Healthcare system navigation difficulties among informal caregivers of older adults: a logistic regression analysis of social capital, caregiving support and utilization factors.

BACKGROUND: Informal caregivers of older adults play a vital role in improving the degree to which older adults access community and healthcare services in a seamless and timely manner. They are fulfilling important navigation and support roles for their older care recipients. However, there is still little knowledge of the most significant facilitators and barriers to effective and efficient system navigation among caregivers. This paper aims to fill these knowledge gaps through investigation of the key factors (i.e., social capital/cohesion, caregiving supports, and utilization factors) affecting navigation difficulties faced by informal caregivers of older adults. METHODS: The Behavioural-Ecological Framework of Healthcare Access and Navigation (BEAN) model is used to frame the study. Using the General Social Survey on Caregiving and Care Receiving 2018, we analyzed 2,733 informal caregivers whose primary care recipients were aged 65 or older. Hierarchical logistic regression was conducted to identify the relationship between system navigation difficulties among informal caregivers and four sequentially ordered blocks of predictors: (1) sociodemographic (2), social capital/cohesion (3), caregiving supports, and (4) healthcare demand. RESULTS: The fully adjusted model showed that the probability of reporting navigation difficulties was lower for caregivers with social capital/cohesion compared to those without social capital/cohesion. In comparison, the probability of reporting navigation difficulties was higher among caregivers with caregiving support and among caregivers whose care receivers use a higher amount of health service use. Several sociodemographic covariates were also identified. CONCLUSION: Our findings support certain aspects of the BEAN model. This study extends our understanding of potential facilitators and barriers that informal caregivers of older adults face while navigating complex community and health systems. There is a need to implement coordinated schemes and health policies especially for older adults with mental/neurological issues to address the challenges of their caregivers given the specific vulnerability identified in this study. The need for further research using different approaches to examine the disproportionate impact of COVID-19 on caregivers' system navigation experience is crucial.

Understanding non-pharmacological palliative care for people with serious COPD: the individual and organizational perspective.

TOPIC IMPORTANCE: This narrative review emphasizes the growing interest in palliative care for people with serious lung diseases, such as COPD. It reflects upon recent publications from the American Thoracic Society (ATS), the World Health Organization (WHO) and European Respiratory Society (ERS) with a focus on non-pharmacological palliative care for people with COPD, from both the healthcare professional and the organizational perspective. REVIEW FINDINGS: The concept of palliative care has changed over time and is now seen as applicable throughout the whole disease trajectory according to need, in conjunction with any disease-modifying therapies. Palliative care should pay attention to the needs of the person with COPD as well as the informal caregiver. Timely integration of palliative care with disease-modifying treatment requires assessment of needs at the individual level as well as organizational changes. High-quality communication, including advance care planning is a cornerstone of palliative care. SUMMARY: Therefore, services should be based on the understanding that palliative care is not just specific standardized actions and treatments, but a holistic approach that includes compassionate communication and treatment and care addressing the patient, informal and formal caregivers. Living with and dying from COPD is much more than objective measurements. It is the sum of relationships with others and the experience of living in the best possible harmony with one's own values and hopes despite having a serious illness.

Medication management during risk of dehydration: A qualitative study among elderly patients with impaired renal function and informal caregivers.

BACKGROUND: Patients with impaired renal function are at an increased risk of dehydration due to vomiting, diarrhoea or fever (so-called sick days). Temporary medication adjustment during sick days is necessary and current initiatives and information materials for patients are available. However, the knowledge, experiences and information needs of patients and informal caregivers about sick day guidance are unknown. AIM: To gain insight into the understanding of safe medication use during periods of dehydration risk in elderly patients with impaired renal function and their informal caregivers. DESIGN AND SETTING: Qualitative interview study with patients with impaired renal function and unrelated informal caregivers from three community pharmacies in the Netherlands. METHOD: The interviews were conducted by telephone or live by two researchers in November 2020-September 2021 and audiotaped and transcribed verbatim. The coding of transcripts was performed deductively and inductively in Nvivo 12, a thematic analysis was applied. RESULTS: In total 12 patients and 11 unrelated informal caregivers were included. Three main themes were derived from the interview guide and subthemes emerged from the transcripts. The included patients and informal caregivers had limited knowledge about medication management during sick days. In contrast to patients, informal caregivers seemed interested in a medication management protocol for sick days. CONCLUSION: Patients with impaired renal function and informal caregivers have little knowledge about and experience with dehydration and safe use of medication during sick days. General practitioners and pharmacists should involve the care network, including informal caregivers, when implementing sick day guidance.

