Assessment of owner perceptions of caregiver burden, veterinarian-client relationship and satisfaction with the provider in canine pruritus: An experimental vignette study.

BACKGROUND: Complicated treatments for skin disease are linked to owner-caregiver burden and poorer perception of the veterinarian-client relationship, regardless of disease severity. HYPOTHESES/OBJECTIVES: Using experimental vignettes, we explored the impact on owner perception of the interaction of treatment complexity and skin disease outcomes. We hypothesised that: (i) vignette conditions involving injection therapy would result in lower burden, better veterinary-client relationship and greater satisfaction relative to multimodal therapy conditions; (ii) the vignette condition of injection therapy with a completely effective outcome would be superior to all other conditions; (iii) ineffective vignette conditions would be inferior to all other conditions; and (iv) the vignette condition injection with a mostly effective outcome would be similar or superior to the multimodal therapy with a completely effective outcome condition. PARTICIPANTS: Three hundred and nine owners of pruritic dogs recruited from a general veterinary practice, pet-related podcast, or social media dog allergy group. MATERIALS AND METHODS: Participants were presented with six counterbalanced online vignettes representing three levels of treatment effectiveness (Completely Effective, Mostly Effective, Ineffective) and two treatment regimens (Multimodal, Injection). Measurements of participant perceptions of caregiver burden, veterinarian-client relationship and satisfaction were recorded. RESULTS: Injection with perfect outcome was superior to other conditions (p < 0.001). Conditions with poor effectiveness were inferior (p < 0.001). Comparison of Injection with a mostly effective outcome to Multimodal treatment with perfect outcome yielded small-to-medium effects of preference for the latter in veterinarian-client relationship and satisfaction (p < 0.01); no difference was observed for caregiver burden. When good effectiveness was assured, injection was preferred (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE: Owners preferred a Completely Effective outcome and were prepared to select the Injection regimen or Multimodal therapy to achieve this; Injection was preferred when effectiveness was assured.

Veterinary team members experiencing high levels of burden transfer are more likely to report burnout and a less optimal psychosocial work environment.

OBJECTIVE: To describe burden transfer in a sample of veterinary workers employed by a Canadian veterinary corporation and to examine the association between different levels of burden transfer and employee burnout and perceived psychosocial work environment. SAMPLE: 475 employees of small-animal veterinary hospitals owned by a corporate practice group. METHODS: Veterinary team members among 14 working groups responded to an online survey that included assessments of burden transfer, psychosocial environment, and burnout within the workplace. Participants were divided into groups on the basis of self-reported burden-transfer scores being low, mid, or high, and multivariate analysis of covariance was conducted to ascertain associations between level of burden transfer, psychosocial environment, and burnout. RESULTS: On average, participants perceived difficult encounters with clients to occur with moderate frequency and reported reactions that were low-moderate in intensity. Individuals with high burden-transfer scores were identified in all working groups. Across the 3 burden-transfer groups, the key finding was that high-level burden transfer was associated with perception of greater emotional demands within the workplace, reduced support from supervisors, reduced feeling of social community in the workplace, and elevated rates of burnout among these participants. CLINICAL RELEVANCE: Findings highlight elevated risks for a certain population of veterinary employees experiencing high levels of burden transfer and underscore the potential need for targeted interventions to support these individuals. Employees who currently react to challenging client interactions with moderate or low intensity may also benefit from these programs as a preventative measure.

Burden and positive aspects of caregiving: cluster profiles of dementia caregiving experiences.

