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Caregiving is universal, but caregiving experiences, and views on how the government should support caregiving, are not. Caregiving is the subject of extensive press coverage, cultural exploration, policy analysis, and daily conversation. Yet less is known about how these experiences inform attitudes. This Element seeks to better understand attitudes toward caregiving policies and explain how varied caregiving experiences shape those attitudes. The analysis is primarily based on an original survey, the National Caregiving and Covid Survey (NCCS). Using YouGov, the authors surveyed representative samples of Asian, Black, Latinx, and white respondents in the spring of 2021. The findings illustrate that views of caregiving policy are linked both to whether one serves as a caregiver and to how one understands their caregiving role. In doing so, the Element presents a clearer picture of the political significance of caregiving in the United States.
Managing Cancer and Living Meaningfully (CALM) therapy may be a beneficial intervention for addressing death anxiety in caregivers yet has not been formally evaluated in this population. The purpose of this Phase 1a Define trial was to evaluate the suitability of CALM for caregivers of patients diagnosed with malignant glioma using qualitative stakeholder interviews prior to pilot testing.
Methods
Twenty-two bereaved caregivers participated in a focus group and completed subsequent caregiver-reported outcome measures. During the focus group, caregivers received information about CALM and provided feedback on the intervention’s relevance and recommendations to improve its content and delivery for the caregiving experience. A team of coders qualitatively analyzed responses using thematic, deductive, latent analysis (kappa = 0.86).
Results
Results suggest that CALM is highly relevant to the caregiving experience and may benefit caregivers emotionally, increase preparedness and self-efficacy in their role, improve their communication with the patient, and provide a unique opportunity to receive specialized care. Potential hurdles for participation included limited time and energy, concerns about burdening the patient by sharing their emotions, and worries that their loved one would not be emotionally or cognitively capable of participating. Participants also recommended additional content areas relevant to caregiving (i.e., burden and bereavement) and provided suggestions to improve CALM’s delivery (timing, initial presentation, session format, and logistics).
Significance of results
Participants’ feedback was largely positive and supports piloting an optimized CALM protocol among malignant glioma caregivers. Further research is needed to determine CALM’s effectiveness in caregivers of patients with malignant gliomas.
End-of-life care for persons living with dementia in home hospice relies heavily on coordination between family care partners (FCPs) and clinicians (e.g., hospice social workers and nurses). FCPs and clinicians have reported support and knowledge gaps in end-of-life dementia care. Interventions are needed to improve FCPs’ support and clinicians’ educational gaps.
Methods
A pilot randomized controlled trial was designed to examine implementation outcomes for a dementia-focused end-of-life intervention for FCPs (n = 37) and clinicians (n = 15). Data on survey completion and acceptability were collected at baseline, during 4 follow-up visits, and at the conclusion of the study.
Results
Twenty-eight (75%) caregivers completed the post-study survey, and 10 (27%) reported using the structured worksheet. Thirteen (87%) clinicians completed the post-training survey, 8 (53%) completed the post-study survey, and 8 (100%) used the worksheet. Clinicians (n = 8) were satisfied or highly satisfied with the instructional videos, and half (50%) used the information frequently with patients. Both groups reported the worksheet helpful, easy to use, and satisfactory, though clinicians rated helpfulness slightly higher (mean = 3.88 vs. 3.70 for FCPs). Clinicians liked the worksheet’s structured guidance and the enhanced collaboration.
Significance of results
This study provides preliminary evidence for implementation outcomes of a dementia-focused end-of-life intervention in home hospice. Findings suggest the intervention can be implemented in a hospice setting, with moderate worksheet uptake and perceived value among FCPs and clinicians.
