Rural Food Environment, Caregiver Influence and School-Aged Children’s Unhealthy Food Choice: New Evidence From Rural China

Background A large number of unhealthy foods with low nutrition content and safety issues exist in the rural food consumption environment of China. Guiding rural children to avoid eating unhealthy foods through family intervention has become much more critical. However, when current rural caregivers are once left behind by their parents and lack of family education in their childhood, how would they affect their children’s unhealthy food choices? The purpose of this study is to highlight the new evidence of current rural caregivers’ influences on children’s unhealthy food choices in China. Methods Based on a survey of 5611 pairs of rural school-aged children and their caregivers in seven provinces, the significant effects of caregivers’ types, parenting attitudes, and socio-demographic characteristics on children’s unhealthy food choices were evaluated through an ordered probit model. Results This study found that rural parents did not perform positive influence than rural grandparents as conventionally believed. When the caregiver type changing from parents to grandparents, the percentage of children who mildly accept unhealthy foods increased 6.94%, while the percentage of children who moderately and severely accept unhealthy foods decreased 6.48% and 0.46%, respectively. In addition, this study underscored the significance of caregivers’ neglectful parenting attitudes on the impact of children’s unhealthy eating behavior. When caregivers’ parenting attitudes changing from doting attitude to neglectful attitude, the percentage of children who mildly accept unhealthy foods decreased 9.75%, while the percentage of children who moderately and severely accept unhealthy foods increased 8.77% and 0.99%, respectively. Conclusions Our study proposes new evidence that the current rural parents’ inherent intention and preference for those unhealthy foods formed in their childhood would be much higher than rural grandparents and might have performed a significantly negative influence on their children. Our findings also have policy implications for health promotion professionals who look for intervention targets of caregivers to improve their health education effectiveness for children. For the health education toward rural caregivers, instead of focusing on the caregiver types, segmenting those rural caregivers with neglectful parenting attitude would be the key step to identify the intervention targets.

Rural Versus Non-Rural Residence and Psychosocial Outcomes Among Caregivers of Patients with Dementia and Related Disorders

We used data on 718 dementia caregivers and multivariable linear regression to test associations between residential locale and psychosocial outcomes (grief, wellbeing, burden, quality of life [QOL], self-efficacy/mastery, and social networks). Rural residence (versus urban or suburban) was not associated with the psychosocial outcomes. However, for rural caregivers, greater self-efficacy/mastery was associated with lower grief (versus urban/suburban) and burden (versus suburban), and greater social network quality was associated with lower burden (versus suburban) and higher QOL (versus urban). Interventions targeting self-efficacy/mastery and social networks may be particularly effective at improving rural caregivers’ mental health and QOL.

Caring ability of urban and rural family caregivers: association with overburden, stress and coping

ABSTRACT Objective: To correlate caring ability with overburden, stress and coping of urban and rural family caregivers of patients undergoing cancer treatment. Method: Cross-sectional study, carried out in a referral hospital for cancer treatment, with urban and rural caregivers who responded the following instruments: questionnaire of sociodemographic characterization of the caregiver and the care provided, Perceived Stress scale, Burden Interview scale and Brief COPE. Pearson's correlation test was used for statistical analysis, with a significance level ≤5%. Results: A total of 163 urban caregivers and 59 rural caregivers participated in the study. Between the caring ability and stress, a negative and moderate correlation was found in rural caregivers. In the relationship between the caring ability and the overburden, there was a statistically significant correlation in urban caregivers in the interpersonal relationship and perception of self-efficacy factor. Between coping and the caring ability, a positive and moderate correlation was identified in coping focused on the problem in the knowledge dimension in urban caregivers. Conclusion: Urban caregivers had greater intensity of overburden and coping focused on the problem in relation to the caring ability.