OBJECTIVES: Although caregiver burden is common in the context of dementia caregiving, the caregiving role is linked to beneficial outcomes too. Individuals reporting higher positive aspects of caregiving tend to exhibit lower burden relative to those reporting few. The goal of this retrospective review of outpatient memory clinic medical records was to demonstrate whether and how constructs of burden and positive aspects of caregiving coexist within individual caregivers, and to explore potential contributors to caregiver profiles created based upon these constructs. METHOD: Cluster analyses were conducted on 1160 caregivers from an initial intake interview meeting criteria on primary measures of Positive Aspects of Caregiving and the Zarit Burden Interview and repeated with 225 caregivers meeting inclusion criteria on all measures. Samples were compared for similarity, and the smaller sample (n = 225) was deemed appropriately representative. Multinomial logistic regressions examined cluster predictors in sample with 225 caregivers. RESULTS: Results suggested a three-cluster solution: a High Burden group, a High Positive Experiences group, and a Low-Moderate Experiences group showing low burden and moderate positive experiences. Greater behavioral problems predicted belonging to the High Burden cluster. Greater care recipient dependence predicted belonging to the High Positive Experiences cluster while greater independence predicted the Low-Moderate Experiences cluster. CONCLUSION: Findings suggest that burden and positive aspects of caregiving do not simultaneously present in caregivers at high levels. Supportive caregiver interventions might be tailored to profiles demonstrated here. Future research should investigate other potential contributors to experiences of burden and positive aspects of caregiving.

The indirect effect of positive aspects of caregiving on the relationship between cognitive decline and dementia caregiver burden.

BACKGROUND: Research has linked increased cognitive decline in a dementia care recipient to worsening caregiver burden, but the presence of positive aspects of caregiving is associated with better outcomes. As cognitive decline worsens, a lack of positive caregiving experiences could lead to burden for the caregiver. This study investigated relationships among dementia caregiver burden, cognitive decline, and positive aspects of caregiving in dementia, predicting an indirect effect of positive aspects of caregiving. METHODS: Data from 724 patients of an outpatient memory clinic in Ohio were examined and dyads included based on clinically supported patient diagnoses on the dementia spectrum. Caregivers completed the Zarit Burden Interview (ZBI) and Positive Aspects of Caregiving (PAC) measures. The Montreal Cognitive Assessment and Mini-Mental State Examination were used to estimate cognitive decline, standardized to create a single variable. Multiple potential covariates were considered for inclusion in the model. A cross-sectional mediation analysis using the Hayes PROCESS macro explored the presence of an indirect effect of PAC on the relationship between cognitive decline and ZBI using 5000 bootstrap samples. RESULTS: Only the potential covariate caregiver age was correlated with any of the primary variables; this variable was controlled in analyses. Significant relationships emerged between cognitive decline and ZBI (r = -0.12, P < 0.001), between PAC and ZBI (r = -0.23, P < 0.001), and between cognitive decline and PAC (r = -0.07, P < 0.05). An indirect effect of positive aspects of caregiving on the relationship between cognitive decline and ZBI was statistically significant (B = 0.0092, 95% bias-corrected confidence interval: 0.0008, 0.0185), accounting for 14.4% of the variance in the model. CONCLUSIONS: A lack of positive aspects of caregiving could be partially responsible for development of dementia caregiver burden as cognitive decline worsens. Longitudinal examination of these relationships is needed to understand causality fully. Findings may help healthcare providers tailor treatment to alleviate caregiver burden.

Self-paced acceptance and commitment training reduces burden transfer, stress, and burnout in veterinary healthcare teams.

OBJECTIVE: An acceptance and commitment training (ACT) educational program targeting reaction to difficult client interactions recently demonstrated efficacy in reducing burden transfer, stress, and burnout in veterinary healthcare teams. The current noninferiority trial compared effectiveness of the original program with a self-paced version. SAMPLE: Employees of 2 corporate veterinary groups were randomized to live (n = 128) or self-paced (124) conditions. The workshop and assessments were completed by 137 (55 live and 82 self-paced). PROCEDURES: Asynchronous modules containing the same content as the original program were placed on in-house veterinary clinic learning systems. Participants of this parallel arms trial completed pretest measures of burden transfer, stress, and burnout. Following assessment, the 3-week ACT program was delivered via videoconferencing (live) or asynchronous modules (self-paced). At post-test and 1-month follow-up, measures were repeated, with added assessment of knowledge, helpfulness ratings, and usage of techniques. A subset (n = 33) of participants repeated measures 9 to 12 months as an extended follow-up. RESULTS: Program helpfulness was rated more highly by live versus self-paced participants. Self-paced showed better program retention. No differences in knowledge or use of program techniques (> 5 times daily) emerged. Relative to pretest, both conditions showed reduced burden transfer, stress, and burnout at post-test and follow-up; no differences by condition emerged. Participants completing extended follow-up maintained improvement from baseline. CLINICAL RELEVANCE: Findings suggest a learning system-based version of this program can improve occupational distress in veterinary healthcare teams, with gains maintained over time. The flexibility of this format promotes program completion and allows broader dissemination.

