Do Inflammation Markers Moderate Associations Between Caregiving and Quality of Life, Health, and Depression?

Caregiving responsibilities can put stress and strain on older adults including emotional distress, depression, decline in physical functioning, and decreased self- reported quality of life. Chronic stress such as from caregiving may be related to chronic inflammation, but this has been less widely examined. Therefore, the purpose of this study is to examine whether the association between caregiving and outcomes including quality of life indicators, self-rated health, and depressive symptoms are moderated by physical activity, stress coping, diet quality inflammatory index, and selected biomarkers of inflammation. We used data from waves 3 and 4 of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, from which 1945 participants identified as caregivers. Caregiver participants were mostly African American (59%) and female (55%) with a mean age was 47.7 years at the start of the study. In linear regression models, caregiving for grandchildren (CGC) predicted higher depressive symptoms and lower quality of life and self-rated health. Results demonstrated that the association between erythrocytes sedimentation rate (ESR) was a significant moderator between CGC and quality of life, self-rated health, and depressive symptoms (p<.05). Serum magnesium levels were significant moderators between caregiving for parents and both quality of life and self-rated health (p<0.05). These results suggest that inflammatory factors may influence the health of diverse older adult caregivers. Further research may evaluate the effect of these moderators over time.

The Relationship between Burden and Financial Factors for Help-Seeking Older Adult Caregivers

Older adult caregivers often experience unique financial challenges (Schultz & Eden, 2016). The purpose of the present study was to explore the relationship between caregiver finances and caregiver burden for this sample. A sample of 131 caregivers seeking counseling services completed questionnaires assessing demographics, care recipient functioning (ADLs/IADLs), and finances (yearly income, impact of caregiving on finances). A majority, 74.8% of caregivers, indicated financial burden since caregiving. A hierarchical multiple regression was computed to predict caregiver burden. The caregiving characteristics block explained 8.1% of the total variance in caregiver burden, F(7, 123) = 1.54, n.s. Specifically, being younger was significantly associated with more caregiver burden. Adding the care recipient functioning block explained an additional 6.9% of the variance in caregiver burden, Fchange(2, 121) = 4.93, p < .01. The caregiving characteristics and care recipient functioning model accounted for 15% of the total variance in caregiver burden, F(9, 121) = 1.55, p < .05. Again, younger age uniquely predicted greater caregiver burden. Lastly, caregiving finance factors contributed an additional 13.5% of the variance, Fchange(4, 117) = 5.54, p < .001. Thus, the final caregiver characteristics, care recipient functioning, and caregiving finances model accounted for 28.5% of the total variance in caregiving burden, F(13, 117) = 3.59, p < .001. Specifically, having less income and greater monthly expenses related to caregiving predicted higher levels of caregiver burden. These findings imply that those with fewer resources may benefit from intervention for the heavier burden they perceive compared to peers with more financial resources.

Engaging Isolated Hispanic and Latino Older Adult Caregivers in Remote Behavioral Interventions

Recruiting Hispanic/Latino older adults for behavioral clinical trials is challenging, particularly those who are isolated. This presentation describes the recruitment process and feasibility/acceptability outcomes for the adaptation of two interventions (Connect for Caregivers and Engage Coaching) aimed at improving the social relationships and supports of older adult Hispanic/Latino caregivers of a family member with dementia. We compare online and community-based recruitment methods for English and Spanish-speaking Hispanic/Latino caregivers across the United States and present recruitment challenges during COVID-19. Of eligible participants, 82% were identified via online (e.g., research registry) and 18% via community-based (including snowball sampling) methods. Of participants recruited via online methods, 22% were Spanish-speaking, versus 100% of those recruited by community-based methods. Overall, 91% of all eligible/interested participants enrolled in at least one of the interventions. We discuss further the feasibility/acceptability of study procedures and the interventions, as the study was conducted remotely (via phone/Zoom) due to COVID-19.

Medication Management Among Older Adults With Multiple Chronic Conditions: What Role Do Caregivers Play?

Many older adults manage multiple chronic conditions (MCC) that require adherence to complex medication regimens. Few studies have investigated the degree to which caregivers support medication-related behaviors. We conducted semi-structured qualitative interviews with 25 caregivers of older adults with MCC to characterize caregiver medication assistance. Two coders used content and constant comparative analysis to analyze transcripts. The mean age of caregivers was 61 years; the majority were female (68%) and identified as non-white (Black, 52%; Hispanic, 8%). Caregivers were predominantly spouses (n=10), or children (n=11). Older adults were on average 73 years old, managing 5 chronic conditions and prescribed 7 medications. Caregivers acknowledged the importance of medications to the older adult’s health, but their involvement in daily medication management was limited. Some caregivers preferred that the older adult continue these tasks to maintain autonomy, especially when caring for older adults who valued maintaining independence. Caregivers assumed medication responsibilities after older adults experienced sudden changes in health or upon observing non-adherence (e.g. full pill bottles). Older adults with higher medication burden (12+ medicines) adopted inefficient, cumbersome medication management practices; caregivers suggested simplified strategies, but the older adults refused to adopt recommended strategies. To combat resistance from the older adult, caregivers disguised assistance and deployed workaround strategies to monitor medication-taking behaviors. These findings suggest older adults and caregivers share a value of promoting independence of medication management, up until safety is seriously questioned. Additionally, there is a breakdown in communication at the time when older adults may benefit from increased caregiver involvement.

