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Background: The caregiving scholarship widely acknowledges informal caregivers' contributions to maintaining older adults' health and well-being. However, informal caregivers encounter economic, physical, social, financial and psychological challenges when caring for older adults. The caregiving literature has shown variations in caregiving intensity and motivation between rural and urban informal caregivers of older adults. This situation is likely to result in rural-urban disparities in caregiver burden. However, the literature on predictors of caregiver burden is more focused on demographic, socio-economic, caregiving and health-related factors with very little attention to geographical dynamics. For this reason, the effects of demographic, socio-economic, caregiving, and health-related factors on the variations in caregiver burden between rural and urban informal caregivers of older adults are yet to be known in the sub-Saharan African context, including Ghana. Notably, the impact of geographical location on caregiver burden is mainly missing in the informal caregiving literature in Ghana. Situated within the stress process model, we determine the association between geographical location and caregiver burden among informal caregivers of older adults in Ghana., Methods: This study employed data from a large cross-sectional survey on informal caregiving, health, and healthcare among caregivers of older adults aged 50 years or above (N = 1,853) in Ghana. We selected the World Health Organization Impact of Caregiving Scale to measure caregiver burden. Generalized multivariable linear regression models were employed to determine the association between geographical location and caregiver burden among informal caregivers of older adults. We reported beta values and standard errors with significance levels of 0.05 or less., Results: The results showed that rural informal caregivers of older adults significantly have a decreased caregiver burden compared to urban informal caregivers (β = -1.64; SE = 0.41). Also, participants across all the self-rated health categories (poor/very poor: β = 12.63; SE = 1.65; fair: β = 9.56; SE = 1.07; good: β = 11.00; SE = 0.61, very good: β = 7.03; SE = 0.49) have a significantly increased caregiver burden for the full sample and for both rural (poor/very poor: β = 13.88; SE = 2.4; fair: β = 6.11; SE = 1.62; good: β = 9.97; SE = 0.96, very good: β = 6.06; SE = 0.71) and urban (poor/very poor: β = 11.86; SE = 2.25; fair: β = 12.33; SE = 1.42; good: β = 11.80; SE = 0.79, very good: β = 7.90; SE = 0.67) participants. This study further revealed that participants with no financial support needs reported a decreased caregiver burden compared to those with financial support needs for the full sample (β = -2.92, p-value < 0.01) and for both rural (β = -3.20; p-value < 0.01) and urban (β =-2.70; p-value < 0.01) participants., Conclusion: The findings from this study underscore geographical location differences in caregiver burden among informal caregivers of older adults in Ghana. Given these findings, the need to consider geographical location variations in providing welfare and health support programs to lessen caregiver burden among informal caregivers of older adults is welcomed. In line with the stress process model, such welfare and health programs should consider background, context, and stressor factors that contribute to variations in caregiver burden between rural and urban informal caregivers of older adults in Ghana and other sub-Saharan African countries., (© 2024. The Author(s).)

Background: Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghana to date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among  informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship  between caregiver burden and HRQoL among informal caregivers of older adults in Ghana., Methods: We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50 years) in the Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was used to measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of  0.05 or less., Results: The mean age of the informal caregivers was 39.15 years and that of the care recipients was 75.08 years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (β = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants with no formal education (β = -1.204, SE= .4085, p value = 0.01), those with primary level of education (β = -2.390, SE= .5099, p value = 0.001) or junior high school education (β = -1.113, SE= .3903, p value= 0.01) had a significantly decreased HRQoL compared to those with tertiary level of education. Participants who were between the ages of 18-24 (β = 2.960, SE= .6306, p value=0.001), 25-34 (β = 1.728, SE= .5794, p value = 0.01) or 35-44 (β = 1.604, SE= .5764, p value= 0.01) years significantly had increased HRQoL compared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the past year before the survey significantly had increased HRQoL compared to those who utilized healthcare services five or more times in the past year (β = 4.786, SE=. 4610, p value= 0.001)., Conclusion: Consistent with our hypothesis, this study reported a significant negative association between caregiver burden and HRQoL. Our findings partially  support the conceptual model of HRQoL used in this study. We recommend that health and social policy measures to improve HRQoL among  informal caregivers of older adults should consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors., (© 2024. The Author(s).)

Introduction: The objective of this cross-sectional, descriptive study was to identify unpaid caregiver differences in demographics, competing work responsibilities, support, health, caregiver burden, and interaction with healthcare professionals in US metropolitan and non-metropolitan settings., Methods: This study leveraged the nationally representative survey of older adults and their unpaid caregivers residing in the USA: the 2017 National Health and Aging Trends Study and National Study of Caregiving. Participants were unpaid caregivers for community-dwelling older adults., Results: A total of 2278 unique unpaid caregivers corresponding to 1431 care recipients were investigated for this study. Non-metropolitan caregivers had significantly lower income than their metropolitan counterparts, were more likely to be married or have a partner, missed less work, and, when traveling to provide care, traveled on average fewer minutes than metropolitan caregivers. However, there were no significant differences in relationship to caregiver, impact on primary work responsibilities, financial assistance, resource utilization or access, caregiver burden, relationship with primary care providers, or self-rated caregiver health., Conclusion: Non-metropolitan caregivers experience lower income with possible greater familial support, but despite the financial disparities do not have higher caregiver burden, poorer self-rated health, or differences in other important measures. Additional studies that further divide the non-metropolitan cohort into more refined categories by population and with larger sample sizes are essential for designing policy and programs to learn from rural caregivers and build resilience among all care providers.