Caregiver burden in cat owners: a cross-sectional observational study.

OBJECTIVES: Caregiver burden has been found in owners of seriously ill pets; however, research to date has been heavily represented by dog owners. Prior caregiver burden work has neither intentionally focused on cat owners nor been appropriately powered to examine differences in owners of cats relative to owners of dogs. We expected that owners of an ill cat would exhibit greater caregiver burden than owners of a healthy cat but lower burden than owners of an ill dog. METHODS: A cross-sectional online assessment of caregiver burden was completed by 1085 pet owners through a pet demographic audience platform, including 333 owners reporting on a cat with current illness, 492 owners of a healthy cat and 260 owners of dogs with a current illness. RESULTS: Owners of an ill cat, examined across all illnesses represented, had greater burden (P <0.001) than the owners of a healthy cat and somewhat lower burden (P = 0.013) than owners of an ill dog. CONCLUSIONS AND RELEVANCE: Caregiver burden is present in owners of an ill cat and may differ from that of dog owners. Future work is needed to determine the reasons underlying this difference between species. Given that restricted sample sizes precluded examination across specific conditions, it will also be important to determine whether particular diseases yield greater burden in cat owners relative to dog owners.

Poorer Cognitive Performance Is Associated with Gastrointestinal Symptoms in Otherwise Healthy Young Adults.

INTRODUCTION: Functional gastrointestinal disorders such as irritable bowel syndrome are often associated with abdominal discomfort, bloating, and cramping. There is growing evidence that gastrointestinal symptoms are also related to cognitive function, but this association has not been previously examined in young adults. METHODS: We examined cross-sectional relationships between nonspecific gastrointestinal symptoms and cognition in 56 healthy young adults (41 female, 15 male) without diagnosis of gastrointestinal disorder. RESULTS: Gastrointestinal symptoms were associated with poorer performance on objective tests of memory (p < 0.01 for all) and greater self-report of cognitive dysfunction (p < 0.01 for all). CONCLUSION: Results suggest that higher gastrointestinal symptoms are associated with greater subjective and objective cognitive difficulty. Future work is needed to clarify underlying mechanisms and the potential functional impact of these cognitive deficits.

Specific agitation behaviours in dementia differentially contribute to aspects of caregiver burden.

BACKGROUND: Agitation is a common symptom in dementia and linked to caregiver burden, but both agitation and burden are multidimensional constructs. The current study sought to determine whether specific presentations of agitation differentially relate to aspects of caregiver burden. METHODS: Medical record data from an outpatient memory clinic were extracted for 609 persons with dementia, including caregiver-reported burden and care recipient agitation. RESULTS: Exploratory factor analysis yielded three domains of agitation on the Cohen Mansfield Agitation Inventory ('Physically Aggressive', 'Physically Non-Aggressive', 'Verbally Agitated') and four domains of burden on the Zarit Burden Interview ('Impact on Life', 'Guilt/Uncertainty', 'Embarrassment/Frustration', 'Overwhelm'). Regression analyses demonstrated all domains of agitation positively predicted overall burden. Regarding specific aspects of burden, Physically Aggressive behaviours predicted Embarrassment/Frustration. Physically Non-Aggressive behaviours predicted Impact on Life and Guilt/Uncertainty. Verbally Agitated behaviours predicted all burden dimensions. CONCLUSIONS: Results suggest specific aspects of agitation may differentially contribute to facets of caregiver burden.

