Caregiving in Older Adulthood and Meaning in Life

While most of the literature on caregiving in adulthood focuses on grandparenting, there is an increasing trend of older adults providing care to an adult care recipient. Older caregivers are often females who are providing care to a spouse with medical conditions and are often doing so while coping with their own functional limitations, with limited support. Within the older adult literature, studies have captured the strain experienced by caregivers of older adults, who are often burdened by the loss of time and opportunity as a result of caregiving. For caregivers in older adulthood however, caregiving may be an avenue to remain engaged and active, and a way to have purpose in life. Therefore, the purpose of this study was to examine the association between caregiving in older adulthood and meaning in life. Data from the 2018 National Health and Aging Trends study were used, which is an annual longitudinal panel survey of Medicare beneficiaries in the United States. Chi square tests were used for bivariate analyses and a logistic regression model was used to predict meaning in life based on caregiving status. After accounting for all other explanatory variables, caregivers were 50% more likely to have meaning in life compared to non-caregivers (OR=1.501, CI= 1.493-1.510). This indicates that caregiving can be a form of meaningful/productive engagement for older adults and interventions should focus on providing adequate emotional and financial support to older caregivers.

Mixed-Methods Study on Caregiver Strain, Quality of Life, and Perceived Health

Background: Caring for someone with dementia is associated with negative and positive experiences. There is little evidence based on large datasets. Objective: To present data around the experience of caring for someone with dementia, to identify support (emotional and practical) needs, and inform future service provision. Methods: A mixed-methods study embedded in the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) Randomized Controlled Trial. We administered questionnaires on strain, quality of life (QoL), and perceived health to 301 caregivers and assessment of cognitive performance, depression, anxiety, and disability in activities of daily living to 301 participants with dementia. Data were analyzed through descriptive and modelling statistics. A subsample of 20 patient-caregiver dyads were qualitatively interviewed. Data around caregivers’ experience of providing care were extrapolated and analyzed through inductive thematic analysis. Results: There were significant negative associations between caregiver strain and QoL (p < 0.01) and between caregiver age and QoL (p < 0.01), and significant positive associations between caregiver strain and disability (p < 0.01), cognitive impairment (p < 0.01), depression (p < 0.05), and anxiety of the person with dementia (p < 0.05). Older caregivers reported a lack of support, reinforced by their reluctance to seek help. All caregivers reported contradictory emotions associated with caring and accumulation of strain over time. Conclusion: While there is recognition that it is essential to support caregivers, dedicated intervention programs, and support strategies to respond to the needs of older caregivers are still needed.

Predictors of caregiver burden in aged caregivers of demented older patients

Background Dementia in the oldest-old is projected to increase exponentially as is the burden of their caregivers who may experience unique challenges and suffering. Thus, we aim to investigate which factors are associated with older caregivers’ burden in caring demented outpatients in a multicenter cohort. Methods Patients and their caregivers, both aged ≧65 years, in the National Dementia Registry Study in Taiwan (T-NDRS) were included in this study. Caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). The correlations between the ZBI scores and characteristics of caregivers and patients, including severity of dementia, physical comorbidities, instrumental activities of daily living (IADL), neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory (NPI), and family monthly income, were analyzed. Results We recruited 328 aged informal caregiver-patient dyads. The mean age of caregivers was 73.7 ± 7.0 years, with female predominance (66.8%), and the mean age of patients was 78.8 ± 6.9 years, with male predominance (61.0%). Multivariable linear regression showed that IADLs (β = 0.83, p < 0.001) and NPI subscores of apathy (β = 3.83, p < 0.001)and irritability (β = 4.25, p < 0.001) were positively associated with ZBI scores. The highest family monthly income (β = − 10.92, p = 0.001) and caregiver age (β = − 0.41, p = 0.001) were negatively correlated with ZBI scores. Conclusions Older caregivers of older demented patients experience a higher care burden when patients had greater impaired functional autonomy and the presence of NPI symptoms of apathy and irritability. Our findings provide the direction to identify risky older caregivers, and we should pay more attention to and provide support for these exhausted caregivers.

Association between perceived social support and better cognitive performance among caregivers and non-caregivers

ABSTRACT Objective: to identify the association between the characteristics of the support network and cognitive performance of older caregivers and compare characteristics between caregivers and non-caregivers. Methods: we evaluated 85 older caregivers and 84 older non-caregivers registered with primary care units regarding sociodemographic characteristics, cognition, and social support. Multiple linear regression analysis was performed. Results: among non-caregivers, significant associations were found between a better cognitive performance and receiving emotional/affectionate support; each one-point increase in the emotional support score and affectionate support score was related to a 0.43-point and 0.39-point increase in cognitive assessment, respectively. Among older caregivers, each one-point increase in the emotional support score was related to a 0.55-point increase in cognitive assessment. Conclusion: strengthening the support networks of older caregivers and encouraging satisfactory exchanges of social support can assist in improving cognitive performance, which can have a positive impact on caregivers’ health.

