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Richard Schulz - One of the best experts on this subject based on the ideXlab platform.
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caregiving and place combining geographic information system gis and survey methods to examine neighborhood context and Caregiver outcomes
Innovation in Aging, 2019Co-Authors: Scott R Beach, Ellen Kinnee, Richard SchulzAbstract:Background Little is known about the impact of neighborhood context on family Caregivers, or how environmental factors combine with individual-level Caregiver risk factors to affect Caregiver outcomes. Objectives To combine Geographic Information System (GIS) and survey methods to examine the effects of Caregiver residence in disadvantaged/underserved neighborhoods on Caregiver outcomes. Research Design and Methods Telephone surveys with 758 Caregivers from the Pittsburgh Regional Caregiver Survey geocoded for classification into Environmental Justice Areas (EJAs) and Medically Underserved Areas (MUAs). We examine the impact of EJA/MUA Caregiver residence on care recipient unmet needs for care, Caregiver depression and burden, and positive aspects of caregiving, adjusting for sociodemographics, caregiving context, care recipient disability level, caregiving intensity, and additional risk factors. Results There was spatial clustering of Caregiver depression and burden outside of the disadvantaged/underserved areas, while positive aspects of caregiving were clustered within EJAs/MUAs. Approximately 36% of Caregivers lived in EJAs/MUAs, and they differed, sociodemographically, on Caregiver risk factors and Caregiver outcomes. Multivariable models showed that Caregivers residing in EJAs/MUAs were less likely to be depressed and reported more positive aspects of caregiving after adjusting for known individual-level risk factors. Residence in disadvantaged/underserved areas also modified the effects of several risk factors on Caregiver outcomes. Discussion and Implications Caregiver outcomes show interesting spatial patterns. Unexpectedly, Caregivers living in these potentially challenging environments were less depressed and reported more gains from caregiving after adjusting for known risk factors. Results suggest that socioeconomic disadvantage does not necessarily translate into poor Caregiver outcomes. Understanding the mechanism for these effects is important to designing effective Caregiver interventions. The paper also demonstrates the value of using GIS methods to study caregiving.
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the impact of family Caregivers on potentially inappropriate medication use in noninstitutionalized older adults with dementia
American Journal of Geriatric Pharmacotherapy, 2012Co-Authors: Joshua M Thorpe, Carolyn T Thorpe, Korey A Kennelty, Walid F Gellad, Richard SchulzAbstract:Abstract Background The risk of potentially inappropriate medication (PIM), both prescription and over-the-counter, use in dementia patients is high. Informal Caregivers often facilitate patients' use of medications, but the effect of Caregiver factors on PIM use has not been a focus of previous research. Objective The aim of this study was to examine PIM use in dementia patients and Caregivers and identify Caregiver risk factors for PIM use in dementia patients. Methods We conducted a secondary data analysis of the baseline wave of the Resources for Enhancing Alzheimer's Caregiver's Health study. The sample comprised 566 persons with dementia aged 65 and older and their coresiding family Caregiver. PIM was defined using the 2003 Beers criteria and was examined in both dementia patients and their Caregivers. Caregiver and patient risk factors included a range of sociodemographic and health variables. Results In dementia patients, 33% were taking at least 1 PIM, and 39% of their Caregivers were also taking a PIM. In fully adjusted models, the following Caregiver factors were associated with an increased risk of dementia patient PIM use: Caregiver's own PIM use, spouse Caregivers, Hispanic Caregivers, and greater number of years that the Caregiver has lived in the United States. Increased Caregiver age was associated with a decreased risk of PIM use in patients. Conclusions PIM use may be higher in dementia patients and their informal Caregivers compared with the general older adult population. Further, patterns of medication use in 1 member of the dyad may influence PIM risk in the other dyad member. These results suggest that interventions to increase appropriate medication use in dementia patients and their Caregivers should target both members of the dyad and target over-the-counter agents along with prescription medications.
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Caregiver cognitive status and potentially harmful Caregiver behavior
Aging & mental health, 2006Co-Authors: L. S. Miller, Richard Schulz, M. S. Lewis, Gail M. Williamson, Charles E. Lance, W. K. Dooley, Myron F. WeinerAbstract:The association between Caregiver cognitive status and potentially harmful Caregiver behavior was assessed in a sample of 180 Caregiver-care recipient dyads. Compromised cognitive status was identified in 39% of these informal Caregivers. Beyond variance explained by demographic factors, amount of care provided, care recipient cognitive status, and Caregiver depressed affect, care recipients reported more frequently being subjected to potentially harmful Caregiver behavior when their Caregivers evidenced compromised cognitive status. While preliminary, critical areas of Caregiver cognition appeared to be deficits in language comprehension and memory. Results indicate that compromised cognitive status is common among informal Caregivers of impaired elders and that this may adversely influence the quality of care they provide.
