Classifying Heart Failure Caregivers as Adequately or Inadequately Resourced to Care: A Latent Class Analysis

Abstract

Objectives

To identify classes of heart failure (HF) caregivers based upon indicators of coping resources and stress, and then, to examine the relationships between the identified caregiver classes and depression, caregiver burden, and life changes.

Methods

Cross-sectional data from 530 HF caregivers were analyzed in this secondary analysis using a three-step latent class mixture model to classify caregivers based on level of resources and examine the relationship between the identified classes and depression, caregiver burden, and life changes. Using an online survey, caregivers reported on social support, problem-solving, family function, depression, caregiver burden, and life changes.

Results

Caregivers were 41.39 (± 10.38) years of age, 49.1% women, 78.3% white, 77.6% urban-dwelling, and 61.7% college/postgraduate educated. Three classes of caregivers (42.3% Adequately Resourced, 25.1% At Risk for Decompensation, 32.6% Inadequately Resourced) were identified. Inadequately Resourced caregivers had the lowest levels of social support, problem-solving, and family function and the highest levels of depression and caregiver burden. Caregivers At Risk for Decompensation had the best family function and reported the most positive perceptions of life changes despite low levels of social support and problem-solving.

Conclusion

Social support, problem-solving, and family function are modifiable coping resources which may buffer stress and influence stress indicators. Caregivers with few coping resources may experience higher degrees of depression and burden, and less positive perceptions of life changes. More research is needed to examine the influence of these coping resources on caregiver adaptation to facilitate the development of targeted interventions which support caregiver mental health.

Keywords

heart failure caregiver coping depression caregiver burden palliative care

Get full access to this article

View all access options for this article.

References

Chi

Demiris

Pike

Washington

Parker Oliver

. Exploring the challenges that family caregivers faced when caring for hospice patients with heart failure. J Soc Work End Life Palliat Care. 2018;14(2–3):162-176.

Guidi

Lucente

Sonino

Fava

. Allostatic load and its impact on health: a systematic review. Psychother Psychosom. 2021;90(1):11-27.

Warraich

Hernandez

Allen

. How medicine has changed the end of life for patients with cardiovascular disease. JACC. 2017;70(10):1276-1289.

National Alliance for Caregiving (NAC) and the AARP Public Policy Institute. Caregiving in the U. S. 2015 report. https://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf. Published 2015. Accessed March 31, 2021.

Grant

Graven

. High priority problems experienced by informal caregivers of individuals with heart failure. Home Health Care Manage Pract. 2019;31(2):75-82.

Family Caregiver Alliance. Caregiver health. https://www.caregiver.org/caregiver-health. Published 2020. Accessed February 26, 2021.

Kitko

McIlvennan

Bidwell

, et al. Family caregiving for individuals with heart failure: a scientific statement from the American heart association. Circulation. 2020;141(22):e864-e878.

Schultz

Eden

. National Academies of Sciences, Engineering, and Medicine Report: Families Caring for an Aging America. The National Academies Press; 2016.

Chung

Pressler

Dunbar

Lennie

Moser

. Predictors of depressive symptoms in caregivers of patients with heart failure. J Cardiovasc Nurs. 2010;25(5):411-419.

10.

Graven

Azuero

Abbott

Grant

. Pyschosocial factors related to adverse outcomes in heart failure caregivers: A structural equation modeling analysis. J Cardiovasc Nurse. 2020;35(2):137-148.

11.

Zincir

Sunbul

Zincir

, et al. Burden and depressive symptoms associated with adult-child caregiving for individuals with heart failure. Sci World J. 2014;2014(641817):1-6.

12.

Family Caregiver Alliance. Caregiver depression: A silent health crisis. https://www.caregiver.org/caregiver-depression-silent-health-crisis. Published 2020. Accessed February 26, 2020.

13.

Lacerda

do Prado

de Barros

ALBL

de Lima Lopes

. Depressive symptoms in the family caregivers of patients with heart failure: an integrative review. Rev Gaúcha Enferm. 2019;40(1):e20180057.

14.

Noonan

Wingham

Taylor

. ‘Who cares?’ The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease, and coronary artery disease: a mixed methods systematic review. BMJ Open. 2018;8(e020927):1-17.

15.

Grant

Graven

Prapanjaroesin

Azuero

Luttik

. Psychiatric examination of the Dutch objective burden inventory in heart failure caregivers. J Cardiovasc Nurs. 2020;35(6):E70-E76.

16.

Luttik

Jaarsma

Tijssen

van Veldhuisen

Sanderman

. The objective burden in partners of heart failure patients: development and initial validation of the Dutch objective burden inventory. Eur J Cardiovasc Nurs. 2008;7(1):3-9.

17.

