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Trevisan C, Grande G, Vetrano DL, Maggi S, Sergi G, Welmer AK, Rizzuto D. Gender Differences in the Relationship Between Marital Status and the Development of Frailty: A Swedish Longitudinal Population-Based Study. J Womens Health (Larchmt) 2020; 29:927-936. [DOI: 10.1089/jwh.2019.8095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Giulia Grande
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Centro Medicina dell'Invecchiamento, IRCCS Fondazione Policlinico “A. Gemelli” and Catholic University of Rome, Rome, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute - Aging Branch, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Anna-Karin Welmer
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Allied Health Professionals, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Zauszniewski JA, Picot SJF, Roberts BL, Debanne SM, Wykle ML. Predictors of Resourcefulness in African American Women. J Aging Health 2016; 17:609-33. [PMID: 16177453 DOI: 10.1177/0898264305279871] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although resourcefulness may facilitate coping with caregiver stress and burden, it has not been among African American women for whom caregiving is culturally prescribed. Objective: Using Rosenbaum’s theory of resourcefulness, this study examined situational (socioeconomic status, social support, daily hassles), physiological (age, body mass index, number of health problems, systolic blood pressure), and psychological factors (positive cognitions) as predictors of resourcefulness. Methods: A random sample of 97 African American caregivers and 110 noncaregivers provided data via structured interviews and 24-hour ambulatory blood pressure monitoring. Results: No physiological indicators predicted resourcefulness; however, daily hassles, social support, and positive cognitions were significant predictors. Age, number of health problems, daily hassles, and social support had indirect effects on resourcefulness through positive cognitions. Discussion: These findings suggest a need to further examine the impact of daily hassles, social support, and positive cognitions on caregiving and continued review of models for predicting resourcefulness in African American women.
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Trevisan C, Veronese N, Maggi S, Baggio G, De Rui M, Bolzetta F, Zambon S, Sartori L, Perissinotto E, Crepaldi G, Manzato E, Sergi G. Marital Status and Frailty in Older People: Gender Differences in the Progetto Veneto Anziani Longitudinal Study. J Womens Health (Larchmt) 2016; 25:630-7. [PMID: 26845424 DOI: 10.1089/jwh.2015.5592] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Marital status has been associated with disability and mortality, but its potential role as a factor influencing frailty has yet to be thoroughly investigated. The analysis of gender-related differences in the relationship between marital status and frailty is another interesting matter that remains to be fully elucidated. The aim of our study was to examine the association between marital status and the incidence of frailty in a cohort of older men and women over a 4.4-year follow-up. MATERIALS AND METHODS A sample of 1887 subjects older than 65 years, enrolled under the Progetto Veneto Anziani (Pro.V.A.) and with no evidence of frailty at baseline, were grouped by marital status. The incidence of frailty after 4.4 years was measured as the presence of at least three of the Fried criteria. RESULTS After the follow-up period, 414 (21.9%) new cases of frailty were identified. Multivariate logistic regression models demonstrated that male gender carried a higher risk of developing frailty among men who had never married (odds ratio [OR] = 3.84, 95% confidence interval [95% CI] = 2.76-5.35; p < 0.0001) and were widowed (OR = 1.43, 95% CI = 1.06-1.95, p = 0.02) than among married participants. For female gender, widows had significantly lower odds of becoming frail than married women (OR = 0.77, 95% CI = 0.66-0.91, p = 0.002). The determinants of frailty more influenced by marital status were unintentional weight loss, low daily energy expenditure, and exhaustion. CONCLUSIONS Marital status seems to significantly influence the onset of frailty, with some gender-specific differences. Unmarried men were at higher risk of frailty, while widowed women carried a lower risk of becoming frail than married women.
