The psychosocial impact of caregiving in dementia and quality of life: a systematic review and meta-synthesis of qualitative research

ABSTRACT

Objective: A systematic meta-synthesis of qualitative studies was conducted to interpret and synthesise findings from studies investigating the experiences, quality of life, and psychosocial impact of caregiving on adult informal caregivers of people with dementia.

Design: The meta-synthesis was conducted according to the principles of meta-ethnography.

Results: Fourteen studies describing the experiences of 265 informal caregivers were reviewed. The meta-synthesis elicited the following themes: (1) understanding and making sense of the dementia diagnosis, changing symptoms, and the caregiver role; (2) coping strategies, psychological facilitators and rewards of caregiver role; (3) challenges of caring for a person with dementia and their behaviour; (4) caregivers' relationships with care-recipient and other informal caregivers; and (5) caregivers’ experiences of formal support services and material resources.

Conclusion: Our findings highlight the need for a person-centred approach to care planning that also accounts for the needs of the informal caregiver to promote better caregiver well-being and quality of life. Caregivers’ emotional support, coping, resilience, need for information and respite care and adjustment to caregiver identity should be reviewed as part of the care package for the person with dementia.     

Illness representations and distress in women undergoing screening for familial ovarian cancer

Women with a familial or genetic predisposition to ovarian cancer are at significantly increased risk of developing the disease, and this warrants effective risk management strategies. A clinical trial of ovarian cancer screening (OCS) is being conducted to establish the effectiveness of this risk management strategy. This article reports data from its psychological partner study which aims to evaluate the psychological effects of OCS. Leventhal's Self-Regulatory Model provided the theoretical framework for understanding emotional responses to OCS. The revised Illness Perceptions Questionnaire (IPQ-R) is based on this model and the IPQ-R, adapted to the risk of ovarian cancer, was completed by women (N?=?1999) prior to screening. The original IPQ-R factor structure was not replicated but IPQ-R variables explained 14.70% of the variance in women's ovarian cancer-specific distress after controlling for age, general anxiety and depression. Negative emotional representations of ovarian cancer risk and general anxiety were moderately associated with greater ovarian cancer-specific distress whereas cognitive illness representations were weakly related to ovarian cancer-specific distress. Further analyses of data from the ongoing psychological evaluation are needed to determine the predictive utility of IPQ-R variables in explaining distress during OCS.     

An Exploration of the Dishonest Side of Self‐Monitoring: Links to Moral Disengagement and Unethical Business Decision Making

The majority of research on self‐monitoring has focused on the positive aspects of this personality trait. The goal of the present research was to shed some light on the potential negative side of self‐monitoring and resulting consequences in two independent studies. Study 1 demonstrated that, in addition to being higher on Extraversion, high self‐monitors are also more likely to be low on Honesty‐Humility, which is characterized by a tendency to be dishonest and driven by self‐gain. Study 2 was designed to investigate the consequences of this dishonest side of self‐monitoring using two previously unexamined outcomes: moral disengagement and unethical business decision making. Results showed that high self‐monitors are more likely to engage in unethical business decision making and that this relationship is mediated by the propensity to engage in moral disengagement. In addition, these negative effects of self‐monitoring were found to be due to its low Honesty‐Humility aspect, rather than its high Extraversion side. Further investigation showed similar effects for the Other‐Directedness and Acting (but not Extraversion) self‐monitoring subscales. These findings provide valuable insight into previously unexamined negative consequences of self‐monitoring and suggest important directions for future research on self‐monitoring. Copyright © 2013 European Association of Personality Psychology     

Book Review

Performance-based measures and ratings of executive functions were examined in a sample of adolescents with attention deficit/hyperactivity disorder (ADHD) and comparison controls. Performance-based measures of executive function included inhibition, working memory, set shifting, and planning, and ratings of these same executive functions were completed by parents and teachers. Adolescents with ADHD demonstrated lower executive function performance than controls and displayed elevated ratings on the executive function ratings by parents and teachers. Significant associations were obtained between the performance-based measures and the parent and teacher ratings, but each measure was not uniquely associated with its respective scale on the rating scales. When performance-based measures and ratings were examined as predictors of ADHD status, the parent and teacher ratings entered as significant predictors of ADHD status. Further commonality analyses indicated that performance-based measures accounted for little unique variance in predicting ADHD status and also displayed little overlap with the behavioral ratings. These findings highlight the diagnostic utility of behavioral ratings of executive function in predicting ADHD status; however, behavioral ratings should not be assumed to be a proxy for performance on measures of executive function in clinical practice.     

Executive functioning deficits in preschool children with Fetal Alcohol Spectrum Disorders

Executive function (EF) deficit is a hallmark of Fetal Alcohol Spectrum Disorders (FASD), but the vast majority of available evidence comes from school-age children and adolescents. Very little is known about EF during the critical developmental period prior to 6 years of age in FASD. We evaluated EF in 39 children with FASD (3.0–5.5 years) and a comparison group of 50 age-matched, nonexposed controls. Measures included the EF Scale for Early Childhood and a Delay of Gratification task. Compared to age-matched controls, preschool children with FASD had impairments on the EF Scale and showed more impulsivity on the Delay of Gratification task. To confirm the EF Scale finding, FASD group performance was compared to a separate normative dataset (N = 1,400). Those with FASD performed below normal (M = –0.57, SD = 0.92). Within the FASD group, IQ was correlated with the EF Scale (partial r = .60, p = .001) and Delay of Gratification (partial r = .58, p = .005). EF Scale performance did not differ significantly across levels of FASD severity (fetal alcohol syndrome [FAS], partial FAS, or alcohol-related neurobehavioral disorder [ARND]). However, compared to normative data, those with FAS had the largest deficits (M = –0.91 SD from the mean, SE = 0.23), followed by partial FAS (M = –0.66 SD from the mean, SE = 0.26), then ARND (M = –0.36 SD from the mean, SE = 0.20). These novel data show that EF deficits manifest well before the age of 6 years in children with FASD, that they occur across the spectrum, and that EF may be most impaired in children with more severe forms of FASD and/or lower IQs.     

Kinetics of diffusion via divacancies in a concentrated random fcc alloy

The diffusion kinetics in a concentrated fcc alloy are described by means of divacancies. The model chosen is the random alloy model with bound divacancies. We show that for the fcc structure the Manning formalism developed originally for monovacancies can be used intact to describe diffusion via divacancies. Monte Carlo simulation results for both tracer and collective correlation factors are in good agreement with the results of the formalism for a wide range of the component atom exchange frequencies with the divacancy except for the slower-moving component.     

Phonon densities of states of gamma-cerium and delta-cerium measured by time-of-flight inelastic neutron scattering

Time-of-flight inelastic neutron scattering spectra were measured on cerium metal at temperatures near the fcc (gamma)-to-bcc (delta) transition temperature. Phonon density-of-states (DOS) curves were extracted from data acquired over a wide range of momentum transfers. A large softening of the phonon DOS was found in going from gamma-cerium to delta-cerium, and this accounts for an increase in vibrational entropy of (0.71 +/- 0.05)k _B/atom. To be consistent with the latent heat of the gamma-delta transition, this increase in vibrational entropy must be accompanied by a large decrease in electronic entropy. The results not only confirm the recent discovery of a significant electronic contribution to the gamma-delta transition but also suggest that it may be twice that previously reported.