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risk factors for potentially harmful informal Caregiver behavior
Journal of the American Geriatrics Society, 2005Co-Authors: Scott R Beach, Richard Schulz, Gail M. Williamson, Myron F. Weiner, Stephen L Miller, Charles E. LanceAbstract:Objectives: Caring for a sick or disabled relative has been linked to compromised Caregiver health, and risk factors for negative Caregiver outcomes have been studied extensively, but little attention has been given to care recipient and Caregiver health as risk factors for potentially harmful behavior by informal Caregivers. This article explores such risk factors. Design: Structured interviews from baseline assessment of the Family Relationships in Late Life Study. Setting: Three U.S. communities. Participants: Referred, volunteer sample of 265 Caregiver/care recipient dyads. Caregivers were primarily responsible for care of an impaired, community-residing family member aged 60 and older and providing help with at least one activity of daily living (ADL) or two instrumental activities of daily living (IADLs). Measurements: Self-reported care recipient demographics, cognitive status, need for care, and self-rated health; self-reported Caregiver demographics, cognitive status, amount of care provided, self-rated health, physical symptoms, and depression. Care recipient reports of potentially harmful Caregiver behavior, including screaming and yelling, insulting or swearing, threatening to send to a nursing home, and withholding food, were the main outcome variable. Results: The following were significant risk factors for potentially harmful Caregiver behavior: greater care recipient ADL/IADL needs (odds ratio (OR)=1.12, 95% confidence interval (CI)=1.03–1.22), spouse Caregivers (vs others; OR=8.00, 95% CI=1.71–37.47), greater Caregiver cognitive impairment (OR=1.20, 95% CI=1.04–1.38), more Caregiver physical symptoms (OR=1.07, 95% CI=1.01–1.13), and Caregivers at risk for clinical depression (OR=3.47, 95% CI=1.58–7.62). Conclusion: Potentially harmful Caregiver behavior is more likely in spouse caregiving situations and when care recipients have greater needs for care and Caregivers are more cognitively impaired, have more physical symptoms, and are at risk for clinical depression. This risk profile is similar to that for negative Caregiver outcomes.
Colin Mchugh - One of the best experts on this subject based on the ideXlab platform.
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Caregiver-oncologist prognostic concordance, Caregiver mastery, and Caregiver psychological health and quality of life
The oncologist, 2021Co-Authors: Kah Poh Loh, Mostafa R. Mohamed, Sindhuja Kadambi, Eva Culakova, Allison Magnuson, Marie Flannery, Paul R. Duberstein, Ronald M. Epstein, Colin MchughAbstract:Background Caregivers of adults with cancer often report a different understanding of the patient's prognosis than the oncologist. We examine the associations of Caregiver-oncologist prognostic concordance with Caregiver depressive symptoms, distress, and quality of life (QoL). We also explore whether these relationships differed by Caregiver environment mastery, an individual's sense of control and effectiveness in managing life situations. Methods We used data from a national geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged ≥70 with incurable cancer considering any line of cancer treatment at community oncology practices, their Caregivers, and their oncologists. At enrollment, Caregivers and oncologists estimated the patient's prognosis (0-6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; identical responses were concordant). Caregivers completed the Ryff's environmental mastery at enrollment. At 4-6 weeks, Caregivers completed the Patient Health Questionnaire-2, distress thermometer, and the 12-Item Short-Form Health Survey. We used generalized estimating equations in models adjusted for covariates. We then assessed the moderation effect of Caregiver mastery. Results Of 411 Caregiver-oncologist dyads (meanage=66.5), 369 provided responses and 28% were concordant. Prognostic concordance was associated with greater Caregiver depressive symptoms (β=0.30; p=0.04) but not distress or QoL. A significant moderation effect for Caregiver depressive symptoms was found between concordance and mastery (p=0.01). Specifically, among Caregivers with low mastery ( Conclusions Caregiver-oncologist prognostic concordance was associated with Caregiver depressive symptoms. We found a novel moderating effect of Caregiver mastery on the relationship between concordance and Caregiver depressive symptoms. Implications for practice Caregiver-oncologist prognostic concordance is associated with greater Caregiver depressive, particularly those with low Caregiver mastery. When discussing prognosis with Caregivers, physicians should be aware that prognostic understanding may affect Caregiver psychological health and assess their depressive symptoms. In addition, while promoting accurate prognostic understanding, physicians should also identify strengths and build resilience among Caregivers.
