Stress and burnout in nursing home and égida workers during COVID-19.

AIMS: Finding out whether there are differences in the levels of stress and burnout between workers providing care to dependent adults and those caring for independent older adults would provide comparative information about two different models of care. During the COVID-19 pandemic, workers caring for older adults were subjected to maladaptive situations that produced stress and burnout. DESIGN: A cross-sectional survey design using the STROBE checklist. METHODS: A total of 900 nursing home and égidas workers were assessed for stress and burnout. Data were collected online from October 2020 to February 2021, when Puerto Rico was experiencing the peak of the third wave of COVID-19. MANOVAs were performed to study the interactions between the workplace and having had COVID, the workplace and the size of institution and the workplace and position held. DATA SOURCES: October 2020 to February 2021. RESULTS: All interactions were significant. Nursing homes showed higher levels of stress and burnout when workers had undergone COVID, when the size of the institution was larger and for technical staff other services; in égidas, having undergone COVID did not influence stress or burnout, which increased when the institution was smaller and for executive staff. CONCLUSIONS: This study showed that the effects of the COVID-19 pandemic affected nursing home workers more significantly than those working in other types of residential models with independent older adults. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Applying preventive interventions aimed at reducing stress and burnout would facilitate the adaptation of workers caring for older adults and help to improve the quality of care. IMPACT: This study analysed the impact of COVID-19 on the stress and burnout of workers providing services to older adults. Nursing home workers who have had COVID-19 have higher stress and burnout. The size of the institution has a different effect depending on whether older adults are dependent or independent. Workers in institutions dedicated to the care of the older adults. REPORTING METHOD: This study has adhered to the relevant EQUATOR guidelines: STROBE. PATIENT OR PUBLIC CONTRIBUTION: During the different waves of the COVID-19 pandemic, it was difficult to establish direct contact with workers providing care to older adults; this reason made it necessary to apply online systems to obtain information. The workers appreciated the fact that the implications for stress and burnout of the situation experienced during this difficult process were investigated.

Transcranial Direct Current Stimulation Intervention in Alzheimer's Disease and Its Follow-Up.

BACKGROUND: Alzheimer's disease (AD) stands as the prevailing type of dementia, marked by gradual memory loss and cognitive decline. Transcranial direct current stimulation (tDCS) is a non-invasive method used to regulate cortical brain function and has been explored as a potential treatment for cognitive impairment. OBJECTIVE: This study aimed to compare the effects of daily home-based active or sham tDCS on cognitive function in patients with early-stage AD and its follow-up after one month. METHODS: The study involved a randomized, blinded, and controlled-placebo design, with 18 participants enrolled. The primary outcome measures were general cognitive function, immediate, and delayed recall, and executive function. Participants included in the study were randomly assigned to the anodal and sham tDCS groups. Participants were assessed before and after the intervention and one month after the end of treatment. The home-based intervention was applied for 5 consecutive days, daily. RESULTS: The results showed a significant interaction between the active and sham groups; in particular, improvements in MMSE scores, immediate memory and delayed recall were observed at one-month follow-up in the active group. CONCLUSIONS: The positive effects of tDCS on cognitive function in AD patients observed suggest that tDCS may induce long-term neuroplastic changes, leading to sustained improvements in cognitive abilities.

Culpa y bienestar en cuidadores familiares de personas mayores dependientes institucionalizadas / Guilt and well-being in institutionalized family caregivers of dependent older adult people

