INFANCY, Issue 4 2003
Amy Vaughan
Little is known about variables that may contribute to individual differences in infant joint attention, or the coordination of visual attention with a social partner. Therefore, this study examined the contributions of caregiver behavior and temperament to infant joint attention development between 9 and 12 months. Data were collected from 57 infants using a caregiver,infant paradigm, an infant,tester paradigm, and a parent report of infant temperament. Nine-month measures of caregiver scaffolding and infant initiating joint attention (IJA) with testers were significantly related to 12-month infant IJA with testers. A temperament measure of positive emotional reactivity was related to 9-month IJA, and a measure of negative emotional reactivity was related to 12-month IJA. Temperament and caregiver scaffolding measures, however, were not associated with the development of infant responding to joint attention. These results further the understanding of the multiple processes that contribute to joint attention development in infancy, and support the hypothesis that initiating and responding measures tap different aspects of joint attention development. [source]

Caregiver Understanding of Adolescent Development in Residential Treatment

JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 4 2002
Susan Kools PhD
PROBLEM Caretaker knowledge and understanding of adolescent development and its application to clinical practice with severely emotionally disturbed adolescents in residential treatment. METHODS Twenty child-care workers and registered nurses participated in semistructured interviews analyzed using dimensional analysis, a grounded theory method. FINDINGS Three distinct categories of caregivers were identified based on level of expertise and engagement in developmentally appropriate treatment practices: inexperienced, party-liners, and transcenders. Developmental issues identified included lack of resident preparation for puberty and staff discomfort with adolescent sexuality. CONCLUSIONS Caregiver, institutional, and social barriers to developmentally sensitive practice were identified. Practice recommendations include direct preparation of children and adolescents in residential treatment for pubertal changes and sexual development, and carefkl discernment of age-appropriate and psycho-pathological adolescent behaviors. [source]

The Family Impact of Atopic Dermatitis in Children: The Role of the Parent Caregiver

PEDIATRIC DERMATOLOGY, Issue 1 2003
Rajesh Balkrishnan Ph.D.
We conducted a cross-sectional, exploratory analysis of how parent caregivers are affected by their child's AD, and how certain parent caregiver characteristics and perceptions affect the family impact of this condition. Parent caregivers of children with AD (n = 49) were administered a survey to collect detailed data on socioeconomic status, health perceptions, and caregiving issues. Family impact of the child's AD was measured using a modified AD Family Impact Scale. Multiple regression analyses revealed that three major factors associated with the parent caregiver were correlated with large increases in the family impact scores: 1) perception that the child's condition is severe (13%, p < 0.01), 2) high use of nonmedical services for child's condition (21%, p < 0.01), and 3) financial concern about the child's condition (18%, p < 0.01). These preliminary data indicate distinct characteristics of the parent caregiver that are associated with higher family impact of AD in children. These parent caregiver factors may be important in identifying suitable audiences and areas for education for optimal management of children's AD. [source]

Caregiver and patient marital satisfaction and affect following hematopoietic stem cell transplantation: a prospective, longitudinal investigation

PSYCHO-ONCOLOGY, Issue 3 2003
Shelby Langer
The process of stem cell transplantation (SCT) is both intra and inter dependent; like patients, spousal caregivers (CGs) are affected by the experience. Few empirical investigations have focused on the needs of CGs or dyadic differences over the course of adaptation,the foci of the present study. SCT recipients and spousal CGs (n=131 dyads) completed the Profile of Mood States (POMS) and the Dyadic Adjustment Scale at three time points: pre-transplant, 6 months post-transplant and 1 year post-transplant. A separate, non-medical group completed the POMS as a normative sample. CGs reported higher levels of depression and anxiety as compared to patients and non-medical norms. With respect to marital satisfaction, couples were matched in their perceptions of the relationship prior to transplantation but grew mismatched over time. Six months and 1 year post-transplant, CGs reported lower levels of marital satisfaction relative to their patient counterparts. Counter to prediction, change in CG marital satisfaction (from pre-transplant to 1 year post-transplant) was predicted only by CG gender, not patient physical, nor psychosocial characteristics. Findings offer implications for person-specific and relationship-protective interventions. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Looking for an Obstetrical Caregiver in the United States: One Woman's Experience

BIRTH, Issue 2 2000
Alison Barrows Ronn
No abstract is available for this article. [source]

Improving Heart Failure Self-Management Support by Actively Engaging Out-of-Home Caregivers: Results of a Feasibility Study

CONGESTIVE HEART FAILURE, Issue 1 2008
John D. Piette PhD
The benefits of heart failure (HF) care management have been demonstrated, yet health systems are often unable to meet patients' needs for support between outpatient visits. Informal care provided by family or friends is a low-cost, and potentially effective, adjunct to care management services. The authors evaluated the feasibility of augmenting HF care management with weekly, automated assessment and behavior change calls to patients, feedback via the Internet to an out-of-home informal caregiver or CarePartner (CP), and faxes to the patient's health care team. The program included 52 HF patient-CP pairs participating for an average of 12 weeks. Patients completed 586 assessments (92% completion rate) and reported problems that might otherwise have gone unidentified. At follow-up, 75% had made changes in their self-care as a result of the intervention. The CP program may extend the impact of HF telemonitoring beyond what care management programs can realistically deliver. [source]