Suzannehagen - One of the best experts on this subject based on the ideXlab platform.
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Stroke Patients’ Informal Caregivers
Stroke, 1999Co-Authors: Carolbugge, Helenalexander, SuzannehagenAbstract:Background and Purpose—Research has revealed that caring for a stroke patient can result in Caregiver strain and a myriad of other difficulties for Caregivers. This study aims to identify the level of strain experienced by Caregivers in the early months after stroke and to assess the relationship between Caregiver strain and Caregiver characteristics, patient characteristics, and service inputs. Methods—Stroke patients were identified through a random stratified sample of general practices. Patients were asked to identify their principal informal Caregiver. Strain was measured with the Caregiver Strain Index, and all data were collected from Caregivers at 1, 3, and 6 months after the patient’s stroke. Multiple regression analysis was used to examine the factors associated with Caregiver strain. Results—Six months after stroke, 37% of Caregivers were experiencing considerable strain. The amount of time a Caregiver spent helping a stroke patient, the amount of time the Caregiver spent with the patient, and ...
Suzanne Hagen - One of the best experts on this subject based on the ideXlab platform.
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Stroke Patients’ Informal Caregivers: Patient, Caregiver, and Service Factors That Affect Caregiver Strain
Stroke, 1999Co-Authors: Carol Bugge, Helen Alexander, Suzanne HagenAbstract:Background and Purpose —Research has revealed that caring for a stroke patient can result in Caregiver strain and a myriad of other difficulties for Caregivers. This study aims to identify the level of strain experienced by Caregivers in the early months after stroke and to assess the relationship between Caregiver strain and Caregiver characteristics, patient characteristics, and service inputs. Methods —Stroke patients were identified through a random stratified sample of general practices. Patients were asked to identify their principal informal Caregiver. Strain was measured with the Caregiver Strain Index, and all data were collected from Caregivers at 1, 3, and 6 months after the patient’s stroke. Multiple regression analysis was used to examine the factors associated with Caregiver strain. Results —Six months after stroke, 37% of Caregivers were experiencing considerable strain. The amount of time a Caregiver spent helping a stroke patient, the amount of time the Caregiver spent with the patient, and the Caregiver’s health were all significantly associated with the level of strain experienced. Although none of the services or patient factors tested in this study were consistently associated with strain, an indicator of stroke severity was significant at each time point. Conclusions —Caregivers are experiencing strain, which has implications for research and service provision. Service providers need to identify Caregivers at risk of greater strain and to help Caregivers work through situations that services cannot alter. Research is needed to identify services that are effective in strain alleviation. Future research should also aim to identify the interface between patient characteristics and strain, burden, and depression and particularly to assess the Caregiver’s perception of these relationships.
Olivier Piguet - One of the best experts on this subject based on the ideXlab platform.
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the impact of dementia severity on Caregiver burden in frontotemporal dementia and alzheimer disease
Alzheimer Disease & Associated Disorders, 2013Co-Authors: Eneida Mioshi, David Foxe, Felicity Leslie, Sharon Savage, Sharpley Hsieh, Laurie A Miller, John R Hodges, Olivier PiguetAbstract:Caregiver burden is greater in frontotemporal dementia (FTD) than in Alzheimer disease (AD). However, little is known of the impact of the 3 main clinical variants of FTD- behavioral-variant frontotemporal dementia (bvFTD), semantic dementia (SemDem), and progressive nonfluent aphasia (PNFA)-or the role of disease severity in Caregiver burden. The Zarit Burden Inventory was used to measure Caregiver burden of bvFTD (n=17), SemDem (n=20), PNFA (n=20), and AD (n=19) patients. Symptom duration, Caregiver age, and relationship type were matched across groups. Moreover, a number of Caregiver (mood, social network) and patient variables (functional disability, behavioral changes, relationship with Caregiver, and dementia stage) were addressed to investigate their impact on Caregiver burden. Caregivers of bvFTD patients reported the highest burden, whereas SemDem and PNFA Caregivers reported burden similar to AD. A regression analysis revealed that Caregiver burden in FTD, regardless of subtype, was explained by a model combining disease staging, relationship changes, and Caregiver depression. Burden increased with disease severity in FTD. This study is the first to show that Caregivers of SemDem, PNFA, and AD patients show similar burden, while confirming that bvFTD Caregivers show higher burden than AD Caregivers. More importantly, this study demonstrates that burden worsens with disease progression in FTD.