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Affiliation(s)
- Caterina Trevisan
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
| | - Nicola Veronese
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
| | - Stefania Maggi
- 2 National Research Council, Aging Branch, Institute of Neuroscience , Padova, Italy
| | | | - Marina De Rui
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
| | - Francesco Bolzetta
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
| | - Sabina Zambon
- 2 National Research Council, Aging Branch, Institute of Neuroscience , Padova, Italy .,4 Department of Medicine (DIMED), Clinica Medica I, University of Padova , Padova, Italy
| | - Leonardo Sartori
- 4 Department of Medicine (DIMED), Clinica Medica I, University of Padova , Padova, Italy
| | - Egle Perissinotto
- 5 Department of Cardiac, Thoracic and Vascular Sciences - Biostatistics, Epidemiology and Public Health Unit, University of Padova , Padova, Italy
| | - Gaetano Crepaldi
- 2 National Research Council, Aging Branch, Institute of Neuroscience , Padova, Italy
| | - Enzo Manzato
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy .,2 National Research Council, Aging Branch, Institute of Neuroscience , Padova, Italy
| | - Giuseppe Sergi
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
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Iavarone A, Ziello AR, Pastore F, Fasanaro AM, Poderico C. Caregiver burden and coping strategies in caregivers of patients with Alzheimer's disease. Neuropsychiatr Dis Treat 2014; 10:1407-13. [PMID: 25114532 PMCID: PMC4122550 DOI: 10.2147/ndt.s58063] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) causes considerable distress in caregivers who are continuously required to deal with requests from patients. Coping strategies play a fundamental role in modulating the psychologic impact of the disease, although their role is still debated. The present study aims to evaluate the burden and anxiety experienced by caregivers, the effectiveness of adopted coping strategies, and their relationships with burden and anxiety. METHODS Eighty-six caregivers received the Caregiver Burden Inventory (CBI) and the State-Trait Anxiety Inventory (STAI Y-1 and Y-2). The coping strategies were assessed by means of the Coping Inventory for Stressful Situations (CISS), according to the model proposed by Endler and Parker in 1990. RESULTS The CBI scores (overall and single sections) were extremely high and correlated with dementia severity. Women, as well as older caregivers, showed higher scores. The trait anxiety (STAI-Y-2) correlated with the CBI overall score. The CISS showed that caregivers mainly adopted task-focused strategies. Women mainly adopted emotion-focused strategies and this style was related to a higher level of distress. CONCLUSION AD is associated with high distress among caregivers. The burden strongly correlates with dementia severity and is higher in women and in elderly subjects. Chronic anxiety affects caregivers who mainly rely on emotion-oriented coping strategies. The findings suggest providing support to families of patients with AD through tailored strategies aimed to reshape the dysfunctional coping styles.
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Affiliation(s)
- Alessandro Iavarone
- Neurological and Stroke Unit, CTO Hospital, Naples, Italy
- Italian Association on Alzheimer’s Disease (AIMA), Naples, Italy
| | - Antonio Rosario Ziello
- Memory Clinic, Neurological Unit, AORN Cardarelli Hospital, Naples, Italy
- Clinical Research, Telemedicine and Telepharmacy Centre, University of Camerino, Camerino, Italy
| | - Francesca Pastore
- Memory Clinic, Neurological Unit, AORN Cardarelli Hospital, Naples, Italy
| | | | - Carla Poderico
- Department of Psychology, Second University of Naples, Caserta, Italy
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Lucchetti G, Lucchetti ALG, Oliveira GR, Crispim D, Pires SL, Gorzoni ML, Panicio CRG, Koenig HG. Nursing home care: exploring the role of religiousness in the mental health, quality of life and stress of formal caregivers. J Psychiatr Ment Health Nurs 2014; 21:403-13. [PMID: 23701527 DOI: 10.1111/jpm.12092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2013] [Indexed: 11/27/2022]
Abstract
Despite the high number of studies on family caregivers, there is little research on the impact of religiosity on formal caregiving (paid providers). We examine the role of religiousness in the mental health, quality of life and stress of nurse aides (NA) who provide care for patients in a nursing home. NA in a Brazilian nursing home were invited to participate. Because of its coping function, we hypothesized that religiousness was related to better mental health and quality of life. Linear regression was used to test this hypothesis and control for confounders. Compared with the Brazilian general population, NA scored higher on measures of religious involvement. Intrinsic religiosity was associated with better mental health and quality of life. Organizational religiosity was associated with better social functioning, better general mental health and fewer anxiety symptoms. Non-organizational religiosity (prayer), however, was associated with negative outcomes, such as higher stress, poorer general health perceptions and more anxiety symptoms. Most NA indicated that they had prayed for and with their patients. In conclusion, paid caregivers (NA) have a strong sense of religiousness, which plays an important role in many ways, including the type of care they provide, their mental health and their quality of life.
