With limited community services, the complex rehabilitation period after critical illness is often the responsibility of family members who, as a result, may experience negative health outcomes. The objectives of this research were to a) identify aspects of the caregiving situation that are associated with caregivers' experiences of emotional distress and psychological well-being; and b) compare health-related quality of life of informal caregivers to survivors of acute respiratory distress syndrome (ARDS) with age- and gender-matched population values.
Cross-sectional survey of informal caregivers to ARDS survivors.
Toronto, Ontario, Canada.
Informal caregivers were individuals who were primarily responsible for providing and/or coordinating ARDS survivors' posthospital care and were not paid to do so.
The dependent variables were emotional distress, psychological well-being, and health-related quality of life. They were evaluated by the Center for Epidemiologic Studies Depression Scale, the Positive Affect Scale, and Medical Outcomes Study Short Form 36, respectively. Independent variables included severity of illness indicators, patient depression (Beck Depression Inventory II), aspects of the caregiving experience (care provided, lifestyle interference, personal gain), and psychosocial resources (mastery and social support). Caregivers experienced more emotional distress when they experienced more lifestyle interference, had lower levels of mastery, and were caring for ARDS survivors with more depressive symptoms (F3,42 = 15.69, p < .001, adjusted R = .50). In contrast, caregiver psychological well-being was associated with personal gains as a result of providing care and having more mastery and social support (F4,41 = 9.40, p < .001, adjusted R = .43). Caregivers reported poorer health-related quality of life across all domains of the Medical Outcomes Study Short Form 36 compared with age- and gender-matched population values.
Informal caregivers experience negative health outcomes that persist almost 2 yrs after ARDS. New approaches, such as family-centered rehabilitation, caregiver education, improved respite, and home care, may benefit informal caregivers.
"All rights reserved. doi:10.1016/j.jpsychores.2006.10.011 and reduced well-being in caregivers of survivors of acute respiratory distress  and is associated with a reduced mortality risk in the elderly . "
[Show abstract][Hide abstract] ABSTRACT: We examined the impact of Alzheimer caregiver transitions (i.e., placement and bereavement) on psychological outcomes and on plasma D-dimer levels, an end product of the coagulation cascade associated with increased cardiovascular risk.
This was a prospective study in which 126 spousal caregivers of Alzheimer's patients were assessed each year for 5 years. We used random regression models to evaluate discontinuous change in our outcomes over time, with emphasis on the impact of caregiver transitions on psychological and physical well-being.
Caregivers experienced immediate improvement in overload and mastery following transitions, and these improvements were maintained over time. There was also a significant drop in depressive symptoms immediately following placement of spouses. D-dimer rose significantly over time but began to significantly decline at 6-months posttransitions.
Caregiver transitions appear to produce immediate and long-term "normalization" of psychological health in caregivers. This normalization also appears related to "downstream" reductions in D-dimer.
Journal of Psychosomatic Research 05/2007; 62(4):439-45. DOI:10.1016/j.jpsychores.2006.10.011 · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives
Totestthehypothesisthatnurseledfollow-up programmes are effective and cost effective in improving quality of life after discharge from intensive care. Design A pragmatic, non-blinded, multicentre, randomised controlled trial.
[Show abstract][Hide abstract] ABSTRACT: Patients who survive critical illness are at risk for permanent physical, func- tional, emotional, and neurocognitive deficits, some or all of which may contribute to a decreased health-related quality of life (HRQL). The reasons for this late morbidity after intensive care unit (ICU) care are multifactorial and include, but are not limited to, the following: • the nature of and treatment for the inciting critical illness • multiple organ dysfunction syndrome and hypoxemia • physiologic and emotional stress in the ICU related to the illness itself, sleep fragmentation, psychoactive medications, and impaired drug metabolism due to simultaneous administration of multiple medications • prolonged immobility and long ICU stay. Patients with the acute respiratory distress syndrome (ARDS) represent some of the most complex, high acuity, and long stay ICU patients. Because of the sig- nificant potential for morbidity, ARDS patients have been the main focus of long- term outcome studies in survivors of critical illness. ARDS survivor data are some of the most complete long-term outcome data available and represent the current state-of-the-art in the critical care outcomes literature. As such, they will form the primary basis for this issue of Critical Care Rounds. Long-term outcome measures in survivors of ARDS Pulmonary function abnormalities Many ARDS survivors have persistent pulmonary function impairments that are typ- ically mild to moderate restrictive changes and an associated reduction in diffusion capacity. 1-3 Orme and colleagues reported that ARDS survivors had abnormal pulmonary function associated with decreased HRQL one year following hospital discharge 4 and Schelling recently reported no additional improvement in pulmonary function after the first year following ARDS. 5 In a recent publication, Neff and colleagues reviewed 30 studies that evaluated pulmonary function in ARDS survivors. 6 They reported significant variability in the proportion of patients with obstructive (0%-33%) and restrictive (0%- 50%) defects, as well as compromised diffusion capacity (33%-82%). This spectrum of pulmonary dysfunction may relate to population heterogeneity with respect to evolving definitions or severity of ARDS, severity of lung injury, ICU ventilatory strategy, prior history of lung disease or smoking, and the presence of other pulmonary processes that fulfill the ARDS definition but that have a very different natural history (eg, cryptogenic organizing pneumonia).
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