Use of the Broselow Tape May Result in the Underresuscitation of Children

ACADEMIC EMERGENCY MEDICINE, Issue 10 2006
ACNP, Carolyn T. Nieman MSN
Abstract Objectives The purpose of this study was to determine the concordance of the Broselow tape with the measured heights and weights of a community-based population of children, especially in light of the increase in obesity in today's children. Methods The authors examined more than 7,500 children in a cross-sectional, descriptive study in two different cohorts of children to compare their actual weight with their predicted weight by a color-coded tape measure. Results In all patients, the percent agreement and , values of the Broselow color predicted by height versus the actual color by weight for the 2002A tape were 66.2% and 0.61, respectively. The concordance was best in infants, followed by school-age children, toddlers, and preschoolers (,= 0.66, 0.44, 0.39, and 0.39, respectively; percent agreement, 81.3%, 58.2%, 60.7%, and 64.0%, respectively). The tapes accurately predicted (within 10%) medication dosages for resuscitation in 55.3%,60.0% of the children. The number of children who were underdosed (by ,10%) exceeded those who were overdosed (by ,10%) by 2.5 to 4.4 times (p < 0.05). The tapes accurately predicted uncuffed endotracheal tube sizes when compared with age-based guidelines in 71% of the children, with undersizing (,0.5 mm) exceeding oversizing by threefold to fourfold (p < 0.05). Conclusions The Broselow tape color-coded system inaccurately predicted actual weight in one third of children. Caregivers need to take into consideration the accuracy of this device when estimating children's weight during the resuscitation of a child. [source]

Caregiver Depressive Symptoms and Observed Family Interaction in Low-Income Children with Persistent Asthma

FAMILY PROCESS, Issue 1 2008
MARIANNE CELANO PH.D.
This study examined the relationship between caregiver depressive symptoms and observed parenting behaviors and family processes during interactions among 101 urban, low-income Africtan American families with children with persistent asthma. Caregivers (primarily female) were assessed on four dimensions (i.e., warmth/involvement, hostility, consistent discipline, relationship quality) in three videotaped interaction tasks (loss, conflict, cohesion). The results indicated that increased depressive symptoms were significantly associated with lower warmth/involvement and synchrony scores and greater hostility scores during the loss and conflict tasks. In the total sample, the highest levels of hostility and the lowest levels of warmth/involvement were found for the conflict task; nevertheless, caregivers with moderate/severe depressive symptoms showed a significantly greater increase in hostility from the loss to the conflict task than caregivers with minimal/mild depressive symptoms. The findings highlight the salience of considering task content in family observational process research to expand our understanding of depressed and nondepressed caregivers' abilities to modulate appropriately their behaviors and affect across various family interactions. Implications for improving asthma management for low-income children with persistent asthma are discussed, including the utility of multidisciplinary interventions that combine asthma education with family therapy. RESUMEN Síntomas de depresión en los responsables de los niños e interacción familiar observada en niños de familias de bajos ingresos que padecen asma crónica Este estudio examinó la relación entre los síntomas de depresión de los responsables de los niños y los comportamientos paternos y dinámicas familiares observados durante interacciones entre 101 familias afronorteamericanas, urbanas y de bajos recursos, con niños que padecen asma crónica. Los responsables de los niños (la mayoría mujeres) fueron evaluados en base a cuatro criterios: calidez/implicación, hostilidad, disciplina constante, y calidad de la relación) en tres tareas de interacción grabadas en cinta de video (pérdida, conflicto y cohesión). Los resultados demostraron que el aumento de los síntomas de depresión estaban relacionados de forma significativa con una menor puntuación en calidez/implicación y comprensión mutua, y una mayor puntuación en hostilidad durante las tareas de pérdida y conflicto. En la muestra total, los mayores niveles de hostilidad y menores niveles de calidez/implicación se encontraron en la tarea de conflicto; sin embargo, los responsables con síntomas de depresión de moderados a severos mostraron un aumento mucho mayor de la hostilidad, de la tarea de pérdida a la de conflicto, que los responsables con síntomas de mínimos a leves. Los resultados enfatizan la importancia de considerar el contenido de la tarea en la investigación observacional de familias para aumentar nuestra comprensión de las habilidades de los responsables de los niños, con o sin depresión, con el fin de modular de una manera apropiada su comportamiento y afecto en diferentes interacciones familiares. Las medidas para mejorar el control del asma en niños que padecen asma crónica y provienen de familias de bajos ingresos están en debate, incluida la utilidad de intervenciones multidisciplinarias que combinen formación sobre el asma con terapia familiar. [source]