Ström

Andersen

Korneliussen

Fagermoen

. Being “on the alert” and “a forced volunteer”: a qualitative study of the invisible care provided by the next of kin of patients with chronic heart failure. J Multidiscip Healthc. 2015;8(1):271-277.

18.

Chung

Lennie

Mudd-Martin

Dunbar

Pressler

Moser

. Depressive symptoms in patients with heart failure negatively affect family caregiver outcomes and quality of life. Eur J Cardiovasc Nurs. 2016;15(1):30-38.

19.

Negarandeh

Delkhosh

Janani

Samiei

Ghasemi

. The relationship between perceived life changes and mental health in family caregivers of patients with heart failure who referred to rajaei cardiovascular medical and research center, Tehran. Int J Community Based Nurs Midwifery. 2015;3(4):283-291.

20.

Peyrovi

Mohammad-Saeid

Farahani-Nia

Hoseini

. The relationship between perceived life changes and depression in caregivers of stroke patients. J Neurosci Nurs. 2012;44(6):329-336.

21.

Pressler

Gradus-Pizlo

Chubinski

, et al. Family caregivers of patients with heart failure: a longitudinal study. J Cardiovasc Nurs. 2013;28(5):417-428.

22.

Lazarus

Folkman

. Stress, Appraisal, and Coping. Spring Publishing Company; 1984.

23.

D’Zurilla

Nezu

Maydeu-Olivares

. Social problem-solving: theory and assessment. In: Chang

D’Zurilla

, eds. Social Problem-Solving: Theory, Research, and Training. American Psychological Association; 2004:11-27.

24.

Dionne-Odom

Hooker

Bekelman

, et al. Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state of the science review. Heart Fail Rev. 2017;22(5):543-557.

25.

Dunbar

Clark

Quinn

Gary

Kaslow

. Family influences on heart failure self-care and outcomes. J Cardiovasc Nurs. 2008;23(3):258-265.

26.

Grant

Graven

. Problems experienced by informal caregivers of individuals with heart failure: an integrative review. Int J Nurs Stud. 2018;80(1):41-66.

27.

Epstein

Ryan

Bishop

Miller

Keitner

. The McMaster model: a view of healthy family functioning. In: Walsh

, ed. Normal Family Process. 3rd ed. Guilford Press; 2003:581-607.

28.

Grey

Knafl

McCorkle

. A framework for the study of self- and family-management of chronic conditions. Nurs Outlook. 2006;54(5):278-286.

29.

Pritchett

Kemp

Wilson

Minnis

Bryce

Gillberg

. Quick, simple measures of family relationships for use in clinical practice and research: a systematic review. Fam Pract. 2011;28(2):172-187.

30.

Lum

Hooker

Bekelman

. Caregiving in heart failure: relationship quality is associated with caregiver benefit and caregiver burden. Heart Lung. 2014;43(4):306-310.

31.

Hooker

Grigsby

Riegel

Bekelman

. The impact of relationship quality on health-related outcomes in heart failure patients and informal family caregivers: an integrative review. J Cardiovasc Nurs. 2015;30 (45):S52-S63.

32.

Bangerter

Griffin

Dunlay

. Qualitative study of challenges of caring for a person with heart failure. Geriatr Nurs. 2018;39(4):443-449.

33.

Garland L

Dew MA

. Effects of problem-solving therapy on depression and anxiety in new family caregivers of persons with cognitive impairment. Am J Geriatr Psychiatry. 2013;21(3):S147-S148.

34.

Tang

Jang

Lingler

Tamres

Erlen

. Stressors and caregivers’ depression: multiple mediators of self-efficacy, social support, and problem-solving skill. Soc Work Health Care. 2015;54(7):651-668.

35.

Garland

Morse

ChiaRebecca

, et al. Problem-solving therapy reduces subjective burden levels in caregivers of family members with mild cognitive impairment or early-stage dementia: secondary analysis of a randomized clinical trial. Int J Geriatr Psychiatry. 2019;34(7):957-965.

36.

Demiris

Parker Oliver

Washington

, et al. A problem-solving intervention for hospice caregivers: a pilot study. J Palliat Med. 2010;13(8):1005-1011.

37.

Bidwell

Lyons

Lee

. Caregiver well-being and patient outcomes in heart failure: a meta-analysis. J Cardiovasc Nurs. 2017;32(4):372-382.

38.

Green

Ayalon

. Improving the cooperation rate of older adults and their caregivers in research surveys. Gerontology. 2015;61(4):355-363.

39.

Ibrahim

Sidani

. Strategies to recruit minority persons: a systematic review. J Immigr Minor Health. 2014;16(5):882-888.

40.

Brooke

Bullock

. Validation of a 6-item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry. 1999;14(11):936-940.

41.