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Affiliation(s)
- G Lucchetti
- Department of Medicine, Federal University of Juiz de Fora, Juiz de Fora; Department of Research, São Paulo Medical Spiritist Association, São Paulo, São Paulo; Department of Research, Hospital João Evangelista, São Paulo, São Paulo
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Bekhet AK, Zauszniewski JA. Psychometric properties of the resourcefulness scale among caregivers of persons with autism spectrum disorder. West J Nurs Res 2013; 36:685-702. [PMID: 24151172 DOI: 10.1177/0193945913509141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Caregiving for children with autism spectrum disorder (ASD) can be very costly to caregivers' well-being. Resourcefulness interventions have shown increases in positive health outcomes. However, before delivering the intervention, there should be a reliable and a valid measure to test resourcefulness. The psychometric properties of the Resourcefulness Scale (RS) have not been examined among ASD caregivers. This study examined the psychometrics of the 28-item RS in a convenience sample of 204 ASD caregivers. A Cronbach's alpha of .91 showed the internal consistency of the RS. Construct validity was supported by the emergence of two dimensions of resourcefulness (personal and social) in a confirmatory factor analysis and by substantial intercorrelations between the two subscales (r = .48, p < .001). Findings suggested the reliability and validity of RS among ASD caregivers, which is a necessary step toward implementing resourcefulness interventions to help ASD caregivers to deal with their stress and improve their quality of life.
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Affiliation(s)
- Abir K Bekhet
- 1Marquette University College of Nursing, Milwaukee, WI, USA
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Musil CM, Jeanblanc AB, Burant CJ, Zauszniewski JA, Warner CB. Longitudinal analysis of resourcefulness, family strain, and depressive symptoms in grandmother caregivers. Nurs Outlook 2013; 61:225-234.e2. [PMID: 23756496 PMCID: PMC3786552 DOI: 10.1016/j.outlook.2013.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/20/2013] [Accepted: 04/28/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Grandmothers living with grandchildren face stressors that may increase depressive symptoms, but cognitive-behavioral strategies, such as resourcefulness, may reduce the effects of stressors on mental health. PURPOSE This analysis examined the contemporaneous and longitudinal relationships among intra-family strain, resourcefulness, and depressive symptoms in 240 grandmothers, classified by caregiving status to grandchildren. METHODS Grandmothers raising grandchildren, grandmothers living in multigenerational homes, and non-caregivers to grandchildren reported on intra-family strain, resourcefulness, and depressive symptoms using mailed questionnaires at three time points over 5 years. Structural equation modeling was used to evaluate the mediating effects of resourcefulness and the relationships between variables. DISCUSSION Grandmother caregiver status had significant effects on depressive symptoms and intra-family strain but not on resourcefulness. At all waves, higher resourcefulness was associated with fewer depressive symptoms, which reduced appraisals of intra-family strain. CONCLUSIONS Interventions focused on strengthening resourcefulness could reduce depressive symptoms over time.
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Affiliation(s)
- Carol M Musil
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA.
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Coping strategies and social support-seeking behaviour among Chinese caring for older people with dementia. AGEING & SOCIETY 2012. [DOI: 10.1017/s0144686x12000724] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTThe study reviewed coping and help-seeking behaviour among Hong Kong Chinese family care-givers of older people diagnosed with dementia. A convenience sample of those caring for family members with dementia (N=11) was recruited in Hong Kong. Semi-structured interviews were conducted, transcribed and analysed using NVivo. The study found evidence of distinct Chinese coping strategies that focused upon internal self-regulation, forbearance and family obligations. In terms of help-seeking behaviour, these care-givers expressed great concern about bothering their family members. When there is a desperate need for help, they turn to community services. Results are discussed in the context of both traditional Chinese cultural values as well as the modern transformations of the Chinese society. In particular, Eastern philosophical teachings tend to focus on changing personal inner perception and thoughts rather than attempting to change the environment. Although family obligations have been traditionally upheld, many modern Chinese societies are undergoing social and demographic changes, resulting in marked decline in multi-generational households. Our findings can have applications not only for Chinese cities but also may have implications to the West as strong well-established Chinese communities are widespread.