Early institutional care is associated with long-lasting adverse outcomes across neurodevelopmental, cognitive, socioemotional, and physical health domains. However, less is known about how resilience emerges following this type of severe neglect. In this review, we define resilience as a descriptive inference reflected in better-than-expected adaptation following adversity among individuals exposed to comparable adversity, and we argue that progress in resilience science requires designs that can test causal mechanisms. We highlight how the randomized foster care intervention in the Bucharest Early Intervention Project (BEIP) provides rare causal evidence on modifiable processes that support resilience following early institutional rearing. Drawing on BEIP findings, we synthesize evidence that improving early caregiving environments leads to more favorable developmental outcomes during childhood and adolescence in multiple domains, while also illustrating that recovery is partial and not uniform across domains. We conclude with key lessons learned about resilience from the BEIP and outline future directions leveraging adult and intergenerational follow-up data to refine how resilience is defined, measured, and mechanistically explained in the context of severe early neglect. By leveraging rare experimental evidence, the BEIP provides a blueprint for identifying modifiable mechanisms through which early intervention can shape resilience across the lifespan following early adversity.
Guided by a lifespan developmental perspective, using a network analysis approach, this study compared the structure of daily stress components in mothers of adolescents and adults with developmental disabilities (DD) and a matched sample of mothers of children without DD. We also examined whether components of daily stress were differentially associated with subsequent depression symptoms. Participants (N = 516; 100% female; M = 54.52 years, SD = 10.21; 94.2% White) were drawn from two cohorts: a DD cohort constructed from two linked longitudinal studies of families of adolescents and adults with autism and fragile X syndrome and a comparison group from the Midlife in United States study. Participants completed an 8-day daily telephone interview and reported depressive symptoms two years later. Findings demonstrated that the daily stress network of mothers of individuals with DD was significantly more interconnected than that of the comparison group. Stressor risk appraisal emerged as a central node in both groups, highlighting the role of cognitive appraisal in shaping stress responses. Negative affective reactivity linked daily stress components with later depressive symptoms, particularly in the DD group. Chronic caregiving stress may heighten interconnectivity within daily stress networks, reducing psychological flexibility and increasing vulnerability to daily stressors.
This chapter discusses the roles and functions of pointing in caring for preverbal children primarily in Western cultures seeking to raise verbally expressive, independent children. The chapter describes how preverbal children can use pointing to elicit sensitive and responsive care from caregivers, therefore supporting developmental outcomes in many domains (language, social, cognitive). It examines pointing within cultural contexts in which it occurs most, contrasting Western caregiving (distal style, prioritizing object labeling) with non-Western cultures (proximal style, favoring tactile interactions). The chapter underscores the necessity to extend research on infants’ pointing beyond the lab to capture caregiver–child interactions in real-world settings, providing an ecologically valid perspective on gestures in children’s everyday lives. It argues for an inclusive research approach that explores infant pointing beyond Western cultures, which so far dominate the literature on this topic.
Why do poor caregivers resist rights-based framings of their situation even when directly exposed to institutionalized rights discourses? Drawing on 44 in-depth interviews with caregivers, care recipients, and officials from Chile Cuida, a state assistance program grounded in the right-to-care framework, this article examines the rights consciousness of long-term, intensive caregivers in Santiago, Chile. We find that, despite significant political exposure to rights discourses, caregivers consistently frame their experiences in terms of familial duty rather than entitlement. Building on rights-consciousness literature, we identify three mechanisms that explain this pattern: cultural incompatibility, whereby caregivers resist framings that appear to contradict familial obligations; familial overspilling, whereby family-based relational expectations are projected onto bureaucratic actors; and bridging strategies, whereby caregivers invoke alternative cultural sources of entitlement – particularly notions of state duty toward the poor – to justify receiving assistance without challenging familial dominance. We argue that discursive exposure to rights frameworks is insufficient when it confronts deeply settled familial cultural repertoires, with significant implications for care policy in the region.
