Caregiving for Patients With Heart Failure: Impact on Patients’ Families

School of Nursing, University of California, Los Angeles, 90095-6917, USA.
American Journal of Critical Care (Impact Factor: 2.12). 11/2011; 20(6):431-41; quiz 442. DOI: 10.4037/ajcc2011472
Source: PubMed


Factors that affect the impact of caregiving on patients' family members who provide care to patients with heart failure have not been adequately addressed. In addition, social support and positive aspects of caregiving have received little attention.
To identify factors associated with the impact of caregiving.
Self-report data were collected from 76 dyads of patients with heart failure and their family caregivers. Clinical data were obtained from medical records.
A sense of less family support for caregiving was associated with a higher New York Heart Association class of heart failure, being a nonspousal caregiver, lower caregivers' perceived control, and less social support. More disruption of caregivers' schedules was associated with higher class of heart failure, more care tasks, and less social support. Greater impact of caregiving on caregivers' health was related to more recent patient hospitalization, lower caregivers' perceived control, and less social support. Nonwhite caregivers and caregivers whose family member had fewer emergency department visits felt more positive about caregiving than did other caregivers. Social support had a moderating effect on the relationship between patients' comorbid conditions and positive aspects of caregiving.
Caregiving has both positive and negative effects on family caregivers of patients with heart failure. The findings suggest the need for interventions to increase caregivers' sense of control and social support. Family caregivers may need additional support immediately after patient hospitalizations to minimize the negative impact of caregiving.

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    • "The results should be interpreted with some caution. Current literature (Clay et al., 2013; Hwang et al., 2011; Morris et al., 1989; Pinquart and Sorensen, 2007) implies that social support could be an essential factor in the relation between providing care and the caregiver's health. Unfortunately, data on social support was not sufficiently available in this study, so household size was used as a limited indicator for social support as it may partially represent the caregiver's social network (Morris et al., 1989; Wellman, 1981 "
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    ABSTRACT: In Europe, the demand for informal care is high and will increase because of the ageing population. Although caregiving is intended to contribute to the care recipient's health, its effects on the health of older European caregivers are not yet clear. This study explores the association between providing informal personal care and the caregivers' health. Data were used from the longitudinal cohort (2004-2009) of the Survey of Health, Ageing and Retirement in Europe (SHARE)(n=7858). Generalized estimating equations were used to explore the longitudinal association of informal care and the caregiver's health using poor self-rated health (less than good), poor mental health (EURO-D score for depression ≥4), and poor physical health (≥2 health complaints). Providing informal personal care was significantly associated with poor mental health (OR=1.23, 95%CI=1.04-1.47) and poor physical health (OR=1.18, 95%CI=1.01-1.38), after adjusting for various socio-demographic and health-related factors. No statistical significant association was found for self-rated health in the adjusted models. Providing informal personal care may negative influence the caregiver's mental and physical health. More awareness of the beneficial and detrimental effects of caregiving among policy makers is needed to make well-informed decisions concerning the growth of care demands in the ageing population. Copyright © 2014 American Health Foundation. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Nov 2014 · Preventive Medicine
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    • "Exactly how this works in practice, however, is not well understood. What is known is that heart failure patients and caregivers who take a collaborative approach to heart failure management have better outcomes like better caregiver quality of life [QOL] (Pressler et al., 2013) and less caregiver strain (Hwang et al., 2011; Luttik et al., 2007a,b), whereas a gap between the patient's and caregiver's appraisal of symptoms and respective contributions to care leads to inadequate symptom management (Janssen et al., 2012; Quinn et al., 2010; Retrum et al., 2013; Rohrbaugh et al., 2008; Sebern and Riegel, 2009). Thus, how patient-caregiver dyads function together in their contributions to care is an important consideration in the overall management of heart failure. "
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    ABSTRACT: Heart failure is a burdensome clinical syndrome, and patients and their caregivers are responsible for the vast majority of heart failure care.Objectives This study aimed to characterize naturally-occurring archetypes of patient-caregiver dyads with respect to patient and caregiver contributions to heart failure self-care, and to identify patient-, caregiver- and dyadic-level determinants thereof.DesignDyadic analysis of cross-sectional data on patients and their caregivers.SettingOutpatient heart failure clinics in 28 Italian provinces.Participants: 509 Italian heart failure patients and their primary caregivers.Methods Multilevel and mixture modeling were used to generate dyadic averages and incongruence in patient and caregiver contributions to heart failure self-care and identify common dyadic archetypes, respectively.ResultsThree distinct archetypes were observed. 22.4% of dyads were labeled as novice and complementary because patients and caregivers contributed to different aspects of heart failure self-care that was generally poor; these dyads were predominantly older adults with less severe heart failure and their adult child caregivers. 56.4% of dyads were labeled as inconsistent and compensatory because caregivers reported greater contributions to the areas of self-care most insufficient on the part of the patients; patients in these dyads had the highest prevalence of hospitalizations for heart failure in the past year and the fewest limitations to performing activities of daily living independently. Finally, 21.2% of dyads were labeled as expert and collaborative because of high contributions to all aspects of heart failure self-care, the best relationship quality and lowest caregiver strain compared with the other archetypes; patients in this archetype were likely the sickest because they also had the worst heart failure-related quality of life.Conclusion Three distinct archetypes of dyadic contributions to heart failure care were observed that represent a gradient in the level of contributions to self-care, in addition to different approaches to working together to manage heart failure. Interventions and clinical programs that involve heart failure dyads should tailor strategies to take into consideration these distinct archetypes and their attributes.
    Full-text · Article · Nov 2014 · International Journal of Nursing Studies
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    • "Most often, one member of the family, such as the patient's spouse or child, takes over the caregiving tasks. As HF progresses, family roles will also change.[89] A complex of elements is associated with the negative consequences of caregiving. "
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    ABSTRACT: Background: Living with heart failure patients is a complex situation for family caregivers. Few studies have been conducted to examine the effects of interventional programs to ease this condition. The purpose of this study was to determine the effectiveness of a supportive educative group intervention in reducing family caregivers’ burden of caregiving. Materials and Methods: This randomized clinical trail was conducted at a selective teaching hospital in Isfahan, Iran in 2012. The intervention consisted of four weekly multimedia training sessions of 2 h that included education and family support for 50 family caregivers. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Paired t-test, Student's t-tests, and repeated measures analysis of variance (ANOVA) were used to test for significant differences of the mean scores of burden between the intervention and control groups over a 3-month period. Results: The intervention was successful in reducing caregiver burden over time both at the end of the intervention period (P = 0.000) and 3 months after the intervention (P = 0.000). Conclusions: Nurses and other healthcare providers can use the findings of this study in order to implement effective programs to reduce family caregivers’ challenges and to provide them more support.
    Full-text · Article · May 2014 · Iranian journal of nursing and midwifery research
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