Combined effect of factors associated with burdens on primary caregiver

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2009
Hyuma Makizako
Background: It is argued that a multidimensional approach is necessary for burden assessment. Reducing caregiver burden is a social problem in the ageing Japan society. We examined the combined effect of factors affecting the care burden among community-dwelling handicapped people and their caregivers. Methods: The participants were 49 handicapped people (aged 53,104 years) who received home-visit rehabilitation, and their 49 caregivers (age 42,85 years). Caregivers were provided questionnaires consisting of questions on social support, subjective well-being, self-efficacy with regard to care continuation, the Motor Fitness Scale and caregiver burden. Care recipients were assessed using the Bedside Mobility Scale and the Barthel Index. Results: We prepared the hypothesis model using structural equation modeling with the bootstrap method within outcome measures. The hypothesis model did not fit the data well. The impact of the Motor Fitness Scale was shifted from the caregiver burden to care self-efficacy and well-being, having a cooperator for care and variable of spouse caregiver or others associated with caregiver well-being in the revised model. The fit of the revised model was acceptable (goodness of fit index, 0.903; comparative fit index, 0.998; root mean square error of approximation, 0.017). In the revised model, the care recipients' disabled state was associated with caregiver burden. In addition, higher burden and poor motor fitness of caregivers might lead to lower care self-efficacy in providing continuous care and lower caregiver well-being. Conclusion: These findings suggested that the program to reduce caregiver burden should focus on aspects of the care recipients' disabled state, the caregivers' well-being, fitness, and care self-efficacy. [source]

Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in Thailand

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2010
R. Oupra RN MSc MNS PhD
Abstract In Thailand, the crude death rate from stroke is 10.9/100 000 population and increasing. Unlike Western countries where community rehabilitation programmes have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community in Thailand. Therefore, family caregivers are the primary source for ongoing care and support. While family members accompany patients during their hospitalisation, they receive little information about how to assist their relatives, and as a result feel inadequately trained, poorly informed and dissatisfied with the support that is available after discharge. Family caregivers report that they suffer both physically and psychologically and find themselves overwhelmed with strain, experiencing burden and exhaustion. This study aimed to develop and implement a nurse-led Supportive Educative Learning programme for family caregivers (SELF) of stroke survivors in Thailand and to evaluate the effect of the SELF programme on family caregiver's strain and quality of life. This was a non-randomised comparative study with concurrent controls, using a two-group pre-test and post-test design. A total of 140 stroke survivors and 140 family caregivers were recruited; 70 patients/caregiver pair in each group. Caregivers of patients admitted to the intervention hospital following an acute stroke received the intervention, while caregivers of patients admitted to the comparison hospital received the usual care provided at the hospital. The data were collected prior to discharge of the patients and after 3 months. The family caregivers in the intervention group had a significantly better quality of life than the comparison group (GHQ-28 at discharge t = 2.82, d.f. = 138, P = 0.006; and at 3 months t = 6.80, d.f. = 135, P < 0.001) and they also reported less strain (Caregiver Strain Index at discharge t = 6.73, d.f. = 138, P < 0.001; and at 3 months t = 7.67, d.f. = 135, P < 0.001). This research demonstrated that providing education and support to the family caregiver of stroke survivors can reduce caregiver strain and enhance their quality of life. [source]

Older people , recipients but also providers of informal care: an analysis among community samples in the Republic of Ireland and Northern Ireland

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2008
Hannah M. McGee PhD
Abstract Data on both the provision and receipt of informal care among populations of older adults are limited. Patterns of both informal care provided and received by older adults in the Republic of Ireland (RoI) and Northern Ireland (NI) were evaluated. A cross-sectional community-based population survey was conducted. Randomly selected older people (aged 65+, n = 2033, mean age (standard deviation): 74.1 years (6.8), 43% men, 68% response rate) provided information on the provision and receipt of care, its location, and the person(s) who provided the care. Twelve per cent of the sample (251/2033) identified themselves as informal caregivers (8% RoI and 17% NI). Caregivers were more likely to be women, married, have less education and have less functional impairment. Forty-nine per cent (1033/2033, 49% RoI and 48% NI) reported receiving some form of care in the past year. Care recipients were more likely to be older, married, have more functional impairment, and poorer self-rated health. Receiving regular informal care (help at least once a week) from a non-resident relative was the most common form of help received [28% overall (578/2033); 27% RoI and 30% NI]. Five per cent (n = 102/2033) of the sample reported both providing and receiving informal care. Levels of informal care provided by community-dwelling older adults were notably higher than reported in single-item national census questions. The balance of formal and informal health and social care will become increasingly important as populations age. It is essential, therefore, to evaluate factors facilitating or impeding informal care delivery. [source]

Psychological Symptoms Are Greater in Caregivers of Patients on Hemodialysis Than Those of Peritoneal Dialysis