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Papastavrou E, Tsangari H, Karayiannis G, Papacostas S, Efstathiou G, Sourtzi P. Caring and coping: the dementia caregivers. Aging Ment Health 2011; 15:702-11. [PMID: 21547752 DOI: 10.1080/13607863.2011.562178] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Caring for a family member with Alzheimer's disease is associated with increased burden and depression. Effective coping with the hardships and demands of caring may help to sustain the caregiver and lessen the effect of the stressors. The objective of this study was to examine caregivers' coping styles and the relationship with reported levels of burden and depression. METHOD A cross-sectional correlation study was employed. One hundred and seventy-two caregivers of patients suffering from Alzheimer's type dementia participated in the study. All patients were recruited from neurology clinics. The Greek versions of four measuring instruments used were: the Memory and Behaviour Problem Checklist, the Burden Interview, the Centre for Epidemiological studies-Depression scale and the Ways of Coping Questionnaire. RESULTS Positive coping is negatively correlated with burden (r = -0.20) and wishful thinking strategies were related positively (r = 0.16). The relation between depression and positive coping strategies is highly significant (p < 0.01), whereas for burden the relation is significant (p < 0.05). Regression analyses showed that positive coping strategies are the most powerful, both in terms of predicting depression levels, and also in terms of moderating the effect of burden on depression. CONCLUSION Positive coping approaches need to be developed by caregivers so as to continue their caring role.
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Affiliation(s)
- Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Nicosia, Cyprus, Greece.
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Choi G, Tirrito T, Mills F. Caregiver's Spirituality and Its Influence on Maintaining the Elderly and Disabled in a Home Environment. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2008; 51:247-259. [PMID: 19042650 DOI: 10.1080/01634370802039528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
<p>This study examined the role that faith-based organizations play for caregivers in maintaining the elderly and disabled in their homes. The study explored if persons who use religious beliefs and practices cope with caregiver stress better than those who do not use religious beliefs and practices. The study also explored the role of religious coping as a factor affecting decisions to institutionalize, and the role that faith-based practices and organizations play in helping caregivers maintain the elderly and disabled in their homes.</p>
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Papastavrou E, Kalokerinou A, Papacostas SS, Tsangari H, Sourtzi P. Caring for a relative with dementia: family caregiver burden. J Adv Nurs 2007; 58:446-57. [PMID: 17442030 DOI: 10.1111/j.1365-2648.2007.04250.x] [Citation(s) in RCA: 277] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This paper is a report of part of a study to investigate the burden experienced by families giving care to a relative with dementia, the consequences of care for the mental health of the primary caregiver and the strategies families use to cope with the care giving stressors. BACKGROUND The cost of caring for people with dementia is enormous, both monetary and psychological. Partners, relatives and friends who take care of patients experience emotional, physical and financial stress, and care giving demands are central to decisions on patient institutionalization. METHOD A volunteer sample of 172 caregiver/care recipient dyads participated in the study in Cyprus in 2004-2005. All patients were suffering from probable Alzheimer's type dementia and were recruited from neurology clinics. Data were collected using the Memory and Behaviour Problem Checklist, Burden Interview, Center for Epidemiological Studies-Depression scale and Ways of Coping Questionnaire. FINDINGS The results showed that 68.02% of caregivers were highly burdened and 65% exhibited depressive symptoms. Burden was related to patient psychopathology and caregiver sex, income and level of education. There was no statistically significant difference in level of burden or depression when patients lived in the community or in institutions. High scores in the burden scale were associated with use of emotional-focused coping strategies, while less burdened relatives used more problem-solving approaches to care-giving demands. CONCLUSION Caregivers, especially women, need individualized, specific training in how to understand and manage the behaviour of relatives with dementia and how to cope with their own feelings.
