Lise Lachance

“Learning to Become a Family Caregiver” Efficacy of an Intervention Program for Caregivers Following Diagnosis of Dementia in a Relative

PURPOSE The purpose of this experimental study was to test the efficacy of a psychoeducational individual program conceived to facilitate transition to the caregiver role following diagnosis of Alzheimer disease in a relative. DESIGN AND METHODS Caregivers were recruited in memory clinics and randomized to an experimental group (n = 62) or a control group (n = 49) receiving usual care. Eligible participants-primary caregivers of a relative diagnosed with Alzheimer in the past 9 months-were assessed blindly before randomization, at the end of the program (post-test), and 3 months later (follow-up) on different outcomes associated with healthy role transition. RESULTS The analyses indicated that at post-test and follow-up, caregivers in the experimental group were more confident in dealing with caregiving situations, perceived themselves to be better prepared to provide care and more efficacious in their caregiver role, were better able to plan for the future care needs of their relative, had better knowledge of available services, and made more frequent use of the coping strategies of problem solving and reframing. The program had no significant effect on use of stress-management strategies, perceived informal support and family conflicts. IMPLICATIONS This program underscores that a proactive intervention approach from the onset of the care trajectory is key to fostering caregiver adaptation to the new challenges they must meet.

Challenges associated with transition to caregiver role following diagnostic disclosure of Alzheimer disease: A descriptive study

BACKGROUND The prevalence of Alzheimers disease is rising. The large number of new cases identified each year means that many new families will set upon a long trajectory of caring for a relative with dementia. Diagnostic disclosure of Alzheimers disease marks the official transition to the caregiver role, yet this early period of the caregiver career have rarely been studied. OBJECTIVES Based on Meleiss theoretical framework for role transition, the objectives of this study were to document the characteristics of the caregiving context during the transition to the caregiver role following diagnostic disclosure of Alzheimers disease and to compare these characteristics by caregiver gender and kinship tie to the relative. DESIGN SETTINGS AND PARTICIPANTS A descriptive design was used. Data were collected using standardized measures selected in accordance with the role transition theoretical framework. The sample recruited in Quebec (Canada) cognition clinics comprised 122 caregivers of an elderly relative diagnosed with Alzheimers disease in the past nine months. RESULTS Findings reveal the context of care to be marked by several challenges for caregivers. The majority of caregivers receives little informal support, has poor knowledge of available formal services, and has difficulty planning ahead for the relatives future care needs. Caregivers themselves report a lack of preparedness to provide care. Compared with men caregivers, women seem to have more problems controlling disturbing thoughts about their new caregiver role and to experience more family conflicts and psychological distress. Compared with offspring caregivers, spouse caregivers are less able to respond to the relatives disruptive behaviors, make less use of problem-solving strategies, and report fewer family conflicts. CONCLUSIONS The challenges faced by caregivers during the transition to the caregiver role are sensitive to nursing interventions. Pro-active interventions from the outset of the caregiving career, such as early assessment of caregiver needs for support and of caregiver preparedness to provide care as well as early psycho-educational interventions, are essential to foster positive caregiver responses to the challenges of their new role.

Burnout, psychological distress, and overwork: the case of Quebec's ophthalmologists

BACKGROUND Studies have shown that physicians are subject to high stress levels that can lead to mental health problems. Ophthalmologists are facing particularly high pressures because of shortages in their number and lack of resources. This study describes the state of mental health of Quebecs ophthalmologists and identifies certain elements of their work environment and personal lives that may contribute to problems. METHODS This cross-sectional study uses self-report questionnaires, including validated instruments, as well as instruments created for the study. A total of 133 out of 266 Quebecs ophthalmologists participated in the study. RESULTS More than 35% of ophthalmologists reported high levels of burnout and psychological distress. The 5 main occupational stressors were growth in demand for services (49.2%), shortage of ophthalmologists (48.1%), amount of work to be done (45.4%), budgetary pressures (44.6%), and repeated training of new work teams (41.9%). Self-acceleration is the defensive strategy used most often to deal with work overload. Nearly half (47.4%) reported having problems reconciling work and personal life. The mean scores indicate that ophthalmologists received little recognition from administration. INTERPRETATION Work overload and systemic organizational deficiencies are burdening ophthalmologists in Quebec. They constantly work harder to preserve their professional ideals, but they receive little recognition from the administration. The levels of distress observed in this context point to the need for the authorities to take action to improve practice conditions. The situation is urgent because population aging has already begun to cause a sharp increase in demand, and younger physicians appear to be suffering most from work overload and burnout.

Older Husbands as Caregivers Factors Associated With Health and the Intention to End Home Caregiving

The purpose of this study, based on Pearlin et al.s model, was to determine the factors associated with the health of older husband caregivers and with their intention to end home caregiving for their wives. The results showed subjective stressors to be associated with outcomes. Role overload was linked to psychological distress and to lower self-perceived health, whereas role captivity was associated with psychological distress and the intention to end home caregiving. The likelihood of ceasing home caregiving increased when caregivers reported high relational deprivation. A high percentage of the variance in psychological distress was explained (51%). The quality of prior husband-wife relationships, the frequency of disruptive behaviors, family conflicts, and self-efficacy were associated with this variable. Selfefficacy had a mediating effect between subjective stressors and psychological distress, whereas the number of services received had a moderating effect on the intention to end home caregiving among husbands with high role captivity. This study provides avenues for interventions sensitive to male caregivers.