Elderly patients and informal caregivers seem to have little knowledge about medication adjustments during sick days or heatwavesInformal caregivers appear to be more interested than patients in information about medication management on sick daysGPs should involve informal caregivers in providing information on medication management during risk of dehydration.

Effects of home disease management strategies based on the dyadic illness management theory on elderly patients with chronic heart failure and informal caregivers' physical and psychological outcomes: protocol of a randomized controlled trial.

BACKGROUND: Currently, most elderly chronic heart failure (CHF) patients go home for rehabilitation after certain treatment in hospitals. However, the results of their rehabilitation at home are not satisfactory. According to studies, dyadic treatments can increase the efficiency of home rehabilitation, enhance both partners' quality of life, lessen the caregiver's load of care, and alleviate the strain of medical resources. Thus, the aim of our research is to design a study protocol that included elderly CHF patients and their informal caregivers as an intervention unit and to explore the impact of the protocol on their health and physical outcomes. METHODS: This is a prospective randomized controlled trial conducted in a triple-A hospital. In total, 80 elderly CHF patients and informal caregivers (80 dyads) will be recruited with informed consent. Based on the randomized numbers, they are divided into a control group (40 dyads) and an intervention group (40 dyads), subjects in the control group will receive usual care, and subjects in the intervention group will receive a home-based disease management program based on the Theory of Dyadic Illness Management on the basis of the control group. The duration of the intervention is 3 months, and the follow-up is 6 months. Data is collected at enrolment, 3 months after the intervention, and 3 months after the end of the intervention. The primary outcome is patients' quality of life and readmission. Secondary outcomes include patients' self-management behaviors, anxiety, and depression and caregivers' quality of life and care burden. DISCUSSION: This study focuses on whether this home-based disease management program can improve the quality of life of elderly patients with CHF, reduce the readmission rate, enhance their self-management capacity, reduce negative emotions, and reduce the burden of informal caregivers. It can provide a new perspective on home management and cardiac rehabilitation of heart failure disease in the elderly, as well as alleviate problems such as the burden of healthcare resources. TRIAL REGISTRATION: Chinese Clinical Trials Registry ChiCRT2300068026. Registered on 3 February 2023, manuscript Version: 1.0,  https://www.chictr.org.cn/ .

Needs of Patients With Gynecologic Cancer and Their Caregivers for Obtaining mHealth-Supported Self-Management: Focus Group Study.

BACKGROUND: Family caregivers of individuals with gynecologic cancer experience high levels of distress. Web-based caregiver support interventions have demonstrated efficacy in improving caregiver outcomes. However, the lack of portability could be a limitation. Mobile health (mHealth) apps could fill this gap and facilitate communication between patient-caregiver dyads. OBJECTIVE: We sought to obtain information on desired usage and features to be used to design an mHealth self-management support app targeting both patients with gynecologic cancer and their caregivers. METHODS: We conducted Zoom focus groups with women who had been treated for gynecologic cancers (ovarian, fallopian, primary peritoneal, uterine, endometrial, cervical, and vulvar); patients were also asked to invite a self-identified "closest support person" (caregiver). A semistructured focus group guide was used to elicit information on patients' and caregivers' perceived gaps in information and support, desired features of an mHealth app, and interest in and preferences for app usage. After transcription, rapid qualitative analysis using a thematic matrix was used to identify common themes across groups. RESULTS: A total of 8 groups were held. The final sample included 41 individuals with gynecologic cancer and 22 support persons or caregivers (total n=63). Patients were aged between 32 and 84 years, and most (38/41, 93%) were White and married. For caregivers (n=22), 15 (68%) identified as male and 7 (32%) as female, with ages ranging between 19 and 81 years. Overall, 59% (n=13) of caregivers were spouses. Questions geared at eliciting 3 a priori topics yielded the following themes: topic 1-gaps in information and support: finding relevant information is time-consuming; patients and caregivers lack confidence in deciding the urgency of problems that arise and from whom to seek information and guidance; topic 2-desired features of the mHealth app: patients and caregivers desire centralized, curated, trustworthy information; they desire timely recommendations tailored to specific personal and cancer-related needs; they desire opportunities to interact with clinical and peer experts through the app; and topic 3-interest and preferences for app usage: need for private space in the app for patients and caregivers to get information and support without the others' knowledge; patients and caregivers desire having control over sharing of information with other family members. CONCLUSIONS: Designing a single mHealth app to be used by patients and caregivers presents unique challenges for intervention designers and app developers. Implications of the study suggest that app developers need to prioritize flexibility in app functionality and provide individuals the ability to control information sharing between patients and caregivers.