Romanticism Bewitched concludes with a discussion of Joanna Baillie’s Gothic tragedy, Witchcraft, written as a response to what she believed to be a missed opportunity by Scott in his novel, The Bride of Lammermoor, to explore the psychological and social dimensions of the rise of witchcraft. The first section outlines the similarities between Scott’s novel and Macbeth. Both Scott’s novel and Shakespeare’s tragedy take place in Scotland in a politically precarious moment with squabbling factions and dwindling confidence in the central authority of the government. In the second section, Baillie argues that the decidedly unsympathetic treatment of the female supernatural by Scott and others perpetuates damaging stereotypes and diverts our attention from the real problem – a social structure founded on inequity. Baillie’s tragedy explores the outbreak of accusations of witchcraft as the consequence of a diseased patriarchy and the abdication of the responsibilities of fathers, literally within the family unit and figuratively as the representatives of the authority of church and state.
Frontotemporal dementia (FTD) and related disorders are major causes of young-onset dementia (YOD), yet caregivers often face delayed diagnosis and high distress. Data on the Canadian caregiving experience in FTD remain scarce. This study aimed to describe caregivers’ profiles and experiences navigating diagnosis and care and to identify factors associated with diagnostic delay and caregiver burden.
Methods:
We conducted an online survey (June 2023–May 2024) of adults providing care to individuals with FTD. The survey captured sociodemographic characteristics, diagnostic journey, healthcare access and caregiver burden (Zarit Burden Interview, ZBI). Neuropsychiatric symptoms (NPS) were assessed using the Neuropsychiatric Inventory. Descriptive and multivariable analyses examined factors associated with delayed diagnosis and burden.
Results:
Ninety-seven caregivers participated (82.5% women; mean age 61.4 ± 13.1 years). Care recipients (58.8% men; mean age 72.9 ± 9.7 years) most commonly had behavioural-variant FTD (57.7%). Mean time to diagnosis was 3.1 ± 4.5 years and was longer for YOD, those without family history and those initially misdiagnosed. Nearly half were initially misdiagnosed as psychiatric disorders or Alzheimer. Women caregivers reported significantly longer diagnostic delays (+20 months, p = 0.005). Most caregivers reported substantial burden (mean ZBI = 23.1 ± 8.3) and severe distress related to NPS, especially disinhibition and irritability, which independently predicted higher burden.
Conclusion:
Canadian FTD caregivers face prolonged diagnostic journeys, high neuropsychiatric-related distress and substantial unmet needs. Findings highlight gaps in awareness, access to specialized care and systematic assessment of caregiver burden, underscoring urgent priorities for improving diagnostic pathways and support services.
This study engages with the experiences and challenges reported by Punjabi family carers of older adults from one census metropolitan city in Canada.
Objective
Our focus was on understanding carers’ interpretations of family and public responsibilities for supporting older adults.
Methods
We interviewed eight Punjabi carers in one Canadian city who provide any form of unpaid help to an older adult living at home, about their experiences and ideas for advocacy. The interviews were analyzed through abductive thematic analysis, using politicization as a sensitizing concept.
Findings
While participants identified ideas for changes in public policy, their underlying mistrust of formal care systems often seemed to reinforce familial responsibility for care and restrict advocacy efforts to local family systems.
Discussion
These truncated networks of support contributed to alienating conditions for carers and limited opportunities for inclusive collective action to improve the current social organization of care for older people at home in Canada.
The aim of this review was to identify, review, and synthesize primary qualitative literature to answer the question “what are the roles and experiences of informal caregivers providing care to a person with non-malignant respiratory disease at end of life from the perspectives of the caregiver and recipient of care?”
Methods
This qualitative systematic review was undertaken using thematic synthesis. Electronic databases (British Nursing Database, Cumulative Index to Nursing and Allied Health Literature Plus, Medline, PsycInfo, ProQuest Sociology, Allied and Complementary Medicine Database [AMED]) covering nursing, medicine, and social sciences were systematically searched from inception to October 2024. Studies were included if they reported data on the experiences and roles of caregivers in non-malignant respiratory disease at end of life, from the perspective of the caregiver or the person with non-malignant respiratory disease. Twenty-two papers met the eligibility criteria and were included in the review. Quality assessment was undertaken using the JBI Critical Appraisal Checklist for Qualitative Research.
