Background: Behavioural and psychological symptoms in dementia (BPSD) are important predictors of institutionalisation as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver wellbeing. Methods: Systematic review and meta-analysis of articles published in English between 1980 and December 2015 reporting which BPSD affect caregiver wellbeing. Article quality was appraised using the Downs and Black Checklist (1998). Results: 40 medium and high quality quantitative articles met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviours were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behaviour scores and mean distress scores were pooled for 4 studies. Irritability, aberrant motor behaviour and delusions were the most strongly correlated to distress, disinhibition was the least correlated. Conclusion: The evidence is not conclusive as to whether some BPSD impact caregiver wellbeing more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver wellbeing. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact wellbeing by including caregiver variables so that interventions can be designed to target BPSD more effectively.

/pdf/a-systematic-review-of-the-relationship-between-behavioral-ewyy71se27.pdf

A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being

Objective The aim of this review is to make a state of the art of the potential influence of neuropsychiatric symptoms (NPs) on caregiver stress and vice versa. Methods We searched PubMed and Google Scholar for potential eligible articles. Results Patients with Alzheimer's disease (AD) usually need high levels of care in all activities of daily living, most of them provided by family members, friends, or informal caregivers. Caregivers have to cope with both age-related conditions and dementia-related factors. Therefore, caregiving in dementia is more difficult and stressful than caregiving for older adults, affected by other conditions. Neuropsychiatric symptoms, such as anxiety, agitation, disinhibition, aggressive behavior, and sleep disturbances are more closely related to caregiver burden, and associated with more negative outcomes such as decline in their general health, quality of life, and social isolation. Caregiver burden worsens relationship between caregiver and patients with AD. Thus, this relationship may increase the frequency and severity of NPs. Predictors of burden were being a woman, a spouse, and old person with immature coping mechanisms, social isolation, with insufficient knowledge about dementia, poor premorbid relationship with patient, and high levels of negative expressed emotions. Conclusion Because of the bidirectional relationship between caregiver burden and NPs, the active management strategies of dementia care should include early identification and treatment risk factors for both caregiver stress and NPs in patients with AD. Therefore, to improve one of them can be exert beneficial for the other.

Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review

Sleep disturbance can contribute to negative health outcomes However, sleep complaints have been under-recognized and undertreated in caregivers of ill family members This systematic review describes the impact of family caregiving on sleep and summarizes factors associated with sleep disturbance in caregivers A literature search using PubMed, MEDLINE, PsycINFO, and CINAHL databases yielded 22 relevant research articles on family caregivers of ill adults Analyses revealed that up to 76% of caregivers reported poor sleep quality, and the proportion is considerably higher for female caregivers compared to male caregivers Sleep measures indicated short sleep duration and frequent night awakenings Characteristics of the care recipient, such as health status, and the caregiver's own health status and symptoms, such as depression, fatigue, and anxiety, were associated with sleep disturbance in caregivers These factors may help clinicians identify caregivers at highest risk for developing sleep disturbance and guide the family toward additional support

/pdf/how-adult-caregiving-impacts-sleep-a-systematic-review-3ai7tonwks.pdf

How Adult Caregiving Impacts Sleep: a Systematic Review

Background More than 5.4 million informal caregivers (ICGs) in the United States care for persons with dementia (PWD). Failure of ICGs to incorporate self-care into their routine may lead to adverse health consequences. Caregivers and researchers need to understand the evidence around dementia ICGs' self-care practices. Purpose To synthesize evidence on the self-care needs and behaviors of Alzheimer's and dementia ICGs and its research implications. Methods PubMed, CINAHL, Scopus, and Web of Science were searched to conduct a systematic review of research. Orem's self-care theory and a concept analysis of self-management behaviors provided a framework for the review. Results Three themes emerged from 29 included studies: self-care needs and behaviors of ICGs, barriers to performing self-care, and enablers of self-care. The self-care needs of dementia ICGs included sleep, social engagement and support, and leisure activities. Self-care behaviors identified by this review were engaging in activities with the PWD, spiritual and religious activities, and taking a break from caregiving. Barriers to self-care were gender roles, self-sacrificing, minority ethnicity, and burden of caregiving. Enabling self-care involved acknowledging personal consequences of caregiving, balancing self-care needs with the PWD's needs, and positioning oneself as an objective/subjective duality. Implications Self-care is a dynamic, challenging aspect to caregiving, but supporting evidence is often limited or cannot be generalized. More studies are needed that include random sampling, heterogeneous samples, and quantitative methods. Additional research is needed to understand how self-care needs, behaviors, and barriers differ by caregiver race/ethnicity, gender, or relationship to the PWD.