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Affiliation(s)
- Evridiki Papastavrou
- School of Health Sciences, Department of Nursing, Cyprus University of Technology, Cyprus.
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Sörensen S, Duberstein P, Gill D, Pinquart M. Dementia care: mental health effects, intervention strategies, and clinical implications. Lancet Neurol 2006; 5:961-73. [PMID: 17052663 DOI: 10.1016/s1474-4422(06)70599-3] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Caring for elderly people with dementia is associated with well-documented increases in burden, distress, and decrements in mental health and wellbeing. More severe behavioural, cognitive, and functional impairments in a patient are associated with higher levels of burden and distress. Distress increases with care hours per week, number of tasks, and declining coping and support resources. Demographic factors also affect levels of burden and distress. Promising, evidence-based interventions exist, but substantial economic and policy barriers preclude their widespread dissemination. Health-care policy makers should consider addressing these barriers; clinicians and families must campaign for reimbursement; and clinical researchers must develop more potent preventive interventions. In this article we review how dementia care affects the mental health of the carer and identify interventions that might be useful in mitigating carer burden and distress.
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Affiliation(s)
- Silvia Sörensen
- Department of Psychiatry, University of Rochester School of Medicine and Dentisry, Rochester, NY, USA.
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Musil CM, Warner CB, Zauszniewski JA, Jeanblanc AB, Kercher K. Grandmothers, caregiving, and family functioning. J Gerontol B Psychol Sci Soc Sci 2006; 61:S89-98. [PMID: 16497965 PMCID: PMC6689403 DOI: 10.1093/geronb/61.2.s89] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We used McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation ( McCubbin, Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resourcefulness, support, and role reward affect perceptions of family functioning for grandmothers raising grandchildren, grandmothers living in multigenerational households, and grandmothers not caregiving for grandchildren. METHODS A sample of 486 grandmothers completed a mailed questionnaire. We used structural equation modeling to (a) test the effects of demographic factors (i.e., grandmother's age, race, marital status, and employment), family stressful life events and strain, grandmother's resourcefulness, subjective and instrumental support, and role reward on perceptions of family functioning for each grandmother group; (b) evaluate differences in the measurement and structural models between the grandmother groups using multisample analysis; and (c) test the model on the full sample, coding for caregiver status. RESULTS The models did not differ significantly by grandmother group; therefore we assessed the composite model using a multisample analysis. We found general support for the resiliency model and equivalence of the models across grandmother groups. Less support, resourcefulness, and reward, and more intrafamily strain and stressful family life events contributed to perceptions of worse family functioning. DISCUSSION Findings demonstrate the importance of the quality of family functioning for grandmothers in all types of families.
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Affiliation(s)
- Carol M Musil
- School of Nursing, Case Western Reserve University, Cleveland, OH 44106-4904, USA.
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Mausbach BT, Aschbacher K, Patterson TL, Ancoli-Israel S, von Känel R, Mills PJ, Dimsdale JE, Grant I. Avoidant coping partially mediates the relationship between patient problem behaviors and depressive symptoms in spousal Alzheimer caregivers. Am J Geriatr Psychiatry 2006; 14:299-306. [PMID: 16582038 DOI: 10.1097/01.jgp.0000192492.88920.08] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Caring for a loved one with Alzheimer disease is a highly stressful experience that is associated with significant depressive symptoms. Previous studies indicate a positive association between problem behaviors in patients with Alzheimer disease (e.g., repeating questions, restlessness, and agitation) and depressive symptoms in their caregivers. Moreover, the extant literature indicates a robust negative relationship between escape-avoidance coping (i.e., avoiding people, wishing the situation would go away) and psychiatric well-being. The purpose of this study was to test a mediational model of the associations between patient problem behaviors, escape-avoidance coping, and depressive symptoms in Alzheimer caregivers. METHODS Ninety-five spousal caregivers (mean age: 72 years) completed measures assessing their loved ones' frequency of problem behaviors, escape-avoidance coping, and depressive symptoms. A mediational model was tested to determine if escape-avoidant coping partially mediated the relationship between patient problem behaviors and caregiver depressive symptoms. RESULTS Patient problem behaviors were positively associated with escape-avoidance coping (beta = 0.38, p < 0.01) and depressive symptoms (beta = 0.26, p < 0.05). Escape-avoidance coping was positively associated with depressive symptoms (beta = 0.33, p < 0.01). In a final regression analysis, the impact of problem behaviors on depressive symptoms was less after controlling for escape-avoidance coping. Sobel's test confirmed that escape-avoidance coping significantly mediated the relationship between problem behaviors and depressive symptoms (z = 2.07, p < 0.05). CONCLUSION Escape-avoidance coping partially mediates the association between patient problem behaviors and depressive symptoms among elderly caregivers of spouses with dementia. This finding provides a specific target for psychosocial interventions for caregivers.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California at San Diego, San Diego, California 92093-0680, USA.
