RESUMO
Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.
Assuntos
Doenças Cardiovasculares , Qualidade de Vida , Humanos , Estados Unidos/epidemiologia , American Heart Association , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Atenção à Saúde , Cuidados PaliativosRESUMO
BACKGROUND: A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy. OBJECTIVE: The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science? METHODS: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness. RESULTS: Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities. CONCLUSIONS: Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.
Assuntos
Cuidadores , Insuficiência Cardíaca , Autocuidado , Humanos , Insuficiência Cardíaca/enfermagem , Insuficiência Cardíaca/terapia , Cuidadores/psicologiaRESUMO
BACKGROUND: The reliability and validity of the subjective component of the Dutch Objective Burden Inventory (DOBI) are unknown. OBJECTIVE: The validity and reliability of the subjective component of the DOBI were examined in caregivers of individuals with heart failure, using the original 38- and a 24-item version. METHODS: In an online cross-sectional investigation, confirmatory factor analysis was used to examine factorial validity. In examining convergent validity, corrected item-dimension correlations assessed item performance and associations between subjective subscale scores and the Bakas Caregiving Outcomes Scale. Cronbach's α examined internal consistency. RESULTS: The original 4-factor solution was retained and both the original and shorter versions of the subjective component of the DOBI supported adequate construct validity and internal consistency. CONCLUSIONS: Both the 38- and 24-item forms of the subjective DOBI supported construct validity and reliability. Further studies examining the usefulness of both versions are needed in carers of individuals with more severe HF.
Assuntos
Cuidadores , Insuficiência Cardíaca , Humanos , Psicometria , Reprodutibilidade dos Testes , Estudos Transversais , Análise Fatorial , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Rural patients with heart failure (HF) have higher mortality and hospitalization rates compared with their urban counterparts. Although research supports the inclusion of informal caregivers in daily self-care activities, data are limited regarding the problems encountered by rural patient/caregiver dyads living with HF in managing HF in the home and how these problems are managed. OBJECTIVE: The aim of this study was to identify and describe HF self-care problems experienced by rural dyads in the home and how these problems are managed. METHODS: Using a descriptive qualitative design, data were collected from rural patient/caregiver dyads living with HF via individual, semistructured, telephone interviews and analyzed using schematic content analysis. Interviews and data analysis occurred concurrently until data saturation was reached. RESULTS: Thematic data saturation was obtained with 11 dyads. On average, patients were 65.3 (±13.9) years old, and caregivers were 62 (±12.37) years old. Four themes illustrating dyadic HF self-care problems and management strategies emerged: (1) HF self-care components, namely, maintenance, symptom monitoring, and management (diet, exercise, activities, strategies); (2) environment (rural barriers, COVID-19); (3) caregiver contributors (confidence, role); and (4) dyadic contributors (dyadic relationship). Dyads described various self-care problems, with the type of relationship and presence of mutuality influencing the problem-solving process and development of management strategies. CONCLUSIONS: The identified themes emphasize the self-care problems experienced by rural dyads living with HF and the contributions of both dyad members to effectively manage these challenges. Findings support the need for culturally sensitive, tailored interventions targeting self-care in rural dyads living with HF.
RESUMO
Stress is a cardiovascular disease risk factor, and resilience may serve as a buffer for stress. Little is known about stress and resilience among rural women. OBJECTIVE: The purposes of this study were to identify profiles of rural women based upon indicators of psychosocial and environmental stress and to examine the relationships between the identified profiles and resilience. DESIGN AND SAMPLE: A cross-sectional, descriptive design was used to explore stress, social support, and resilience among a representative sample of women (n = 354). MEASURES: Data were collected to measure perceived stress, social support, chronic stress, and resilience. RESULTS: A latent profile analysis identified three profiles (59.9% Low Stress, 25.4% Moderate Stress, and 14.7% High Stress). Women in the High Stress profile were less likely to afford necessities and have attended college and more likely to be employed. Women in the Low Stress profile had the highest scores for all five resilience subscales. CONCLUSION: The current study demonstrates the social and environmental impact of stress and how this stress can manifest differently for different women. Underserved women may benefit from strategies that reduce stress and improve social support and resilience. Future research is needed for advancing health equity in rural populations.