HEMODIALYSIS INTERNATIONAL, Issue 4 2003
M. Tugrul Sezer
Background:,The purpose of this study was to evaluate and compare psychosocial characteristics in caregiving relatives (caregivers) of hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods:,Thirty-three caregivers (17 women, 16 men) of HD patients, 27 caregivers (11 women, 16 men) of PD patients, and a control group of 49 subjects who do not care for family members with chronic illness (23 women, 26 men) are included in this study. The brief symptom inventory (BSI), social disability schedule (SDS), and brief disability questionnaire (BDQ) were used for the psychosocial evaluation. Results:,The mean age, men-to-women ratios, duration of education, and distribution of marital status did not differ significantly among the three groups. In addition, dialysis duration and distribution of caregiver type were not different between the HD and PD groups. Although the mean global severity index scores of the three groups were similar, somatization and depression scores from BSI subitems were greater in the HD group than the scores of the PD and control groups. Although the mean SDS and BDQ scores were higher in the HD group, the differences did not achieve statistical significance. BSI subitems such as somatization, obsession,compulsion, interpersonal sensitivity, depression, and anxiety were positively correlated among themselves. Hostility and somatization were negatively correlated with age and education, respectively. Nevertheless, somatization was positively correlated with age. Social disability was negatively correlated with duration of education. Conclusion:,Somatization and depression are greater in the caregivers of center HD patients compared to PD and control groups. According to the findings of this study, we suggest that caregiving family members of dialysis patients especially on HD also should be evaluated for psychosocial problems and supported as needed. Further studies are needed to explore whether psychosocial parameters of caregivers predict outcomes for caregivers and patients. [source]

Mother,child and father,child mutuality in two contexts: consequences for young children's peer relationships

INFANT AND CHILD DEVELOPMENT, Issue 2 2010
Eric W. Lindsey
Abstract This study examines the role that context plays in links between relative balance, or mutuality in parent,child interaction and children's social competence. Sixty-three toddlers and their parents were observed in a laboratory play session and caregiving activity (i.e. eating snack). Mutuality was operationalised as the relative balance in (a) partners' compliance to initiations, and (b) partners' expression of positive emotion. Caregivers rated children's social competence with peers, and children's prosocial and aggressive behaviour with peers was observed in their childcare arrangement. Contextual differences were observed in the manifestation of parent,child mutuality, with both mother,child and father,child dyads displaying higher mutual compliance scores in the play context than in the caregiving context. Father,child dyads also displayed higher levels of shared positive emotion during play than during the caregiving context. There were no differences in a way that parent,child mutuality during play and caregiving was associated with children's social competence with peers. Overall, the results suggest that parent,child mutuality is a quality of parent,child interaction that has consistent links to children's peer competence regardless of the context in which it occurs. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Enhancing mothers' interactions with toddlers who have sensory-processing disorders

INFANT MENTAL HEALTH JOURNAL, Issue 3 2010
Nurit Jaegermann
The objective of the current study was to examine the effects of a brief Mediational Intervention for Sensitizing Caregivers (the MISC-SP) designed to enhance the quality of mothers' interaction with their toddlers who have sensory processing disorders (SPD). The basic assumption was that quality parent,child interactions can serve as a protective factor moderating the potential negative effects of toddlers' sensory processing and regulation difficulties on their development. The effects of the intervention were compared to those of another intervention designed to enhance children's sensory functioning (the SI group) and to a control group receiving no intervention. Participants were 86 toddlers (12,18 months old) with SPD and their mothers, who were randomly assigned to the aforementioned three research groups. Following the intervention period, mothers in the MISC-SP group showed more sensitive behavior, supported their toddlers' communication behavior better, and used teaching behaviors more appropriately than did mothers in the two other groups. [source]

The impact of personal characteristics on engagement in nursing home residents with dementia

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2009
Jiska Cohen-Mansfield
Abstract Objective To examine the impact of personal attributes on engagement in persons with dementia. Methods Participants were 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia. Cognitive functioning was assessed via the Mini-Mental State Examination, and engagement was assessed via the Observational Measure of Engagement. Data pertaining to activities of daily living were obtained from the Minimum Data Set. Results Women had longer mean engagement duration than men, and significant results were not seen with the other demographic variables. Significant, positive correlations were found between higher cognitive functioning and longer engagement duration, more attention, a more positive attitude, and a higher refusal rate. There was a positive and significant correlation between the comorbidity index and engagement duration, and between the number of medications and attention. All functional status variables yielded significance in a positive direction. Participants with poor hearing had a higher refusal rate. Cognitive status was the most consistent and potent predictor of engagement in this population. Conclusion Despite a higher refusal rate among those with higher cognitive levels, their overall engagement with stimuli is higher. Caregivers should anticipate higher refusal rates in those with poor hearing, and therefore compensatory methods should be used in presenting stimuli in this population. The potent role of cognitive and functional status on engagement of persons with dementia underscores the importance of tailoring activities to nursing home residents' needs, interests, and limitations. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Caregiver preference for rivastigmine patch relative to capsules for treatment of probable Alzheimer's disease