Antecedentes y objetivo: La experiencia de los cuidadores familiares tras el ingreso en una residencia de personas mayores ha recibido escasa atención, probablemente porque muchos cuidadores experimentan una sensación inicial de alivio emocional inicial. Sin embargo, para algunos cuidadores el ingreso en una residencia de mayores es un factor de estrés a pesar de la reducción de la carga física de los cuidados. La angustia del cuidador tras la institucionalización se ha relacionado con las nuevas cargas y retos que se encuentran en la residencia de mayores. La ambivalencia y la culpa relacionados con la decisión de institucionalización se han identificado como fuentes de estrés. Por eso, este estudio examinó el efecto de la culpa y el bienestar en el estrés percibido de cuidadores familiares de personas dependientes institucionalizadas. Materiales y métodos: Participaron 201 cuidadores familiares de personas institucionalizadas en una residencia de mayores (La Rioja, España). Se evalúo el estrés percibido, la culpa para el cuidado y el bienestar subjetivo, variables sociodemográficas y relacionadas con el cuidado. Se realizaron análisis de regresión lineal y correlaciones entre las variables. Resultados: La culpa y 5 dimensiones de bienestar (ansiedad, vitalidad, autocontrol y depresión, excepto salud general) predijeron significativamente el estrés (R2adj=0,552 [F (6, 198)=41,71; p<0,001]). El tamaño del efecto fue grande (IC del 95%: 0,461). Conclusiones: Prestar atención a los sentimientos de culpa de los cuidadores familiares durante la institucionalización es fundamental. Ello permitirá diseñar e implementar intervenciones psicosociales que mejoren la adaptación del cuidador inmediatamente después de la institucionalización. (AU)

Introduction and objective: The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons. Materials and methods: Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed. Results: Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461). Conclusions: Paying attention to family caregivers’ feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization. (AU)

[Guilt and well-being in institutionalized family caregivers of dependent older adult people]. / Culpa y bienestar en cuidadores familiares de personas mayores dependientes institucionalizadas.

INTRODUCTION AND OBJECTIVE: The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons. MATERIALS AND METHODS: Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed. RESULTS: Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461). CONCLUSIONS: Paying attention to family caregivers' feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization.

Coping and guilt in informal caregivers: a predictive model based on structural equations.

Caregivers experience great stress, and coping can be one of the factors, which determine the extent of stress. The aim of the present paper is to analyze the effects of coping strategies on distress of the older adult's caregiver, including guilt as a mediating factor in those maladaptive strategies. The sample consisted of 201 informal caregivers of institutionalized older adults. The three constructs measured were: stress, guilt, and coping strategies. Results showed that strategies that have a better ability to reduce stress are active, positive reframing and acceptance; on the contrary, behavioral disengagement, self-distraction, self-blame and venting positively predicted the feeling of guilt that facilitated the perception of stress. Given the important association obtained between the experience of guilt and psychological distress in caregivers, it could be relevant to develop psychoeducational interventions with caregivers including techniques to reduce this feeling of guilt and develop cognitive behavioral strategies that facilitate adaptation.

Factors associated with satisfaction and depressed mood among nursing home workers during the covid-19 pandemic.

AIMS AND OBJECTIVES: This paper aims to examine the satisfaction and depressed mood experienced by nursing home workers during the COVID-19 pandemic and associated variables. Specifically, to analyse the factors that may contribute to nursing home workers developing adaptive behaviours that promote satisfaction or, on the contrary, show characteristics associated with a negative mood. BACKGROUND: Nursing homes have faced unprecedented pressures to provide appropriately skills to meet the demands of the coronavirus outbreak. DESIGN: A cross-sectional survey design using the STROBE checklist. METHODS: Professionals working in nursing homes (n = 165) completed an online survey measuring sociodemographic and professional characteristics, burnout, resilience, experiential avoidance, satisfaction with life and depression. Data were collected online from April to July 2021, the time in which Spain was experiencing its fifth wave of COVID-19. Two multiple linear regression models were performed to identify salient variables associated with depressive mood and satisfaction. RESULTS: Resilience, personal accomplishment and satisfaction had a significant and negative relationship with depression and emotional exhaustion, depersonalisation and experiential avoidance had a positive relationship with depression. However, emotional exhaustion, depersonalisation and experiential avoidance had a negative and significant relationship with satisfaction and personal accomplishment, and resilience had a positive and significant relationship with satisfaction. In addition, it was found that accepting thoughts and emotions when they occur is beneficial for developing positive outcomes such as satisfaction. CONCLUSIONS: Experiential avoidance was an important predictor of the effects that the COVID-19 pandemic can have on nursing home workers. RELEVANCE TO CLINICAL PRACTICE: Interventions focusing on resources that represent personal strengths, such as acceptance, resilience and personal accomplishment, should be developed. NO PATIENT OR PUBLIC CONTRIBUTION: The complex and unpredictable circumstances of COVID's strict confinement in the nursing home prohibited access to the centres for external personnel and family members. Contact with the professionals involved could not be made in person but exclusively through online systems. However, professionals related to the work environment have subsequently valued this research positively as it analyses 'How they felt during this complicated process'.

