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1.
J Adv Nurs ; 77(5): 2278-2292, 2021 May.
Article in English | MEDLINE | ID: mdl-33434343

ABSTRACT

AIMS: The "Finding a Balance Point" framework was used to explore the caregiving process over time for family caregivers of people with dementia in Taiwan. This study aimed to: (a) identify Taiwanese caregivers' different balance trajectories; (b) explore predictors of trajectory group membership; and (c) examine associations of different balance trajectories with caregiving outcomes. DESIGN: A correlational longitudinal design was used. METHODS: Data were collected from 200 family caregivers' self-completed questionnaires and they were followed over 2 years (June 2015-May 2017). Discrete balance trajectories were identified by group-based trajectory modelling. Predictors of trajectory group membership were identified from potential predictors of caregiving characteristics and caregiving factors using multivariate logistic regression. Associations of trajectory groups with caregiving outcomes (depressive symptoms and health-related quality of life) were explored using the generalized estimating equation. RESULTS: Balance trajectories best fit a two-group trajectory model (poor and good). Caregivers with a poor sense of balance between competing needs were more likely to have more depressive symptoms (b = 11.71, 95% CI [9.04, 14.38], p < .001), worse physical health (b = -6.22, 95% CI [-8.71, -3.74], p < .001), and worse mental health (b = -11.1, 95% CI [-13.58, -8.63], p < .001) than caregivers with a good sense of balance. Caregivers experiencing lower role strain (b = -1.45, SE = 0.48, p = .003) or higher predictability (b = 2.83, SE = 0.76, p < .001) were more likely to belong to the good-balance group. CONCLUSIONS: Caregivers with poor balance between competing needs are more likely to have worse caregiving outcomes. Role strain and predictability significantly predicted balance trajectory groups. Family caregivers with lower caregiving task difficulty and/or better knowledge of the care receiver were more likely to be in the good balance trajectory group. IMPACT: Our findings support the framework, "Finding a Balance Point," and clarify the family caregiving process for people with dementia. This framework could be used to tailor interventions for home care nurses to improve family caregivers' caregiving outcomes.


Subject(s)
Dementia , Quality of Life , Caregivers , Family , Humans , Longitudinal Studies , Taiwan
2.
J Nurs Res ; 28(4): e99, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32501963

ABSTRACT

BACKGROUND: Employed family caregivers are affected by job demands, which can affect quality of care provided to recipients. However, it is important to understand how job demands and the ability to reconcile employment and caregiving influence family caregivers' quality of life. PURPOSE: The aim of this study was to examine the extent to which job demands influenced quality of life for employed family caregivers of older adults with dementia in Taiwan. METHODS: This cross-sectional study analyzed secondary data from self-completed questionnaires collected from December 2010 to December 2011. Participants were 214 employed family caregivers of older adults with dementia in Taiwan. How job demands and caregiving influence quality of life was determined with hierarchical multiple regression analysis. Job demands included working hours, workplace inflexibility, work inefficiency, and difficulty in reconciling work and family caregiving. RESULTS: After controlling for demographics, caregiving resources, and caregiving role demands, employed family caregivers of older adults with dementia with fewer working hours and greater work efficiency reported significantly better quality of life (ß = -.130, p = .049; ß = -.263, p < .001) than those with more working hours and less work efficiency. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Employed family caregivers of older adults with dementia who had more working hours and less work efficiency had a greater likelihood of poorer quality of life than other employed family caregivers. Clinicians could use these findings to identify groups at high risk for poor quality of life. We suggest developing policies and interventions to help employed family caregivers of older adults with dementia to reduce working hours and improve work efficiency in order to improve quality of life, which could also improve quality of care for recipients.


Subject(s)
Caregivers/psychology , Dementia/nursing , Job Satisfaction , Quality of Life/psychology , Aged , Aged, 80 and over , Caregivers/standards , Caregivers/statistics & numerical data , Cross-Sectional Studies , Employment/psychology , Employment/standards , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Taiwan
3.
Geriatr Nurs ; 39(6): 676-682, 2018 11.
Article in English | MEDLINE | ID: mdl-29859698

ABSTRACT

Many family caregivers are also employed full- or part-time and are known to be affected by job demands. This study explored the mediating effect of job demands on the relationship between caregiving demands and caregiver health outcomes in primary family caregivers of older persons with dementia in Taiwan (N = 214). A cross-sectional design using a self-completed structured questionnaire was implemented. Structural equation modeling analyses showed that job demands partially mediated the relationship between caregiving demands and caregiver health outcomes. The indirect effect of caregiving demands on caregiver health outcomes through job demands was 0.208 (95% confidence interval: 0.053 - 0.335). Nurses should evaluate job demands when screening for high-risk caregiver groups vulnerable to high caregiving demand. Interventions aimed at lessening both caregiving demands and job demands may improve caregiver health outcomes for family caregivers of older adults with dementia.


