The health of grandparents raising grandchildren: a literature review

A typology of caregiver burden for custodial Black grandmothers

Previous studies of custodial grandparenting tend to aggregate population data or not distinguish custodial grandparenting experiences by race, even though research demonstrates that custodial grandparenting for Black grandmothers is compounded by intersectional disadvantages. Our aim is to contribute to the gerontologic health literature with a nuanced understanding of caregiver burden that captures the strains and joys of custodial grandparenting, more accurately representing the heterogeneous experiences of Black caregiving. Data for this analysis is derived from a mixed methods descriptive concurrent parallel design with 20 custodial Black grandmothers. Quantitative analysis included bivariate associations. Qualitative thematic analysis was used. Quantitative and qualitative data were collected in parallel manner, analyzed independently, then aligned. We identified three distinct groups: High, Moderate, and Low Burden. Two-fifths of custodial Black grandmothers experienced low caregiving burden and one-quarter reported high burden which contrasts with research emphasizing the strains of caregiving for this population. Findings reveal diversity and significant variation in the caregiving experiences of Black grandmothers influencing, and influenced by, psychological and physical well-being. These findings also demonstrate meaningful sociodemographic differences across the three groups, supporting the typology of caregiver burden. The caregiver burden typology can be utilized to inform policy and support services, and as a starting point for future research to assess heterogeneity in custodial Black grandmother's experiences.

Associations of Grandparenting Dimensions/Styles with Mental Health in Children and Adolescents: A Systematic Review and Meta-Analysis

In recent decades, grandparents' increased involvement in child-rearing around the world has accelerated research on grandparenting. However, findings have remained inconsistent, and no reviews have examined how grandparenting dimensions and styles affect child and adolescent mental health. In our systematic review and meta-analysis, we synthesized evidence on the relationship between dimensions and styles of grandparenting and children's and adolescents' mental health. In nine databases, we identified 3197 studies on the relationship between dimensions and styles of grandparenting and children's and adolescents' mental health, 20 of which we ultimately reviewed. To better integrate the results, we performed a meta-analysis of studies addressing the same mental health outcomes (i.e., depression, anxiety, and internalizing symptoms). Moreover, to synthesize evidence from the studies, we conducted both random- and common-effects meta-analyses. The reviewed studies involved 11,434 children overall. Among our findings, the associations between positive dimensions and styles of grandparenting and children's and adolescents' depression and anxiety were moderately significant (depression: r = -0.33; anxiety: r = -0.12), as were the correlations between negative dimensions and styles and all three mental health outcomes (depression: r = 0.15; anxiety: r = 0.15; internalizing symptoms: r = 0.25). In general, positive dimensions and styles of grandparenting are negatively associated with mental health conditions, whereas negative ones are positively associated. In this article, we discuss those and other findings and propose directions for future studies.

The relationship between grandparental childcare experience and relative handgrip strength among middle-aged and older adults

Delayed marriage and childbirth often result in individuals becoming grandparents in middle and older age, coinciding with significant physical transitions. This study examines the relationship between the intensity of grandparental childcare, measured in terms of time-commitment over the last year, and relative handgrip strength among South Korea adults aged 45-84. Data from 3,742 participants with grandchildren were analyzed using the 2008-2010 waves of the Korean Longitudinal Study of Aging. After applying propensity score matching, a final sample of 286 participants was analyzed with multivariate logistic regression model. Results showed that grandparents who provided childcare for an average of less than 40 h per week (Odds Ratio [OR] = 3.62) were more likely to have lower handgrip strength compared to those without caregiving experience. Additionally, those over the age of 65 showed a similar trend (OR = 2.76). Conversely, grandparents with positive self-rated health were less likely to exhibit lower handgrip strength than those rating their health as moderate (OR = 0.28). Grandparents who provided care for more than half the year were also less likely to have lower handgrip strength than those who provided less frequent care (OR = 0.26). This study highlights grandparental childcare as both a vital family support mechanism and a factor influencing physical health. Findings on caregiving intensity, particularly the role of moderate weekly childcare hours and longer terms involvement, underscore the importance of aligning caregiving commitments with grandparents' health perceptions and capacities. Developing guidelines for optimal childcare duration and recommending physical activities tailored to support grandparents' well-being would further promote healthy aging within a family-centered caregiving system.

