Prevalence and Impact of Caregiving: A Detailed Comparison Between Dementia and Nondementia Caregivers

Ory, Marcia G.; Hoffman, Richard R.; Yee, Jennifer L.; Tennstedt, Sharon L.; Schulz, Richard

doi:10.1093/geront/39.2.177

Cited by 849 publications

(666 citation statements)

References 19 publications

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“…Our hypothesis that caregivers with high HCTD would show greater evidence of strain and depression was supported by the independent relationship between high HCTD and increased strain and depressive symptoms, after controlling for possible confounders (number of assisted health care tasks, caregiver self-efficacy, 32,34 and poor patient mental health-related quality of life 35,36 ). The strength of the relationship between HCTD and strain/depression is particularly striking.…”

Section: Discussionmentioning

confidence: 75%

Difficulty Assisting with Health Care Tasks Among Caregivers of Multimorbid Older Adults

et al. 2011

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BACKGROUND: Family caregivers provide assistance with health care tasks for many older adults with chronic illnesses. The difficulty they experience in providing this assistance, and related implications for their well-being, have not been well described. OBJECTIVE: The objectives of this study are: (1) to describe caregiver's health care task difficulty (HCTD), (2) determine the characteristics associated with HCTD, and (3) explore the association between HCTD and caregiver well-being. DESIGN: This is a cross-sectional study. PARTICIPANTS: Baseline sample of caregivers to older (aged 65+years) multimorbid adults enrolled in an ongoing cluster-randomized controlled trial (N=308). MAIN MEASURES:The HCTD scale (0-16) is comprised of questions measuring self-reported difficulty in assisting older adults with eight health care tasks, including taking medication, visiting health care providers, and managing medical bills. Caregivers were categorized using this scale into no, low, medium, and high HCTD groups. We used ordinal logistic regression and multivariate linear regression analyses to examine the relationships between HCTD, caregiver self-efficacy, caregiver strain (Caregiver Strain Index), and depression (Center for Epidemiological Studies Depression Scale), controlling for patient and caregiver socio-demographic and health factors. KEY RESULTS: Caregiver age and number of health care tasks performed were positively associated with increased HCTD. The quality of the caregiver's relationship with the patient, and self-efficacy were inversely associated with increased HCTD. A onepoint increase in self-efficacy was associated with a significant lower odds of reporting high HCTD (OR, 0.64; 95% CI, 0.54, 0.77).Adjusted linear regression models indicated that high HCTD was independently associated with significantly greater caregiver strain (B, 2.7; 95% CI, 1.12, 4.29) and depression (B, 3.01; 95% CI, 1.06, 4.96). CONCLUSIONS: This study demonstrates that greater HCTD is associated with increased strain and depression among caregivers of multimorbid older adults. That caregiver self-efficacy was strongly associated with HCTD suggests health-system-based educational and empowering interventions might improve caregiver well-being.

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Section: Discussionmentioning

confidence: 75%

Difficulty Assisting with Health Care Tasks Among Caregivers of Multimorbid Older Adults

et al. 2011

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“…241 The challenges that carers of PLWD face are well documented. 23,242 Family caregivers of people who have dementia and other health conditions face additional challenges in managing both conditions and dealing with the impact of the accompanying behavioural and psychological symptoms of dementia on care routines. 102 Our study suggests that care pathways need to recognise the contribution of family members and, when available, incorporate their contribution in the care of PLWD.…”

Section: Carer Inclusion and Supportmentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Further, caregiving status appears to be associated with greater concentrations of stress hormones and antibodies (19), and male caregivers appear at greater risk for coronary heart disease relative to male non-caregivers(20). A comprehensive comparison of dementia and non-dementia caregivers(21) found dementia caregivers provided significantly greater hours of care per day, managed more ADLs/IADLs, and reported greater emotional, physical, and financial strain. Finally, a review of caregiving literature summarizes the health risks associated with caregiving, including high rates of depression, anxiety, and physical health morbidity found in this population (22).…”

Section: Objectivementioning

confidence: 99%

A Comparison of Psychosocial Outcomes in Elderly Alzheimer Caregivers and Noncaregivers

Mausbach

Chattillion

Roepke

et al. 2013

The American Journal of Geriatric Psychiatry

123

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Objectives To conduct ananalysis of the stress, coping, and mood consequences of Alzheimer’s caregiving. Design Cross-sectional. Setting Community-based study. Participants Sample included 125 Alzheimer’s caregivers and 60 demographically similar older adults with non-demented spouses (i.e., non-caregivers). Measurements We compared caregivers and non-caregivers on stress, coping, and mood outcomes. We also examined anti-depressant use within the caregiver sample. An emphasis was placed upon effect size differences, including Cohen’s d as well as more clinically meaningful effect sizes. Results Caregivers were significantly more likely to endorse depressive symptoms and to meet clinically significant cutoff for depression (40% for caregivers; 5% for non-caregivers). Approximately 25% of caregivers reported taking anti-depressant medication, although 69% of these continued to experience significant symptoms of depression. Caregivers also utilized fewer positive coping and greater negative coping strategies relative to non-caregivers. Conclusions The number of caregivers will increase dramatically over the next two decades, and caregivers will likely seek care from primary care providers. We provide an overview of the psychological issues facing caregivers so that effective screening and treatment may be recommended.

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Prevalence and Impact of Caregiving: A Detailed Comparison Between Dementia and Nondementia Caregivers

Cited by 849 publications

References 19 publications

Difficulty Assisting with Health Care Tasks Among Caregivers of Multimorbid Older Adults

Difficulty Assisting with Health Care Tasks Among Caregivers of Multimorbid Older Adults

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

A Comparison of Psychosocial Outcomes in Elderly Alzheimer Caregivers and Noncaregivers

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