PDG alone (younger age of PWD, lower educational attainment of caregivers, and spousal caregiver). Conclusions The different risk factor profiles evidence a distinction between PDG and caregiver burden. They may possibly be distilled into a framework to direct our approach to PDG interventions, which may include using caregiver burden as an opportunity to initiate conversations on grief, exploring the various aspects of losses and encouraging adaptive coping.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Contrasting the risk factors of grief and burden in caregivers of persons with dementia: Multivariate analysis

Liew

Tai

Yap

et al. 2018

Int J Geriat Psychiatry

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“…29,30 The total score ranges from 0 to 60, with scores !16 indicating clinically significant depression. 26,31 MM-CGI, 11,32,33 ZBI, 34,35 and CES-D 36 have been validated in the local context.…”

Section: Methodsmentioning

confidence: 99%

Comparing the Effects of Grief and Burden on Caregiver Depression in Dementia Caregiving: A Longitudinal Path Analysis over 2.5 Years

Liew

Tai

Yap

et al. 2019

Journal of the American Medical Directors Association

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Objectives: Caregivers of persons with dementia can experience loss and grief long before the death of the person. Although the phenomenon of caregiver grief has been increasingly described, it is uncertain if caregiver grief has independent effectsdseparate from the well-studied construct of caregiver burdendon adverse outcomes such as caregiver depression. We sought to compare the effects of baseline grief and burden on caregiver depression at baseline and 2.5 years later. Design and Setting: A cohort study with 2.5 years of follow-up. Participants: Family caregivers of community-dwelling persons with dementia (n ¼ 183). Measures: Participants completed questionnaires with scales that assessed caregiver grief, burden, and depression. Baseline grief and burden scores were included in a path analysis to predict depression at baseline and at 2.5 years. Results: At baseline, grief and burden had synergistic relationships with each other (P ¼ .012), where the high levels of grief amplified the effect of burden on caregiver depression. Both grief and burden had longitudinal effects on caregiver depression at 2.5 years (P <.001 and P ¼ .047, respectively), albeit with some differences in mechanism; both had effects which were indirectly mediated through baseline depression (P < .001 and P ¼ .002, respectively), but only grief had a direct path toward depression at 2.5 years (P ¼ .030), which was distinct from baseline depression. Conclusions and Implications: The findings highlight the need to identify and address caregiver grief in dementia services. They present a window of opportunity to improve caregiving outcomes, especially during the "latent phase" when caregivers encounter loss and grief but have yet to fully experience the debilitating effects of depression.

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“…When the experience of loss and grief is not recognized, caregivers may have difficulty noticing the changes that have occurred in the PWD and may fight the inevitable disease progression in the PWD. As such, they may resort to control-based coping strategies – by becoming more authoritarian and paternalistic when relating to the PWD – which can often lead to the sense of loss of autonomy in the PWD and the feeling of helpless in the caregivers (over what they cannot control) [4, 5]. Consequently, caregiver grief has been linked to negative outcomes such as caregiver depression [6] and caregivers’ desire to institutionalize the PWD [7].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a simple screening tool for caregiver grief in dementia caregiving

et al. 2019

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Background Loss and grief are experienced by caregivers of persons with dementia (PWD), relating to the ambiguous loss of PWD even when they are still alive and the anticipation of future loss related to their physical death. Such experience of caregiver grief is not easily recognized in clinical practice, despite its association with adverse effects such as caregiver burden, caregiver depression and caregivers’ desire to place the PWD in nursing homes. We constructed a simple screening tool – based on factors associated with caregiver grief – to identify caregivers with high grief. Methods Spouses or children of community-dwelling PWD ( n = 403) completed self-administered questionnaires containing a well-established grief scale and information related to the caregiver and PWD. We split the study sample into two – the derivation sample ( n = 300) was used to identify factors associated with grief (using logistic regression) and derive a simple tool based on the number of identified factors; the validation sample ( n = 103) evaluated the performance of the tool using the receiver-operating-characteristic-curve-analysis (ROC). Results Four key factors were identified by the multivariable regression – more severe dementia (odds ratio, OR 6.9), behavioral problems in PWD (OR 5.0), spousal caregivers (OR 6.0) and daily caregiving (OR 3.0). The screening tool (based on the number of key factors) had an area under ROC of 0.77. At the optimal cut-off of ≥2 key factors, the tool had a sensitivity of 0.91 and a specificity of 0.42. Conclusions The identified factors are consistent with current understanding on caregiver grief. They can be easily integrated into the workflow of routine services to screen for caregivers who are more likely to benefit from further grief-related assessment. Electronic supplementary material The online version of this article (10.1186/s12877-019-1070-x) contains supplementary material, which is available to authorized users.

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Detecting pre-death grief in family caregivers of persons with dementia: measurement equivalence of the Mandarin-Chinese version of Marwit-Meuser caregiver grief inventory

Cited by 16 publications

References 45 publications

Contrasting the risk factors of grief and burden in caregivers of persons with dementia: Multivariate analysis

Contrasting the risk factors of grief and burden in caregivers of persons with dementia: Multivariate analysis

Comparing the Effects of Grief and Burden on Caregiver Depression in Dementia Caregiving: A Longitudinal Path Analysis over 2.5 Years

Development and validation of a simple screening tool for caregiver grief in dementia caregiving

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