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All authors have read and approved the manuscript. Study concept and design: TML. Drafting of the manuscript: TML. Funding: TML. Project supervision: TML. Written informed consent was obtained from all the participants. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Skip to main content Skip to sections. Advertisement Hide. Download PDF.

Development and validation of a simple screening tool for caregiver grief in dementia caregiving. Open Access. First Online: 27 February Part of the following topical collections: Psychology, psychiatry and quality of life. Background Loss and grief are experienced by caregivers of persons with dementia PWD , relating to the ambiguous loss of PWD even when they are still alive and the anticipation of future loss related to their physical death. Results Four key factors were identified by the multivariable regression — more severe dementia odds ratio, OR 6. Conclusions The identified factors are consistent with current understanding on caregiver grief.

Background Bereavement in dementia caregiving can occur long before the physical death of the PWD. Participants and procedures in the derivation sample The derivation sample is based on an ongoing study on dementia caregiving at two tertiary hospitals in the North-East of Singapore. Evaluating the simple screening tool in an independent validation sample We validated the screening tool in an independent sample, based on our separate study which recruited another caregivers to complete the Chinese MM-CGI instead of the English MM-CGI.

Of the participants in the derivation sample, of them were children caregivers and 35 were spousal caregivers.

Materials and methods

Only four variables remained significant in the multivariable regression, namely, stage of dementia, severe behavioral problems in PWD, spousal caregivers and caregivers who provide daily care. Notably, it had an acceptable ability to discriminate caregivers with high grief, with an AUROC of 0. Using the four key factors identified from multivariable regression, we evaluated whether a simple screening tool — based on the number of key factors alone — was adequate to detect caregivers with high grief. At the optimal cut-off of two or more key factors, the screening tool had a sensitivity of 0.

In the presence of two or more key factors, the tool could capture a larger proportion of caregivers with high grief In the presence of two or more key factors, the tool could similarly capture a larger proportion of caregivers with high grief We can further consolidate the screening tool into a simple algorithm that can be easily integrated into the workflow of routine health and social services which are involved in the care of PWD.

Áreas de práctica

As seen in Fig. Based on the presence of the two key factors in the PWD, it then directs practitioners to identify caregivers with specific characteristics such as spouse, or children providing daily care to the PWD for further grief evaluation, using scales such as the MM-CGI or MM-CGI-SF [ 10 , 11 ] which have better specificity in confirming the presence of high grief. Due to its simplicity, this algorithm may be easily integrated as part of the routine workflow in health and social services, and hence can remove the need for dedicated staff to specifically perform this screening role.

It can also be directly used by frontline staffs, on a regular basis, as a simple visual aid to alert them on the caregivers who may require from further referrals for grief assessments. Open image in new window. Acknowledgements The authors thank the participants for their support of this research.

Ethics approval and consent to participate The Domain Specific Review Board of Singapore granted ethical approval for the study. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. DOCX 37 kb. DOCX 38 kb. Detecting Predeath grief in family caregivers of persons with dementia: validity and utility of the Marwit-Meuser caregiver grief inventory in a multiethnic Asian population. CrossRef Google Scholar. Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review.

Br J Psychiatry. Int Psychogeriatr. Piiparinen R, Whitlatch CJ. Existential loss as a determinant to well-being in the dementia caregiving dyad: a conceptual model. Detecting pre-death grief in family caregivers of persons with dementia: measurement equivalence of the mandarin-Chinese version of Marwit-Meuser caregiver grief inventory. BMC Geriatr. Grief reactions in dementia carers: a systematic review. Int J Geriatr Psychiatry. The impact of anticipatory grief on caregivers of persons with Alzheimer's disease.

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Home Health Care Serv Q. Comparing the effects of grief and burden on caregiver depression in dementia caregiving: a longitudinal path analysis over 2.


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J Am Med Dir Assoc. Lindauer A, Harvath TA. Pre-death grief in the context of dementia caregiving: a concept analysis. J Adv Nurs. However, career years and age were not associated with English proficiency. Doctors with higher degree are more likely to be employed by hospitals of higher grades, while doctors with bachelor degree or associate degree tend to work in smaller township hospitals.

It is not surprising that doctors with higher levels of education and from teaching academic hospitals were more sophisticated in English, both reading skills and publishing experience. Furthermore, doctors from teaching hospitals and universities have more opportunity to go abroad and are more likely to be exposed to English language environment. This is somewhat in contrast to the answer that However, this could be due to that there was a long time gap between the participants read the English literature and they answered the survey.

This results illustrate overall English literature usage should be much improved. On the other hand, one surprising finding from this study is that with the prolific writers who had published more than ten papers in English journals as a main author, The limitations of the study include that the sample might be biased and did not reflect the true status of English usage pattern among mainland Chinese doctors.

For example, doctors from less developed areas are likely less accessible to on-line survey. Teaching hospital doctor counted for Furthermore, the participants were all registered DXY website user, their internet skills as well as English skill may be better than the non-DXY-users on average, also it is possible that those willing to take participate this survey might have better English skill than those did not respond.

Another possibility is that young doctors are more likely to respond to the survey than well-established and busier senior doctors. In conclusion, our study provides the first survey on English language usage pattern of Chinese mainland doctors. Mainland Chinese doctors were more likely to consult medical materials in Chinese when they encounter clinical difficulties.

This limited survey suggests to improve English education at the undergraduate and post-graduate levels should be recommended.

Handbook of Statistical Analyses Using Stata

We would also like to advocate making authentic Chinese translation of high quality international educational journals, such as Radiographics in the case of radiology specialty, available to Chinese doctors. Data were expressed as the frequency and percentage for categorical variables.


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Quantitative data were expressed as median and interquartile range or mean and standard error as appropriate. This is a cohort survey and there was no comparison between groups. Structural equation modeling: strengths, limitations, and misconceptions. Annu Rev clin psychol ; We constructed a latent variable named English to represent English language skills. Latent variable is a virtual variable that cannot be measured or observed but it can be reflected by other observed and measured variables.

As in our case, English language skills cannot be directly measured but can be reflected by using reading skills and publishing experiences. The path diagram of SEM was shown in Figure 3. Boxes with variable names inside them are observed variables that we obtained directly from survey. The Circle with variable name English within it is the latent variable that we constructed theoretically.

The arrows or paths represent the hypothesized relationships between variables. When a path points from one variable to another, it means that the first variable affects the second. Small numbers written along the arrow connecting two variables were estimated coefficient after running the model estimation. In this model, English language skills variable Engish were influenced by gender, age, diploma, hospital hospital level , rank e. Generalized SEM allows for different distributions of dependent variables. Distributions and link functions of other variables are denoted in Figure 3.

The number of the variable 2. The month is broken up into weeks, with a separate line for each day of each day of each week. Changes this month; Non-combustion use of fossil fuels in physical units Table 1. Automating repetitive tasks with macros for instance. Many employers want to check that you have the skills they need in Excel before they employ you. Whether your application is an individual tank, a tank farm, a reservoir, or a river, our resistance- tape level gauge provides a reliable solution. Answers to Excel Sample Questions Here are the answers to the free sample questions appearing on this page.

Introduction to Process Optimization functions involved are nonlinear.