Perceived Life Meaning and Purpose and Its Association with Mental and Physical Health among Family Caregivers

Abstract Evidence suggests that having a sense of life meaning and purpose is related to physical health. However, the association between life meaning and purpose and physical and mental health among family caregivers remains unclear. This study aimed to examine whether family caregivers’ perceived life meaning and purpose was associated with their physical and mental health (depression and anxiety). The National Study of Caregiving (NSOC) III cross-sectional survey (2017, N = 2,652) was utilized. One item was used to measure family caregivers’ perceived life meaning and purpose and two composite variables were generated to measure depression and anxiety. Physical health was assessed by questions including pain, breathing problems, limited arm/leg strength, low energy, and sleep problems. Weighted logistic regression analyses with covariate adjustments (i.e., caregiver’s age, sex, and race/ethnicity) were conducted to examine the association among family caregivers’ perceived life meaning and purpose, mental and physical health. Results indicated that family caregivers’ perceived life meaning and purpose was associated with a lower probability of having depressive symptoms (OR, .29, 95% Confidence Interval [CI], .15, .57) and anxiety (OR, .43, 95% CI, .23, .79). Furthermore, perceived life meaning and purpose was associated with a lower probability of having breathing problems (OR, .50, 95% CI [.25, .99]). Findings suggest that having a strong sense of life meaning and purpose is linked to better mental health and physical symptoms. Further research is needed to determine the mechanism regarding how life meaning and purpose may improve mental and physical health among family caregivers.

A growing body of literature shows that family and unpaid caregivers of older adults with cancer are assuming more care responsibilities, especially after discharge from an inpatient admission, and frequently report feeling unprepared to do so. Interprofessional collaborative practice can rectify this gap to help ensure caregivers are included in the care team and patient education in the hospital. This retrospective data analysis of electronic health record data examines the prevalence of caregiver involvement in education activities conducted by health care practitioners for older adult cancer inpatients at an academic medical hospital in the midwestern United States. Our dataset includes a total of 676 admissions of older adult cancer inpatients (565 unique patients) between 9/1/2018 and 10/1/2019. Descriptive statistical analyses were conducted to determine the prevalence of caregiver involvement in patient educational activities. The average patient was 75 years old (range: 66-89), white(95%) and male (57%). Approximately 5,720 educational topics were discussed with patients, and 88% of admissions included some patient education. Caregivers were included in 29.6% of educational topics discussed and at least one education session for 42.9% of all admissions. Caregivers are important collaborators in supporting the health and well-being of older adults with cancer, but they are often not included in patient educational activities prior to discharge. Practioners may need to evaluate barriers to including caregivers in patient education activities. A better understanding of this gap in education can help inform future interprofessional collaborative practice initiatives.

