Stress, social support, and psychological distress of family caregivers of the elderly

The effects of stress and social support and their interaction with the psychological well-being of 87 family caregivers of impaired elderly were examined. Perceived stress and satisfaction with support accounted for 32% to 36% of the variance in psychological distress or depression, p less than .001; however, when characteristics of the caregiver situation were included in the models, the effects of perceived stress were found to be spurious. The revised models accounted for 44% to 48% of the variance in psychological distress or depression, p less than .000, and included years of caregiving and mental impairment of the elder instead of perceived stress. Although there were no buffering effects for social support, main effects accounted for 19% to 22% of the variance in psychological distress or depression. The findings indicate that caregivers who are caring for a mentally impaired elder, who have been providing care for an extended time, and who have low social support are at high risk for psychological distress or depression.     

The lived experience of spiritual well-being amongst family caregivers of persons with dementia on palliative care

Family caregivers of persons with dementia are known to experience caregiver burden, anxiety, and social isolation. Spiritual well-being may help ameliorate these characteristics. The meaning of this phenomenon, though, is not known to have been explored previously within this caregiving population. This hermeneutic phenomenological study examined the lived experiences of spiritual well-being in 10 family caregivers. The analysis of semi-structured interviews revealed 5 prominent themes: being connected, strength, presence, hardships, and duty. Phenomenological writing revealed the essence of spiritual well-being in the context of this study. This understanding will help nurses appreciate the importance some family caregivers place on spirituality and recognize when a family caregiver may benefit from a spiritual guidance referral. Further research is recommended to examine associations between spiritual well-being and burden, depression, and social isolation in caregivers of persons with dementia at different stages of receiving palliative care.     

Predictors of burden among wife caregivers

The relationship of caregiver health, past marital adjustment, as well as received social support to caregiving burden was studied in 78 wives who served as primary caregivers to husbands with irreversible memory impairment for an average of 4 years and 10 months. In addition, socioeconomic status and attitudes toward asking for help were investigated. This paper is based on the same data set as a previous article that focused on depression. Past marital adjustment was a significant (p less than .001) predictor of subjective burden and accounted for 20% of the total explained variance (22%). Socioeconomic status and attitude toward asking for help were the significant (p less than .001) predictors of objective burden and accounted for 12% of the total variance (17%). Received social support did not predict caregiver adjustment. The finding that past marital adjustment was significantly related to subjective burden suggests that caregivers with unhappy past marriages may need intervention in order to reframe past grievances in their marriages. Findings regarding social status indicate that caregivers with a higher income could purchase services, thus decreasing the amount of disruption in their lives and households.     

Correlates of caregiving satisfaction: prerequisites to elder home care

In this comparative study, a path analytic model was used to identify variables predictive of satisfaction in providing care to elderly family members, and to determine differences in the predictor variables between past and present caregivers as potential precipitators of institutionalization. Nineteen current caregivers and 29 past caregivers were recruited from health agencies in a rural area. Demographic predictors of caregiving satisfaction included age and sex of the client and age of the caregiver; psychological problems of the client influenced caregiver satisfaction. Measures of situational stress (medical, psychological, environmental) revealed that the past caregivers had higher psychological and environmental stress and less life satisfaction than current caregivers. Additional analysis revealed that the most common pattern of nursing home admission was hospitalization of the client for physical illness, with subsequent physician-recommended nursing home placement. Areas of identified need for preventing premature relinquishing of the caregiving role are discussed.     

Reciprocal suffering: caregiver concerns during hospice care

ContextFor many hospice caregivers, the constancy and difficulty of caregiving impact their physical quality of life and cause depression, psychological distress, guilt, loneliness, and restrictions on social activities.ObjectivesDeviating from traditional unidimensional research on hospice caregivers, this study explored the transactional nature of reciprocal suffering by examining caregiver concerns through four dimensions: physical, psychological, social, and spiritual.MethodsResearchers analyzed audiotapes of intervention discussions between hospice caregivers and research social workers.ResultsResults indicated that, of the 125 pain talk utterances, most referenced psychological concern (49%), followed by physical (28%), social (22%), and spiritual (2%) concerns. Reflections on concerns revealed a global perspective of caregiving, which highlighted the patient’s needs juxtaposed to the caregiver’s recognized limitations.ConclusionBy examining the reciprocal nature of suffering for caregivers, this study reinforced the need for assessing caregivers in hospice care, with specific emphasis on the importance of providing caregiver education on pain management.     

