Psychosocial factors and caregiver burden among primary family caregivers of frail older adults with multimorbidity.

BACKGROUND: Provision of care for frail older adults with multiple chronic diseases (multimorbidity) poses increasing challenge for family caregivers. Our study aims to evaluate to what extent caregiving competence, social support and positive aspects of caregiving can mitigate the effect of burden experienced by family caregivers of frail older adults with multimorbidity. METHODS: A descriptive cross-sectional study was conducted in 2 primary care clinics. Family caregivers of older adults aged 65 years and above were invited to complete interviewer-administered questionnaires. Descriptive statistics were used to describe sociodemographic and clinical data. Caregiver's burden was measured using the Zarit Burden Interview (ZBI). Mann-Whitney U test was used to compare differences in Caregiving Competence Scale (CCS), short Positive Aspects of Caregiving (S-PAC) and modified Medical Outcome Study Social support (mMOS-SS). Multivariable logistic regression was used to analyse factors associating with caregiver burden. RESULTS: A total of 188 participants were recruited. 71.8% reported caregiver burden (ZBI score ≥ 10). Caregivers who perceived burden had significantly lower CCS, S-PAC and mMOS-SS scores than those who did not (10.0 vs 11.6; 26.8 vs 29.8; 24.8 vs 31.4, p < 0.001 respectively). Factors significantly associated with higher odds of perceived burden were presence of alternative caregivers (OR 3.3, 95% CI 1.09, 10.19, p = 0.04), use of community resources (OR 4.4, 95% CI 1.15, 16.83, p = 0.03) and time spent caregiving per week (OR 1.1, 95% CI 1.02, 1.10, p = 0.003). DISCUSSION AND CONCLUSION: This study found that caregivers had high perception of burden as demand in caregiving may increase. Anticipating caregiver burden and social support needs may be important part of managing these frail older adults.

Sarcomatoid renal cell carcinoma metastatic to the breast: report of a case with diagnosis on fine needle aspiration cytology.

BACKGROUND: Tumors metastatic to the breast are a rare occurrence. The correct identification is essential as there are divergent management implications. Fine needle aspiration cytology (FNAC) is an effective method of diagnosis when coupled with the judicious use of immunocytochemistry. CASE: A 50-year-old Indian woman presented with a palpable right breast lump that was clinically suspicious for malignancy. There were no contralateral breast masses or palpable axillary lymphadenopathy. There was a history of nephrectomy carried out several years earlier for renal cell carcinoma (RCC). FNAC of the right breast lump yielded malignant epithelioid and occasionally spindled cells within an inflamed background, while immunocytochemistry showed positive reactivity of tumor cellsfor CD10, with negative staining for CK7. The cytologic diagnosis favored a tumor of renal origin. The patient underwent wide central excision of the right breast lump, whereby the diagnosis of metastatic RCC with sarcomatoid features was confirmed. On follow-up, she developed metastases to multiple organ sites and died. CONCLUSION: A high index of suspicion is required in the diagnosis of disease metastatic to the breast. FNAC is a reliable diagnostic tool in the distinction of metastasis from primary malignancy of the breast.