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Sörensen S, Pinquart M. Racial and ethnic differences in the relationship of caregiving stressors, resources, and sociodemographic variables to caregiver depression and perceived physical health. Aging Ment Health 2005; 9:482-95. [PMID: 16024408 DOI: 10.1080/13607860500142796] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Racial and ethnic differences in the association of stressors, resources, and sociodemographic characteristics with depressive symptoms and perceived physical health were investigated. Data from 653 White non-Hispanic caregivers, 278 African American, and 218 Hispanic Alzheimer's caregivers (209 males, 940 females) who were assessed at the baseline data collection of the REACH study, a multisite trial of caregiver interventions, was obtained. Multiple sample analysis, which allows testing whether a pattern of relationships is invariant across different samples, was used. Results support the hypothesis that, despite significant differences in resources and stressors, the predictors of depression and health are relatively uniform across groups. Ethnic differences were found for the effect of age, income, gender, and care receiver's self-care impairments on caregiver depression. For perceived physical health, there were ethnic differences for the effect of income, gender, and type of caregiver relationships.
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Affiliation(s)
- Silvia Sörensen
- Program Geriatrics and Neuropsychiatry, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, NY 14642-8409, USA.
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Morano CL, King D. Religiosity as a mediator of caregiver well-being: does ethnicity make a difference? JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2005; 45:69-84. [PMID: 16172063 DOI: 10.1300/j083v45n01_05] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study used an adaptation of the stress and appraisal model to examine the mediating effects of religiosity on caregiving strain and gain with an ethnically diverse sample of 384 Alzheimer's disease caregivers. While the regression analysis indicated that religiosity did not mediate the stress of providing care for the entire sample, there were significant differences in the use of religiosity depending on the ethnicity (African American, Hispanic, and White non-Hispanic) of the caregiver, as well as significant differences between the three cohorts in the levels of caregiving strain (depression) and gain (self-acceptance). Implications for the use of religiosity as a protective factor for AD caregivers are discussed.
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Affiliation(s)
- Carmen L Morano
- School of Social Work, University of Maryland, Baltimore 21201, USA
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Lynch TR, Cheavens JS, Morse JQ, Rosenthal MZ. A model predicting suicidal ideation and hopelessness in depressed older adults: the impact of emotion inhibition and affect intensity. Aging Ment Health 2004; 8:486-97. [PMID: 15724830 DOI: 10.1080/13607860412331303775] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to begin a preliminary examination of constructs theorized to be related to suicidal behavior by testing a model of the influence of both temperament and emotion regulation on suicidal ideation and hopelessness in a sample of depressed older adults. The model was evaluated using structural equation modeling procedures in a sample of depressed, older adults. Findings supported a temporally predictive model in which negative affect intensity and reactivity lead to emotion inhibition, operationalized as ambivalence over emotional expression and thought suppression, which in turn lead to increased presence of suicidal predictors, operationalized as hopelessness and suicidal ideation. These results suggest that suicide prevention efforts in older adults may be improved by targeting emotion inhibition in treatment, especially among affectively intense and reactive older adults.
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Affiliation(s)
- T R Lynch
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27704, USA.
