Added: Payton Spahn - Date: 25.10.2021 05:57 - Views: 25125 - Clicks: 3760
Introduction: Research in human caregiving shows burden is often present in the caregiver and can be reduced by interventions that increase positive perceptions of caregiving. Recent work suggests burden is also present in owners of a seriously ill companion animal. To help determine if findings from the human caregiving literature are likely to generalize to companion animal caregiving, we undertook a comparison of burden and positive aspects of caregiving in these groups. Material and Methods: Caregivers recruited through social media disease support and information groups completed self-report questionnaires of burden and positive aspects of caregiving in an online research protocol.
Discussion: Although both groups showed elevated burden, companion animal caregivers reported less burden and a more positive appraisal of caregiving. Elements of burden showing similarities across groups provide a foundation for understanding caregiver burden in the companion animal owner.
The inverse correlation between positive aspects of caregiving and burden suggests the impact of positive caregiving experiences should be considered in burden interventions, but because companion animal owners already positively appraise caregiving, enhancing positive aspects of caregiving may not offset burden as it does in human caregiving samples. Caregiver burden is a multifaceted reaction of distress to the problems and challenges encountered while providing informal care for someone with an illness 12.
This burden encompasses a range of negative experiences present in this context, such as feelings of guilt, anger toward the care recipient, not having enough time to manage responsibilities, fear of what the future holds, financial strain, or feeling that one's health or social life has suffered due to caregiving 1. Burden in caregiving has been linked to adverse emotional states, psychiatric morbidity, and physical, financial, and social repercussions for the caregiver 3. Research demonstrates physiological consequences of burden, including higher daytime cortisol 45detrimental psychosocial outcomes including anxiety and depression 67increased risk of mortality for the caregiver 8and greater likelihood of institutionalization for the care recipient 9.
The burden of caregiving has been well-studied in recent decades and is of great public health ificance. Behavioral interventions have been shown to reduce burden and distress in family caregivers 1011with positive aspects of caregiving playing an integral role in outcomes Many different positive aspects of caregiving have been identified in the literature, including emotional satisfaction, such as feeling that providing care makes one feel more useful, needed, appreciated, or confident; personal or spiritual growth; feelings of competency and mastery; relationship gains, role satisfaction, and fulfilling a sense of duty 13 — A positive appraisal of caregiving is viewed as protective against negative outcomes for both the caregiver and care recipient; when present in the context of caregiving, a positive appraisal of the caregiving experience can give meaning to the caregiver's life and strengthen relationships 16predicting better health, less depression, and lower burden 12 Importantly, positive aspects of caregiving have been shown to moderate treatment outcomes for burdened caregivers, such that individuals endorsing lower positive aspects of caregiving demonstrate greater benefit from behavioral intervention 12suggesting that a tendency to positively appraise the caregiving experience may impact the degree to which a caregiver responds to behavioral intervention for caregiver burden.
While the impact of caregiving in human relationships is relatively well-established, this topic has rarely been examined in individuals providing care for a seriously ill companion animal. Over one-third of households in the United States include a dog It is common for a companion animal, particularly a dog or cat, to be viewed by the owner as a member of the family 17 — Although research suggests several health and social benefits of owning a companion animal [reviewed by Cherniack and Cherniack 20 ], debate exists regarding the notion that pet ownership is uniformly beneficial 21and the impact of providing long-term care for a companion animal with medical problems is not well understood.
This issue becomes increasingly relevant as advances in veterinary medicine present the option to extend the life of a seriously ill companion animal.
Protracted symptom management could be complex and time consuming for the companion animal owner, leading to caregiver burden. Past qualitative research 22 suggested issues related to caregiver burden were present in a small sample of owners of an aged or chronically ill dog, including greater care needs of the companion animal and related concerns of finances, work, and social life. More recently, measurement of companion animal caregiver burden 2324showed that, compared to those with a healthy companion animal, owners of a dog or cat with a serious illness reported greater caregiver burden and psychosocial distress, including above average levels of stress and clinically meaningful symptoms of depression.
Such findings suggest that intervention may be warranted in this population. The potential for future work translating caregiver burden treatments from human to companion animal caregiver populations will be informed by an appreciation of how caregiving experiences, particularly burden and positive aspects of caregiving, compare.
Because prior work in human medicine demonstrates that the degree to which the caregiving experience is positively appraised influences response to intervention for caregiver burden, we sought to understand how burden and positive aspects of caregiving relate and compare in groups of individuals providing care for a relative or a companion animal. We chose dementia caregiving as the comparison sample due to the well-established findings of burden and record of successful interventions in this population. This comparison will provide a foundation for future interventions in companion animal caregivers.
We hypothesized that, consistent with past work, burden and positive aspects of caregiving would be negatively related to each other. To our knowledge, no prior comparisons of this nature have been conducted; as such, we do not have formal a priori hypotheses regarding group differences.