Subject(s)
Caregivers/statistics & numerical data , Dementia/nursing , Employment/psychology , Health Status , Adaptation, Psychological , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Latent Class Analysis , Male , Middle Aged , Surveys and Questionnaires , Taiwan
4.
J Adv Nurs ; 73(12): 2962-2972, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28816364

ABSTRACT

AIMS: To examine the role of balancing competing needs in the relationship between caregiving demand and caregiving outcomes (caregivers' role strain and depressive symptoms). BACKGROUND: Caregivers who do not balance competing needs are more likely to experience negative caregiving outcomes, suggesting that balance mediates between caregiving demand and caregiving outcomes. Identifying a mediator of negative caregiving effects may help in developing tailored interventions for family caregivers of persons with dementia. DESIGN: A cross-sectional, correlational design. METHODS: Data were collected from family caregivers' self-completed questionnaires between March 2013 - April 2014. A convenience sample of 120 family caregivers and care receivers with dementia was enrolled. We examined whether balance mediated the relationship between caregiving demand and caregiving outcomes (caregivers' role strain and depressive symptoms) by multiple regression analysis. To evaluate the significance of the indirect effect of caregiver balance, we used the Sobel test and Monte Carlo method, an alternative approach to testing mediation. RESULTS: Balancing competing needs completely mediated the association of caregiving demand with depressive symptoms and partially mediated the association of caregiving demand with role strain. CONCLUSION: Assessing caregivers' self-perceived sense of balance may help to identify caregivers at high risk for role strain and depressive symptoms. Interventions to enhance caregivers' perceived sense of balance between competing needs may provide a strategy for reducing the negative effects of caregiving.


Subject(s)
Caregivers/psychology , Dementia/nursing , Depression/psychology , Family/psychology , Aged , Aged, 80 and over , Cross-Sectional Studies , Humans , Middle Aged
5.
Res Nurs Health ; 37(4): 336-46, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24934578

ABSTRACT

The Finding a Balance Scale, designed to measure the degree to which caregivers can balance the competing demands of caregiving and other priorities, assists health care providers in understanding the process of family caregiving. The aim of this study was to examine the scale's psychometric properties and determine an appropriate cutoff score for identifying caregivers at high risk for poor caregiving consequences. We found adequate reliabilities and appropriate validities in a convenience sample of 197 family caregivers of elders with dementia in Taiwan. The optimal cutoff was also determined. The validated Finding a Balance Scale provides an assessment tool to explore the competing responsibilities, conditions, and difficulties for family caregivers of elders with dementia in Taiwan.


Subject(s)
Activities of Daily Living/psychology , Adaptation, Psychological , Caregivers/psychology , Dementia/nursing , Family/psychology , Frail Elderly , Psychometrics , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Dementia/psychology , Female , Humans , Male , Middle Aged , Risk Factors , Stress, Psychological , Surveys and Questionnaires , Taiwan
6.
J Adv Nurs ; 69(5): 1051-62, 2013 May.
Article in English | MEDLINE | ID: mdl-22776026

ABSTRACT

AIM: To report the moderating effects of work-related conditions and interactive family-care-giving variables, including mutuality and preparedness, on caregiver role strain and mental health for family caregivers of patients with dementia. BACKGROUND: Few studies have examined the interrelationships among caregivers' working conditions, care-giving dynamics and caregiver well-being. DESIGN: Cross-sectional, correlational study. METHODS: Data were collected by self-completed questionnaires from 176 primary family caregivers of patients with dementia in Taiwan from May 2005-January 2006. Caregiver role strain and mental health were analysed by multiple regressions using a hierarchical method to enter independent variables and two- and three-way interaction terms after controlling for caregiver age and gender, employment status, and work flexibility and the simple effect of each independent variable. RESULTS: More preparedness was associated with less role strain for family caregivers with less work/care-giving conflict. More care-giving demand was associated with poorer mental health only for caregivers with low work/care-giving conflict and with average and low preparedness, but not high preparedness. For family caregivers with less work/care-giving conflict, more preparedness decreased role strain and maintained mental health even when care-giving demand was high. CONCLUSION: These results provide a knowledge base for understanding complex family caregiver phenomena and serve as a guide for developing interventions. Future studies with longitudinal follow-ups are suggested to explore actual causal relationships.


Subject(s)
Caregivers , Conflict, Psychological , Dementia/nursing , Aged , Cross-Sectional Studies , Humans , Reproducibility of Results
7.
J Adv Nurs ; 67(4): 829-40, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21077933

ABSTRACT

AIMS: This paper is a report of a study that examined the effects of work demands, including employment status, work inflexibility and difficulty reconciling work and family caregiving, on role strain and depressive symptoms of adult-child family caregivers of older people with dementia. BACKGROUND: Family caregivers also employed for pay are known to be affected by work demands, i.e. excessive workload and time pressures. However, few studies have shown how these work demands and reconciliation between work and family caregiving influence caregivers' role strain and depressive symptoms. METHOD: For this cross-sectional study, secondary data were analysed for 119 adult-child family caregivers of older people with dementia in Taiwan using hierarchical multiple regression. RESULTS: After adjusting for demographic characteristics, resources and role demands overload, family caregivers with full-time jobs (ß=0.25, P<0.01) and more difficulty reconciling work and caregiving roles (ß=0.36, P<0.01) reported significantly more role strain than family caregivers working part-time or unemployed. Family caregivers with more work inflexibility reported more depressive symptoms (ß=0.29, P<0.05). CONCLUSION: Work demands affected family caregivers' role strain and depressive symptoms. Working full-time and having more difficulty reconciling work and caregiving roles predicted role strain; work inflexibility predicted depressive symptoms. These results can help clinicians identify high-risk groups for role strain and depression. Nurses need to assess family caregivers for work flexibility when screening for high-risk groups and encourage them to reconcile working with family-care responsibilities to reduce role strain.


Subject(s)
Caregivers/psychology , Dementia/nursing , Depression/psychology , Employment/psychology , Role , Adolescent , Adult , Adult Children/psychology , Aged , Aged, 80 and over , Caregivers/statistics & numerical data , Child , Conflict, Psychological , Cross-Sectional Studies , Dementia/psychology , Employment/statistics & numerical data , Female , Humans , Male , Middle Aged , Parents/psychology , Regression Analysis , Stress, Psychological/etiology , Taiwan/epidemiology , Workload/psychology
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