Caregiver burden, treatment complexity, and the veterinarian-client relationship in owners of dog with skin disease.

BACKGROUND: Increasing complexity of treatment plans is associated with higher levels of caregiver burden in owners of dogs with skin disease. It is possible that elevated caregiver burden resulting from treatment complexity could, in turn, affect the veterinarian-client relationship. HYPOTHESES/OBJECTIVES: We expected that treatment complexity, caregiver burden, and the client's perception of the veterinarian-client relationship would be related to each other. We also expected an indirect effect of caregiver burden on the cross-sectional association between treatment complexity and the veterinarian-client relationship, and that this effect would be robust to adjustment for the dog's skin disease course and severity. PARTICIPANTS: Participants were 349 owners of dogs with skin disease recruited through online consumer panels. MATERIALS AND METHODS: Cross-sectional online assessments were completed for caregiver burden, treatment plan complexity, veterinarian-client relationship, and skin disease course and severity. Demographic information also was collected. RESULTS: The indirect effect of caregiver burden on the relationship between treatment complexity and veterinarian-client relationship was statistically significant, accounting for 42.76% of the variance in the model. After controlling for disease severity and course, that effect remained statistically significant, accounting for 37.76% of the variance. CONCLUSIONS AND CLINICAL IMPORTANCE: Findings support the notion that greater treatment complexity is related to the owner's perception of the veterinarian-client relationship via caregiver burden. Efforts to reduce caregiver burden by using the simplest effective treatment may benefit the veterinarian-client relationship.

Contexte - La complexité croissante des plans de traitement est associée à des niveaux plus élevés de fardeau pour les soignants propriétaires de chiens atteints de maladies de peau. Il est possible que le fardeau élevé des soignants résultant de la complexité du traitement pourrait, à son tour, affecter la relation vétérinaire-client. Hypothèses/Objectifs - Nous nous attendions à ce que la complexité du traitement, le fardeau des soignants et la perception du client de la relation vétérinaire-client seraient liés les uns aux autres. Nous nous attendions également à un effet indirect de le fardeau du soignant sur l'association transversale entre la complexité du traitement et le vétérinaire-client relation, et que cet effet serait robuste à l'ajustement de l'évolution et de la gravité de la maladie de peau du chien. Participants - Les participants étaient 349 propriétaires de chiens atteints de maladies de la peau recrutés par le biais de consommateurs en ligne panneaux. Matériels et méthodes - Des évaluations transversales en ligne ont été réalisées pour le fardeau des soignants, le traitement la complexité du plan, la relation vétérinaire-client et l'évolution et la gravité des maladies de la peau. Informations démographiques a également été collecté. Résultats - L'effet indirect du fardeau des soignants sur la relation entre la complexité du traitement et le vétérinaire-la relation client était statistiquement significative, représentant 42,76 % de la variance du modèle. Après contrôle pour la gravité et l'évolution de la maladie, cet effet est resté statistiquement significatif, représentant 37,76 % des la variance. Conclusions et importance clinique - Les résultats appuient l'idée qu'une plus grande complexité du traitement est liée à la perception du propriétaire de la relation vétérinaire-client via le fardeau des soignants. Efforts pour réduire le soignant fardeau en utilisant le traitement efficace le plus simple peut être bénéfique pour la relation vétérinaire-client.