However, the caregiving experience for these two groups may differ for many reasons, perhaps most notably due to the option of euthanasia for companion animal caregivers. We believe it is plausible that greater burden would be found in dementia caregivers, while positive aspects of caregiving may be greater in companion animal caregivers.
Specifically, the companion animal caregiver has made a decision to provide care rather than euthanize for a diagnosis of serious illness. The decision to assume the caregiving role may thus predispose the companion animal caregiver to a more positive caregiving experience. Exploratory item comparisons were also conducted to elucidate any group differences that might inform future research. The present paper draws data from two independent studies with similar methods.
Companion animal caregiver data were extracted from an existing dataset that has been ly described New data were collected for the dementia caregiver sample. Companion animal care recipients were required to be a dog or cat with a current diagnosis of an illness that a veterinarian concurred would be considered a serious illness i. Dementia care recipients were required to have a diagnosis of dementia given by a physician.
Demographic variables of age, gender, education, race, income, and duration of caregiving were assessed via questionnaire. The ZBI assessed caregiver burden. In its original form, the ZBI is a item self-report inventory that asks caregivers to rate the frequency with which they experience the stressful or negative implications of caregiving. This is rated on a 5-point scale ranging from 0 never to 4 nearly always.
The ZBI was modified for companion animal caregivers to include 18 items, and the adapted version was recently validated In order to compare groups, just these items were used in the current analyses. Both the total sum and individual item responses were examined in the current study. A summed score above 20 on the original ZBI is considered indicative of clinically meaningful burden 1.
Cronbach's alpha for the current study was 0. The PAC is a 9-item scale that assesses positive experiences associated with caregiving on a 5-point scale ranging from 1 disagree a lot to 4 agree a lotwith higher scores representing a more positive appraisal. Total sum and individual item responses were examined in the current study. Data were collected during October of for companion animal caregivers and October of for dementia caregivers.
These methods were employed to help optimize demographic matching for the two samples of interest. Data collection for both protocols was similar. Both online protocols began with informed consent. Respondents were required to acknowledge that participation was voluntary, that responses would be used for research, and that they met inclusion criteria.
Consent to participate was given by clicking to advance to the study protocol. Only those providing informed consent were enrolled. Meta-analysis of 84 studies comparing caregiving relatives to non-caregiving relatives of frail older adults showed moderate effect sizes for group differences in caregiver stress As there have been no prior comparisons of these exact issues in companion animal and family caregivers, we intentionally over-recruited for the current study to ensure a sufficient sample with complete data. Statistical analyses were identical for full and matched samples unless otherwise indicated.
Independent samples t -tests examined expectations that group differences would emerge in total scores on the adapted ZBI and PAC; degrees of freedom were adjusted for unequal variances when present. To examine the relationship between PAC and ZBI scores within each caregiver group separately, we stratified by group and conducted linear regression analyses, controlling for any demographic variables that displayed ificant associations with both PAC and ZBI.
In order to determine relevant covariates, bivariate correlations Pearson for continuous data, Spearman for ordinal data examining relationships among demographic variables and caregiving measures i. The familywise alpha level for ificance tests was set at 0. All statistical analyses were conducted using SPSS There were no ificant group differences for gender, education, or race. The matched samples showed no differences between groups for age, education, race, gender, income, or length of caregiving.
See Table 1 for sample characteristics and group comparisons. In the full sample, clinically ificant burden was endorsed by On the PAC, companion animal caregivers reported a more positive appraisal of caregiving In the matched sample, There were no ificant relationships between primary variables and age, gender, education, race, income status, or length of caregiving.
There were no such associations among dementia caregivers. See Table 4 for full correlation. Given that there were no ificant associations between any demographic or caregiving variables and both burden and positive aspects of caregiving, no further analyses were needed. The current study compared caregiver burden and positive aspects of caregiving in companion animal and family caregivers. Burden was greater in dementia caregivers but clinically elevated in both groups and ificantly related to financial strain in companion animal caregivers.
While overall burden was lower for companion animal caregivers, exploration of individual items suggested several similar experiences. Positive aspects of caregiving were negatively correlated with caregiver burden in both groups and were ificantly greater in companion animal caregivers. While the two caregiving groups showed demographic differences in the full sample, the matched sample demonstrated that findings were robust.
Differences in burden and positive aspects of caregiving between caregivers of relatives with dementia compared to companion animal caregivers are not surprising for several reasons. Although companion animals are often regarded as part of the family 17 — 19they are likely not viewed by most people as fully equivalent to human family members, and there are differences between companion animal and human relationships in attachment Use of dementia caregivers as the human caregiving comparison group may also partially explain differences in caregiver burden, given the possibility of behavioral disturbance and safety risk in this population 6.
This notion is supported by the exploratory item analyses showing that dementia caregivers were more likely than companion animal caregivers to experience the feeling that they cannot leave the house. But perhaps the most important difference is the option of euthanasia for the companion animal caregiver.