The relationships between depression and other outcomes of chronic illness caregiving

Background  

Many caregivers with chronically ill relatives suffer from depression. However, the relationship of depression to other outcomes of chronic caregiving remains unclear. This study tested a hypothesized model which proposed that hours of care, stressful life events, social support, age and gender would predict caregivers' outcomes through perceived caregiver stress. Depression was expected to mediate the relationship between perceived stress and outcomes of chronic caregiving (physical function, self-esteem, and marital satisfaction).     

Comparing Perceived Burden for Korean and American Informal Caregivers of Stroke Survivors

Little is known about the burden of cross‐cultural care for stroke patients. This article compares the perceived burden for caregivers of stroke survivors in Korea and the United States. A brief interview was conducted to determine specific problem areas for caregivers. Caregiver burden (using the Sense of Competence Questionnaire) and social support (using the ENRICHD Social Support Inventory) also were measured. The overall‐sense‐of‐burden‐from‐caregiving score was significantly higher in the Korean cohort than in the American cohort, as was the scale regarding satisfaction with the relationship with the recipient of care. The primary predictors of overall burden for the combined sample were caregiver and patient depression and insufficient social support. Lower perceived social support among Korean caregivers was strongly related to caregiver depression, while it was more strongly related to increased hours of caregiving in the American sample. These findings can help rehabilitation nurses plan supportive interventions that incorporate cultural values for stroke survivors and their caregivers.     

Life satisfaction among informal caregivers in comparison with non-caregivers

Being a caregiver with responsibility for someone with reduced health compared with not being a caregiver may mean different views of life satisfaction. Knowledge of what leads to reduced life satisfaction in caregivers may be helpful in interventions. Informal caregivers gainfully employed or not, aged 50-89 years, were studied with regard to life satisfaction depending on the extent of caregiving to identify types of social support of value for caregivers. A cross-sectional study was conducted including a sample of 151 informal caregivers with a high caregiving extent, 392 caregivers with a lower caregiving extent and 1258 non-caregivers. The sample was randomly selected to correspond with older Swedes as a whole aged 50-89 years. A questionnaire containing a modified form of Older Americans' Resources Schedule (OARS) and Life Satisfaction Index Z (LSIZ) was used; 19.6% helped someone with activities of daily living and of these 27% stated that they did so frequently. Frequent caregiving implied significantly higher age, being more often married and retired, than less frequent caregivers and non-caregivers. Frequent caregivers also performed personal activities of daily living (PADL) to a higher extent than less frequent caregivers and had significantly lower LSIZ (mean 14.8) than less frequent caregivers (mean 17.6) and non-caregivers (mean 17.7). No significant differences were found between less frequent caregivers and non-caregivers in LSIZ. One-fourth had support from others, the commonest type being able to converse with a next of kin, and help and advice from professionals. Lower life satisfaction was associated with not being employed, low social resources, not refreshed after a night's sleep, overall poor health and frequent caregiving in the entire sample. High caregiving extent was associated with lower life satisfaction. The most important factors explaining lower life satisfaction among frequent caregivers were having low social resources and having poor health. Economic compensation or payment was the support most desired.     

Concepts in Caregiver Research

Purpose: To clarify and delineate conceptualizations of the effects of caregiving for nursing research and practice with family caregivers.
Organizing Construct: The biopsychosocial (psychosocial and physiological) sequelae, both negative and positive, associated with providing care for a relative or friend with a chronic illness.
Methods: Literature reviewed was obtained via searches of CINAHL, MEDLINE, and PsycInfo computerized databases through mid-2002. Key words for the searches were caregiver, caregiving, family caregiving, caregiver burden, and caregiver appraisal. Reports of both earlier reviews of literature and original research were included.
Findings: Negative concepts included caregiver burden, hassles, strain, and stress. Positive concepts included caregiver esteem, uplifts of caregiving, caregiver satisfaction, finding or making meaning through caregiving, and gain in the caregiving experience. A neutral concept for describing the caregiving process is caregiver appraisal. Although earlier studies were focused on negative aspects of caregiving, more recent research has also included positive aspects.
Conclusions: More attention should be given to (a) gender and cultural differences in caregiving, (b) development of flexible interventions, and (c) the biophysical sequelae of caregiving.     

