Effectiveness of a Grief Intervention for Caregivers of People With Dementia

MacCourt, Penny; McLennan, Marianne; Somers, Sandie; Krawczyk, Marian

doi:10.1177/0030222816652802

Cited by 34 publications

(64 citation statements)

References 28 publications

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“…Spousal caregivers are generally older and have a lower level of education, which may affect their ability to seek help. In addition, the grief that a caregiver feels before the death of a PWD is usually not openly acknowledged, publicly mourned, or socially supported, which may cause caregivers to refrain from disclosing their concerns [ 46 ]. Embedded in a culture influenced by Confucianism and Buddhism, it is even more difficult for Chinese, especially those from the older generation, to express negative feelings and raw emotions [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Anticipatory grief of spousal and adult children caregivers of people with dementia

Cheung

et al. 2018

BMC Palliat Care

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BackgroundAnticipatory grief (AG) among caregivers of people with dementia is common and has been found to be related to negative health outcomes. Previous studies showed different patterns of AG between spousal and adult children caregivers of people with dementia (PWD) at different stages; however, the levels of such grief are not yet compared. The findings in Western studies are very limited, and inconsistencies have also been found in Asian studies.MethodsOne hundred and eight primary caregivers (54 spousal and 54 adult children) of community-dwelling PWD were recruited from elderly community services sectors in Hong Kong, China through quota sampling. The demographics, AG (measured by the Marwit-Meuser Caregiver Grief Inventory-short form), subjective caregiver burden, and well-being of the participants were assessed. A Functional Assessment Staging Test was used to grade the stages of dementia of the PWD. In this study, those in stages 4 and 5 were regarded as being at an earlier stage, and those in stages 6 and 7 at a later stage of dementia.The Mann-Whitney U-test and the Chi-square test were used to compare the variables between spousal and adult children caregivers, and the Kruskal–Wallis test was used to compare the outcomes among the sub-groups (spousal caregivers caring for relatives with earlier/later stage dementia; and adult children caregivers caring for relatives with earlier/later stage dementia). A post-hoc analysis was also conducted to identify differences between the sub-groups. Pearson’s correlation was performed to investigate the bivariate relationships among AG, subjective caregiver burden, and well-being.ResultsThe results showed that spousal caregivers caring for relatives in a later stage of dementia experienced the highest level of AG and subjective caregiving burden, as compared with spousal caregivers caring for relatives in an earlier stage of dementia and adult children caregivers. Well-being was significantly negatively correlated with AG and subjective caregiver burden, while AG was also significantly correlated with subjective caregiver burden.ConclusionThis study found that spousal caregivers of relatives in a later stage of dementia have significantly higher levels of AG, warranting special attention and extra support from palliative professionals.

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Section: Discussionmentioning

confidence: 99%

Anticipatory grief of spousal and adult children caregivers of people with dementia

Cheung

et al. 2018

BMC Palliat Care

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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%

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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“…To date, no intervention-studies have been conducted in the Chinese-speaking populations to address those with high PDG, possibly hindered by the lack of a relevant Chinese scale to assess PDG. Although prior studies have demonstrated the benefits of PDG interventions [ 7 , 46 , 47 ], they were primarily conducted in Caucasian populations. We remain uncertain whether PDG interventions are equally effective in the Chinese community, and whether there is a need to adapt the interventions to ensure that they can be culturally-relevant and sensitive to Chinese caregivers.…”

Section: Discussionmentioning

confidence: 99%

“…Caregivers of PWD may begin their bereavement long before the physical death of the PWD [ 7 ]. The caregivers’ responses to perceived losses in the pre-death context – which we refer to as pre-death grief (PDG) – include the anticipation of future loss related to the physical death of PWD and the mourning of present loss related to the psychological death of PWD (a unique phenomenon in dementia whereby the PWD is still physically present but emotionally disconnected from the caregiver) [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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BackgroundPre-death grief (PDG) is a key challenge faced by caregivers of persons with dementia (PWD). Marwit-Meuser Caregiver Grief Inventory (MM-CGI) and its abbreviated MM-CGI-Short-Form (MM-CGI-SF) are among the few empirically-developed scales that detect PDG. However, they have not had a Mandarin-Chinese version even though Chinese-speaking populations have among the largest number of PWD. We produced a Mandarin-Chinese version of MM-CGI and evaluated whether it had equivalent scores and similar psychometric properties to the English version.MethodsWe produced the Chinese MM-CGI through the methods of forward-backward translation and cognitive debriefing. Then, we recruited family caregivers of PWD (n = 394) to complete either the Chinese (n = 103) or English (n = 291) version. The two versions were compared in their score-difference (adjusting for potential confounders using multiple linear regression), internal-consistency reliability (using Cronbach’s α) and test-retest reliability (using intraclass correlation-coefficient), known-group validity (based on the relationship with the PWD and stage of dementia) and construct validity (using Spearman’s correlation-coefficient).ResultsThe two versions showed similar mean scores, with the adjusted score-difference of 1.2 (90% CI -5.6 to 7.9) for MM-CGI and − 0.4 (90% CI -2.9 to 2.1) for MM-CGI-SF. The 90% CI for adjusted score-difference fell within predefined equivalence-margin (±8 for MM-CGI and ± 3 for MM-CGI-SF) and indicated equivalence of the scores. The two versions also demonstrated similar characteristics in reliability and validity.ConclusionsThe Chinese MM-CGI opens the way for PDG assessment and intervention among Chinese-speaking caregivers. Establishing its measurement equivalence with the English version paves the way for cross-cultural research on PDG in dementia caregiving.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0804-5) contains supplementary material, which is available to authorized users.

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Effectiveness of a Grief Intervention for Caregivers of People With Dementia

Cited by 34 publications

References 28 publications

Anticipatory grief of spousal and adult children caregivers of people with dementia

Anticipatory grief of spousal and adult children caregivers of people with dementia

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

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

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