Contexto - O aumento da complexidade dos planos de tratamento está associado a altos níveis de sobrecarga do cuidador de cães com doenças de pele. É possível que a sobrecarga do cuidador elevada resultante da complexidade da terapia possa, desta forma, afetar a relação veterinário-cliente. Hipótese/Objetivos - Nós imaginamos que a complexidade do tratamento, a sobrecarga do cuidador, e a percepção do cliente da relação veterinário-cliente estariam relacionadas. Nós também imaginamos que poderia uma mediação da sobrecarga do cuidador na associação transversal entre a complexidade do tratamento e a relação veterinário-cliente, e que este efeito seria robusto para ajustar o curso e a gravidade da doença de pele do cão. Participantes - Os participantes foram 349 tutores de cães com doença de pele recrutados através de formulários online. Materiais e métodos - Avaliações transversais online foram preenchidas para sobrecarga do cuidador, complexidade do plano de tratamento, relação veterinário-cliente, e curso da doença de pele e gravidade. Dados demográficos também foram coletados. Resultados - O efeito indireto da sobrecarga do cuidador na relação entre a complexidade do tratamento e a relação veterinário-cliente foi significativamente significativa, sendo responsável por 42,76% da variância no modelo. Após controlar para gravidade da doença e curso, esse efeito permaneceu estatisticamente significativo, respondendo por 37,76% da variância. Conclusões e importância clínica - Os achados corroboram com a ideia de que a complexidade do tratamento está relacionada à percepção do tutor sobre a relação veterinário-cliente pela sobrecarga do cuidador. Esforços para reduzir a sobrecarga do cuidador utilizando planos terapêuticos mais simples podem beneficiar a relação veterinário-cliente.

Introducción- el aumento de la complejidad de los planes de tratamiento se asocia a mayores niveles de responsabilidad de los propietarios de perros con enfermedades de la piel. Es posible que esta mayor carga para el propietario resultante de la complejidad del tratamiento pueda, a su vez, afectar a la relación veterinario-cliente. Hipótesis/Objetivos- esperábamos que la complejidad del tratamiento, la mayor responsabilidad para cuidadores y la percepción de los propietarios de la relación veterinario-cliente estuvieran relacionadas entre sí. También esperábamos un efecto de mediación de la mayor carga del cuidador en la asociación transversal entre la complejidad del tratamiento y la relación veterinario-cliente, y que este efecto sería sólido para el ajuste del curso y la gravedad de la enfermedad de la piel del perro. Participantes- los participantes fueron 349 propietarios de perros con enfermedades de la piel reclutados a través de paneles de consumidores vía telemática. Materiales y métodos- se completaron evaluaciones transversales en línea sobre la carga del cuidador, la complejidad del plan de tratamiento, la relación veterinario-cliente y el curso y la gravedad de la enfermedad de la piel. También se recopiló información demográfica. Resultados - El efecto indirecto de la carga del cuidador sobre la relación entre la complejidad del tratamiento y la relación veterinario-cliente fue estadísticamente significativo, explicando el 42,76% de la varianza del modelo. Después de controlar la gravedad y el curso de la enfermedad, ese efecto siguió siendo estadísticamente significativo y representó el 37,76 % de la varianza. Conclusiones e importancia clínica- los hallazgos respaldan la noción de que una mayor complejidad del tratamiento está relacionada con la percepción del propietario de la relación veterinario-cliente mediante una mayor carga del cuidador. Esfuerzos para reducir la carga del cuidador mediante el uso de tratamientos efectivos más simples pueden beneficiar a la relación veterinario-cliente.

Factors of Dementia Caregiver Burden Differentially Contribute to Desire to Institutionalize.

The experience of dementia caregiver burden is multidimensional. Little is known about how different aspects of burden contribute to the consideration of moving a loved one to a structured living facility. In the present study, caregiver burden (Zarit Burden Interview; ZBI) and consideration of structured living arrangements (Desire to Institutionalize Scale; DIS) were self-reported by 339 caregivers. Exploratory factor analysis was used to determine the ZBI factor structure; these factors were then examined via hierarchical linear regression for prediction of DIS. Factor analysis indicated a 4-factor ZBI solution: Impact on Life, Guilt, Embarrassment/Frustration, and Escape/Uncertainty. Regression analyses indicated that only Escape/Uncertainty (p < .001) was associated with DIS. Of the 4 identified factors of caregiver burden, desire to escape the caregiving role was most related to consideration of structured living arrangements. Future work should explore longitudinal contribution of this factor to determine its role in actual changes made in living arrangements.