Ethical implications in using robots among older adults living with dementia.

The aging of the world's population due to accelerating demographic shift on all continents is causing increasing pressure worldwide, giving rise to a "crisis of care" or "care wave." The increase in longevity is resulting in an increase in chronic diseases (such as dementia), an increase in care needs to perform the activities of daily living, and situations of isolation and profound loneliness among older adults. These circumstances are opening the debate on the need to use technology, such as robots, to improve the wellbeing of older adults and their caregivers. The aim of this paper is to address the ethical questions in using social and companion robots for people with dementia, such as concerning consent, the replacement of human care, the potential for increased dependency, and the burden on caregivers. Involving older adults and other stakeholders offers the potential to pursue robotics to support older people while also ensuring a strong ethical commitment. The study is a review of high-impact articles on the topic of the use of social and companion robots with older people with dementia.

Family burden and psychological distress among Chinese caregivers of elderly people with dementia: a moderated mediation model.

BACKGROUND: Although the Stress-Coping Model (SCM) has been widely used to explain the coping process of individuals facing stressful situations, its applicability to caregivers of elderly people with dementia (PwD) in China needs to be further investigated. Furthermore, the role of external resources in caregivers stress coping is not yet clear. Therefore, our study aimed to investigated the mediating and moderating mechanisms between family burden and psychological distress in PwD caregivers based on the SCM. METHODS: A cross-sectional study, with 193 pairs of PwD and caregivers completed the self-designed questionnaire, Family Burden Scale of Disease, Kessler Psychological Distress Scale, General Self-Efficacy Scale, Simplified Coping Style Question, The Family Adaptation and Cohesion Evaluation Scales II-CV and Social Support Rating Scale. Partial least squares-structural equation modeling (PLS-SEM) analyzed the mediating and moderating effects. RESULTS: Family burden positively correlated with psychological distress; the chain mediation effects of self-efficacy and positive coping between family burden and psychological distress was significant; the interaction term (family function_positive coping) did not but (social support_positive coping) had a significant positive impact on psychological distress. CONCLUSIONS: The findings provides a practical basis for the use of SCM in informal caregivers of elderly PwD, assists understanding the mechanism of the relationship between family burden and psychological distress. And it supplies new perspectives for reducing the negative psychological health status and a theoretical basis for designing interventions for caregivers.

Comprehensive needs assessment tool for informal cancer caregivers (CNAT-ICs): Instrument development and cross-sectional validation study.