Assuntos
Resiliência Psicológica , Estudos Transversais , Feminino , Humanos , População Rural , Apoio Social , UniversidadesRESUMO
Heart failure is a clinical syndrome that affects >6.5 million Americans, with an estimated 550 000 new cases diagnosed each year. The complexity of heart failure management is compounded by the number of patients who experience adverse downstream effects of the social determinants of health (SDOH). These patients are less able to access care and more likely to experience poor heart failure outcomes over time. Many patients face additional challenges associated with the cost of complex, chronic illness management and must make difficult decisions about their own health, particularly when the costs of medications and healthcare appointments are at odds with basic food and housing needs. This scientific statement summarizes the SDOH and the current state of knowledge important to understanding their impact on patients with heart failure. Specifically, this document includes a definition of SDOH, provider competencies, and SDOH assessment tools and addresses the following questions: (1) What models or frameworks guide healthcare providers to address SDOH? (2) What are the SDOH affecting the delivery of care and the interventions addressing them that affect the care and outcomes of patients with heart failure? (3) What are the opportunities for healthcare providers to address the SDOH affecting the care of patients with heart failure? We also include a case study (Data Supplement) that highlights an interprofessional team effort to address and mitigate the effects of SDOH in an underserved patient with heart failure.
Assuntos
Atenção à Saúde , Insuficiência Cardíaca/terapia , Determinantes Sociais da Saúde , Escolaridade , Exposição Ambiental , Etnicidade , Insegurança Alimentar , Identidade de Gênero , Letramento em Saúde , Acessibilidade aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/epidemiologia , Humanos , Cobertura do Seguro , Grupos Minoritários , Modelos Teóricos , Preparações Farmacêuticas/provisão & distribuição , Pobreza , Grupos Raciais , Classe Social , Apoio Social , Desemprego , Populações VulneráveisRESUMO
INTRODUCTION: Depressive symptoms, negative life changes, poor self-care, and higher caregiver burden are common in caregivers who assist individuals with heart failure (HF) in managing daily activities and disease-related symptoms. Previous research findings suggest social support, problem solving, and family function may influence these outcomes. However, the influence of these factors on outcomes in rural HF caregivers is unknown. The purpose of this study is twofold: (1) to examine whether social support, problem solving, and family function predicted depressive symptoms, caregiving-related life changes, self-care, and caregiver burden in rural HF caregivers; and (2) to compare differences in these variables between rural and urban caregivers. METHODS: Rural caregivers (n=114) completed an online researcher-developed sociodemographic and clinical survey and standardized (Likert-type) self-report instruments. Participants were recruited locally from south-eastern USA (using face-to-face and telephone contacts, posted flyers, newspaper advertisements, and social media), nationally (newspaper advertisements and social media sites) and internationally (using social media). Potential participants were directed to the study website to complete the online surveys. These methods recruited participants who lived in 24 states within the USA, as well as from Canada, England, Ireland, Scotland, and Wales. Demographic statistics and Mann-Whitney U-test, as well as bivariate correlations, multivariate linear modelling, and Roy's largest root, were used to analyse data, controlling for covariates. RESULTS: Rural (n=114) caregivers were primarily Caucasian (84.2%), women (58.8%), and 41.45 (±9.013) years old. Social support had significant effects on depressive symptoms (ηp2=0.384, p<0.001), self-care (ηp2=0.108, p=0.001), and life changes (ηp2=0.055, p=0.016), while problem solving showed significant effects on depressive symptoms (ηp2= 0.078, p=0.004) and caregiver burden (ηp2=0.23, p<0.001). Family function had significant effects on life changes (ηp2=0.104, p=0.001), self-care (ηp2=0.088, p=0.002), and caregiver burden (ηp2=0.116, p<0.001). Compared to urban (n=412) participants, rural caregivers experienced significantly less social support (p=0.001), worse problem-solving skills (p=0.003) and family functioning (p=0.009), and greater depressive symptoms (p≤0.01) and subjective burden (p=0.001). There were no significant differences in caregiver self-care (p=0.416) and perceived life changes (p=0.346) among rural and urban caregivers. CONCLUSION: Both social support and problem solving have significant effects on depressive symptoms in rural HF caregivers, while social support and family function influences self-care. Problem solving and family function also affect caregiver burden, while social support and family functioning influences caregiver life changes. Rural caregivers are often separated by long distances, and have transportation issues and limited access to healthcare providers and support services; therefore, innovative strategies are needed to explore the usefulness of these variables in improving caregiver outcomes.