Owner quality of life, caregiver burden and anticipatory grief: How they differ, why it matters.

BACKGROUND: Understanding client perspective is important for veterinary communications, particularly during problem visits. Key client experiences of caregiver burden, anticipatory grief and quality of life (QoL) have been previously examined in this context, but never simultaneously considered. METHODS: A sample of 393 owners of an elderly or seriously ill companion animal was recruited online to complete cross-sectional measures of psychosocial function, companion animal presentation and demographics. RESULTS: Exploratory factor analysis demonstrated that owner caregiver burden, anticipatory grief and QoL reflect distinct constructs. Cluster analysis showed these experiences occur in four separate owner profiles: 'distressed', 'resilient', 'non-distressed' and owners experiencing strain due to 'other influences'. These groups appear to be differentially influenced by various factors, such as the companion animal's QoL, nature of the illness and the owner's attachment. They also show distinct differences in consideration of euthanasia and emotional functioning, including experience of stress and depressive symptoms. CONCLUSIONS: Constructs of caregiver burden, anticipatory grief and QoL are not interchangeable and may differentially impact owner decisions and behaviour. The veterinarian's understanding of owner profiles relevant to these issues and distinguishing underlying features may foster effective communication.

Development of an assessment measure for sexual disinhibition in dementia.

OBJECTIVE: Sexual disinhibition (SD), a neuropsychiatric symptom characterized by sexually inappropriate comments and/or behaviors, remains under identified in dementia, possibly due to a lack of standardized assessment methods. A recent systematic review of measures used to assess SD proposed four behavioral domains and identified the need for a population-specific measure. The present study addressed this by examining the underlying factor structure of SD to create a new caregiver-report measure. METHODS: Dementia caregivers (n = 622) recruited online were randomly assigned to Initial Validation (n = 311) or Cross-Validation (n = 311) groups. RESULTS: Initial Validation revealed five behavioral domains that served as provisional scales for cross-validation, leading to measure development. CONCLUSIONS: The current study is the first to statistically evaluate the underlying factor structure of SD, resulting in a new measure that can help better characterize and identify SD.

Treatment complexity and caregiver burden are linked in owners of dogs with allergic/atopic dermatitis.

BACKGROUND: Skin disease severity and treatment plan complexity are both related to owner experience of caregiver burden; however, to date they have not been examined simultaneously in owners of dogs with atopic or other chronic allergic dermatitis. HYPOTHESES/OBJECTIVES: We expected to replicate and extend previous work by showing that caregiver burden is linked to treatment complexity and disease severity in this population. Moreover, we hypothesized that a relationship between burden and treatment complexity would be present in both subjective (owner report of experience) and objective (number of weekly treatments) measures, and that these relationships would exist independent of skin disease severity. PARTICIPANTS: Eighty-six owners of dogs with atopic or other chronic allergic dermatitis recruited through social media dog allergy groups. METHODS AND MATERIALS: Cross-sectional online assessments were completed for caregiver burden, treatment plan complexity and skin disease severity. RESULTS: Caregiver burden was correlated with skin disease severity (r = 0.40) and both subjective (r = 0.37) and objective (r =0.30) measures of treatment complexity (P < 0.01 for all). Relationships between caregiver burden and treatment complexity remained significant after accounting for skin disease severity. CONCLUSIONS AND CLINICAL IMPORTANCE: Greater treatment plan complexity is associated with higher caregiver burden in owners of dogs with atopic or other chronic allergic dermatitis. The independence of this relationship highlights the importance of simplicity in effective treatment planning.

Varying roles of glucoregulatory function measures in postprandial cognition following milk consumption.