Background: Growing cancer incidence and its subsequent burden is a worldwide concern. Needs assessment for caregivers has recently received growing attention, as it identifies specific unmet needs. The remaining tools have been established within the healthcare context of Western countries and have been studied only in some Asian populations; it seems appropriate to develop needs assessment tools that apply to a wider ethnic and socio-cultural context. Objective: This study planned to adapt and examine the psychometric properties of the CNAT-C for the Sri Lankan informal caregivers for wider applicability. Design: An instrument development and cross-sectional validation study was conducted. Setting: Apeksha Hospital Maharagama, Sri Lanka (National Cancer Institute). Participants: A sample of 226 informal caregivers (ICs) providing palliative care for patients with advanced cancer was selected. Methods: A CNAT-C (41 items; seven factors) was incorporated and used after a cross-cultural adaptation following WHO guidelines after the permission and pilot test. ICs completed the socio-demographic and clinical details along with the validated Centre for Epidemiological Studies-Depression (CES-D), and the World Health Organization-Quality of Life-Brief (WHOQOL-BREF). Internal consistency and test-retest were used to check the reliability. Convergent and divergent validity of the Sinhala version of CNAT (S-CNAT) was confirmed using the CES-D scale and WHOQOL-BREF. Construct validity was evaluated using the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Results: Most of the participants were female (60 %) and married (72 %), and the mean age was 41.78 (SD+14.54). Face and content validity were established during the cross-cultural adaptation. Cronbach's alpha was 0.903 for the overall S-CNAT and the test-retest reliability was 0.965. The S-CNAT was associated positively with the CES-D while negatively with the WHOQOL-BREF. Both EFA and CFA discovered a structure contained seven factors (35 items); domain named as healthcare staff/nurses' support and information, physical/practical needs, medical officers' support, psychological needs, social/family support, spiritual/religious support, and hospital facilities/service. Conclusions: The Sinhala version of CNAT is shown to have adequate validity and reliability in assessing the comprehensive and multidimensional/unmet needs of informal caregivers of patients with advanced cancer (S-CNAT-ICs). It would be a helpful tool to determine the unmet needs of ICs and guide future interventions to meet those needs and enhance or maintain the quality of life for patients and their informal caregivers.

A Feasibility Study of Qualitative Methods Using the Zarit Burden Interview in Heart Failure Caregivers.

OBJECTIVES: The primary goal of this study was to identify and understand the burden experienced by informal caregivers of patients with HF at the time of hospital discharge. The researchers aimed to guide future education interventions and promote informal caregiver burden screening. DESIGN: The researchers administered the Zarit Burden Interview (ZBI) as a quantitative tool to assess informal caregiver burden. The ZBI is a standardized questionnaire used to measure the extent of burden experienced by informal caregivers. After administering the ZBI, the researchers conducted semi-structured interviews with five informal caregivers of patients with HF. These interviews were guided by probing questions related to ZBI items that were rated with high levels of burden (3 "quite frequently" or 4 "nearly always"). RESULTS: The quantitative data showed that the informal caregivers' burden scores on the ZBI ranged from 4 to 41. Male informal caregivers tended to report lower burden scores. The non-spouse informal caregiver had the highest burden score at 41. The qualitative analysis of the interviews revealed several themes related to informal caregiver burden, including fear, patient expectations, patient dependence on caregivers, social isolation, and stressors associated with medication changes after discharge. Despite the qualitative insights into specific burden-related issues, the quantitative analysis of the ZBI scores showed that, on average, informal caregivers reported little to no burden at the time of acute exacerbation of HF in the patient. CONCLUSION: The study's findings suggest that while informal caregivers may not report prominent levels of overall burden, they do face specific challenges and stressors, such as social isolation and managing medication changes post-discharge. These findings can inform the development of targeted support and interventions for informal caregivers of patients with HF.

Experiences and Needs of Carers of Patients With Head and Neck Cancer: A Systematic Review.

PURPOSE: The needs of head and neck cancer (HNC) carers tends to be poorly addressed as most support systems are directed towards patients. This systematic review synthesises the existing qualitative evidence from carers for adult HNC patients to explore their experiences and needs as a basis to inform the initial development of an item prompt list for HNC carers for use in routine clinical practice. METHODS: Seven electronic databases were searched from their inception until November 2022, supplemented by citation chaining and snowballing. Primary qualitative or mixed-methods studies reporting the experiences of carers for HNC patients, elicited using interviews, were included. Screening and selection, data extraction and quality assessment (Critical Appraisal Skills Programme Checklist) were independently conducted by two researchers. Data were analysed using inductive thematic synthesis and confidence evaluated using GRADE CERQual. RESULTS: Thirty studies met the inclusion criteria. Two overarching themes and nine subthemes emerged: (i) the experiences of loss associated with being a carer (loss of: role and everyday routine, certainty leading to emotional distress, security as fear of recurrence prevailed, finances, intimacy and togetherness, enjoyment from social activities); and (ii) factors promoting coping and adjustment to role of carer (information, supportive mechanisms, personal attributes). CONCLUSION: New insight into the experiences of HNC carers provides the basis for item generation of a HNC carer prompt tool. IMPLICATIONS FOR CANCER SURVIVORS: With such a range of potential unmet concerns, the development of a prompt list should help to elicit these and provide additional means to targeted support.