Assuntos
Cuidadores , Insuficiência Cardíaca , Feminino , Insuficiência Cardíaca/terapia , Humanos , Qualidade de Vida , Autocuidado , Apoio Social , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Heart failure (HF) caregivers experience increased demands and burden. Social support and problem solving may influence the effect of these variables on caregiver outcomes. OBJECTIVE: The aim of this study was to examine whether social support and problem solving mediate relationships among caregiver demands and burden, self-care, depression, and life changes in heart failure caregivers. METHODS: Using a cross-sectional, exploratory design, heart failure caregivers (n = 530) completed online questionnaires on caregiver demands and burden, social support, problem solving, depression, self-care, and life changes. Path analysis examined a hypothesized mediating role of social support and problem solving in the relationships among caregiver demands and burden and caregiver outcomes. The analysis included (1) a model-development phase (n = 329) to make data-based decisions on measurement indicators and model structure and (2) a confirmatory phase (n = 201) to provide unbiased inference on the model structure resulting from the initial phase. RESULTS: Participants were 41.39 (±10.38) years old and primarily white (78.3%) men (50.9%) caring for a spouse (44.9%). Per the magnitudes of the estimated path coefficients, social support mediated the relationship between caregiver burden and depression but did not relevantly mediate the relationship between caregiver burden and self-care or caregiver life changes. In the presence of social support as a parallel mediator, problem solving was not a relevant mediator between caregiver burden and demands and caregiver outcomes. CONCLUSIONS: Social support mediates the effects of caregiver burden on depression but has little effect on self-care or life changes. In the presence of social support, problem solving does not mediate the effects of caregiver demands and burden on caregiver outcomes.
Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Depressão/epidemiologia , Insuficiência Cardíaca/terapia , Resolução de Problemas , Autocuidado , Apoio Social , Adulto , Estudos Transversais , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Psychometric properties of the 38-item version of the Dutch Objective Burden Inventory (DOBI) have been evaluated primarily in older female caregivers, with no published studies that vary by a different gender and age distribution. OBJECTIVE: The aim of this study was to test the construct validity and reliability of the DOBI in caregivers of individuals with heart failure from the United States and other countries. METHODS: This secondary analysis from a cross-sectional study used an online survey. Factorial validity was tested with confirmatory factor analysis, item performance was examined with ordinal item response analysis, and convergent validity was tested correlating DOBI subscale scores with Bakas Caregiving Outcomes Scale scores. Internal consistency reliability was assessed with Cronbach α. RESULTS: Item response analysis removed 14 items. Confirmatory factor analysis retained the original 4-factor solution. Original and reduced instruments demonstrated good internal consistency. Validity was supported by meaningful associations with the Bakas Caregiving Outcomes Scale. CONCLUSIONS: Both the original 38-item DOBI and the reduced 24-item DOBI had support for their construct validity and internal consistency. The 24-item DOBI may be a useful alternative to the 38-item version, because it maintains psychometric properties of the original instrument while decreasing data collection burden. However, more research is needed to assess whether the shorter version is useful in assessing objective caregiving burden.
Assuntos
Sobrecarga do Cuidador/diagnóstico , Sobrecarga do Cuidador/psicologia , Cuidadores/psicologia , Insuficiência Cardíaca/terapia , Adulto , Canadá , Sobrecarga do Cuidador/etiologia , Estudos Transversais , Emoções , Feminino , Insuficiência Cardíaca/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Países Baixos , Psicometria , Reprodutibilidade dos Testes , Autoimagem , Apoio Social , Inquéritos e Questionários , Reino Unido , Estados UnidosRESUMO
OBJECTIVE: Diabetes is a major health problem that is closely linked with cardiovascular disease (CVD), the leading cause of death in the United States. The purpose of this analysis was to determine the effect of a culturally relevant diabetes health promotion program on diabetes knowledge and self-reported self-care behaviors. DESIGN: A cluster randomized controlled trial was conducted in 12 rural church settings. Seven churches were randomized to the intervention group and five to the control group. SAMPLE: The sample included 146 African American participants diagnosed with diabetes and prediabetes. INTERVENTION: The intervention group participants (n = 75) received the diabetes health program, and those in the control group (n = 71) group received a publicly available diabetes health brochure. MEASURES: Data were collected about diabetes knowledge, self-care activities, fatalism, and social support. RESULTS: Linear mixed model was the statistical test used to analyze group differences. Compared with the control group, the intervention group showed significant changes from pretest to posttest for diabetes knowledge and behaviors associated with diet and blood glucose testing. CONCLUSION: Health promotion programs implemented by public health nurses among rural groups at increased risk for developing CVD can facilitate understanding about strategies to reduce disease risk.
Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Promoção da Saúde/métodos , Estado Pré-Diabético/epidemiologia , População Rural/estatística & dados numéricos , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Análise por Conglomerados , Dieta , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Autocuidado , Apoio Social , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Approximately 50% of individuals living with heart failure (HF) experience depressive symptoms. Social support has been found to have a positive influence on depressive symptoms in individuals with HF. OBJECTIVE: The purposes of this review were to (1) examine recent literature regarding the impact of social support on depressive symptoms in individuals with HF, (2) synthesize findings across those studies, (3) assess potential areas of future research regarding social support, and (4) identify implications for nursing practice. METHODS: An integrative review of current empirical literature was conducted through a search of the CINAHL and PsycARTICLES computerized databases for the period of January 2000 to December 2010. The key words used for the search were heart failure, social support, coping, depressive symptoms, and depression. RESULTS: Fifteen studies matched inclusion criteria. Eleven of these studies found social support to prevent or reduce depressive symptoms. Emotional and tangible support as coping resources or strategies, the perceived availability of or satisfaction with support, and assistance with problem solving positively influenced depressive symptoms. Perceived emotional and tangible support and the presence and availability of social networks lessened depression in patients with HF. Findings from 4 studies on the impact of social support were not statistically significant. Different definitions of social support and a variety of measurement instruments used made it difficult to generalize study findings. CONCLUSIONS: Social support seems to positively impact and influence the psychological well-being of those with HF. Additional research is needed to identify specific characteristics of support that is effective in influencing depressive symptoms in this population. Furthermore, more research is needed regarding how factors such as ethnicity influence depressive symptoms and depression.
Assuntos
Depressão/etiologia , Depressão/prevenção & controle , Insuficiência Cardíaca/complicações , Apoio Social , Adaptação Psicológica , Insuficiência Cardíaca/psicologia , HumanosRESUMO
The growing number of older adults in the United States necessitates that nurses be prepared to care for this population. A case exemplar was created for use in a baccalaureate nursing program to prepare students for care of older adults in multiple settings, as well as to heighten interprofessional health care partnerships. The case exemplar follows the character, Mrs. Gates, in a scenario throughout the program. Another character, Mrs. Strokes, is introduced in a high-fidelity laboratory simulation activity for more advanced students. The case scenario uses a team approach to care and includes activities that optimize critical thinking. This article describes the process of creating a case exemplar, including project pilot testing, and the potential for interprofessional education. The incorporation of case exemplars such as these can enhance the teaching-learning process, thereby improving care for older adults and their families.
Assuntos
Bacharelado em Enfermagem/métodos , Enfermagem Geriátrica/educação , Simulação de Paciente , Idoso , Criatividade , Currículo , Feminino , Humanos , Pesquisa em Educação em Enfermagem , Projetos Piloto , PensamentoRESUMO
OBJECTIVES: To identify classes of heart failure (HF) caregivers based upon indicators of coping resources and stress, and then, to examine the relationships between the identified caregiver classes and depression, caregiver burden, and life changes. METHODS: Cross-sectional data from 530 HF caregivers were analyzed in this secondary analysis using a three-step latent class mixture model to classify caregivers based on level of resources and examine the relationship between the identified classes and depression, caregiver burden, and life changes. Using an online survey, caregivers reported on social support, problem-solving, family function, depression, caregiver burden, and life changes. RESULTS: Caregivers were 41.39 (± 10.38) years of age, 49.1% women, 78.3% white, 77.6% urban-dwelling, and 61.7% college/postgraduate educated. Three classes of caregivers (42.3% Adequately Resourced, 25.1% At Risk for Decompensation, 32.6% Inadequately Resourced) were identified. Inadequately Resourced caregivers had the lowest levels of social support, problem-solving, and family function and the highest levels of depression and caregiver burden. Caregivers At Risk for Decompensation had the best family function and reported the most positive perceptions of life changes despite low levels of social support and problem-solving. CONCLUSION: Social support, problem-solving, and family function are modifiable coping resources which may buffer stress and influence stress indicators. Caregivers with few coping resources may experience higher degrees of depression and burden, and less positive perceptions of life changes. More research is needed to examine the influence of these coping resources on caregiver adaptation to facilitate the development of targeted interventions which support caregiver mental health.