PURPOSE: Past work suggests milk consumption may facilitate cognition in children and college students with higher fasting glucose compared to other beverages (e.g., fruit juice). However, no studies have evaluated this phenomenon in adults, or considered other measures of glucoregulatory function. This open-label study assessed the role of glucoregulatory function in postprandial cognition after milk intake in adults. We hypothesized participants with lower fasting or post-consumption plasma glucose following a glucose excursion challenge (glucose response) would demonstrate better cognition following beverages of higher (juice) versus lower (milk) or no (water) glycemic content. METHODS: Forty-four nondiabetic, overnight-fasted adults attended three laboratory visits, ingesting 237 mL of 2% fat milk, apple juice, or water at each visit in a randomized, counterbalanced, crossover design. Participants completed cognitive testing (CNS Vital Signs) at baseline and 30, 90, and 150 min post-ingestion; primary outcomes were CNS Vital Signs composite scores. Fasting and post-consumption plasma glucose levels were assessed, with glucose response indexed as the change in plasma glucose from baseline to 30 min after juice (ΔGlucose). RESULTS: Mixed modeling revealed participants with higher fasting glucose demonstrated better complex attention after water versus juice at 30 min, but better performance after juice versus water at 150 min (p = 0.02). Participants with a larger ΔGlucose demonstrated better processing speed (p = 0.01) 30 min after milk versus water; this effect also reversed at 150 min. CONCLUSION: Different methods of measuring glucoregulatory function reveal its differing roles in postprandial cognition. Time since ingestion may also determine which beverages best optimize cognition.

Early caregiver burden in owners of pets with suspected cancer: Owner psychosocial outcomes, communication behavior, and treatment factors.

BACKGROUND: Owners of companion animals with serious illnesses are likely to experience "caregiver burden." This topic has not been fully evaluated in veterinary oncology. OBJECTIVES: To examine owners of a dog or cat with suspected cancer for relationships between early caregiver burden and (a) psychosocial factors: depression, stress, and quality of life; (b) owner communication behavior; and (c) specific pet treatment plan factors. ANIMALS: None. METHODS: This cross-sectional, observational study recruited 164 owners of a cat or dog presenting for evaluation by a veterinary oncology service at a single referral institution. Measures of caregiver burden, psychosocial function, treatment plan elements, and demographics were collected online via owner self-report. Medical records were reviewed to identify factors including diagnosis, medications, treatment schedules, and owner communications. RESULTS: Caregiver burden correlated with higher stress (rs = 0.40, P < .001), greater symptoms of depression (rs = 0.50, P < .001), and lower quality of life (rs = 0.39, P < .001). Pet treatment plan factors related to caregiver burden included changes in care routines, perception that compliance with new routines was challenging, and difficulty adhering to medication routines. There was low correlation between caregiver burden and owner-driven communications (rs = 0.15, P = .07). CONCLUSIONS AND CLINICAL IMPORTANCE: Findings suggest caregiver burden is similar in owners of pets with cancer and owners of pets with other diseases. Caregiver burden is present in the earliest stages of disease. Major correlates of burden including life-disruptive treatments and schedules provide key areas for potential intervention by veterinary teams.

Euthanasia from the Veterinary Client's Perspective: Psychosocial Contributors to Euthanasia Decision Making .

End-of-life decision making for a companion animal relies on the veterinarian acting as educator and counselor. However, little research has been conducted to understand client variables in this context. The current study examined potential client-related contributors to steps taken toward a euthanasia decision. Caregiver burden, anticipatory grief, depression, stress, and income all correlated positively with this outcome. However, when client factors were examined in a regression model controlling for animal quality of life, only caregiver burden and income emerged as significant predictors. All 3 caregiver burden factors: general strain, affective/relational discomfort, and guilt/uncertainty were significantly related to consideration of euthanasia.

The Role of Sexual Disinhibition to Predict Caregiver Burden and Desire to Institutionalize Among Family Dementia Caregivers.