Feasibility and Acceptability of an ABCD Program for Child Development Among Skipped Families in Rural Thailand: A Pilot Study

Introduction

The study aimed to develop and examine the aesthetic, bedtime story, connecting with nature, and drawing (ABCD), community based, program for grandparents to help them promote their grandchildren's development.

Methods

The action research was conducted in two phases. In the first phase, semi-structured interviews and focus group discussions were utilized to gather information from healthcare providers, teachers, and community leaders to develop the ABCD program. This was followed by a critical evaluation of the program's activities, materials, and contents. The second phase was to examine the program's effectiveness. A one-group pretest-posttest design was used to study the effectiveness of the program among 20 dyads of grandparents and grandchildren.

Results

All grandparents attended and completed the program. The grandparents' knowledge increased significantly (p = 0.024), and satisfaction with the program was high (X = 9, SD = 0.93) while children's development was not statistically different (p = 0.317).

Conclusion

The ABCD program was found to be feasible and acceptable to grandparents of skipped families to promote their grandchildren's development. The importance of healthcare providers, teachers, and community leaders in providing ABCD programs must also be recognized.

Evaluation of Prevention Programs for Grandparent Caregivers: a Systematic Review

This systematic review critically evaluates 21 grandparent-focused prevention programs designed to benefit grandparent caregivers or target grandparent caregivers as agents of change for grandchild development. These grandparent programs were published in 35 peer-reviewed articles in the last 31 years. For each program, we described the phase of development of program (i.e., feasibility, pilot, and efficacy), delivery characteristics, and adaptations of existing evidence-based programs to meet the needs of grandparent caregivers in diverse sociocultural backgrounds. For programs tested under a controlled trial design, we evaluated core components and preliminary effects on targeted outcomes. Most studies targeted grandparents who served as primary or custodial caregivers in the USA, while limited studies targeted supplementary grandparent caregivers. Thirteen programs which were evaluated using pretest-posttest designs demonstrated feasibility and acceptability of the grandparent programs. Moreover, eight programs which were evaluated using randomized-controlled trials (RCTs; 5 pilot and 3 full-scale efficacy trials) demonstrated promising outcomes. Additionally, we identified six core components and 17 specific elements in eight programs evaluated using RCT designs. Overall, we provide a comprehensive critique of this body of literature as well as directions for future studies, including the need to develop programing tailored to grandparent caregivers with unique needs.

Parenting in Adversity: Effects of Older Caregivers, Biological Carers and Troubled Carers on Child Outcomes in High HIV-Affected Communities

Caregiving by older adults is a common phenomenon, enhanced in the era of HIV infection. This longitudinal study was set up to examine the effect of caregiver age, relationship and mental wellbeing on child (4-13 years) outcomes (psychosocial and cognitive) in a sample of 808 caregiver- child dyads in South Africa and Malawi. Respondents were drawn from consecutive attenders at Community Based Organisations (CBOs) and interviewed with standardised inventories at baseline and followed up 12-15 months later. Analysis focused on three separate aspects of the caregiver; age, relationship to the child, and mental wellbeing, results are stratified with regard to these factors. Results showed that compared to younger caregivers, over 50 years were carrying a heavy load of childcare, but caregiver age for the most part was not associated with child outcomes. Being biologically related to the child (such as biological grandparenting) was also not a significant factor in child outcomes measured. However, irrespective of age and relationship, caregiver mental health was associated with differences in child outcome - those children of caregivers with a greater mental health burden were found to report experiencing more physical and psychologically violent discipline. Over time, the use of violent discipline was found to reduce. These data suggest that older caregivers and grandparents are providing comparable care to younger caregivers, for young children in the face of the HIV epidemic and that interventions should focus on mental health support for all caregivers, irrespective of age or relationship to the child.

Sleep Quality and Disability for Custodial Grandparents Caregivers in the Southern United States

Sleep quality amongst caregivers with disability may have been compounded by the COVID-19 pandemic. We evaluated differences in sleep quality amongst custodial grandparents from a southern state that were identified through state-based Kinship Care support groups coordinators and online. Participants ( N = 102) completed the Pittsburgh Sleep Quality Index and self-reported disability statuses. Gamma tests showed a strong negative relationship between disability and sleep duration indicating fewer hours of sleep, higher use of sleep medication and greater sleep disturbances. Disability is not significantly related to sleep latency, sleep efficiency, and daytime dysfunction. T-tests showed no strength of relationship between disability and overall sleep quality. During the first year of the COVID-19 pandemic, custodial grandparents with disability had greater issues with their sleep quality than those without disability. Sleep, as it pertains to its overall preponderant role in maintaining good health, should be examined amongst custodial grandparent caregivers and those with disability.