Assuntos
Cuidadores , Insuficiência Cardíaca , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Cuidadores/psicologia , Adaptação Psicológica , Análise de Classes Latentes , Estudos TransversaisRESUMO
Diabetes is a major public health threat and contributory risk factor for cardiovascular disease, especially among underserved populations living in the rural, southern states. In these areas, African Americans have the highest rates of both diabetes and cardiovascular disease, but not much is known about the psychosocial factors that influence diabetes outcomes. This study examined bivariate correlations among diabetes knowledge, diabetes self-care activities, perceived diabetes self-management, diabetes fatalism, and social support. The data were collected during a cluster randomized trial involving rural African American participants living with diabetes and prediabetes in a rural, southeastern area. The findings of this analysis point to associations among social support, diabetes fatalism, diabetes self-care activities, and perceived diabetes self-management. Diabetes knowledge was not significantly correlated with any of these factors or their subscales.
Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Negro ou Afro-Americano/psicologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , População Rural , AutocuidadoRESUMO
OBJECTIVES: To explore gender and racial differences in heart failure (HF) self-care processes and examine whether gender and race predict HF self-care. METHODS: A secondary analysis of baseline data (n = 107) from a longitudinal HF study (54.2% males; 56% non-Caucasians) was conducted. The self-care of heart failure index was used to measure self-care maintenance, management, and confidence. Descriptive statistics and univariate analyses examined gender and racial differences in HF self-care outcomes. Multiple linear regression examined whether gender and race predicted HF self-care maintenance, management, and confidence. RESULTS: Univariate analyses indicated that Caucasians reported significantly better self-care maintenance (p = 0.042), while non-Caucasians reported significantly better self-care management (p = 0.003). Males had significantly higher self-care confidence scores versus women (p = 0.017). Multiple regression analysis indicated Caucasian race predicted significantly worse self-care management (ß = -11.188; p = 0.006) versus non-Caucasian, while male gender predicted significantly higher self-care confidence scores (ß = 7.592; p = 0.010) versus female gender. Gender nor race significantly predicted self-care maintenance. DISCUSSION: Although gender and race may influence HF self-care, other factors may be more important. More research is needed to identify individual factors that contribute to HF self-care to improve education and intervention.
Assuntos
Insuficiência Cardíaca , Autocuidado , Escolaridade , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , Análise MultivariadaRESUMO
Cardiovascular disease is a global public health problem and leading cause of death. Stress is a modifiable cardiovascular disease risk factor. The objectives of this study were to examine whether stress was a predictor of resilience among rural younger women and to explore whether social support mediated the relationship between acute stress and resilience and between chronic stress and resilience. The study had a cross-sectional, descriptive design. A total of 354 women were randomly recruited in the rural, southeastern United States. Survey instruments were used to collect data about acute stress, chronic stress, social support, and resilience. A structural equation model was fit to test whether social support mediated the relationship between perceived stress and resilience and between chronic stress and resilience. Chronic stress predicted family and belongingness support and all the resilience subscales: adaptability, emotion regulation, optimism, self-efficacy, and social support. Acute stress predicted the self-efficacy subscale of resilience. Family support partially mediated the relationship between chronic stress and self-efficacy. Belongingness support partially mediated the relationships between chronic stress and the social support subscale of resilience.
