Caregiver Burden and Dementia: A Systematic Review of Self-Report Instruments.

BACKGROUND: As the demand for dementia care grows rapidly worldwide, heavy "caregiver burden" has been associated with stress and depression. Even so, standard metrics for interdisciplinary research of caregiver burden are limited. OBJECTIVE: The objective of the present review is to recommend valid, reliable, and comprehensive self-report instruments of caregiver burden. METHODS: A systematic review was performed using four databases, searched in April 2021. Articles that established or evaluated self-report instruments for dementia caregiver burden were included, while studies that involved non-dementia caregivers or did not clearly define caregiver burden were excluded. Established guidelines for reliability and agreement studies were used to assess quality and risk of bias. Assessments of self-report instruments were made based on reliability, validity, feasibility, and quality of psychometric evaluations, and comparative evaluations were presented in visual form using radar graphs. RESULTS: Search terms yielded 1,720 articles, and 40 were included in the systematic review after excluding those of low quality. Based on the results of these studies, we recommend the Zarit Burden Interview, Screen for Caregiver Burden, Caregiver Burden Interview, and Burden Scale for Family Caregivers, due to their validity, reliability, and inclusion of multiple subjective and objective dimensions of burden. CONCLUSION: Targeting specific sources of caregiver burden can help prevent negative outcomes for both dementia patients and caregivers. Future studies should apply self-report instruments to measure and address caregiver burden longitudinally.

A Longitudinal Study on the Association of Interrelated Factors Among Frailty Dimensions, Cognitive Domains, Cognitive Frailty, and All-Cause Mortality.

BACKGROUND: Cognitive frailty integrating impaired cognitive domains and frailty dimensions has not been explored. OBJECTIVE: This study aimed to explore 1) associations among frailty dimensions and cognitive domains over time and 2) the extended definitions of cognitive frailty for predicting all-cause mortality. METHODS: This four-year cohort study recruited 521 older adults at baseline (2011-2013). We utilized 1) generalized linear mixed models exploring associations of frailty dimensions (physical dimension: modified from Fried et al.; psychosocial dimension: integrating self-rated health, mood, and social relationship and support; global frailty: combining physical and psychosocial frailty) with cognition (global and domain-specific) over time and 2) time-dependent Cox proportional hazard models assessing associations between extended definitions of cognitive frailty (cognitive domains-frailty dimensions) and all-cause mortality. RESULTS: At baseline, the prevalence was 3.0% for physical frailty and 37.6% for psychosocial frailty. Greater physical frailty was associated with poor global cognition (adjusted odds ratio = 1.43-3.29, ß: -1.07), logical memory (ß: -0.14 to -0.10), and executive function (ß: -0.51 to -0.12). Greater psychosocial frailty was associated with poor global cognition (ß: -0.44) and attention (ß: -0.15 to -0.13). Three newly proposed definitions of cognitive frailty, "mild cognitive impairment (MCI)-psychosocial frailty," "MCI-global frailty," and "impaired verbal fluency-global frailty," outperformed traditional cognitive frailty for predicting all-cause mortality (adjusted hazard ratio = 3.49, 6.83, 3.29 versus 4.87; AIC = 224.3, 221.8, 226.1 versus 228.1). CONCLUSION: Notably, extended definitions of cognitive frailty proposed by this study better predict all-cause mortality in older adults than the traditional definition of cognitive frailty, highlighting the importance of psychosocial frailty to reduce mortality in older adults.

Efficacy of an educational intervention on students' attitudes regarding spirituality in healthcare: a cohort study in the USA.

OBJECTIVE: To determine if an educational intervention focused on the role of spirituality in healthcare positively affects medical students' attitudes and perceptions relating to this topic. DESIGN: A pre-post cohort study. SETTING: An undergraduate medical institution affiliated with an academic medical center in the USA. PARTICIPANTS: A total of 110 medical students currently on their clinical rotations received the educational intervention, of whom 71 (65%) completed both the presurvey and postsurvey. Demographic variables did not significantly differ from the national average of medical students, or from a comparison group. All students who attended the intervention were given the opportunity to participate in the survey. INTERVENTIONS: The educational intervention consisted of a 60-minute lecture focusing on religion/spirituality (R/S) in healthcare, followed by a 90-minute case discussion in a small group setting. PRIMARY AND SECONDARY OUTCOME MEASURES: Assessment consisted of 18-item preintervention and postintervention survey quantifying student's attitudes towards, comfort with, and perceptions of R/S in healthcare. RESULTS: Attitudes towards, comfort with, and perceptions of R/S in healthcare were generally positive preintervention. Following the intervention, students expressed an increased willingness to include R/S competency in their future practice (p=0.001), were more comfortable sharing their own R/S beliefs with a patient when appropriate (p=0.02), and were more willing to approach a patient with R/S concern (p=0.04). The other surveyed attitudes demonstrated positive, but non-significant improvement. CONCLUSION: An educational intervention focusing on approaching patients with R/S concerns has the ability to improve the attitudes and comfort of medical students. By incorporating a total of 150 minutes of education about R/S, medical schools can help develop this particular area of cultural competence, preparing a generation of physicians to professionally approach R/S concerns of patients. Future research should move beyond quantifying attitudes and strive to understand changes in knowledge and student behaviour.