Development and psychometric evaluation of the self-care of informal caregivers inventory.

Background: In recent years, a growing body of literature on informal caregivers' health and well-being has emerged, highlighting the need for a tool to measure their self-care practices. Objective: The aim of the study was to develop a theory-based instrument measuring the self-care behaviors of informal caregivers and test its psychometric properties. Design: The initial phase of instrument development entailed a detailed, six-step process (conceptualization, theoretical adaptation, back-translation and cultural adaptation, cognitive interviewing, item enhancement, and content validity), followed by formal psychometric testing (participant engagement, validity, internal consistency reliability, test-retest reliability). Setting: Study conducted at a hospital located in Tehran, Iran. Participants: A sample of 234 informal caregivers of cancer outpatients receiving treatment in oncology wards was enrolled. Caregivers had to be 18 years or older, recognized as the primary caregiver by the patient, and willing to provide informed consent. Methods: The Self-Care of Informal Caregivers Inventory items comprise three dimensions: self-care maintenance (11 items), self-care monitoring (7 items), and self-care management (9 items), which achieved a content validity index rating of 100 % in a panel of experts. Data were collected from caregivers during routine clinic visits. Construct validity was verified through exploratory structural equation modelling and reliability was verified using Cronbach's α and multidimensional model-based reliability. Test-retest reliability was evaluated using the Intraclass Correlation Coefficient. Results: All three dimensions showed good model fit indices (self-care maintenance: Comparative Fit Index = 1.00, Tucker-Lewis Index = 0.99, Root Mean Square Error of Approximation = 0.044; self-care monitoring: Comparative Fit Index = 1.00, Tucker-Lewis Index = 1.00, Root Mean Square Error of Approximation = 0.027; self-care management: Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99, Root Mean Square Error of Approximation = 0.048) and Cronbach's α of 0.88, 0.88, and 0.91, respectively. The overall multidimensional model-based reliability was 0.93. The Intraclass Correlation Coefficient values for the three dimensions were 0.94, 0.60, and 0.51, respectively. Conclusion: Preliminary testing provides support for use of the Self-Care of Informal Caregivers Inventory in research. Using this theory-based instrument to assess the self-care practices of informal caregivers can assist in identifying topics to discuss and opportunities for guidance. Tweetable Abstract: The Self-Care of Informal Caregivers Inventory: A validated tool for informal caregivers is useful for research. #Informalcaregivers #SelfCare.

Feasibility and acceptability of virtual programs for people with dementia and their caregivers.

OBJECTIVE: To assess the feasibility and acceptability of the Oshawa Senior Community Centres (OSCC55 +) virtual programs (VP) in addressing the needs for social connection and interaction for people with dementia (PWD) and their informal caregivers (ICG). BACKGROUND: During the pandemic, PWD faced increased loneliness and reduced social interaction due to a loss of community programs. The OSCC55 + developed VPs to combat social isolation and provide respite for ICG. These efforts highlight the importance of accessible, and technology-based VPs for maintaining social connectedness for PWD. METHODS: A qualitative interpretive research design with PWD (n = 14) interviews and ICG focus group and one-on-one interviews (n = 11). This research explored the lived experiences of PWD and their ICG, examining the feasibility and acceptability of the VPs. RESULTS: The PWD and ICG interviews provided insight into the positive impacts of VP, challenges of VP, program barriers, program facilitating factors, and suggestions for future improvement for the OSCC55 + VPs. Participants highlighted that the VP created an option for them to remain socially connected to their community; while also outlining the positive impact on reducing loneliness, challenges with technology use, the importance of involving younger generations and volunteers, and the need for more culturally inclusive programs. CONCLUSIONS: The VP developed by OSCC55 + were perceived as effective and useful for PWD and their ICG, helping to reduce feelings of loneliness and relieving caregiving tasks. These findings suggest that VP can complement in-person programs in the future, offering a hybrid model that leverages the strengths of both approaches to better meet the needs of PWD and ICG.