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Little is known about heart failure (HF) caregiver self-care. This article reports a secondary analysis of data from a cross-sectional, descriptive study involving 530 HF caregivers. A three-step latent class mixture model identified HF caregiver classes at risk for poor self-care and examined the relationship between the identified self-care classes and caregiver burden and depression. Caregivers completed online surveys on self-care, caregiver burden, depression, problem-solving, social support, and family function. Caregivers were 41.39 (±10.38) years old, 78.3% Caucasian, and 50.9% men. Three classes of HF caregivers (24% Low-Risk, 24.9% Moderate-Risk, 51.1% High-Risk) were identified. High-Risk caregivers had the worst self-care and the lowest levels of social support, problem-solving, and family function. Moderate-Risk caregivers were the most experienced and had the best self-care yet had the most comorbidities. High-Risk caregivers reported more caregiver burden and depression. "At-risk" caregivers may benefit from self-care and support programs, but more research is needed.
Assuntos
Cuidadores , Insuficiência Cardíaca , Criança , Estudos Transversais , Depressão , Feminino , Insuficiência Cardíaca/terapia , Humanos , Análise de Classes Latentes , Masculino , AutocuidadoRESUMO
OBJECTIVE: The purpose of this study was to provide an in-depth analysis of the components and outcomes of telehealth interventions for family caregivers of individuals with chronic health conditions. METHODS: A systematic review of 17 databases was conducted for randomized controlled trials published between January 2002 and January 2017. Interventions were analyzed based on type of telecommunication modality, caregiver and care recipient characteristics, intervention components, and caregiver outcomes. RESULTS: A total of 57 articles met criteria for inclusion. Telephone was the most frequently used mode of telehealth delivery and focused primarily on caregivers of older adults with dementia and stroke. Skills training was the most prevalent treatment strategy across telephone, web, and combined telephone and web modalities. Improved psychological functioning was reported most frequently across telehealth modalities. CONCLUSION: Telehealth is an effective tool in delivering caregiver interventions and leads to significant improvement in caregiver outcomes. Telephone was used most often to deliver cognitive-behavioral and psychoeducational strategies as compared to web and combined telephone and web modalities. Further research is needed to examine the effects of telehealth interventions on caregiving skills and self-efficacy, as well as health outcomes.
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Heart failure is a serious and complex chronic illness and family caregivers often assist these individuals in performing self-care. Unsurprisingly, caregivers often are overwhelmed by daily activities associated with heart failure management and frequently have depressive symptoms. This study examined predictors (i.e., sociodemographic and clinical characteristics, social support, social problem-solving, family functioning, and objective and subjective burden) of depressive symptoms in 530 informal caregivers of individuals with heart failure in a large cross-sectional, descriptive study in the community. Younger caregivers who provided care for longer periods of time, lived in rural areas, and had less social support and lower problem-solving skills were more likely to have depressive symptoms. These findings emphasize the need for further studies to develop dynamic and innovative approaches that incorporate multiple components to lessen caregiving challenges. Social support and problem-solving skills training may be useful components to lessen depressive symptoms in these younger, rural caregivers.
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Cuidadores/psicologia , Depressão/psicologia , Insuficiência Cardíaca/enfermagem , Qualidade de Vida/psicologia , Atividades Cotidianas , Adaptação Psicológica , Adulto , Idoso , Estudos Transversais , Depressão/etiologia , Feminino , Insuficiência Cardíaca/psicologia , Humanos , Pessoa de Meia-Idade , Estresse Psicológico/psicologiaRESUMO
Heart failure (HF) symptoms are known to influence depressive symptoms, yet a symptom profile has not been identified. HF symptoms relative to symptom experience (frequency, severity, interference with physical activity and enjoyment of life) associated with depressive symptoms were examined. Data from three HF studies (N = 308) which used the Heart Failure Symptom Survey were included in this cross-sectional secondary analysis. Supervised classification for and identification of symptoms most associated with depressive symptoms were accomplished using random forest algorithms via conditional inference trees. The HF symptom profile associated with depressive symptoms across all four symptom experience domains included fatigue, dizziness, and forgetfulness/difficulty concentrating. Abdominal bloating, worsening cough, and difficulty sleeping were also important, but did not consistently rank in the top 5 for symptom importance relative to all symptom experience domains. Symptom profiling may enhance early identification of patients at risk for depressive symptoms and inform symptom management interventions.