Results
Thematic synthesis of the data generated five analytical themes: Caregivers experience shifting identity and new roles; Adaptation is necessary to cope with loss and change; Caregivers need more information and coordinated care services; Emotional effects of caregiving; and Future uncertainty and facing death. The findings illustrated the complexity of the caregiving role and highlight unmet needs during the end of life stage.
Significance of results
This evidence synthesis highlights the significant contribution caregivers make in the lives and deaths of those with non-malignant respiratory disease. Challenges of caregiving in this context increase the stress of caregivers, including unpredictable disease progression and difficult symptoms such as breathlessness. There are persistent inequalities between malignant and non-malignant care pathways. Caregivers would welcome more recognition and information from healthcare professionals to support their role.
Formal volunteering is an important economic and social activity. In many countries, prevalence of volunteering is decreasing overall, including among older people who constitute a major volunteering resource. This qualitative study explored reasons for non-volunteering among seniors, with a focus on those who attribute their non-volunteering to their existing helping commitments. Forty-nine Australian interviewees aged 60 + years described a range of social, psychological, and temporal factors that resulted in their prioritization of informal rather than formal volunteering activities. These factors are mapped onto a theoretical framework matrix, with social identity and social capital theories appearing to possess the most explanatory power. The findings suggest that programs designed to encourage formal volunteering among older people need to be implemented in a manner that recognizes that members of this group can hold many other responsibilities that limit their ability to participate, especially those assisting in the care of multiple generations.
This chapter focuses on the challenges and experiences of caregiving in dementia, emphasizing the importance of protecting caregiver health and well-being. It discusses effective communication strategies, provides a list of useful web-based educational resources for caregivers, and explores direct and indirect caregiver support interventions. The chapter highlights the need for better support and resources for caregivers, including access to respite care and palliative care services. It also provides strategies for healthcare providers to better engage and support caregivers. Overall, the chapter emphasizes the need to prioritize caregiver health and well-being in dementia care to improve outcomes for both caregivers and individuals with dementia.
Chapter 9 highlights some of the more commonly acknowledged challenges and tension points that we as established dyadic health scientists believe are salient to the field moving forward. Although some of these have been identified and written about as limitations for decades (e.g., lack of diversity in our samples), we discuss each one with regard to their implication for dyadic health science and propose strategies and future directions. We argue throughout this chapter about the importance of achieving balance in addressing these issues in order to foster sustainable, impactful progress as a field. Finally, we discuss the roles that we can play as part of this field – as scholars, mentors, and reviewers – and discuss our shared responsibility to meet these challenges and ensure dyadic health science continues to be relevant to and representative of all adult dyads navigating health or illness challenges.
Living in a city for older adults inevitably involves facing and coping with the frequent deaths of neighbors, friends, and acquaintances, serving as a constant reminder of one’s mortality. Through the stories of three individuals, this chapter offers a glimpse into the experiences of dying, caregiving for the dying, and grieving in The Villages. It also contrasts the pervasive presence of death with the relative invisibility of the "fourth age."
Describe an overview of the approach to using CBT with dementia caregivers.
Critically appraise the evidence-base for CBT for CaregiversExercise choice of use of CBT with a range of issues affecting dementia caregivers based on the evidence-base for CBT.
Function more confidently as an evidence-based practitioner of CBT working with a range of dementia caregivers.
