Susan Ronaldson

Self-esteem in carers of frail older people: Resentment predicts anxiety and depression

Objectives: Anxiety and depression are major health problems for carers of frail older people. Positive reactions to caregiving have been shown to protect people against anxiety and depression. The aims of this study are to explore specific aspects of self-esteem, termed positive caregiving reactions, and examine its relationship with caregiving anxiety and depressive symptoms. Method: A cross-sectional study of a cohort of carers (n = 119) of community-living people (≥70 years) identified empirically as frail completed postal questionnaires. Positive caregiver reactions were evaluated using the self-esteem subscale (seven items) of the Caregiver Reaction Assessment (CRA). Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale. Results: Anxiety and depressive symptoms were related significantly (p < 0.05) to six of the seven CRA self-esteem items. Caregiving resentment scores were relatively low, mean score (SD) 1.79 (0.91) on a 1–5 scale with higher scores indicating more resentment: yet regression analysis revealed that this factor was the only independent predictor of anxiety and depressive symptoms (r 2 = 0.093, p = 0.044 for anxiety, and r 2 = 0.121, p = 0.041 for depression). Conclusion: The results of this study indicate that those carers who resent having to care for their frail older relative are susceptible to anxiety and depressive symptoms. This study supports the notion that there is a need for assessment of caregiving reactions in carers of frail older people.

Reactions to caregiving in frailty research

Frailty is a syndrome characterized by decreased functional ability and associated with institutionalization. Many community-living frail older people rely upon the support of a family member or friend. However, there is a paucity of research exploring the reactions to caring for older people empirically identified as frail. The objective of this study was to describe carers of community-living older people identified as frail, using accepted criteria, identify care characteristics and ascertain relationships that contribute to reactions to caregiving. A cross-section of carers of community-living frail people (≥ 70 years) completed a postal questionnaire; the Caregiver Reaction Assessment (CRA) evaluated reactions to caregiving. Ninety-three carers completed the questionnaire (68% response rate). Correlation and multivariate analysis of variance tests (MANOVA) demonstrated statistically significant relationships between several care characteristics and reactions to caregiving. Carers who provide more than 20 h of care per week and report a low self-perceived health status are susceptible to significant health and financial problems and disruption to their daily schedule. Two strategies for improving reactions to caring for persons with frailty are proposed: financial support that assists carers to improve their health status and the provision of regular formal assistance, rather than intermittent respite care.

Residential respite care is associated with family carers experiencing financial strain

Care services for older people are provided with the expectation of supporting carers in their caregiving role. The aim of the study is to investigate the association between the utilisation of care services by older people and the caregiving experience.

Reactions to caregiving during an intervention targeting frailty in community living older people

BackgroundThe demands and consequences of caregiving are considerable. However, such outcomes are not commonly investigated in the evaluation of interventions targeting frailty. This study aims to explore family carers’ reactions to caregiving during an intervention targeting frailty in community living older people.MethodA study of carers (n=119) embedded in a 12 month randomised controlled intervention targeting frailty in people 70 years or older, compared to usual care. Reactions to caregiving were measured in the domains of health, finance, self-esteem, family support and daily schedule. Anxiety and depression levels were also evaluated. Carer outcomes were measured at baseline, 6 months and 12 months and at 3 months post frailty intervention.ResultsCarers of frail older people in the intervention group showed a sustained improvement in health scores during the intervention targeting frailty, while health scores for carers of the frail older people in the control group, decreased and therefore their health worsened (F=2.956, p=0.034). The carers of the frail older people in the intervention group reported overall better health (F=5.303, p=0.023) and self-esteem (F=4.158, p=0.044), and co-resident carers reported higher self-esteem (F=4.088, p=0.046). Anxiety levels increased for carers in both intervention and control groups (F=2.819, p=0.04).ConclusionThe inclusion of carers in trials targeting frail older people may assist in the identification of at-risk carers and facilitate the provision of information and support that will assist them to continue providing care. Further research that explores the features of frailty interventions that impact on the caregiving experience is recommended.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12608000565347

A learning and teaching resource on patient self-management of chronic pain.

Objective. To develop, pilot test, and evaluate an instructional module on patient self-management for undergraduate pharmacy students in an Australian university. Design. Learning outcomes and associated content and assessment tasks were developed, featuring lecture and readings, in-class discussions, and online delivery of in-depth interviews with patients who were living with chronic pain. Assessment. Students completed a premodule and postmodule questionnaire and were further assessed by multiple-choice questions following completion of the module and again at the end of the semester. Positive changes were identified in the students’ discourse surrounding patient self-management of chronic pain. Responses to multiple-choice questions showed that knowledge was sustained over the course of the semester. Conclusions. Completion of a comprehensive module on patient self-management increased undergraduate pharmacy students’ understanding and knowledge of patients experiencing chronic pain. The module could be implemented across other healthcare disciplines.