Family caregivers need support with heart failure patients

Millions of family members are serving as caregivers for patients with heart failure and the numbers will continue to rise. It appears that caregivers desire to be involved in the patient's care even when the caregiving tasks average 8 hours per day. Burden, stress, and depression have been found to be significantly associated with the caregiving role in this population. Decreasing any negative aspects of caregiving should be a priority. Alarmingly, caregivers have reported being ignored or made to feel like an outsider by health care providers. Nurses are in a pivotal position to improve patient and caregiver outcomes by including the family caregivers of heart failure patients in all aspects of care and in promoting the well being of the caregiver. This article will highlight the importance of social support on patient and caregiver outcomes, and second, review studies on family caregiving among heart failure patients. Recommendations for nursing practice and further research will be discussed.     

Predictors of postbereavement depressive symptomatology among family caregivers of cancer patients

The present study investigated two aspects of the sequelae of recent bereavement among family caregivers following the death of their cancer patient: (1) the extent to which depressive symptomatology among family caregivers measured following the death of their patient could be predicted by their levels of depressive symptomatology in the months prior to death, their physical health, the setting in which the patient's death occurred, patient age, gender of the caregiver, consanguinity, financial stress, social support from family and friends during the terminal stage, impact of caregiving activities on caregiver's daily schedule, caregiver optimism, perceived esteem attributed to caregiving, the time between the prebereavement assessment and death, and the time between death and the postbereavement assessment; and (2) whether these same explanatory variables could successfully differentiate those bereaved caregivers whose psychological health improved during the first 3 months following bereavement from those who did not improve. A sample of 114 family caregivers of cancer patients were surveyed for approximately 3 months before and 3 months after the death of their patient. A multivariate analysis of variance using the regression approach was undertaken to determine the primary predictors of postbereavement depressive symptomatology. In addition, a logistic regression analysis was used to attempt to predict those caregivers whose depressive symptomatology would improve during the postbereavement period. Critical factors in determining levels of postbereavement depressive symptomatology were caregiver optimism, prebereavement depressive symptomatology, and levels of social support from friends. Caregiver optimism and prebereavement depressive symptomatology were important in predicting whether caregivers' depressive symptomatology would improve or not. Physicians must be aware that if the social history of a patient reveals that he/she is anticipating or has recently experienced the loss of a family member for whom they were the primary caregiver, this information may be critical in determining whether the illness behavior exhibited by the patient has medical or psychosocial origins.     

Determinants of well-being in primary caregivers of spinal cord injured persons

A study of well-being in middle-aged and elderly spinal cord injured persons (Decker & Schulz, 1985) found that long-term coping was facilitated by the presence of a primary support person or caregiver. The purpose of this study was to identify the determinants of life satisfaction and depression in 67 primary caregivers of middle-aged and elderly spinal cord injured persons. The study revealed that the availability of social support and feelings of control over one's life were important determinants of caregivers' well-being. In addition, those caregivers spending more time each day assisting the disabled person and feeling burdened by these responsibilities experienced more depression and less life satisfaction. In working with spinal cord injured persons, rehabilitation nurses must consider the well-being of the spinal cord injured person/primary caregiver dyad as an important focus of nursing assessment and intervention.     

The relationship among background characteristics, purpose in life, and caregiving demands on perceived health of spouse caregivers

Little is known about the impact on the family at home of managing the final course of cancer. Research to date has focused on the negative impact of physical caregiving on the caregiver's physical and emotional well-being. Limited information exists about other dimensions of the experience which may serve to buffer or prevent negative health outcomes. The purposes of this study were to examine the effect of personal meaning and the experience of caregiving on spouse caregiver health. Cross-sectional data were obtained from interviews with 65 spouse caregivers of persons with advanced cancer. Findings from the multiple regression analysis revealed that sense of purpose in life (Beta = .32, p less than or equal to .05) and the caregiver's level of uncertainty (Beta = -.46, p less than or equal to .01) were statistically significant predictors of health. The results of this study suggest that a stronger sense of purpose in life is positively associated with perceived health. Further, the finding that a higher level of caregiver uncertainty is negatively associated with health suggests the need for nursing interventions to assist caregivers to cope with their role.     

Effects of the situational context and interactional process on the quality of family caregiving

A staged theoretical model designed to explain the quality of elder caring by family members was tested. The model posits how the situational context, interactional process, and caregiving burden perceived by the caregiver affect the quality of elder caring. The purpose was to determine the amount of variance explained by the interactional process beyond that explained by the situational context and caregiving burden. Data were collected from 209 elder-caregiver dyads using interviews, observations, and caregiver self-reports. The strongest predictors of caregiving burden were the caregiver's stressful negative life events (situational context) and discrepancy between past and present image of elder (interactional process). The strongest predictors of quality of elder caring were the caregiver's perception of subjective burden and a monitoring role definition on the part of the caregiver (interactional process). ©1995 John Wiley & Sons, Inc.     