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Pinquart M, Sörensen S. Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. J Gerontol B Psychol Sci Soc Sci 2003; 58:P112-28. [PMID: 12646594 DOI: 10.1093/geronb/58.2.p112] [Citation(s) in RCA: 689] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In the present meta-analysis, we integrated findings from 228 studies on the association of six caregiving-related stressors and caregiving uplifts with burden and depressed mood. Care recipients' behavior problems showed stronger associations with caregiver outcomes than other stressors did. The size of the relationships varied by sample characteristics: Amount of care provided and care receivers' physical impairments were less strongly related to burden and depression for dementia caregivers than for caregivers of nondemented older adults. For spouse caregivers, physical impairments and care recipients' behavior problems had a stronger relationship to burden than for adult children. Furthermore, we found evidence that the association of caregiver burden with the number of caregiving tasks, perceived uplifts of caregiving, and the level of physical impairment of the care receiver were stronger in probability samples than in convenience samples.
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Affiliation(s)
- Martin Pinquart
- Department of Developmental Psychology, University of Jena, Jena, Germany.
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Browder S. "My mind's made up": assumptions and decision-making in accounts of caregiving women. J Women Aging 2003; 14:77-97. [PMID: 12537077 DOI: 10.1300/j074v14n03_06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this qualitative study, rural women caregivers for elderly relatives or friends were interviewed about their decision-making. Women deliberating decisions differed from women implementing decisions in how they perceived their caregiving tasks and in their experience of stress. The difference in deliberative and implemental accounts suggests that mindset is a mediating factor for the women in the present study. Women in the process of implementing decisions regarding caregiving described their experiences in a more positive light and reported less stress. Deliberating decisions regarding caregiving, however, was likely to color the experience of caregiving, leaving the caregiver feeling vulnerable, doubtful about herself, and more stressed.
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Affiliation(s)
- Sally Browder
- Lyon College, PO Box 2317, Batesville, AR 72503-2317, USA
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Grant I, Adler KA, Patterson TL, Dimsdale JE, Ziegler MG, Irwin MR. Health consequences of Alzheimer's caregiving transitions: effects of placement and bereavement. Psychosom Med 2002; 64:477-86. [PMID: 12021421 DOI: 10.1097/00006842-200205000-00012] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the extent to which the chronic stress of Alzheimer's disease caregiving may be alleviated by placement or death of the Alzheimer's disease patient, we prospectively compared groups of caregivers (CG) who continued to care for their Alzheimer's disease spouse at home, CG who placed their spouses, and CG whose spouses died with similarly aged noncaregiving comparison subjects (control subjects). METHODS A sample of 119 CG who had been studied for at least 18 months at 6-month intervals was included in the present analyses (ie, had at least three assessments). Data were gathered on CG mood, blood pressure, and medical symptoms among 38 CG whose spouses were at home at all three visits (home-home-home [HHH]); 28 CG who placed their spouse at follow-up (home-placed-placed [HPP]); 27 CG whose spouses were placed and subsequently died at follow-up (home-placed-deceased [HPD]); and 26 CG whose spouses died at home (home-deceased-deceased [HDD]). Data were compared with 48 noncaregiving control subjects (NC group). RESULTS CG in the HPP, HPD, and HDD groups showed improvement in depressive and physical symptoms compared with HHH and NCs. CG had significantly higher systolic blood pressure at rest than did NCs. Both placement and death of the Alzheimer's disease spouse were associated with higher systolic blood pressure in response to postural challenge in CG experiencing these transitions. CONCLUSIONS Despite improvement seen in mood and medical symptoms among CG who place their spouses or experience the spouse's death, there may be longer term physiological alterations, possibly in sympathoadrenalmedullary arousal, that cause the cardiovascular system to continue to respond to acute stressors such as postural challenge more actively for a period of 6 to 12 months after such transitions.
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Affiliation(s)
- Igor Grant
- Department of Psychiatry, University of California, San Diego, La Jolla, California 92093-0680, USA.