Behaviours such as hitting, spitting, swearing and kicking can be a common response to personal, social and environmental challenges experienced by people with dementia. Little attention, however, has been given to how partners in care experience and respond to these behaviours in the home. This paper examines the emerging theme of 'aggression,' in seven interviews with nine former partners in care of people with dementia in Ontario, Canada. We explore how partners in care talk about, interpret and respond to these behaviours drawing on recent conceptualizations of structural and interpersonal violence in health and social geography and contributing to the growing body of research on relational care. We discuss the responses to, and implications of, these behaviours at a range of spatial scales and identify important considerations for future research.

Background: In the transitional stage of socioeconomic development, the traditional practice of home-based care in China is being tested. The evolution and factors of home-based care utilization are the prerequisites for the formulation of a support policy. However, no extant research has studied home-based elder care on a national scale., Aim: This paper aims to examine changing caregiving relationships nationwide for home-based elderly individuals and investigate the changing factors of care utilization in a ten-year period, with special attention to the effects of "location" on care patterns., Methods: The data come from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Andersen and Newman's behavioral model is employed as the theoretical framework for this research. The trends in care use from 2002 to 2011 are explored and multilevel multinomial analyses are performed to investigate the changing factors of care patterns between 2002 and 2011., Results: From 2002 to 2011, China saw a sharp decrease in children as caregivers, a significant increase in spousal caregivers, and a gradual decrease in other caregivers. Compared to 2002, the effects of the predisposing and enabling factors are more important than the need factors in 2011. Location and the interactions of the north-south divide and the urban-rural divide had a significant effect on care patterns., Conclusions: From 2002 to 2011, there was a decline in the traditional values-advocated care system and the elderly had to rely more on their own resources to find caregivers. In the design of a support program, there is an urgent need for policy makers to take social inequality among elderly individuals and the effects of location into consideration., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This paper contributes to the literature on the geographies of care and caregiving by examining the implications of weather for providing home and community care for children and older adults. Integrating research from two previous qualitative studies of formal and informal care provisioning in Ontario, Canada, the authors re-analyzed semi-structured interviews with 83 directors, managers, paid staff, volunteers and family members to examine the challenges they faced when providing care during the winter season. Similar to other settings where winter conditions like snow, ice and cold temperatures are commonplace, the studies were set within a health policy context in which there is not enough recognition of the difficulties of weather for coordinating, managing and providing care to disabled, injured, chronically ill and frail individuals. The re-analysis focused on how winter conditions translate into geographical, administrative, economic, operational, physical, social and psychological barriers within and across different 'scales of care'. The findings indicate that the problems posed by weather are crucial yet often underestimated aspects of home and community care provided by formal and informal caregivers. The analysis of weather-related challenges for care provisioning needs to be extended to other seasonal conditions (e.g., the challenges of delivering care in extreme heat), to the developing world and even to the burgeoning debates on the health implications of global environmental change.

In most industrialised countries, the care needs of those who are sick, disabled and frail are increasingly met in peoples' homes. One of the implications of this shift in the site of care is that individuals with long-term care needs and their family care providers experience social and spatial isolation. Many are housebound and most face considerable challenges in getting out of the house. This paper illuminates these challenges as they are experienced by mothers of children with long-term care needs, and the resulting isolation and disconnection that they experience. Eleven semistructured interviews were conducted in two regions of Ontario, Canada. Grounded theory informed the analysis of the mothers' accounts of their experiences of getting out of the house. The present findings are derived from a larger investigation of the meanings and experiences of the home as a place of caring for families with children who have long-term care needs. Secondary analysis of the data found that three main challenges restricted the mothers' abilities to leave their houses. Mothers experienced difficulties getting out of the house when they attempted to leave with the child, and when the child was left with an alternative care provider. Physical challenges were associated with the work and planning required in moving the child's equipment and supplies, meticulous planning of the outing within the daily schedule, and navigating barriers in the built and natural environments. Social challenges reflected the lack of people within the mothers' social network of family and friends who have the knowledge and expertise to care for the child. Service challenges resulted from the gaps between the policies and practices of paid respite, and the conditions that must be satisfied in order for mothers to be able and/or willing to leave the house. The authors also examined the reasons why some of the mothers worked from home, and the strategies that they used to get out of the house for employment. In this paper, the authors discuss each challenge, and how it contributes to the mothers' social and spatial isolation. The mothers' experiences elucidate the differences between living in a community and being part of a community. The consequences of the isolation on mothers' daily lives are not recognised in home and community care policy. The suggestions that are put forward concerning paid respite have relevance for home and community care policy and practice.

Children with chronic conditions and their families face many similar challenges that can be stressful for the family including, daily caregiving activities, financial difficulties caused by unexpected expenses, and increased use of health services to treat and help manage the condition. Many of these families, in addition to facing daily caregiving responsibilities, must travel substantial distances to access some of the necessary aspects of their child's health care. In this study, the Burke et al. (1994-1996) data of repeatedly hospitalized children and their families are used to explore a geographical dimension of family impact, distance. Outcome measures from the Feetham Family Functioning Survey and the Questionnaire on Resources and Stress are analyzed using exploratory and multivariate analysis. Results show that distance to hospital plays a role in the two areas of family life regarding relationships within the immediate family, and issues surrounding the ability to maintain the child in the family home. The implications of the results for family, health care intervention, and government policies and guidelines are discussed.