The Self-Care Needs and Behaviors of Dementia Informal Caregivers: A Systematic Review.

Objective: Sleep disturbances are a common issue for those who provide informal care to someone with a life-limiting condition. The negative consequences of poor sleep are well documented. The purpose of the present study was to determine the sleep patterns of caregivers of patients with advanced cancer. Method: An extensive systematic review of studies reporting empirical sleep data was undertaken in 2015 in accordance with the PRISMA Statement. A total of eight electronic databases were searched, with no date restrictions imposed. Additionally, a search of the bibliographies of the studies identified during the electronic search was conducted. Search terms included: “sleep,” “insomnia,” “sleep disturbance,” “circadian rhythm,” “caregiver,” “carer,” “advanced cancer,” “palliative cancer,” and MESH suggestions. The inclusion criteria required studies to be in English and to report primary qualitative and/or quantitative research that examined sleep in caregivers of patients with advanced cancer. Unpublished studies, conference papers, and dissertations were excluded. Results: Overall, 10 studies met the inclusion criteria and were included in the review. Two major findings emerged from the data synthesis. First, at least 72% of caregivers reported moderate to severe sleep disturbance as measured by the Pittsburgh Sleep Quality Index. Second, objective measurement of caregivers' sleep identified that some caregivers experienced up to a 44% reduction in their total sleep time compared to the recommended eight hours. Significance of Results: Reduction in total sleep time appears to be the biggest issue facing caregivers' sleep. Future studies need to explore the specific factors that cause these sleep disturbances and thus help to identify interventions to optimize sleep.

/pdf/sleep-disturbances-in-caregivers-of-patients-with-advanced-1dm2j1pd8c.pdf

Sleep disturbances in caregivers of patients with advanced cancer: A systematic review.

Objective: We tested a stress process model of multilevel stressors on sleep disturbance for family caregivers (FCG) of persons with dementia (PWD).Methods: For this cross-sectional study, trained research assistants collected data from a purposive sample of 180 PWD–FCG dyads at two teaching hospitals, two local hospitals, and two community long-term care service programs in northern Taiwan. PWDs’ neuropsychiatric symptoms were assessed using the Chinese Neuropsychiatric Inventory (CNPI), FCGs’ distress by CNPI Caregiver Distress Scale, physical fatigue by Visual Analogue for Fatigue Scale, mental fatigue by Attentional Function Index, depressive symptoms by the Center for Epidemiological Studies Depression Scale – Short Form, and sleep disturbance by the General Sleep Disturbance Scale.Results: FCGs’ most prevalent sleep disturbance problems were sleep quality problems (99.4%). Hierarchical regression models revealed that FCGs’ sleep disturbance was predicted by their physical fatigue, their depressive s...

Family caregivers’ sleep disturbance and its associations with multilevel stressors when caring for patients with dementia

BACKGROUND In Taiwan, eighty-five percent of dementia patients are cared for by family caregivers (FCGs), who have indicated insomnia to be a prevalent personal health problem. PURPOSE The aim of this study was to explore sleep disturbance and associated factors among FCGs caring for dementia patients. METHODS A purposive sample of 180 dementia patient dyads and their FCGs was recruited from northern Taiwan. Dementia patients neuropsychiatric symptoms were assessed using the Chinese Neuropsychological Inventory (CNPI). FCG distress, depressive symptoms, and sleep disturbance were assessed using the CNPI Caregiver Distress Scale, Center for Epidemiological Studies-Depression Scales, and Lee's General Sleep Disturbance Scale, respectively. RESULTS Sleep disturbance was reported as interfering with the daily lives of 13.3% of FCGs. The hierarchical regression model indicated (1) relationships between patients and FCGs and (2) FCG depressive symptoms as two significant predictors of sleep disturbance in FCGs, explaining 45.8% of variance. FCG depressive symptoms represented the most significant single predictor - contributing 31% of variance. CONCLUSIONS Sleep disturbance in FCGs is predicted by the patient-FCG relationship and FCG depressive symptoms. To better care for FCGs of dementia patients, nurses should assess patients behavioral problems, FCG distress, and FCG depressive symptoms. Nurses may also better allocate social resources based on the specific relationships between FCGs and their dementia patients. In addition, nurses should redirect FCG attention toward positive thinking in order to alleviate depressive symptoms and decrease sleep disturbance.

Sleep disturbance and associated factors amongst family caregivers of dementia patients

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Family caregivers’ sleep disturbance and its associations with multilevel stressors when caring for patients with dementia

Sleep disturbance and associated factors amongst family caregivers of dementia patients