An individual who provides informal care for a family member may do so reluctantly or out of necessity, owing to financial limitations or lack of other supports In contrast, when faced with diagnosis of a serious illness in a companion animal, the owner can decide to euthanize, which may lead to a rarefied group of caregivers predisposed to a more positive experience in caregiving. In other words, degree of choice in assuming the caregiving role is variable in human caregiving relationships, but the companion animal owner has a clear alternative. More research is needed to fully understand the characteristics of companion animal caregivers, but the current work helps lay a foundation for this understanding.
Regardless of differences in overall levels of burden and positive aspects of caregiving, we observed some group similarities. First, caregivers in both groups reported similar financial strain related to caregiving, particularly once income status was controlled in analyses. Finding financial strain in the dementia caregiver group is expected and consistent with past work 3132but also makes sense for the companion animal caregiver. Inthe percentage of Americans covered by a single health coverage type was With the out-of-pocket expenses of advanced companion animal health care, financial distress in the companion animal caregiver might be anticipated or even greater than in the dementia caregiver.
This idea is supported by the link between burden and income in companion animal but not dementia caregivers in matched samples. Additionally, caregivers in the two groups reported similar levels of guilt, specifically feeling they should be doing more for their loved one.
Such findings have been repeatedly shown in dementia caregivers 34 — 36but why do companion animal caregivers feel they are not doing enough? The answer may again relate to difficulty affording treatment or could perhaps be due to time pressures and availability. While laws have been enacted to support family caregivers in many countries, similar protections typically do not exist for the companion animal caregiver. Inability to take time off might lead to providing a lower than desired level of care, in turn contributing to feelings of guilt for the companion animal caregiver.
Finally, comparable levels of fear for what the future holds for the loved one were also found in the two groups, further underscoring the presence and importance of emotional burden in companion animal caregiving. Although these item analyses were conducted in an exploratory manner and require replication, the striking similarity in group means for these three ZBI items sits in stark contrast to the highly ificant differences observed on other items.
The current work highlights the impact of caregiving for a seriously ill companion animal, with important implications for interventions to decrease caregiver burden in this population. Caregiving literature has documented that both psychotherapeutic and multicomponent interventions tailored to the specific needs of the caregiver may be effective in reducing burden in human caregiving samples 3738 ; research is needed to determine whether such interventions are beneficial for companion animal caregivers as well.
Given that positive aspects of caregiving were negatively related to burden, a reasonable path for future work would seemingly be to determine if enhancing this strength reduces burden in companion animal caregivers. However, at least one past work suggests that individuals endorsing few positive aspects of caregiving showed greater benefit from intervention This might mean that the average companion animal caregiver, with an already positive appraisal of caregiving, would not show substantial benefit from standard psychotherapeutic interventions.
Specifically, combining findings of the current manuscript with knowledge from prior work, it appears that interventions to enhance positive aspects of caregiving e. Rather, practical interventions to alleviate the daily load of caregiving and increase instrumental support might be more important. This notion aligns with suggestions 23 that educational strategies, intentional respite, and skills-based problem-solving should be considered in deing interventions to reduce burden associated with companion animal caregiving.
This work is not without limitations. The companion animal caregiver participants in the current study included individuals providing care for a companion animal with a chronic, but manageable, illness. In contrast, dementia is typically progressive and life-limiting 39 Future research should consider other caregiving groups for comparison. Additionally, although we were able to categorically match groups for length of care i.
While doing so may have influencedas greater length of caregiving is linked to higher burden 4142it would also have reduced the generalizability of our findings. Additionally, the companion animal and dementia caregivers who participated in the current study were recruited through social media, a decision made to enhance group similarity i. However, the experiences of individuals recruited through social media may not fully reflect the general companion animal and dementia caregiver populations. Recruitment methods could thus have introduced bias into the sample, though recent work 23244344 suggests patterns of burden are similar across recruitment methods.
Other characteristics, including high socio-economic class and relatively homogeneous gender and racial demographics may also influence generalizability ofand should be considered in future work. Finally, the cross-sectional de of this study is a limit—longitudinal des that better address causation are an important next step.
Multiple areas of further research may stem from this work. Euthanasia is an available option for the companion animal caregiver, but this does not necessarily mean it is considered an acceptable option to all. An important question to consider in future research of companion animal caregiving may thus be perception of choice in caregiving.
It may also be of benefit to investigate specific companion animal caregiving populations that may be especially burdensome, including diagnoses such as canine cognitive dysfunction. Additionally, existing interventions for family caregivers should be examined to determine adaptability for companion animal caregivers.
Recent work has begun to pinpoint specific contributors to companion animal caregiver burden 45 ; continued efforts to delineate the determinants of burden are needed, followed by work to begin establishing appropriate interventions.Serious companion needed
email: [email protected] - phone:(772) 935-4837 x 2665
Caregiving for a Companion Animal Compared to a Family Member: Burden and Positive Experiences in Caregivers