INFORMAL CAREGIVERS' PERCEPTIONS OF BURDENS AND BENEFITS PREDICT GREATER CONFIDENCE IN THEIR ABILITIES
Cristina de Rosa, 1 Rebecca Lorenz, 1 and Suzanne Sullivan, 2 1. University at Buffalo,Buffalo,New York,United States,2. University at Buffalo,University at Buffalo,New York,United States Informal caregivers experience both burdens and benefits from caregiving. This analysis aimed to determine whether caregiver perceptions of burdens and benefits predicted feelings of confidence in their abilities. In the National Study of Caregiving (NSOC) Round II (2015), we identified 1,390 caregivers as "primary" for providing the greatest number of care hours in the past month to individuals age 65 and over. Logistic regression was performed to assess the influence of primary caregivers' gender, age, relationship to their care recipients, and self-reported indications of burdens and benefits on the odds that they would report confidence in their abilities. Caregivers were more likely to report confidence in their abilities when caregiving taught them to deal with difficult situations ( These findings suggest that confidence in abilities is influenced by caregivers' perception of learning to handle difficult situations, satisfaction, closeness to the recipient, and burdens associated with changes in routine. Future research should further explore burdens and benefits of caregiving. Health care providers should routinely assess caregivers and provide referrals for additional resources. Patient symptom management is a fundamental goal of cancer home hospice care. However, informal family caregivers, who are primarily responsible for daily patient care, also experience negative symptoms, especially at the end of the patient's life. While research has attended to patient symptom progression in home hospice, little research focuses on caregiver symptoms. To address this, we examined the frequency of both patient and caregiver symptoms to determine how these symptoms change in the last two months of the patient's life. Sixty-three cancer hospice caregivers from 4 US states prospectively reported daily patient and caregiver symptoms via an Interactive Voice Response phone system. We analyzed data from up to the last 60 days of the patient's life. Most caregivers were female (71.4%), Caucasian (88.9%), spouses of the patient (46%); average age was 59 years old (SD=13). Patients were mostly female (54%), with diverse solid tumor cancer diagnoses, and 72 years old (SD=11) on average. Most commonly reported moderate-tosevere patient symptoms were fatigue (67%), pain (47.5%), and loss in appetite (42.3%). Most common moderate-tosevere caregiver symptoms were fatigue (57.8%), trouble sleeping (45.1%), anxiety (52%), and depression (40.4%). Patient and caregiver symptoms were significantly correlated (Pearson r = .51, p<.001). Mixed-effects models found that both patient and caregiver symptoms (collapsed by week) worsened as patient death approached (ps <.01). Researchers and clinicians who are aware of the strong relationship between patient and caregiver symptoms are best able to address caregiver symptoms as part of hospice care, particularly as patient death approaches.

PERCEIVED LIFE MEANING AND PURPOSE AND ITS ASSOCIATION WITH MENTAL AND PHYSICAL HEALTH AMONG FAMILY CAREGIVERS
Yu-Ping Chang, 1 Loralee Sessanna, 1 and Young Sik Seo, 2 1. University at Buffalo,Buffalo,New York,United States,2. Roswell Park Comprehensive Cancer Center,Buffalo,New York,United States Evidence suggests that having a sense of life meaning and purpose is related to physical health. However, the association between life meaning and purpose and physical and mental health among family caregivers remains unclear. This study aimed to examine whether family caregivers' perceived life meaning and purpose was associated with their physical and mental health (depression and anxiety). The National Study of Caregiving (NSOC) III cross-sectional survey (2017, N = 2,652) was utilized. One item was used to measure family caregivers' perceived life meaning and purpose and two composite variables were generated to measure depression and anxiety. Physical health was assessed by questions including pain, breathing problems, limited arm/leg strength, low energy, and sleep problems. Weighted logistic regression analyses with covariate adjustments (i.e., caregiver's age, sex, and race/ethnicity) were conducted to examine the association among family caregivers' perceived life meaning and purpose, mental and physical health. Results indicated that family caregivers' perceived life meaning and purpose was associated with a lower probability of having depressive symptoms (OR, .29, 95% Confidence Interval [CI], .15, .57) and anxiety (OR, .43, 95% CI, .23, .79). Furthermore, perceived life meaning and purpose was associated with a lower probability of having breathing problems (OR, .50, 95% CI [.25, .99]). Findings suggest that having a strong sense of life meaning and purpose is linked to better mental health and physical symptoms. Further research is needed to determine the mechanism regarding how life meaning and purpose may improve mental and physical health among family caregivers.