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Caregiving and Detrimental Mental and Physical Health Outcomes. PHYSICAL ILLNESS AND DEPRESSION IN OLDER ADULTS 2002. [DOI: 10.1007/0-306-47178-7_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Martini TS, Grusec JE, Bernardini SC. Effects of interpersonal control, perspective taking, and attributions on older mothers' and adult daughters' satisfaction with their helping relationships. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2001; 15:688-705. [PMID: 11770475 DOI: 10.1037/0893-3200.15.4.688] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Older mother-adult daughter dyads (N = 44) were interviewed separately about 3 variables hypothesized to affect satisfaction with the help provided to mothers by their daughters: feelings of interpersonal control, perspective-taking abilities, and attributions made about the self and other dyad member during positive and negative helping interactions. The most important predictors of partner satisfaction were mothers' and daughters' ability to accurately perceive the partner's feelings about the helping relationship and their feelings of interpersonal control. The most salient predictors of mothers' and daughters' own satisfaction were the attributions they made about the partner during a negative helping situation and their feelings of interpersonal control. These findings underscore the importance of considering interpersonal psychological variables in research concerned with helping relationships in later life.
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Affiliation(s)
- T S Martini
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
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Nijboer C, Triemstra M, Tempelaar R, Sanderman R, van den Bos GA. Determinants of caregiving experiences and mental health of partners of cancer patients. Cancer 1999; 86:577-88. [PMID: 10440685 DOI: 10.1002/(sici)1097-0142(19990815)86:4<577::aid-cncr6>3.0.co;2-s] [Citation(s) in RCA: 248] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research regarding informal caregiving showed considerable individual variation in responses to cancer caregiving. The current longitudinal study examined determinants of caregiver outcomes in terms of caregiver experiences at 3 months and caregiver's mental health at 6 months after hospital discharge. It included both negative and positive dimensions of caregiving outcomes. METHODS One hundred forty-eight patients with newly diagnosed colorectal carcinoma and their partners were included. Caregiver experiences were assessed by the Caregiver Reaction Assessment Scale, which contains four negative subscales (disrupted schedule, financial problems, lack of family support, and loss of physical strength) and one positive subscale (self-esteem). The mental health of the caregiver was assessed in terms of depression and quality of life. Possible determinants of the caregiver's experiences and mental health were categorized according to characteristics of the caregiver, the patient, and the care situation. Caregiving experiences were studied as a fourth additional category of possible determinants of the caregiver's mental health. RESULTS Each domain of the caregiving experience was explained by different factors, with total explained variances ranging between 11-46%. Negative caregiver experiences were associated with a low income, living with only the patient, a distressed relationship, a high level of patient dependency, and a high involvement in caregiving tasks. Caregivers with a low level of education and caregivers of patients with a stoma were able to derive more self-esteem from caregiving. Although caregiving may lead to depression, especially in those experiencing loss of physical strength, caregivers may sustain their quality of life by deriving self-esteem from caregiving. CONCLUSIONS It is important that professionals involved in the ongoing care of cancer patients and their families be aware of the increasing demands made on caregivers and the specific problems and uplifts they perceive in caregiving. Professional caregivers are urged to involve informal caregivers with care explicitly and continuously. However, specific attention to those caregivers who live only with the patient, those with a low income, those with a distressed relationship, and those with a high level of patient dependency and care involvement is warranted.
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Affiliation(s)
- C Nijboer
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
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Enhancing Practitioner Ability To Recognize and Treat Caregiver Physical and Mental Consequences. TOPICS IN GERIATRIC REHABILITATION 1998. [DOI: 10.1097/00013614-199809000-00005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Despite the large body of literature on caregiver stress, there has been a relative dearth of investigation of the experience of caregiving among African Americans. African Americans are currently the largest minority group in the United States and a rapidly growing segment of the American elderly population. Increasing evidence demonstrates the stressfulness of, as well as the variability in adaptation to, caregiving in this population. There are differences in individuals' psychological resources and coping with the caregiving experience, which to date are not well understood. This descriptive study examined similarities and differences in appraisals of behavior problems, resourcefulness, and coping efforts between 25 African American and 25 Anglo-American caregivers of relatives diagnosed with probable Alzheimer's disease. African American caregivers were found to have higher scores in resourcefulness than Anglo-American caregivers, and they reported benign appraisal of disruptive behavior in the impaired elders. No differences were found in caregivers' coping efforts.
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Affiliation(s)
- E W Gonzalez
- College of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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