All Is Good, but Not Really: Daily Reports of Satisfaction With Home- and Community-Based Services

An extensive body of literature documents correlates of and barriers to health service use, yet much less is known about satisfaction with home- and community-based services for persons with dementia (PwD). Daily diary data from 122 rural caregivers (CG) of PwD (814 daily diaries) were used to assess everyday service use experiences. At the last diary interview, CG identified areas where service use expectations were and were not being met. CGs reported problems with services used on fewer than 5% of study days (e.g., service provider was delayed because of car trouble). In contrast, 82% of CG identified areas where service expectations were not being met. Their most common concerns were lack of control over service availability and lack of adequate training among service providers. Recommendations for alternative ways for capturing service use satisfaction will be offered, and implications for theory and practice will be discussed.

Rural-Urban Differences in Informal Caregiving, Caregiving Intensity, and Health-Related Quality of Life

Introduction Rural areas in the US have a disproportionately high population of older adults and have reduced access to services. Older adults in rural areas are more reliant on family and friends for care. However, little is known about rural-urban disparities among the 40+ million caregivers nationwide. As rural-urban health disparities are pervasive among older adults, there is a need to understand how rural-urban disparities impact caregiving experiences and health-related quality of life (HRQoL). The objectives of this study were to examine rural-urban differences caregiving, caregiving intensity (caregiving hours/week and types of care provided), and caregiver HRQoL. Methods Data were abstracted from the 2009 Behavioral Risk Factor Surveillance System (latest dataset to include county of residence and caregiver module). The primary measure of rural-urban status was Index of Relative Rurality (IRR) decile. Associations between rural-urban status and caregiving and rural-urban differences in caregiving intensity and HRQoL were examined using generalized linear models, controlling for confounding and accounting for complex sampling. Results Rural respondents were more likely to be caregivers than urban respondents (IRR decile OR=1.015, 95%CI 1.014-1.016). Rural caregivers, on average, provided 2.43 hours/week more caregiving for each one-decile increase in IRR decile (95%CI 2.34-2.52) and had worse overall HRQoL (OR=1.34, 95%CI 1.33-1.35). Conclusion Rural informal caregivers offer higher levels of care than urban counterparts, and increased caregiving in rural areas is associated with reduced HRQoL. These results can inform policies designed to improve caregiver health, and facilitate the translation of existing programs and interventions to address rural caregivers’ needs.

Unmet Home- and Community-Based Service Needs Among Informal Caregivers in Rural and Urban Areas

Home- and community-based services (HCBS) can reduce caregiver burden. We compared the prevalence of HCBS unmet needs among caregivers in rural and urban areas and identified factors associated with unmet HCBS needs. We used 2015-2018 Behavioral Risk Factor Surveillance System data, including the optional Caregiver Module, from 44 states, District of Columbia, and Puerto Rico. Caregivers were individuals providing care/assistance to a friend/family member with a long-term illness/disability during the past 30 days. Unmet needs were defined as needing, but not receiving, one or more of the following: caregiving classes, help accessing services, support groups, individual counseling, or respite care. “Rural” was defined as living outside Metropolitan Statistical Areas (available only for landline respondents). We calculated weighted estimates and used log-binomial regression to estimate adjusted prevalence ratios (PR). 19% of 25,180 caregivers lived in a rural area. Rural caregivers were less likely to report unmet HCBS needs (14.4% versus 20.6% urban, p<0.001), even after accounting for sociodemographic and caregiving characteristics (PR=0.81, 95% CI: 0.65-0.99, p=0.040). Unmet needs were more common among caregivers who provided more care, personal care, or care for someone with Alzheimer’s disease/dementia, regardless of rural residence. Although rural individuals can experience more barriers to accessing health services, rural caregivers in our study reported fewer unmet HCBS needs than urban caregivers. Additional research is needed to determine if stronger systems of informal support in rural areas may explain this difference. Further investigation of factors contributing to differences in unmet service needs among rural and urban caregivers is needed.