PROLONGED MECHANICAL VENTILATION AT HOME VERSUS LONG TERM CARE: CAREGIVER CHARACTERISTICS AND STRAIN
Esther-Lee Marcus, 1 Jeremy Jacobs, 2 and Jochanan Stessman, 3 1. Herzog Medical Center,Herzog Medical Center,Yerushalayim,Israel,2. Hebrew University of Jerusalem,Jerusalem,Yerushalayim,Israel,3. Hadassah Hebrew University Medical Center,Clalit Health Services,Yerushalayim,Israel Although the number of Prolonged Mechanical Ventilation (PMV) patients and their informal caregivers (CGs) is rising both at Home or Long Term Care (LTC), little is known concerning CG characteristics or strain. We enrolled 120 patients and 106 informal CGs: 34/46 and 72CGs/74 PMV patients from Home Hospital and LTC respectively. CGs were married (82%), female (60.4%), mean age 59 ±14 years; spouses (29%) or children (40%) of the PMV patient. The 13-item Modified Caregiver Strain Index (MCSI) (Maximum severity=26) was 13.6± 6.5, similar at Home vs. LTC (14.3±7.5 vs. 13.3±6.0, p=0.9). Most frequent complaints were distress concerning patient's changes (93%) or upsetting behaviours (82%), feeling overwhelmed (82%), sleep disturbance (69%) and emotional adjustments (67%). Home CGs reported significantly more physical and financial burden, confinement, and need for work adjustment, while LTC CGs reported greater emotional disturbance and upsetting patient behaviours. Hierarchical clustering identified three clusters of CG strain: burden (physical/time/financial), emotional (upsetting adjustment/ behaviours/overwhelmed) and disturbance (work/plans/confinement). Emotional strain was most frequent, irrespective of site of care; however CGs at Home vs. LTC experienced significantly higher burden and disturbance vs. higher emotional strain respectively. In multivariate models, after adjusting for numerous patient and CG variables, increasing CG strain was consistently associated with rising patient symptomatology. This relationship was pronounced among CGs of Home PMV patients, with a significant interaction variable of Home*Patient symptomatology. Our findings identify specific patterns of strain among caregivers of PMV patients whether at home or LTC, and highlight the importance of addressing their unique needs.

SUPPORT NEEDS AS PERCEIVED BY GRANDPARENT-CAREGIVERS: A QUALITATIVE SYSTEMATIC REVIEW
Schola Matovu, 1 Deborah Whitley, 2 and Heather Young, 3 1. University of Utah College of Nursing,Salt Lake City,Utah,United States,2. Georgia State University,Atlanta,Georgia,United States,3. University of California Davis,Sacramento,California,United States Caregiving can have adverse mental and physical health outcomes. Older grandparents who are primary caregivers for their grandchildren report multiple health conditions such as depression, anxiety, hypertension, cardiac disease and chronic fatigue, which are caused by or otherwise exacerbated by the caregiving demands. We conducted this qualitative systematic review to identify support needs that contribute to such poor health outcomes and as perceived by grandparentcaregivers for minor grandchildren. We searched relevant databases (PubMed, PyschINFO, CINAHL, and Social Work Abstracts) using terms such as: child rearing, parenting, child custody, grandparents, support needs, and caregiving. Studies were included for review if they were written in the English language; used only qualitative methods; and were published from January 1990 to January 2020. Included studies were critically appraised using the Critical Appraisal Skills Programme checklist. Data were extracted from these studies and synthesized using meta-ethnography. Of the 2828 studies identified, 58 studies from 12 countries met all inclusion criteria for review. Three main themes emerged from the review: 1) grandparent-caregivers' personal needs, and 2) grandchildren needs. Both themes were further divided into subthemes of health (mental & physical), financial, social (interpersonal, cultural and environmental factors and services). Findings from this review have potential to: 1) inform design of comprehensive interventions and screening needed to address perceived support needs; and 2) identify gaps in and barriers to available support resources for older grandparent-caregivers. Further research is needed on comprehensive assessment of support needs and risk for poor health outcomes among grandparent-caregivers.

TESTING PREDICTIVE FACTORS OF DEPRESSIVE SYMPTOMS AMONG GRANDPARENTS UNDER THE COVID-19 PANDEMIC Yuqin Jiao, and Christine Fruhauf, Colorado State University, Fort Collins, Colorado, United States
An estimated 69.5 million Americans are reported to be grandparents. Among them, about 10% are raising grandchildren and the number of grandparents who are raising grandchildren (GRG) is increasing. Previous research on GRG suggests that the unexpected caregiving duties may lead to negative physical and mental health including more depressive symptoms when compared to non-caregiving grandparents (NGRG). Additionally, grandparent-grandchild relationships determined by emotional availability (EA) of the grandparent may be impacted. These factors might further be complicated, especially as it relates to the health and well-being of GRG, as a result of the COVID-19 pandemic. Thus, the overarching goal of this presentation is to use the