Neuropsychiatric symptoms in dementia are associated with greater caregiver burden and desire to institutionalize, though previous work largely examines the cumulative effects of many behavioral symptoms. Sexual disinhibition could be particularly stressful due to stigma attached to these behaviors. Links between care recipient sexual disinhibition, caregiver burden, and caregiver desire to institutionalize were examined by analyzing cross-sectional data from 730 family caregivers recruited online. Caregiver burden, caregiver desire to institutionalize, and neuropsychiatric symptoms, including sexual disinhibition, were assessed via caregiver report. Burden (P < .001) and desire to institutionalize (P = .008) were greater among caregivers who endorsed sexual disinhibition. Sexual disinhibition uniquely predicted desire to institutionalize after accounting for presence (P = .02) and severity (P = .03) of other neuropsychiatric symptoms. A similar pattern was seen for burden (presence P < .04; severity P = .06), and follow-up analyses revealed caregiver burden mediated the relationship between care recipient sexual disinhibition and caregiver desire to institutionalize (presence bias-corrected 95% confidence intervals [BCa 95% CI] [0.003, 0.08], severity BCa 95% CI [0.007, 0.06]). Sexual disinhibition appears to be a particularly difficult neuropsychiatric symptom for the family caregiver, contributing to desire to institutionalize via caregiver burden.

Measurement of sexual disinhibition in dementia: A systematic review.

Sexual disinhibition in dementia is correlated with multiple negative care recipient and caregiver outcomes but remains largely overlooked in the literature. Its prevalence is not well understood, with studies reporting between 1.8% and 25% presence of sexual disinhibition in dementia samples. One reason for the variability in the reported presence of sexual disinhibition may be lack of standardized methods for assessment. Several widely used measures for neuropsychiatric symptoms do not include items to assess sexual disinhibition. When measures do include sexual disinhibition, it is not addressed in a consistent manner. Inconsistency in how questions about sexual disinhibition are phrased is problematic, given that recent work shows it can differentially influence endorsement. Working toward a gold standard of sexual disinhibition measurement in dementia is needed. To this end, a systematic review of the literature to identify potentially appropriate instruments for measurement of sexual disinhibition in this population was conducted through the Web of Science and PubMed databases between January 2019 and February 2019. An overview of the 20 measures identified in this search is provided. Each measure is evaluated for appropriateness of use in dementia samples through broad examination of psychometric properties, structure, and format and the extent to which measure content overlaps with current conceptualizations of sexual disinhibition in dementia. Five common content domains were identified: hypersexuality, lewd/aberrant sexual behavior, inappropriate sexual advances, inappropriate sexual comments, and socially disruptive sexual behavior. No single measure addressed all content domains. Directions for future research are identified and discussed.

Validation of an abbreviated instrument to assess veterinary client caregiver burden.

BACKGROUND: Caregiver burden is present in many clients managing illness in a companion animal, but current assessment tools are time-consuming and lack normative reference values. OBJECTIVES: Statistical reduction of items in a measure of caregiver burden to create an abbreviated version, validation of the abbreviated version, and calculation of reference values. ANIMALS: None. METHODS: This study was conducted using observational methods. Owners of an ill cat or dog were recruited through social media (n = 429). Veterinary clients with an ill (n = 459) or healthy (n = 961) cat or dog were recruited through a general veterinary and an academic hospital with multiple specialties. The study was conducted in 3 stages: (a) reduction of the Zarit Burden Interview (ZBI) adapted for use in pets via factor and item analyses, (b) psychometric validation of the abbreviated instrument, and (c) standardization of the abbreviated (7 items) and full (18 items) measures. RESULTS: A 7-item measure showed high correlations with the full measure (r = 0.88-0.93) and good internal consistency (α = .71-.75) across samples of veterinary clients with an ill cat or dog. This abbreviated measure correlated significantly (P < .001) and positively with stress (r = 0.40-0.75) and negatively with quality of life (r = -0.32 to -0.56). Reference values derived from clients with a healthy companion animal suggest "normal" burden ranges of 0 to 17 on the full measure and 0 to 8 on the abbreviated version. CONCLUSIONS AND CLINICAL IMPORTANCE: For situations precluding full assessment of client caregiver burden, this brief 7-item version can be used with good internal consistency and validity. Reference values can help determine if a client's caregiver burden is increased.