Development and Validation of a Community Assessment Tool for Diverse Rural Family Caregivers

The aging of the United States population has led to an increase in the prevalence of Alzheimer’s Disease and Related Dementias (ADRD). Many individuals with ADRD receive care from family members and friends who, themselves, experience poor health outcomes. ADRD family caregivers from diverse backgrounds are frequently underserved by health and social service systems. However, research suggests that diverse caregivers possess culturally-based strengths that serve as protective factors against poor outcomes. This presentation reports findings from a study to develop and validate a community assessment of the needs, assets, and resources of rural Latinx and Native American ADRD family caregivers. Initial assessment items were based upon validated measures developed for diverse ADRD and comparable caregiver populations. A Delphi process was used to obtain ratings from a 9-member expert panel (ADRD policy makers, providers, and family caregivers) about the degree to which the assessment was: (1) inclusive of different cultural groups; (2) respectful of cultural values and norms; (3) comprehensive with respect to needs, assets, and resources, and; (4) relevant to the lived experiences of diverse rural caregivers. Experts also provided qualitative feedback about modifying phrases to make the assessment more relevant to diverse respondents, removing sections, and adding items and response options to better reflect rural life. After two formal rounds of review and multiple iterations, between 77% and 100% of experts agreed that all sections of the assessment met criteria. Findings highlight the benefits of a systematic process for developing and validating community assessments for diverse, rural populations.

Using Video Telehealth to Support Family Caregivers of People With Dementia

In 2030, predictions indicate that dementia will affect 75 million people worldwide and increase to 132 million by 2050. Persons’ with dementia (PWD) associated behavioral changes are highly correlated with caregiver burden. Caregivers of PWD commonly report concerns regarding personal and home safety, meaningful activities, advance care planning, and evaluation and diagnosis of dementia of the PWD. Further, caregivers’ emotional response to PWD challenging behavior has greater influence than the actual behavior on decisions to place PWD in a nursing home. Caregiver intervention reduces behavioral and psychological symptoms in the PWD, the caregiver’s emotional distress from these symptoms, and cost to healthcare systems. Yet, one in four dementia caregivers are not receiving dementia support services. Difficulty attending in person clinic-based appointments may be one barrier to caregivers engaging in treatment. This symposium highlights telehealth approaches, by various disciplines (Geriatrician, Neurologist, Geriatric Psychiatric, Geropsychologist, and Occupational Therapist), across urban and rural settings to address caregiver needs and improved access to care. The first presentation will focus on education of rural caregivers of PWD and increased connection to services (Sussman et al). The second presentation will focus on Video to home dementia visits for caregivers (Gately & Moo). The third study will focus on rural tele dementia caregiver support groups and effects on caregiver burden (Rossi et al). The final study will describe co-occurring caregiver and PWD telehealth groups (Thielke & Fredrickson).

Telehealth Psychological Interventions for Rural Caregivers: Improving Care to Persons With Dementia

Geropsychologists are well-suited to assess dementia, assist caregivers in understand the disease and associated behavioral changes and ways to cope with their loved one’s disease. However, majority of these services are offered during in-person clinic appointments in urban settings. This study aims to describe the utilization and potential benefits of providing dementia education telehealth services to Veterans and their families residing in rural mountain and plain areas of Colorado. Psychological intervention was provided via telehealth from the primary VA hospital to small community clinics or to Veterans homes via video mobile application. The present study provides demographics of participants who elect this service and discusses how these challenge ageism and other biases relate to technology use. Further, we examined how engagement in this intervention may impact utilization of geriatric and extended care services as well as use of primary care, emergency room visits, and use of anti-psychotic medications.

Do Competing Demands Elevate Caregiver Challenges?

Family members caring for relatives with dementia simultaneously hold other roles and face other everyday challenges related to employment, finances, interactions with others, and the like. Using the Pearlin stress process model as a foundation, we evaluated contributions of secondary role and intrapsychic stressors such as health, relationship, and financial worries, and role captivity and overload, to 157 rural caregivers’ morale and well-being. Whereas family conflict and role overload contributed significantly to higher agitation, money worries, poor health, and role captivity interfered with positive mental health (p<.05). Nevertheless, some caregivers characterized employment and volunteering as respite from caregiving and appreciated informal help even when family ties were complicated. Findings highlight complex responses to dementia-related caregiving and point to the need for a range of resources and support deployed creatively to assist caregivers in places such as rural Appalachia where geography, underfunding, and low income limit access to services.