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2007
Bengt Winblad
Abstract Background Family caregivers comprise a critical component in the care of Alzheimer's disease (AD) patients. Among their many tasks, caregivers are responsible for administering and managing medications. Effective interventions incorporate the needs of both the AD patient and the caregiver, and understanding treatment preferences may maximize intervention effectiveness. Transdermal patches may offer advantages over conventional oral formulations. Methods A 24-week randomized controlled trial compared the rivastigmine patch to the rivastigmine capsule and placebo in patients with probable AD. At baseline and Weeks 8 and 24, the AD Caregiver Preference Questionnaire (ADCPQ) was used to evaluate caregiver expectations, preferences and satisfaction with treatment. Double-dummy treatment blinding ensured that caregiver preference for the patch or capsule was not confounded by perceptions of efficacy or tolerability. Reasons for preference were also elicited. The analytic sample included caregivers who completed the ADCPQ at Weeks 8 and/or 24. Results One thousand and fifty-nine caregivers completed the ADCPQ. More than 70% of caregivers preferred the rivastigmine patch to the capsule. The patch was significantly preferred to the capsule with respect to ease of following the schedule and ease of use. Caregivers indicated greater satisfaction overall, greater satisfaction with administration, and less interference with daily life with the patch versus the capsule (all p,,,0.01). Conclusion Caregivers of AD patients preferred the patch to the capsule for drug delivery. Preference for the rivastigmine patch could potentially lead to improved compliance and improved clinical benefits. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Insights on Immunizations From Caregivers of Children Receiving Medicaid-Funded Services

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2000
Deborah B. Evers
ISSUES AND PURPOSE. Despite numerous programs aimed at improving immunization rates among American children, under-immunization remains a significant problem. This study was conducted to gain insight into parents' /guardians' knowledge and attitudes regarding childhood immunizations. DESIGN AND METHODS. Thirteen African-American mothers and grandmothers participated in semistructured, audiotaped focus-group interviews. RESULTS. Four major themes emerged: health knowledge and beliefs about immunizations, system barriers that impede obtaining immunizations, facilitators that enhance obtaining immunizations, and suggestions for change. PRACTICE IMPLICATIONS. Immunizations are one of the most important health advantages available to children. Therefore, nurses must become aware of the problem of underimmunization and work to address some of the concerns caregivers have identified in this study. The health and lives of the nation's children depend on it. [source]

Conceptions of Dementia in a Multiethnic Sample of Family Caregivers

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2005
Ladson Hinton MD
Understanding variability in conceptions of dementia in multiethnic populations is important to improve care and guide research. The objectives of this study were to describe caregiver conceptions of dementia using a previously developed typology and to examine the correlates of conceptions of dementia in a multiethnic sample. This is a cross-sectional study conducted in Boston and the San Francisco Bay area. Participants were a convenience sample of 92 family dementia caregivers from four ethnic/racial groups: African-American, Anglo European-American, Asian-American, and Latino. In-depth, qualitative interviews explored the caregivers' ideas about the nature and cause of dementia (i.e., explanatory models). Explanatory models of caregivers were categorized as biomedical, folk, or mixed (folk/biomedical). Quantitative analyses examined the association between ethnicity and other caregiver characteristics, and explanatory model type. Overall, 54% of caregivers, including 41% of Anglo European Americans, held explanatory models that combined folk and biomedical elements (i.e., mixed models). For example, many families attributed Alzheimer's disease and related dementias to psychosocial stress or normal aging. Ethnicity, lower education, and sex were associated with explanatory model type in bivariate analyses. In multiple logistic regression analysis, minority caregivers (P<.02) and those with less formal education (P<.02) were more likely to hold mixed or folk models of dementia. Although minority and nonminority caregivers often incorporated folk models into their understanding of dementia, this was more common in minority caregivers and those with less formal education. Further research on cross-ethnic differences in a larger, more-representative sample is needed. [source]

Risk Factors for Potentially Harmful Informal Caregiver Behavior

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005
Scott R. Beach PhD
Objectives: Caring for a sick or disabled relative has been linked to compromised caregiver health, and risk factors for negative caregiver outcomes have been studied extensively, but little attention has been given to care recipient and caregiver health as risk factors for potentially harmful behavior by informal caregivers. This article explores such risk factors. Design: Structured interviews from baseline assessment of the Family Relationships in Late Life Study. Setting: Three U.S. communities. Participants: Referred, volunteer sample of 265 caregiver/care recipient dyads. Caregivers were primarily responsible for care of an impaired, community-residing family member aged 60 and older and providing help with at least one activity of daily living (ADL) or two instrumental activities of daily living (IADLs). Measurements: Self-reported care recipient demographics, cognitive status, need for care, and self-rated health; self-reported caregiver demographics, cognitive status, amount of care provided, self-rated health, physical symptoms, and depression. Care recipient reports of potentially harmful caregiver behavior, including screaming and yelling, insulting or swearing, threatening to send to a nursing home, and withholding food, were the main outcome variable. Results: The following were significant risk factors for potentially harmful caregiver behavior: greater care recipient ADL/IADL needs (odds ratio (OR)=1.12, 95% confidence interval (CI)=1.03,1.22), spouse caregivers (vs others; OR=8.00, 95% CI=1.71,37.47), greater caregiver cognitive impairment (OR=1.20, 95% CI=1.04,1.38), more caregiver physical symptoms (OR=1.07, 95% CI=1.01,1.13), and caregivers at risk for clinical depression (OR=3.47, 95% CI=1.58,7.62). Conclusion: Potentially harmful caregiver behavior is more likely in spouse caregiving situations and when care recipients have greater needs for care and caregivers are more cognitively impaired, have more physical symptoms, and are at risk for clinical depression. This risk profile is similar to that for negative caregiver outcomes. [source]