Tension between professional obligations and extraprofessional caregiving responsibilities is one reason physician scientists leave academic medicine. The COVID-19 pandemic exacerbated this challenge by increasing caregiving demands and decreasing time spent on research as much as 40%. CARES at UAB (Caregiving Affected Research Early-Career Scientists Retention Program at the University of Alabama at Birmingham) provided “extra hands” awards to early-career physician and non-physician research faculty to hire personnel to expedite research projects already awarded but deleteriously affected by caregiving during the pandemic. Evaluation included tracking awardee publications and grants, surveying awardees, and conducting semi-structured individual in-depth interviews. CARES at UAB distributed 28 grants totaling $1,005,266. Twenty-six awardees (93% retention) remain in academia 2.25–3.25 years after award initiation. Awardees attribute over 200 manuscripts to the funding and have secured 15 new NIH K-, R-, and U-series grants. Surveys indicate improved awardee well-being and decreased caregiving burden since receipt of funding. Scientific productivity, feeling valued, sense of community, and lifeline emerged as themes from interviews. Group “listening sessions” yielded university-level recommendations around tenure and promotion, caregiving culture, and mentoring. Resource to hire “extra hands” holds promise to retain early-career physician and non-physician research faculty with extraprofessional caregiving responsibilities.
Positive health outcomes are realized when individuals receive interprofessional care, which also includes collaboration with family and care providers. We used social network analysis to explore interprofessional care networks and experiences of independent, community-dwelling older adults and how they perceive collaboration between different medical and non-medical network members. Twenty-three participants were interviewed and asked to name individuals contributing to their health and well-being (network of care) and position them in a concentric circle to reflect the relative strength of relationships. The average network size was 11. Closest relationships were with spouses, children, and family physicians. Relationship strength with network members was marked by frequency, accessibility, longevity, and impact of interactions. Participants were ardent self-advocates for their care, but reported few apparent episodes of collaboration between network members. Our study highlights that coordinated and collaborative care for independent community-dwelling older adults is lacking and does not routinely engage non-medical network members.
Respite for individuals caring for family living with dementia is a common way to take personal time away from caregiving. Other than respite, there is little indication that caregivers receive adequate support from community and healthcare services. As a result, caregivers tend to experience a decline in well-being, due, in part, to a reduction in meaningful leisure experiences. The purpose of this article is to share findings from research aimed at discovering ways to enhance caregiver participation in meaningful leisure. Findings highlight how participants sacrificed their leisure time in favour of caregiving responsibilities and experienced a diminished sense of social connection. Findings also highlight how participants can have their own care needs met through leisure programming that lets them know they matter. We draw from these findings to suggest ways to direct more attention and resources to meeting caregiver needs.
The aim of this article is to develop and pilot test a new supportive care intervention, Empower GBM, designed for patients with glioblastoma and their family caregivers to reduce psychological distress and improve quality of life.
Methods
Qualitative interviews were conducted with patients diagnosed with glioblastoma and their caregivers to obtain information about their experiences and needs in coping with glioblastoma. We also gathered their feedback about the supportive care intervention we were proposing (Phase I). Following Phase I, we conducted a single-arm pilot to evaluate the feasibility and acceptability of the 6-session intervention (Phase II).
Results
During interviews (N = 14), patients and caregivers reported having the most difficulty and distress surrounding disease progression and management, maintaining dignity and autonomy, negotiation of roles and responsibilities, and maintaining connection with one another. Participants endorsed that an intervention like Empower GBM with skills focused on managing symptoms to increase independence, increasing caregiving efficacy and support, and coping with dyadic challenges would be of potential benefit. Preliminary results from the pilot study (N = 11) suggested the intervention is both feasible (e.g., 82% completed all 6 sessions and post-treatment surveys) and acceptable (88.9% reported a mean satisfaction score of 3 or higher; mean score of 3.57/4.0). Improvements in psychological outcomes, functional well-being, and caregiving efficacy from pre- to post-treatment survey results suggested the potential benefits of the intervention.
Significance of results
We developed a novel supportive care intervention informed by the dyadic illness model that is designed to meet the individual and interpersonal needs of patients with glioblastoma and their caregivers. Unique features include its flexibility to be delivered to patients and/or their family caregivers individually or jointly, while providing skills and strategies to meet the needs of both individuals and the dyad as the unit of care in coping with glioblastoma.