Longitudinal effects of ambivalent and guilt feelings on dementia family caregivers' depressive symptoms.

BACKGROUND: The world prevalence of people with dementia is increasing. Most of the care received by people with dementia is provided by family caregivers, and this prolonged activity has a significant impact on caregivers' levels of depression. Stressors and frequency of leisure are known predictors of caregivers' depressive levels. The longitudinal impact of caregivers' ambivalent and guilt feelings is unknown. METHODS: Participants were 177 family caregivers of relatives with dementia who were assessed three times during a 2-year period. In addition to demographic variables, psychological symptoms of the dementias, and frequency of leisure activities, caregivers' ambivalent feelings, guilt, and depressive symptoms were measured. The longitudinal association of changes in these variables with changes in caregivers' depressive symptoms over time was assessed using mixed linear models. RESULTS: Changes over time in the assessed variables predicted 48.05% of variance of changes over time in depressive symptoms. Even when variables strongly associated with increased depressive symptoms were controlled (lower caregivers' age and educational level, higher reaction to BPSD, and lower leisure activities), increases in ambivalence and guilt contributed to an increase of 9.22% of the variance of changes depressive symptoms over a 2-year period. The effects of ambivalent feelings on depression are indirect, mediated by guilt feelings. Cessation of caregiving do not seem to alter these findings. CONCLUSIONS: Caregivers' ambivalent and guilt feelings are significant predictors of caregivers' mental health. Caregivers may significantly benefit from early detection of ambivalent and guilt feelings and preventive strategies targeting triggers associated with ambivalent and guilt symptoms.

Longitudinal associations in dementia family caregivers of ambivalent feelings and disruptive behaviors with C-reactive protein, interleukin-6, and D-dimer.

OBJECTIVE: Caregivers' ambivalent feelings toward the care recipient have been found to be associated with depression and anxiety. There is no research linking caregivers' ambivalent feelings and cardiovascular risk. This study was aimed to analyze longitudinally the effect of ambivalence on caregivers' cardiovascular risk, defined by circulating levels of high-sensitivity C-reactive protein, interleukin-6 (IL-6), and D-dimer. METHOD: Participants were 121 dementia family caregivers who were assessed three times during a 2-year period. Sociodemographic and health variables, behavioral and psychological symptoms of dementia (BPSD), ambivalent feelings, and C-reactive protein (CRP), IL-6, and D-dimer values were assessed. Mixed linear models were used to analyze the association between variables, including testing whether ambivalent feelings moderated the links between BPSD and biomarkers. RESULTS: Increases over time in D-dimer were associated with increases in ambivalence, older age, female gender, and body mass index (BMI). Increases over time in CRP were associated with increases in BMI, older age, female gender, and the interaction of BPSD with caregivers' ambivalent feelings. The moderation analysis showed that increased BPSD was significantly associated with increased CRP when caregivers experienced high levels of ambivalence (p = .006). In contrast, BPSD were not significantly associated with CRP when caregivers experienced low levels of ambivalence (p = .73). Increases in IL-6 were associated with female gender and BMI. The tested model explained 42.85%, 33.15%, and 5.36% of longitudinal variance in CRP, D-dimer, and IL-6 levels, respectively. CONCLUSION: The findings suggest that high ambivalent feelings are relevant for understanding cardiovascular vulnerability in dementia caregivers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations of knowledge about Alzheimer's disease, dysfunctional cognition, and coping with caregiver's blood pressure / El conocimiento sobre la enfermedad de Alzheimer, la cognición disfuncional y el afrontamiento en la tensión arterial del cuidador

Dysfunctional ways of thinking and coping with caregiving have been associated with worse caregivers' cardiovascular health. The objective of this study is to analyze the associations between caregivers' knowledge about Alzheimer's disease, dysfunctional thoughts, experiential avoidance, and blood pressure. Participants were 123 family caregivers of a relative with dementia. Path analysis was used to analyze the association between the assessed variables. The obtained model shows that there is a significant and negative relationship between caregivers' knowledge about Alzheimer's disease and systolic blood pressure, potentially mediated by caregivers' dysfunctional thoughts and experiential avoidance. The findings of this study provide support to the idea that a lack of knowledge about Alzheimer's disease may contribute to maladaptive ways of thinking about caregiving, increasing caregivers' cardiovascular risk. (AU)

El pensamiento disfuncional acerca del cuidado o el inadecuado afrontamiento del mismo han sido asociados con una peor salud física de los cuidadores. El objetivo de este estudio es analizar las asociaciones entre el conocimiento de los cuidadores sobre la enfermedad de Alzheimer, los pensamientos disfuncionales, la evitación experiencial y la presión arterial. Los participantes de este estudio fueron 123 cuidadores de un familiar con demencia. Un modelo de senderos fue empleado para analizar la relación entre las variables. El modelo obtenido muestra que existe un relación negativa y significativa entre el conocimiento de los cuidadores acerca de la enfermedad d Alzheimer y la presión arterial sistólica, potencialmente medida por los pensamientos disfuncionales y la evitación experiencial de los cuidadores. Los resultados de este estudio apoyan la idea de que una falta de conocimiento acerca de la enfermedad de Alzheimer puede contribuir a cogniciones desadaptativas acerca del cuidado, incrementando el riesgo cardiovascular de los cuidadores. (AU)