The Influence of Social Roles on the Well-Being of Older Caregivers: Social Isolation as a Potential Mediator

Engagement in productive roles has been associated with better health in later life. According to identity accumulation theory, more social roles help individuals be more socially integrated, leading to enhanced psychological well-being by diminishing the risk of focusing their energy into a single role. However, less is known about the mechanisms behind the relationship between productive roles and mental health of older caregivers. The aims of this study are to examine: (1) the association between productive social roles and psychological well-being for caregivers and non-caregivers, and (2) the mediating effect of social isolation on this relationship. The study analyzed 3,951 community-dwelling Medicare beneficiaries ages 65 or above from Rounds 1 to 3 of the National Health and Aging Trends Study (210 caregivers, 3,741 non-caregivers). Multiple-group analysis for structural equation modeling was conducted to compare caregivers to non-caregivers. For both caregivers and non-caregivers, having a volunteer role increased well-being, while paid employment was not significantly associated with well-being. Social isolation mediated neither employee nor volunteer role with well-being for both caregivers and non-caregivers. Assuming that volunteering for others without monetary compensation brings meaning in life, this finding supports the provision of services (e.g., respite care) that could supplement caregiving time, allowing caregivers to have more freedom to use the time in such community-engaging roles. Even though self-rated health was controlled, there is a chance that healthier individuals engage in productive roles. Thus, reciprocal relationships between productive roles and health should be considered in future investigations.

Caring for older dependent people in low and middle-income countries: the effect of age on mental health in caregivers

Background: Older people worldwide are living with chronic health problems, of whom 80% are from low and middle-income countries. Caregiver stress is a complex interplay of health and socio-economic factors with older caregivers; however, the effects of caregiver age upon their mental health have not been well-described. This study aimed to examine whether caregiver age predicts their mental health outcomes in terms of psychological morbidity and care burden in Latin America and China. Methods: The present study was based on cross-sectional baseline data of seven low and middle-income countries: Cuba, the Dominican Republic, Peru, Venezuela, Mexico, China, and Puerto Rico. Data were collected between February 2003 and June 2009 by the 10/66 Dementia Research Group. Data from 1348 households where the caregiver provided care for one older person in the household were included in the current analysis. Psychological morbidity was assessed through the Self-Reporting Questionnaire. The Zarit Burden Inventory was used to measure the levels of care burden of caregivers. Multivariate logistic regression was used to investigate the effects of caregiver age upon psychological morbidity and care burden. Meta-analysis was performed to obtain a pooled estimate of overall odd ratios and 95% confidence intervals of the analyses from the different countries, using the inverse-variance weighted fixed-effect method.Results: The prevalence of households with older caregivers is almost at the same level as that of households with younger caregivers in Puerto Rico and China. The models unadjusted and adjusted for all potential covariates (household size, number of household assets, caregiver sex, caregiver marital status, caregiver education, cognitive impairment of older person, functional dependency of older person, behavioural problems of older person, and caregiving hours) showed that there was no statistically significant difference in psychological morbidity and care burden between older caregivers and non-older caregivers across countries. The adjusted pooled estimates, however, indicated lower psychological morbidity among older caregivers (OR = 0.61, 95% CI: 0.41–0.93, I2 = 0.0%).Conclusions: Older caregivers are at lower risk of mental health problem than younger caregivers. This information may help to provide a greater understanding for service support, policy makers, and health care providers.

Predictors of Caregiver Burden in Aged Caregivers of Demented Older Patients

BackgroundDementia in the oldest-old is projected to increase exponentially as is the burden of their caregivers who may experience unique challenges and suffering. Thus, we aim to investigate which factors are associated with older caregivers’ burden in caring demented outpatients in a multicenter cohort.MethodsPatients and their caregivers, both aged ≧65 years, in the National Dementia Registry Study in Taiwan (T-NDRS) were included in this study. Caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). The correlations between the ZBI scores and characteristics of caregivers and patients, including severity of dementia, physical comorbidities, instrumental activities of daily living (IADL), neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory (NPI), and family monthly income, were analyzed.ResultsWe recruited 328 aged informal caregiver-patient dyads. The mean age of caregivers was 73.7± 7.0 years, with female predominance (66.8%), and the mean age of patients was 78.8±6.9 years, with male predominance (61.0%). Multivariable linear regression showed that IADLs (β=0.83, p<0.001) and NPI subscores of apathy (β=3.83, p<0.001)and irritability (β=4.25, p<0.001) were positively associated with ZBI scores. The highest family monthly income (β= -10.92, p=0.001) and caregiver age (β= -0.41, p=0.001) were negatively correlated with ZBI scores.ConclusionsOlder caregivers of older demented patients experience a higher care burden when patients had greater impaired functional autonomy and the presence of NPI symptoms of apathy and irritability. Our findings provide the direction to identify risky older caregivers, and we should pay more attention to and provide support for these exhausted caregivers.