Unmet Desire for Caregiver-Patient Communication and Increased Caregiver Burden

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2005
Terri R. Fried MD
Objectives: To examine the adequacy of caregiver-patient communication in serious illness and its relationship to caregiver burden. Design: Cross-sectional cohort study. Setting: Participants' homes. Participants: One hundred ninety-three persons aged 60 and older seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease and their caregivers. Measurements: Communication concerns, measured in terms of agreement with statements regarding desire for and difficulty with communication about the patient's illness. Caregiver burden, measured using a 10-item subset of the Zarit Burden Inventory, with scores ranging from 0 to 40 and higher scores indicating greater burden. Results: Of caregivers, 39.9% desired more communication, and 37.3% reported that communication was difficult. Of patients, 20.2% desired more communication, and 22.3% reported that communication was difficult. Disagreement regarding communication concerns was frequent in caregiver-patient pairs; of caregivers who desired more communication, 83.1% of patients did not, and of patients who desired more communication, 66.7% of caregivers did not. Caregivers who desired more communication had significantly higher caregiver burden scores than did caregivers who did not (9.2 vs 4.7, P<.001), even after adjusting for patient's diagnosis, income, and functional status and caregivers' age, sex, and relationship to the patient. Conclusion: A large proportion of caregivers and seriously ill older persons had an unmet desire for increased communication, although they frequently disagreed with each other about this desire. Caregivers' desire for increased communication may be a modifiable determinant of caregiver burden. [source]

Meta-Analysis of Psychosocial Interventions for Caregivers of People with Dementia

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2003
FRACP, FRANZCP, Henry Brodaty MD
OBJECTIVES: To review published reports of interventions for caregivers (CGs) of persons with dementia, excluding respite care, and provide recommendations to clinicians. DESIGN: Meta-analytical review. Electronic databases and key articles were searched for controlled trials, preferably randomized, published in English from 1985 to 2001 inclusive. Thirty studies were located and scored according to set criteria, and the interventions' research quality and clinical significance were judged. SETTING: Home or noninstitutional environment. PARTICIPANTS: Informal CGs,persons providing unpaid care at home or in a noninstitutional setting. MEASUREMENTS: The primary measures were psychological morbidity and burden. Other varied outcome measures such as CG coping skills and social support were combined with measures of psychological distress and burden to form a main outcome measure. RESULTS: The quality of research increased over the 17 years. Results from 30 studies (34 interventions) indicated, at most-current follow-up, significant benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95% confidence interval (CI) = 0.13,0.50), caregiver knowledge (ES = 0.51; CI = 0.05,0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15,0.48), and patient mood (ES = 0.68; CI = 0.30,1.06), but not caregiver burden (ES = 0.09; CI = ,0.09,0.26). There was considerable variability in outcome, partly because of differences in methodology and intervention technique. Elements of successful interventions could be identified. Success was more likely if, in addition to CGs, patients were involved. Four of seven studies indicated delayed nursing home admission. CONCLUSION: Some CG interventions can reduce CG psychological morbidity and help people with dementia stay at home longer. Programs that involve the patients and their families and are more intensive and modified to CGs' needs may be more successful. Future research should try to improve clinicians' abilities to prescribe interventions. [source]

The Quality of Life of Family Caregivers of Adults with Intellectual Disabilities in Taiwan

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2007
Yueh-Ching Chou
Background, Taiwanese family carers of people with intellectual disabilities not only suffer from long-term stress but also need to cope with social difficulties. The aim of this study is to evaluate the quality of life (QOL) among family carers of people with intellectual disabilities. Materials and methods, A census interview survey was conducted in Hsin-Chu City in Taiwan and included the primary family caregivers of 792 adults with intellectual disability who were living with their families. The survey packet contained the WHOQOL-BREF Taiwan-version scale with four core domains and the activities of daily life/instrumental activities of daily life (ADL/IADL) scales. Results, The mean score for ,physical' was highest and that for ,environment' was lowest. The strongest predictors of caregivers QOL were the caregiver's health status, their family income and the level of severity of the intellectual disability of the adult. Conclusions, The results of the study support the need to expand services and individualize support to families of adults with intellectual disability living in family homes. [source]

Barriers to Caregiver Compliance with Eating and Drinking Recommendations for Adults with Intellectual Disabilities and Dysphagia