Meaning in stroke family caregiving: A literature review

Meaning plays an important role in stroke family caregiving. Understanding meaning facilitates the development of effective interventions that support stroke family caregivers. However, knowledge about this subject is fragmented and sparse. This review fills this knowledge gap by examining existing findings regarding meanings in stroke family caregiving. Specifically, a search of seven databases and a manual search produced a total of five articles for review. Embedded in the lived experience of caregivers, meanings in stroke family caregiving were interpreted as a physical, psychological, and social suffering; an obligation resulting from moral ethics, religion doctrines, others' expectations, and social norms; and a subjective choice based on love, hope, and a sense of reciprocity. However, the detailed process of how and when caregivers identify meaning in caregiving needs further exploration. To gain a full picture of meaning in caregiving, more studies should be conducted among stroke family caregivers from different cultural, economic, and social backgrounds.     

Relationship of empathy to appraisal, depression, life satisfaction, and physical health in informal caregivers of older adults

The relationship between empathy and caregiving appraisal and outcomes was examined among 140 informal caregivers of older adults. Caregivers with high cognitive empathy appraised the caregiving situation as less stressful and less threatening, were less depressed, and reported higher life satisfaction than did caregivers with low cognitive empathy. The caregivers' appraisal, along with educational levels and total household income, significantly predicted individual differences in caregiver depression, life satisfaction, and perceived physical health. Emotional empathy was negatively related to life satisfaction. There appeared to be distinct roles for emotional and cognitive empathy in informal caregiving outcomes. The study supported the important role of caregiving appraisal and resources in caregiving outcomes.     

The meaning of daily activity in family caregiving for the elderly

Sixty ethnographic interviews with 15 family caregivers for frail older people living in the community were analyzed to understand the meaning of activity in caregiving. Sch?n's (1983) reflection-in-action framework was used to organize the data. Three goals of caregiving activity were derived: (a) getting things done, (b) achieving a sense of health and well-being for the care receiver, and (c) achieving a sense of health and well-being for the caregiver. The family caregiver was conceptualized as a lay practitioner involved in the clinical reasoning and ethical dilemmas integral to the provision of health care for the care receiver. The caregivers' judgments regarding the prioritization and attainment of goals determined the forms of caregiving activities. Implications for occupational therapy practice and the relationship between the caregiver and the professional are discussed.     

Predictors of burden for caregivers of patients with Parkinson's disease.

Parkinson's disease (PD) is a chronic, progressive neurological disease that affects an estimated 1 million Americans each year. Its progressive nature leads to increased burden for the caregiver. This study explored factors that contribute to the perception of burden in caregivers of individuals with PD using a cross-sectional design. The sample consisted of 41 caregivers who were married to or cohabitating with individuals with PD. Questionnaires were mailed to spousal caregivers and returned via mail. Burden was determined by utilizing the Zarit Burden Inventory. The independent variables that were measured were activities of daily living (ADLs), perceived social support, psychological well-being, and marital satisfaction. All four factors were found to significantly predict perceived burden. Multiple regression analysis showed that ADLs and perceived social support were significant predictors of caregiver burden, accounting for 44.3% of the variance. The implication for healthcare professionals is that they should provide information on PD symptom management, thus promoting independence in performing ADLs, identifying appropriate resources to reduce caregiver burden, and using support groups.     

A practical guide to caring for caregivers

Patients who provide care to family members or friends with dementia are likely to be in a family physician's practice. The caregiver role can be stressful, and identifying these patients can give the family physician opportunities to help patients cope with the challenges of the caregiver role. Family physicians have a systematic approach for assessing the degree of caregiver burden in these patients. Because caregivers are at increased risk for depression and anxiety, screening should be done to exclude the presence of either disorder. The caregiver's skill in managing behavioral problems in the family member with dementia should be assessed. If there are problems, family physicians should provide practical counseling about common caregiving stresses and about resources that benefit caregivers. Helping the caregiver learn strategies for coping with difficulties may help reduce some of the stress the caregiver is experiencing.     

Toward a measure of caregiver satisfaction with hospice social services

An evaluation of caregiver satisfaction with social services in a large hospice in a major southeastern city was conducted utilizing an instrument developed for this study. The usual processes for developing an instrument were followed, resulting in a survey questionnaire which was useful in testing the degree of satisfaction of caregivers with the hospice's social services. Results indicated that most caregivers were very satisfied with hospice social services. The development of such an instrument could aid others in the field in evaluating caregiver satisfaction with hospice services.