Development and Validation of an Implicit Relational Assessment Procedure (IRAP) to Measure Implicit Dysfunctional Beliefs about Caregiving in Dementia Family Caregivers

Caregivers of people with dementia who endorse dysfunctional beliefs about caregiving are at high risk of experiencing higher levels of distress. These dysfunctional beliefs are presented in the form of rules, verbal statements that specify what responsibilities one should expect in order to be a “good caregiver,” and are characterized as rigid, unrealistic, or highly demanding. Previous studies relied exclusively on self-report measures when assessing such dysfunctional beliefs about caregiving. The objectives of this study were: 1) to develop and validate an Implicit Relational Assessment Procedure (IRAP) to measure implicit dysfunctional beliefs about caregiving (CARE-IRAP), and 2) considering the relatively high age of the sample, to analyze the adaptation of the IRAP for older adults, comparing the IRAP performance between older adult caregivers and middle-aged caregivers. Participants were 123 dementia family caregivers with a mean age of 62.24 ± 12.89. Adaptations were made to the IRAP by adjusting the accuracy and response time criteria. The sample was split into middle-aged caregivers (below 60 years) and older adult caregivers (60 or older). The CARE-IRAP scores presented significant positive correlations with explicit measures of dysfunctional beliefs about caregiving and experiential avoidance in caregiving. A similar pattern of results was observed across the two age groups. The results revealed that caregivers endorse implicit dysfunctional beliefs about caregiving and offer preliminary support for the use of the IRAP as a valid measure of implicit caregiving beliefs. This exploratory study is the first to adapt the IRAP criteria to older adults, and future studies should further explore criteria suitable for this population.

Systematic Review of Exercise for Caregiver–Care Recipient Dyads: What Is Best for Spousal Caregivers—Exercising Together or Not at All?

Background and Objectives Though exercise for care recipients receives considerable emphasis, few dyadic studies focus on caregivers. This systematic review identified dyadic exercise interventions, which measured outcomes for older adult caregivers. Studies that met inclusion criteria were examined to better understand whether caregivers derived greater benefit from exercising with care recipients, or not exercising at all. Research Design and Methods PRISMA guidelines were followed to identify quantitative studies of dyadic exercise interventions in which caregivers enrolled with care recipients, and either coparticipated in exercise; or while their care recipients exercised independently, caregivers received a separate, nonexercise intervention or usual care (UC). To be included, studies had to measure physical or psychosocial outcomes for caregivers. Study quality was assessed via the Downs and Black checklist. Results Eleven studies met inclusion criteria. In six, the dyad exercised; in five, care recipients exercised while caregivers received a separate program, or UC. Results suggest that caregivers may improve both psychosocial and physical health when exercising together with care recipients. Caregivers who did not exercise but received a separate, nonexercise intervention, such as support, education, or respite, showed psychosocial benefits. Those who received UC were less likely to derive physical or psychosocial benefits. Included studies were fair to good quality with moderate to high risk of bias. Discussion and Implications Often examined secondarily, caregivers are overlooked for participation in interventions with care recipients. This analysis suggests that caregivers may benefit from dyadic interventions in which they either exercise together with their care recipients or receive a separate nonexercise intervention or respite.

Older Adult Caregivers’ Experiences in an Online, Interactive Mindfulness Intervention

Background. While today’s older adults experience longevity, they often manage several chronic conditions and increasingly serve as informal caregivers for aging parents, children with life-long disabilities, and spouses. Older adult caregivers managing personal chronic illness often experience significant psychosocial hardships. Objective. The primary purpose of this study was to explore the experiences of older adult caregivers in an online, interactive mindfulness intervention. Methods. Self-reported older caregivers who participated in an online-based mindfulness program (n = 20) were recruited for semi-structured interviews. Participants were asked to provide feedback about any previous experience with mindfulness and/or meditation, hopes or goals held prior to the start of the program, desired expectations, motivation for joining, impressions of sessions, most beneficial topics, potential application of content, and any perceived effects. Participants’ responses were analyzed using qualitative content analysis. Results. Five themes emerged from the analysis: Managing the Comprehensive Effects of Caregiving, Openness to Meditation and Mindfulness, Course Engagement and Incremental Growth, Building Rapport through Shared Experiences, and Ongoing Application and Opportunities for Refinement. Participants reported both short-term post-exercise benefits such as increased calm, relaxation, and stress relief, as well as long-term positive outcomes. Notably, participants found the program’s unique interactive feature to be particularly beneficial as a form of perceived social support. Conclusions. Caregivers for older adults may derive benefit and potentially experience reduced subjective caregiver burden as a result of participating in a Mindfulness-Based Stress Reduction (MBSR) program, particularly when the program is augmented with a self-compassion approach and perceived social support.

DETERMINANTS OF PHYSICAL AND MENTAL HEALTH AMONG LGBT OLDER ADULT CAREGIVERS

Caregivers experience chronic stress that can negatively affect their health, resulting in lower quality of life. This study aims to understand the physical and mental health of caregivers by examining modifiable risk and protective factors. Life experiences of LGBT older adults are considered. In the longitudinal study, Aging with Pride: National Health Aging, Sexuality and Gender Study, approximately one third (31%, n=754) of LGBT older adults (50+ years) provide care: 38% to partner/spouse, 29% friends, 20% other relatives, and 8% ex-partner/ex-spouse. Linear regression models examined the effects of risk and protective factors at T0 on health outcomes at T2. Mastery, physical activity, and nutrition predicted better physical functioning, lower mental distress, and higher health-related quality of life (HRQOL). Social participation and support, community engagement, and lower identity stigma predicted better mental health. Microaggression predicted lower physical HRQOL. Interventions enhancing protective factors may promote physical and mental health of LGBT caregivers.