Sense of coherence and burnout in nursing home workers during the COVID-19 pandemic in Spain.

Care staff in nursing homes work in a challenging environment, and the COVID-19 pandemic has exacerbated those challenges in an unprecedented way. On the other hand, the sense of coherence (SOC) is a competence that could help these professionals perceive the situation as understandable, manageable and meaningful. This study aims to analyse the extent to which potential risk and protective factors against burnout have affected nursing home workers during the COVID-19 pandemic and to assess the contribution of these factors to their burnout. Three hundred forty professionals who worked in nursing homes in Spain completed a survey and reported on their sociodemographic characteristics and their organisational characteristics of the job related to COVID-19, SOC and burnout. Multiple linear regression analyses were performed. The results showed that the SOC is highly related to the dimensions of burnout and is a protective factor against this. In addition, the increase in hours has a negative effect, facilitating inadequate responses to stressful situations; and whereas perceived social support and availability of resources have a protective effect, the deterioration in mental and physical health is the most important risk factor. This study could help better understand the psychological consequences of the effort that nursing home workers and can also help design mental health prevention and care interventions for workers that provide them with resources and supports that foster their coping skills.

Features and psychometric properties of the Montreal Cognitive Assessment: Review and proposal of a process-based approach version (MoCA-PA).

The current study presents a rapid review of the psychometric features of the standard Montreal Cognitive Assessment (MoCA), and the proposal for a modified version of the test, informed by the methodology of the Boston Process Approach to neuropsychological assessment. In order to aid the process of identification of the primary underlying neurocognitive mechanism responsible for defective test performance, the MoCA-Process-Based Approach (MoCA-PA) adds complementary or satellite test conditions in some of its subtests, includes "new" qualitative indices to capture the cognitive processes involved in each cognitive task, and incorporates new qualitative classifications of error subtypes. It provides concurrent assessment of multiple cognitive processes within each task, without significantly increasing administration time or placing significant additional burden upon the respondent. We present preliminary results obtained from an initial sample of 45 community-dwelling older adults attending a University program for seniors. Results suggest the usefulness of additional indices in providing additional information on cognitive deterioration that may be overlooked with the only consideration of quantitative scores. Future research will aim to collect normative data for different clinical populations using the newly developed indices in order to determine the validity and clinical utility of the relatively novel qualitative process-based methods used in the MoCA-PA.

Relationship Between Personality Traits, Generativity, and Life Satisfaction in Individuals Attending University Programs for Seniors.

Personality traits of older adults and their contribution to life satisfaction and generative interest were assessed. A total of 342 older participants (66% women), mean age = 67.89 years old ( SD = 6.52, range = 55-84 years old), who attended the University of the Experience in Salamanca (Spain), were evaluated. Information on sociodemographic data, perceived health and activity, personality traits, generativity, and life satisfaction was collected using self-reported questionnaires. Results confirmed a relation between personality traits, life satisfaction, and generativity. In addition, generative concern, neuroticism, extraversion, agreeableness, and conscientiousness predicted life satisfaction at this stage. Moreover, the role of personality on generativity was confirmed. Individuals with interest and agreeableness toward others, who are organized, persistent, and motivated, are more predisposed to generativity. These results open the way to develop intervention programs that enhance positive personality traits and generative interest to improve quality of life of older people.

Differences between young and old university students on a lexical decision task: evidence through an ex-Gaussian approach.

This work compared two common variants of a lexical decision task (LDT) through two different analysis procedures: first, the classical ANOVA method, and second, by fitting the data to an ex-Gaussian distribution function. Two groups of participants (old and young university students) had to perform, blocks of go/no-go and yes/no tasks. Reaction times and error rates were much lower in the go/no-go task than in the yes/no task. Changes in the ex-Gaussian parameter related to attention were found with word frequency but not with the type of LDT tasks. These findings suggest that word frequency shows an attentional cost that is independent of age.