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      Challenges and Strategies for Hospice Caregivers: A Qualitative Analysis

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          Abstract

          Family caregivers of hospice patients are responsible for the day-to-day care of their loved ones during the final months of life. They are faced with numerous challenges. The purpose of this study was to understand the challenges and coping strategies used by hospice caregivers as they care for their family members.

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          Most cited references23

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          Review of the literature on the effects of caring for a patient with cancer.

          To adequately help family caregivers (FCs) of cancer patients, clinicians need to understand the complexity of the problems and responsibilities associated with cancer patients illness that FCs experience. This systematic review identified the types of problems and burdens that FCs of cancer patients experience during the patient's illness. We also analyzed the language caregivers use to communicate their problems and responsibilities related to caregiving for the cancer patient. Of 2845 titles identified, 192 articles met the inclusion criteria and are included in this review. Of these, 164 were research-based. In addition to FC responsibilities and the impact of being a caregiver on daily life, a number of other physical, social, and emotional problems related to caregiving for these FCs were identified. A substantial evidence base supports the conclusion that FCs experience many difficult problems and increased responsibilities during and after the patient is undergoing treatment and rehabilitation for cancer. The insights gained from this review will help researchers and clinicians to understand the complexity of problems and responsibilities FCs experience. This understanding may encourage them to include support for FCs as part of total or holistic patient care. However, more research is needed to better understand the variations in caregiving experiences over time; how the caregiving perspective is influenced by different cultural, ethnic, or socioeconomic backgrounds as well as gender and age; and how problems and responsibilities related to caregiving interfere with daily life. Copyright © 2009 John Wiley & Sons, Ltd.
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            Social network types among older adults: a multidimensional approach.

            Theories of social relations suggest that individuals' personal networks reflect multiple aspects of relationships, and that different constellations are more or less supportive of well-being. Using data from the Berlin Aging Study (N = 516; age, M = 85 years), we derived network types that reflect information about structure, function, and quality, and we examined their association with well-being. A cluster analysis revealed six network types: diverse-supported, family focused, friend focused-supported, friend focused-unsupported, restricted-nonfriends-unsatisfied, and restricted-nonfamily-unsupported. Well-being was predicted differentially by the six types. Although the oldest-old individuals (85 years of age or older) were overrepresented in the friend-focused-supported and restricted types, age did not moderate the association of types with well-being. A holistic consideration of structure, function, and quality of social networks in old age offers unique insights.
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              Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination.

              There are many reports of psychological morbidity in spousal carers of patients with dementia. The consequences of this increased stress on the immune system are unclear. We investigated whether antibody responses to influenza vaccination differed between carers and a control group, and the relation of the antibody response to the hypothalamic-pituitary-adrenal (HPA) axis. 50 spousal carers of dementia patients, median age 73 years (IQR 66-77), and 67 controls (68 years [66-71]) of similar socioeconomic status were enrolled. Anxiety and depression were measured by the Savage Aged Personality Screening Scale and stress by the Global Measure of Perceived Stress scale. Principal-component analysis was used to yield a summary score of emotional distress from these two scales. Salivary cortisol concentrations were measured over a single day at three times (0800-1000, 1100-1300, and 2000-2200). Participants received a trivalent influenza vaccine and IgG antibody titres to each strain were measured on days 0, 7, 14, and 28. Mean scores of emotional distress were significantly higher in carers at each time point than in controls (all p<0.0003). Mean (SD) salivary cortisol concentrations, calculated as area under the curve (AUC), were higher in carers than controls at all three assessments (6 months 16.0 [8.0] vs 11.2 [4.4], p=0.0001; respectively). Eight (16%) of 50 carers and 26 (39%) of 67 controls had a four-fold increase in at least one of the IgG titres (p=0.007). There was an inverse relation between AUC cortisol and IgG antibody titre to the Nanchang strain that was significant on day 14 (r=-0.216, p=0.039). Elderly carers of spouses with dementia have increased activation of the hypothalamic-pituitary-adrenal axis and a poor antibody response to influenza vaccine. Carers may be more vulnerable to infectious disease than the population of a similar age.
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                Author and article information

                Journal
                The Gerontologist
                GERONT
                Oxford University Press (OUP)
                0016-9013
                1758-5341
                April 05 2016
                : gnw054
                Article
                10.1093/geront/gnw054
                5881722
                27048707
                f40a37a4-5461-4094-a78f-f0d86005d840
                © 2016
                History

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