"They forget that I'm a human being"-ward round communication with older patients living with frailty and informal caregivers: a qualitative study.

PURPOSE: Skilful communication prompts quality patient care. Informal caregivers occupy a crucial role when caring for hospitalised older patients living with frailty. However, skilful communication with both patients and informal caregivers during ward rounds has not been studied. Thus, we aimed to explore communication preferences of patients and informal caregivers during ward rounds. METHODS: We conducted semi-structured interviews with hospitalized patients and informal caregivers until information redundancy occurred. We used inductive coding of the transcribed interviews followed by a reflexive thematic analysis. RESULTS: The study included 15 patients and 15 informal caregivers. Patients had a median age of 85 years (range 75-100 years) and seven patients were females. Informal caregivers' median age were 45 years (range 38-80 years) and 13 were females. Three themes were generated: (1) building relationships and conveying information, (2) alleviating informal caregiver strain and (3) sharing the decision-making process. Themes highlighted the importance of collaborative and empathetic approaches in healthcare interactions, emphasizing interpersonal communication skills, such as fostering professional relationships. The interviews unveiled informal caregiver burden stemming from disempowerment during hospital discharge process and managing mistrust within the healthcare system. The shared decision-making process should address patients' and informal caregivers' needs and circumstances. CONCLUSIONS: Communication preferences of a population of older patients living with frailty and informal caregivers during ward rounds encompass interpersonal communication, demonstrating ample time, and being seen as a human being. Informal caregivers value being included in the decision-making process. Skilful communication includes for doctors to recognize informal caregivers' narratives and burdens.

Dual Caregiving and Mental Health Among Long-Term Care Nursing Assistants: The Moderating Role of Social Support.

AIM: To investigate the association of long-term care nursing assistants' dual caregiving roles with mental health and to determine whether social support moderates this relationship. DESIGN: A cross-sectional survey. METHODS: We surveyed 962 certified long-term care nursing assistants working in long-term care and medical facilities across Taiwan from October 2022 to July 2023. 'Dual caregiving roles' denote the fulfilment of caregiving duties both at work and within families. Mental health was evaluated using the 5-item Brief Symptom Rating Scale. Logistic regression analysis was utilized to investigate the association of dual caregiving roles and psychological job demands with poor mental health. Moreover, we explored whether family, colleague, and supervisor support moderated the association between dual caregiving roles and poor mental health. RESULTS: Among long-term care nursing assistants, 15% had dual caregiving responsibilities. Individuals with both dual caregiving roles and high psychological job demands faced the highest risk of poor mental health compared to those without dual caregiving roles and low psychological job demands. Having dual caregiving roles was associated with poor mental health compared to workers without such roles. Additionally, support from family, colleagues, and supervisors mitigates the association between caregivers' dual caregiving roles and poor mental health. CONCLUSION: A substantial proportion of long-term care nursing assistants had dual caregiving roles, leading to an additional mental health burden when combined with high psychological job demands. High social support attenuated this association. IMPLICATIONS FOR THE PROFESSION: Long-term care nursing assistants with dual caregiving roles had poorer mental health outcomes. Yet, support from family, colleagues, and supervisors mitigated these effects. These results emphasize the importance of enhancing social support to protect the mental well-being of long-term care nursing assistants managing both formal and informal caregiving duties. REPORTING METHOD: This study adheres to the STROBE guideline of reporting. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Preparedness for caregiving among informal caregivers of people with dementia: A scoping review.