Changes in Health Outcomes among Older Husband Caregivers: A One-Year Longitudinal Study:

This one-year longitudinal study carried out on a sample of 232 older husband caregivers sought to describe changes in psychological distress and self-perceived health, and to examine relationships between factors drawn primarily from Pearlins model of caregiving and changes in these two health outcomes. Prediction analyses shows that nearly two thirds of the husbands have unsuccessful outcomes with respect to these two dimensions, that is, most husbands obtain either steadily poor scores at both times of the study or worse scores on one or both outcomes. Higher levels of education and informal instrumental support at time 1, as well as an increase in role overload, are predictive of unsuccessful outcome for psychological distress, whereas an increase in self-efficacy predicts successful outcome for self-perceived health. Overall, husband caregivers vary in their response to caregiving over time. The findings support previous study results showing subjective stressors, rather than objective stressors, and caregiver resources to be significant predictors of caregiving outcomes.

Psychopathological manifestations of children with intellectual disabilities according to their cognitive and adaptive behavior profile.

Children with intellectual disabilities show deficits in cognitive abilities and adaptive behavior which increase the risk of psychopathological disorders. This exploratory study aims at delineating profiles of children based on their cognitive functioning and adaptive behaviors, and to compare them on psychopathological manifestations. A cognitive assessment and an evaluation of adaptive behaviors are conducted with 52 school-age children receiving services from a rehabilitation center for people with intellectual disabilities. Adaptive behaviors are evaluated by a special educator and a questionnaire concerning psychopathology is filled out by a parent and a teacher. Cluster analyses highlight three profiles among children: Performing, Uncooperative and Non-performing. They differ on cognitive functions, collaboration and in terms of practical abilities of adaptive behaviors. Chi-square tests show significant differences in social competences, but not in problematic behaviors, according to the viewpoint of parents and teachers. Potential explanations are provided to understand the absence of significant differences in problematic behaviors between the three profiles.

Predicting longitudinal patterns of psychological distress in older husband caregivers: further analysis of existing data.

Further analysis of existing data from a previous longitudinal study of older husband caregivers sought to determine whether primary objective and subjective stressors drawn from Pearlins model of caregiving could predict three patterns of psychological distress observed in the sample over 1 year: (a) stable high (n = 115), (b) stable low (n = 44), and (c) rising (n = 46). Results of discriminant function analyses show that subjective stressors (level of role overload, role captivity and relational deprivation) at baseline, distinguish the stable low group of husbands from the stable-high. The results suggest that there is considerable stability over time. Many husband caregivers report high-psychological distress and need help, whereas there is a need of preventive interventions to keep psychological distress low. Implications for singular interventions that target specific factors according to group membership are discussed.

A Comparative Descriptive Study of Characteristics of Early- and Late-Onset Dementia Family Caregivers:

Characteristics of early- and late-onset dementia family caregivers were described and compared. Based on a theoretical model of role transition, data were collected through structured interviews from 48 caregivers of adults with Alzheimer’s disease or a related dementia older than the age of 70 and 48 caregivers of similarly diagnosed adults younger than the age of 60. A significantly higher proportion of caregivers of younger adults were spouses and gainfully employed compared with those of older adults; they had more years of schooling, took care of a person with more severe impairments, received more help, perceived themselves as better prepared to deal with future needs, and better informed about services. They did not differ from caregivers of older adults in terms of psychological distress, role confidence, self-efficacy, and social support. This study highlights differences and similarities to be considered in the development of services tailored to the specific needs of each group.

Empirical Testing of a Longitudinal Model Derived from the Roy Adaptation Model

This article presents the steps and results of the empirical testing of a theoretical longitudinal model, derived from Roys nursing conceptual model, of the psychosocial determinants of adaptation in different target groups. The model was elaborated and empirically verified based on the integrated results of four longitudinal studies involving groups vulnerable to mental health problems. By means of structural equation analyses, the cross-sectional model was verified at two points in time. The results showed that the model was relatively stable over time. The model was also tested using longitudinal data. Results showed little consistency in the patterns of relationships across studies. The significant links that emerged from the analyses shed some light on the complexity of the process of adaptation to different types of stressors. They underscore the importance for nursing practice to develop interventions aimed at certain variables: perceived stress, conflicts in the exchange of support, and passive and avoidance coping strategies. The results also highlight the importance of the relationship between perceived stress, passive/avoidance coping strategies and psychological distress.

A one-year follow-up study of family caregivers of institutionalized elders with dementia

The purpose of this one-year follow-up study was to determine whether the caregiving experience of primary caregivers (N = 142) of institutionalized demented elders changed over time and to identify the factors predictive of caregiver well-being after a year. Based on the stress and coping model of Lazarus and Folkman, five dimensions of this experience were considered: caregivers’ stressors, their cognitive appraisal of these stressors, social support, coping strategies and well-being (psychological distress and positive affect). MANOVA and t test results revealed that two stressors changed over time. The elders’ functional impairment deteriorated and their depressive behaviors decreased. However, there was no change in the appraised disturbance associated with these stressors. Conflicts in informal social support decreased significantly, but there was no change in well-being. More formal support at T1 was predictive of decreased psychological distress and increased positive affect at T2. A coping strategy, the use of affective regulation at T1, was also predictive of increased positive affect at T2. Knowledge of the caregiving experience over time and of predictors of caregiver well-being provides guidelines for interventions that could be directed at this clientele by health care workers in institutional settings.