Viabilidad de una intervención psicológica individualizada para personas mayores con demencia y discapacidad visual / Feasibility of an individualised psychological intervention for older adults with dementia and visual impairment

INTRODUCCIÓN: Ante el fenómeno del envejecimiento de la población, los problemas de salud relacionados con la edad tales como las demencias o la discapacidad visual asociada a enfermedades crónicas han ido aumentando progresivamente. El presente trabajo describe y analiza la eficacia y viabilidad de una intervención individualizada dirigida a dos varones usuarios de un centro de día con un diagnóstico de demencia y discapacidad visual severa que les dificulta la realización de las actividades propias del centro. MATERIAL Y MÉTODO: El proyecto tuvo una duración de tres meses y contó con una fase de evaluación pre- y postintervención. Para la evaluación se utilizaron los instrumentos Mini-Examen Cognoscitivo, Escala de Depresión Geriátrica y un instrumento de registro observacional basado en el Dementia Categorization Recordin Observational System. La fase de intervención tuvo una duración de ocho semanas y se realizaron diferentes dinámicas adaptadas a los gustos e intereses de los participantes. RESULTADOS Y CONCLUSIONES: Tras la fase de intervención se observó una reducción clínicamente significativa de la sintomatología depresiva de ambos usuarios, así como una disminución en la frecuencia de conductas apáticas durante las horas que pasaban en el centro. Asimismo, se observó un aumento en las conductas de tipo prosocial y en las de implicación con las tareas realizadas. Los resultados obtenidos apuntan a que la personalización de las actividades que se realizan en centros a usuarios concretos incrementa la estimulación de los participantes, mejorando su bienestar mediante pequeñas adaptaciones poco costosas de las intervenciones que se realizan

INTRODUCTION: The ageing of the population has led to a progressive increase in age-related diseases, such as dementia or visual impairment, due to chronic diseases. This work describes and analyses the efficacy and feasibility of an individualised intervention carried out with two male users of a day-care centre with a diagnosis of dementia and a severe visual impairment, which made it difficult for them to take part in the regular activities of the centre. MATERIAL AND METHOD: The intervention process had a time frame of three months, and had an assessment phase before and after the intervention. For the assessment, use was made of the Mini-Mental State Examination, Geriatric Depression Scale, and an observational tool based on the Dementia Categorization Recording Observational System. The intervention lasted for eight weeks, and consisted of different dynamics adjusted to the preferences of the participants. RESULTS AND CONCLUSIONS: After the intervention, a clinically significant reduction in the depressive symptomatology was observed for both participants, along with a reduction in the frequency of apathetic behaviour during the time they spent in the centre. Furthermore, an increase was observed in the prosocial behaviour and on the engagement with the task. The results show that the personalisation of the activities for particular users increases the stimulation of the participants, improving their well-being through small and inexpensive adaptations to the interventions that are carried out in the centres

Care-recipients' disruptive behaviors and caregivers' cognitive fusion: relevant variables for understanding caregivers' ambivalent feelings / Comportamientos problemáticos de la persona cuidada y fusión cognitiva en el cuidador: variables relevantes para entender los sentimientos de ambivalencia de los cuidadores

The goal of this study was to analyze the relationship between stressors (frequency of and reaction to disruptive behaviors), cognitive fusion and ambivalence among caregivers, and more specifically to study whether cognitive fusion acts as a mediator in the relationship between stressors and ambivalence. To assess these variables, individual interviews were conducted with a total of 364 caregivers of a relative with dementia. Significant and positive correlations were found among stressors, cognitive fusion and ambivalence (p< .05). The model suggests that there is a significant and positive relationship between reaction to disruptive behaviors and ambivalent feelings among caregivers, although it seems to be mediated by cognitive fusion. The final model explains 37% of the variance of ambivalence, and it shows an excellent fit to the data. The results suggest that the relationship between frequency of disruptive behaviors and ambivalence seems to be mediated by reaction to disruptive behaviors and cognitive fusion; consequently this last variable seems to be relevant for understanding emotional ambivalence among caregivers

El objetivo de este estudio fue analizar la relación entre factores estresantes (frecuencia y reacción a comportamientos problemáticos), fusión cognitiva y ambivalencia en cuidadores. Específicamente, estudiar si la fusión cognitiva actúa como variable mediadora en la relación entre factores estresantes y ambivalencia. Se realizaron entrevistas individuales a un total de 364 cuidadores familiares de personas con demencia. Se encontraron correlaciones significativas y positivas entre los factores estresantes, fusión cognitiva y ambivalencia (p< 0,05). El modelo sugiere que existe una relación significativa y positiva entre la reacción a los comportamientos problemáticos del familiar y los sentimientos de ambivalencia, aunque parece estar mediada por la fusión cognitiva. El modelo final explica el 37% de la varianza de la ambivalencia y muestra un ajuste excelente a los datos. Los resultados sugieren que la relación entre frecuencia de comportamientos problemáticos y ambivalencia parece estar mediada por la reacción a dichos comportamientos y la fusión cognitiva. Esta última variable parece ser relevante para comprender la ambivalencia emocional en los cuidadores