INTRODUCTION: Dementia is a global health concern, and informal caregivers often provide care for those affected. Caregiver preparedness is crucial for optimizing quality of life. However, knowledge about the determinants of caregiver preparedness is limited. PURPOSE: The aim of this scoping review was to identify the factors associated with preparedness for caregiving among informal caregivers of people with dementia. METHODOLOGY: The review adhered to the methods from the Joanna Briggs Institute. Studies exploring the preparedness of informal caregivers of people with dementia were included in this review. Data were extracted from studies found in five major databases: PubMed, PsycINFO, Scopus, CINAHL, and Embase. RESULTS: The final review included twenty-three studies. Self-efficacy and confidence, resilience and self-conduct, knowledge, education and training, mutuality, mental health, less caregiving conflict, and mindfulness were associated with caregiver preparedness. CONCLUSION: This review identified a significant research gap in preparedness among caregivers of people with dementia. More research is essential to understand the factors associated with caregivers' preparedness. Recognizing these elements can inform tailored interventions, assisting informal caregivers in their caregiving transition and journey.

Effects of Songwriting Group Music Therapy Program among Informal Caregivers of Older Adults with Dependency.

Informal caregivers of older people face demanding responsibilities that can negatively affect their wellbeing, highlighting the relevance of interventions that address their specific needs. This study aimed to assess the effects of a group music therapy program based on different songwriting approaches applied to informal caregivers of older adults with dependency. A sample of 113 caregivers participated, being assigned either to the intervention (n = 60) or the control group (n = 53). The intervention group caregivers received 10 weekly sessions of the songwriting program, while the control group continued with their usual care service. Psychological symptoms and health-related quality of life (HRQoL) were assessed at baseline and follow-up using the State-Trait Anxiety Inventory, Beck Depression Inventory-II, Zarit Burden Interview, and SF-36. Group × Time interactions revealed significant improvements in the intervention group compared to the control one in trait anxiety (p = 0.022), social functioning (p = 0.013), role limitations due to physical problems (p = 0.020), and physical component summary (p = 0.022). These findings provided valuable evidence on this novel intervention, showing positive effects for caregivers' wellbeing. The current research emphasizes the importance of considering music therapy as a potential intervention among caregiver support programs.

The impact of family burden on the psychological distress of informal caregivers for older adults living with dementia: The role of internal and external coping resources.

OBJECTIVES: Numerous studies have demonstrated that informal caregivers of people living with dementia (PLWD) have serious adverse psychological problems, but little research has been done on the role of integrating caregivers' various coping resources in reducing psychological effects. Therefore, the current study aimed to investigate the impact of caregivers' internal (self-efficacy and positive coping) and external coping resources (family function and social support) on the family burden and psychological distress. METHODS: A cross-sectional study, and a self-designed questionnaire, Family Burden Scale of Disease, Kessler Psychological Distress Scale, General Self-Efficacy Scale, Simplified Coping Style Question, The Family Adaptation, Partnership, Growth, Affection, Resolve Scale and Social Support Rating Scale were completed by 193 pairs of PLWD and caregivers. Partial least squares-structural equation modeling (PLS-SEM) was used to analyze the mediating effects of coping resources. RESULTS: Self-efficacy, positive coping, family function, and social support respectively mediated the relationship between family burden and psychological distress (ß = 0.402, ß = 0.059, ß = -0.111, ß = 0.053; P < 0.05). Besides, the serial mediation effects of self-efficacy and positive coping, family function and social support were also significant (ß = 0.104, ß = 0.045; P < 0.05). CONCLUSIONS: This study confirmed the mediating role of internal and external coping resources between family burden and psychological distress in caregivers of older PLWD, providing a theoretical basis for promoting the,mental health of caregivers.

Sociodemographic Determinants of Psychological Distress Among Adult Informal Caregivers.