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 2 2006
Darren D. Chadwick
Background, There is scant research on the subject of dysphagia and people with intellectual disabilities. This study explores the barriers which caregivers believe make following Speech and Language Therapists' (SLTs) dysphagia management strategies more difficult. Method, Semi-structured open-ended interviews were conducted with 46 caregivers who supported 40 intellectually disabled adults with dysphagia. Results, Caregivers perceived particular difficulties in modifying food and drinks to safe consistencies, achieving the agreed positioning during mealtimes, and in using support and prompting strategies. Problematic support and prompting strategies included difficulties with pacing correctly; facilitating people to adequately relax and concentrate; observing and prompting people to pace suitably and take safe amounts of food and drink in each mouthful. Additional barriers identified included time pressures, staff turnover and insufficient reviewing of SLT management strategies by caregivers. Conclusions, Findings suggest that additional training and monitoring is required to ensure caregivers are aware of their role and responsibility in promoting safe oral intake for adults with dysphagia and intellectual disabilities. Ongoing support is suggested for people with intellectual disabilities and dysphagia to help them understand the reasoning behind management strategies. [source]

Identifying trajectories of birth-related fatigue of expectant fathers

JOURNAL OF CLINICAL NURSING, Issue 12 2009
Ya-Ling Tzeng
Aims and objectives., The objectives of this prospective study were to identify birth-related fatigue trajectories in expectant fathers with the progress of labour and the physiological, psychological and situational factors related to specific trajectory patterns. Background., An increasing number of fathers participate in their partner's labour; however, their fatigue experience remains unclear. Previous studies have focused on overall groups without considering the possibility of between-subject heterogeneity. With an advanced data-analytic strategy, it is feasible to identify subgroup variation within the population over time. Design., A prospective, repeated measures design was used. Method., A convenience sample of 108 Taiwanese expectant fathers was followed throughout the labour process. Data were collected by visual analogue scales and self-administered questionnaires. The repeated measures of fatigue were analysed by using semi-parametric, group-based modelling. Results., Two distinct groups of individual trajectories among the expectant fathers were identified; the persistent low-fatigue group (49·2%) and the persistent high-fatigue group (50·8%). After birth, a moderate level of fatigue persisted in the high-fatigue group. The fastest period of increasing level in the persistent high-fatigue group was in the latent phase. The persistent high-fatigue group also experienced significantly more sleep difficulties prior to labour and more anxiety than the persistent low-fatigue group. Conclusions., Identifying and characterising meaningful clusters of trajectories could provide a better understanding of the birth-related fatigue experience of fathers and contributes to recognising the target client and timing for early intervention. Relevance to clinical practice., There are points in time at which professional caregiver actions may have an effect on the birth-related fatigue of fathers. Caregivers should prevent high levels of fatigue, which could accumulate as fathers accompany the women entering the labour phase. Fathers who present with high fatigue at onset of labour should receive early intervention, especially in the rapid-increasing fatigue period. [source]

ICD: a qualitative study of patient experience the first year after implantation

JOURNAL OF CLINICAL NURSING, Issue 8 2004
Helen CM Kamphuis MSc
Background., The experiences of how patients live with an implantable cardioverter defibrillator are still poorly understood. Only a few qualitative studies have investigated this phenomenon. This paper was undertaken as part of a larger project to evaluate quality of life and psychological well-being in those survivors of cardiac arrest who have received an implantable cardioverter defibrillator. Aims and objectives., The aim of this qualitative study was to explore how implantable cardioverter defibrillator recipients perceive their lives during the first year after implantation of the device. Methods., A sample of 21 patients who received an implantable cardioverter defibrillator was interviewed during three consecutive periods: one, six and 12 months postdischarge from the hospital. The semi-structured interviews were based on insights gained from a literature review. The transcripts were subjected to content analysis. Results., Analysis of the data revealed seven major categories: physical deterioration, cognitive changes, perceived social support, dependency, contact with the doctor, confrontation with mortality and uncertainty surrounding having a shock. Anxiety, uncertainty, disappointment, frustration, unexpected barriers, acceptance of and dependency on the implantable cardioverter defibrillator played a major role in the lives of implantable cardioverter defibrillator recipients. Well-being improved throughout the year. During the first months after discharge from the hospital the focus was on regaining physical health. During the early postimplantation period both the implantable cardioverter defibrillator recipient and family members had adapted to the situation. Reflection on the impact and consequences of the cardiac arrest was reported more often in the late postimplantation period. Conclusions., Content analysis is a resourceful approach giving answers to questions that have hardly been addressed within the domain of cardiology. Implantable cardioverter defibrillator recipients face a complex first year, especially the first 6 months. Cognitive deterioration and confrontation with mortality are problems that need to be researched further. Relevance to clinical practice., Caregivers are able to explain to future patients what they can expect in the first year after implantation. Caregivers may become more receptive to physical, psychological and social limitations and to emotional and social problems that occur in implantable cardioverter defibrillator recipients, enabling them to act upon them. [source]

Syndrome specificity and behavioural disorders in young adults with intellectual disability: cultural differences in family impact