Bowen

AMI

Daniel

Williams

Baird

. Identifying multiple submissions in internet research: preserving data integrity. AIDS Behav. 2008;12(6):964-973.

42.

Teitcher

Bockting

Bauermeister

Hoefer

Miner

Klitzman

. Detecting, preventing, and responding to “fraudsters” in internet research: ethics and tradeoffs. J Law Med Ethics. 2015;3(1):116-133.

43.

Cohen

Mermelstein

Kamarck

Hoberman

. Measuring the functional components of social support. In: Sarason

Sarason

, eds. Social Support: Theory, Research, and Applications. Martinus Nijhoff Publishers; 1985:73-94.

44.

Graven

Grant

Vance

Pryor

Grubbs

Karioth

. Predicting depressive symtpoms and self-care in patients with heart failure. Am J Health Behav. 2015;39(1):77-87.

45.

D’Zurilla

Nezu

Maydeu-Olivares

. Manual for the Social Problem-Solving Inventory-Revised. North Tonawanda: Multi-Health Systems Inc; 2002.

46.

Smilkstein

Ashworth

Montano

. Validity and reliability of the family APGAR as a test of family function. J Fam Pract. 1982;15(2):303-311.

47.

Swain

Harrigan

. Measures of well-established self-report instruments. In: Swain

Harrigan

Woog

, eds. Measures of Family Functioning for Research and Practice. Springer; 1985:1-50.

48.

Dunbar

Clark

Deaton

Smith

O’Brien

. Family education and support interventions in heart failure. A pilot study. Nurs Res. 2005;54(3):158-166.

49.

Radloff

. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1 (3):385-401.

50.

Kim

Chung

Askew

, et al. Translating CESD-20 and PHQ-9 scores to PROMIS depression. APA Soc Clin Psychol. 2017;24(3):300-307.

51.

Makdessi

Harkness

Luttik

McKelvie

. The Dutch objective burden inventory: validity and reliability in a Canadian population of caregivers for people with heart failure. Eur J Cardiovasc Nurs. 2011;10(4):234-240.

52.

Bakas

Champion

Perkins

Farran

Williams

. Psychometric testing of the revised 15-item bakas caregiving outcomes scale. Nurs Res. 2006;55(5):346-355.

53.

IBM Corporation. IBM SPSS Statistics for Windows, Version 22.0. IBM Corporation; 2013.

54.

Muthen

. Mplus user's guide (7th ed.). Muthen & Muthen; 2012.

55.

Asparouhov

Muthen

. Auxiliary variables in mixture modeling: three-step approaches using M plus. Struct Equ Modeling. 2014;21(3):329-341.

56.

McLarnon

MJW

O’Neill

. Extensions of auxiliary variable approaches for the investigation of mediation, moderation, and conditional effects mixture models. Organ Res Methods. 2018;21(4):955-982.

57.

Vermunt J

. Latent class modeling with covariates: two improved three-step approaches. Pol Anal. 2010;18(4):450-469.

58.

Hou

Chen

Zhang

Fan

. The relationship between caregiver reactions and psychological distress in family caregivers of persons with heart failure. J Cardiovasc Nurs. 2020;35(3):234-242.

59.

Durante

Greco

Annoni

Steca

Alvaro

Vellone

. Determinants of caregiver burden in heart failure: does caregiver contribution to heart failure patient self-care increase caregiver burden? Eur J Cardiovasc Nurs. 2019;18(8):691-699.

60.

Tramonti

Bonfiglio

Bongioanni

, et al. Caregiver burden and family functioning in different neurological diseases. Psychol Health Med. 2019;24(1):27-34.

61.

Yeh

Bull

. Use of the resiliency model of family stress, adjustment, and adaptation in the analysis of family caregiver reaction among families of older people with congestive heart failure. Int J Older People Nurs. 2012;7(2):117-126.

62.

Pharr

Francis

Terry

Clark

. Culture, caregiving, and health: exploring the influence of culture on family caregiver experiences. ISRN Pub Health. 2014;89826(1):1-8.

63.

Sharma

Chakrabarti

Grover

. Gender differences in caregiving among family – caregivers of people with mental illness. World J Psychiatry. 2016;6(1):7-17.

64.

Pinquart

Sorensen

. Gender differences in caregiver stressors, social resources, and health: an updated meta-analysis. J Gerontol BPsychol Sci Soc Sci. 2006;61(1):P33e45.

65.

Bradley

. Problem-solving differences between men and women. 2020. Healthguidance.org; https://www.healthguidance.org/entry/13967/1/problem-solving-differences-between-men-and-women.html. Published 2020. Accessed November 12, 2021.

66.

Luttik

Jaarsma

Lesman

Sanderman

Hagedoorn

. Quality of life in partners of people with congestive heart failure: gender and involvement in care. J Adv Nurs. 2009;65(7):1442-1451.