Background and objective Providing care for a loved one with a chronic illness or disability can be mentally and emotionally challenging. Determining the factors that contribute to psychological distress among informal caregivers can be important in developing effective interventions to support this vulnerable population. This study aimed to examine the sociodemographic determinants of psychological distress among adult informal caregivers in the United States. Research design and method Secondary data analysis using the 2022 Health Information National Trends Survey was conducted. A total of 807 informal caregivers were included in the study. Sociodemographic characteristics, caregiving conditions, and caregivers' relationship to care recipients were assessed. Psychological distress was measured using Patient Health Questionnaire 4. Weighted multivariate logistic regression analysis was conducted to determine the associations between sociodemographic factors and psychological distress. Results The prevalence of psychological distress was 40%. The average age of the sample was 56 years with most caregivers being female and non-Hispanic White. Older age was associated with lower odds of distress (OR=0.974, 95% CI: 0.949-0.999). Female caregivers had higher odds of distress compared to males (OR=1.922, 95% CI: 1.023-3.612), and caregivers with household incomes of $75,000 or more had significantly lower odds of distress compared to those with incomes below $35,000 (OR=0.266, 95% CI: 0.119-0.595). Race/ethnicity and educational level did not show significant associations with caregiver distress. Conclusion Younger age, female birth gender, and lower household income were associated with higher odds of distress among informal caregivers. These findings can inform the development of targeted interventions to support caregivers' mental health.

Associations of mental health with vaccination readiness in informal caregivers and the vaccination status of their care recipients during the Covid-19 pandemic - A cross sectional analysis.

INTRODUCTION: Vaccinations are important for informal caregivers and their care recipients. Mental health problems are common among care givers. The aim of this study was to investigate vaccination readiness in informal caregivers and associations with mental health issues. Associations between vaccination readiness in informal caregivers and the vaccination status of their aged care recipients were examined. METHODS: Within the multicenter prospective registry study 'Bavarian ambulatory Covid-19 Monitor (BaCoM) ', informal caregivers were asked for symptoms of depression (PHQ-9), burden of caretaking (BSFC-s), psychological antecedents of vaccination readiness (5C model) and previous Covid-19 infections of their care recipients. The vaccination status against Covid-19, seasonal influenza and pneumococcal disease was determined via vaccination certificates. Data analysis was performed using ordinal regressions and Mann-Whitney-U tests. RESULTS: Data of n = 91 informal caregivers, associated with n = 84 care recipients were collected. Symptoms of depression were associated with reduced vaccination readiness (Calculation: p = 0.026, OR = 1.18), as well as the perceived burden of caretaking (Confidence: p = 0.006, OR = 0.88). A previous Covid-19 infection of the care recipients was associated with decreased vaccination readiness of informal caregivers (Median (Q1-Q3) Confidence: 5.0 (4.5-6.0) vs. 4.0 (3.0-5.0); Calculation: 5.0 (3.0-6.0) vs. 4.0 (1.0-5.0)). The vaccination status of the care recipients interrelated significantly with vaccination readiness of their informal caregivers (Confidence: p < 0.001; Complacency: p < 0.01; Constraints p < 0.05). No significant interrelations between vaccination readiness and the vaccination status against seasonal influenza or pneumococcal disease occurred. CONCLUSION: Mental health issues of informal caregivers seem to be associated with the actual vaccination status against Covid-19 in their care recipients. Target group specific counselling as well as an active involvement of informal caregivers in shared decision-making processes can be of relevance, but even more attention should be paid to the protection of mental health for informal caregivers. TRIAL REGISTRATION NUMBER: German Register of Clinical Studies DRKS 26039.

Systematic review following COSMIN guidelines: Short forms of Zarit Burden Interview.

This comprehensive review assessed the psychometric properties of abbreviated versions of the Caregiver Burden Instrument (ZBI-22). Initially, 40 articles that met the inclusion criteria were identified through a systematic search of four databases. Additionally, 26 articles were included through manual searches, totaling 66 articles in the analysis. Different versions of instruments measuring caregiver burden were examined, considering item variability and differences in factor structures. Although most measures exhibited satisfactory content validity, as well as construct validity supported by high internal consistencies, it is important to note that measurement invariance, criterion validity and test-retest reliability were not established for all measures analyzed. Furthermore, structural validity was not satisfactory for all versions. Research and clinical practice could benefit from a standardized approach that allows for a more accurate and consistent assessment of caregiver strain.