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 3 2006
J. Blacher
Background This study examined whether behaviour problems and adaptive behaviour of low functioning young adults, and well-being of their families, varied by diagnostic syndrome [intellectual disability (ID) only, cerebral palsy, Down syndrome, autism], as well as by cultural group. Methods Behaviour disorders in young adults with moderate to severe ID were assessed from information provided by 282 caregivers during in-home interviews. The sample consisted of 150 Anglo participants, and 132 Latino, primarily Spanish-speaking, participants drawn from Southern California. Results Behaviour disorders and maternal well-being showed the same pattern across disability syndromes. Autism was associated with the highest scores in multiple behaviour problem areas as well as maternal reports of lower well-being. Down syndrome was associated with the lowest behaviour problem scores and the highest maternal well-being. When behaviour problems were controlled for, diagnostic groups accounted for no additional variance in maternal stress or depression. The pattern of behaviour problems and well-being did not differ by sample (Anglo vs. Latino), although level on well-being measures did. Latina mothers reported significantly higher depression symptoms and lower morale, but also higher positive impact from their child than did Anglo mothers. Conclusions Caregivers of young adults with autism report more maladaptive behaviour problems and lower personal well-being, or stress, relative to other diagnostic groups, regardless of cultural group. However, cultural differences exist in caregiver reports of depression, morale, and positive perceptions. Implications for service provision aimed at families of children with challenging behaviour problems are discussed in the context of culture. [source]

Autonomy and intellectual disability: the case of prevention of obesity in Prader,Willi syndrome

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 7 2002
R. H. van Hooren
Abstract Background The policy concerning care for people with intellectual disability (ID) has developed from segregation via normalization towards integration and autonomy. Today, people with ID are seen as citizens who need to be supported to achieve a normal role in society. The aim of care is to optimize quality of life and promote self-determination. The promotion of autonomy for people with ID is not easy and gives rise to ethical dilemmas. Caregivers are regularly confronted with situations in which there is a conflict between providing good care and respecting the client's autonomy. This becomes evident in the case of prevention of obesity in people with Prader,Willi syndrome (PWS). Method As part of a study about the ethical aspects of the prevention of obesity, in-depth qualitative interviews were conducted with the parents and professional caregivers of people with PWS. Results In analysing interviews with parents and formal caregivers, the present authors found that the dichotomy between respecting autonomy and securing freedom of choice on the one hand, and paternalism on the other, is too crude to do justice to the process of care. The stories indicated that caregivers see other options and act in other ways than to intervene without taking into account the wishes of the individual with PWS. The present authors elaborated these options, taking models of the physician,patient relationship as a heuristic starting point. They extended the logic of these models by focusing on the character of the process of interaction between caregiver and care receiver, and on the emotional aspects of the interactions. Conclusion This approach results in more attention to processes of interpretation, deliberation and joint learning. [source]

Comparison of Adaptive Behavior in Children With Heavy Prenatal Alcohol Exposure or Attention-Deficit/Hyperactivity Disorder

ALCOHOLISM, Issue 11 2009
Nicole Crocker
Background:, Adaptive behavior, the ability to respond successfully to everyday demands, may be especially sensitive to the effects of heavy prenatal alcohol exposure. Similar adaptive dysfunction is common in other developmental disorders including attention-deficit/hyperactivity disorder (ADHD). ADHD is frequently present in alcohol-exposed children and this overlap in clinical presentation makes identification of alcohol-exposed children difficult. Direct comparison of children with prenatal alcohol exposure and ADHD may yield distinct patterns of cognitive and behavioral performance and add to growing knowledge of the neuropsychological and behavioral profile of prenatal alcohol exposure. Therefore, the aim of the current study was to compare adaptive behavior in children with histories of heavy prenatal alcohol exposure (ALC), nonexposed children with ADHD (ADHD), and typically developing controls (CON). Methods:, Sixty-five children (ALC = 22, ADHD = 23, CON = 20) were selected from a larger ongoing study of the behavioral teratogenicity of alcohol. Alcohol-exposed and control participants were selected to match the ADHD subjects on age, sex, socioeconomic status, and race/ethnicity. Caregivers were administered the Vineland Adaptive Behavior Scales, a semi-structured interview, and were asked to rate their child's behavior on 3 domains of adaptive function. Data were analyzed using regression techniques. Results:, Relative to controls, children in both the ALC and ADHD groups showed adaptive behavior deficits on all 3 domains and children in the ALC group were significantly more impaired than the ADHD group on the daily living skills domain. Within the ALC group, socialization standard scores were lower at older ages. This negative relationship between age and standard scores in the ALC group was also observed on the communication domain, a finding not previously reported. Conclusions:, This study suggests that both children with prenatal alcohol exposure and children with ADHD show impairments in adaptive function relative to controls, but that the pattern of impairment differs between these clinical groups. Adaptive ability in children with prenatal alcohol exposure is characterized by an arrest in development, as evidenced by a lack of improvement with age in socialization and communication scores. In contrast, children with ADHD exhibit a developmental delay in adaptive ability as their scores continued to improve with age, albeit not to the level of control children. Continued research focused on elucidating the patterns of deficits that exist in alcohol-exposed children ultimately will lead to improved differential diagnosis and effective interventions. [source]

Caring for the Caregivers

JOURNAL OF TRAVEL MEDICINE, Issue 2 2006
Uriel Katz MD
First page of article [source]