Stepping Up and Stepping In: Exploring the Role of Nurses in Supporting Grandparents Raising Grandchildren

This study focused on the experiences of grandparents raising grandchildren in rural, Prince Edward Island, Canada. Termed grand-families, there are numerous reasons why grandparents must step up and step in to care for their grandchildren. Often these reasons are related to their adult children's struggles with mental illness and substance use disorders. Adopting Clandinin and Connelly's approach to narrative inquiry, we present findings from the conversational interviews conducted with 12 grandparents raising their grandchildren. Interview data were analyzed through the narrative dimensions of time, place, and relationship. Findings are presented as rich narratives which illuminate the evolution and storied experiences of grand-families. Particularly revealing are the challenges grandparents face as they navigate various systems, including health care, that do not acknowledge the uniqueness of their family form. Nurses work with grand-families across varied clinical settings. Grounded within the philosophy of Patient and Family Centered Care and family nursing theory, this article offers recommendations for supportive interventions that nurses can implement when caring for grand-families across clinical settings. This study has the potential to facilitate the development of evidence-based supports and services, which are responsive to the needs, realities, and complexities of grand-families.

Grandparents' Mental Health and Lived Experiences while Raising Their Grandchildren at the Forefront of COVID-19 in Saudi Arabia

Understanding grandparents' lived experiences and healthy aging is essential to designing efficient, effective, and safe services to support a family structure in which grandparents care for their grandchildren. However, no study to date has explored this concept in an Arab and Muslim country during a pandemic. The purpose of this study was to examine grandparents' experiences raising their grandchildren to provide recommendations for needed mental health interventions during and after COVID-19. We used a phenomenological approach to gain a detailed and in-depth understanding of the lived experiences of 15 grandparents caring for their grandchildren. This study shows the need for support service interventions (support groups, health professional support, and respite care) for grandparents in Saudi Arabia, especially during global crises like COVID-19, that enhance social distance and social isolation. Raising grandchildren affects the physical, mental, and social wellbeing of the grandparents.

The impact of grandchild care provision on grandparents’ depressive symptoms across Europe using multi-level analysis: do the grandchild caring patterns and the country’s economy matter?

Little research has examined the cross-national differences in the impact of grandchild care provision on the grandparents’ depression, by taking into account of both macro- and micro-level factors. This study used a unique grandchild caring pattern variable in order to examine the effect of the changes in the intensity of grandchild caring on the grandparents’ depressive symptoms in European countries, and whether the grandparents’ country level economy influenced such effect. Longitudinal data derived from the Survey of Health, Ageing, and Retirement in Europe 2010–2018 covered 13 countries and 24,656 grandparents aged 50–90. Multi-level linear regression analyses with REML estimation were used. This study found that providing grandchild care had a protective effect against grandparents’ depressive symptoms in both lower and higher income countries. Moreover, providing more intensive grandchild care reduced the grandparents’ depressive symptoms to a greater extent in lower income countries than higher income countries. In addition, grandmothers benefited more from grandchild caring than grandfathers, and the gender gap in the effects of grandchild care provision on one’s depressive symptoms was wider in lower income countries than higher income countries in Europe. Future research can further investigate the mechanisms behind such results. The research findings can be used to develop targeted interventions aimed at grandparents providing childcare of different intensity.

Childhood Separation From Parents and Self-Harm in Adolescence: A Cross-Sectional Study in Mainland China

As the prevalence of self-harm among adolescents in Chinese escalates, finding out the potential risk factors associated with self-harm behaviors has aroused much attention. This study aims to explore the association between parent-child separation and series of self-harm (SH) subtypes among Chinese adolescents. We survey a total of 4,928 middle school students aged from 12 to 18 years at school. Parent-child separation was investigated from four dimensions-occurrence of parental separation, separation status, age at first separation and duration of separation. Self-harm series are deemed as five subtypes-highly lethal self-harm, less lethal self-harm with visible tissue damage, self-harm without visible tissue damage, self-harmful behaviors with latent damage and psychological self-harm. Multivariate logistic regression is used to explore the associations between parent-child separation and different subtypes of self-harm among adolescents. Paternal separation is associated with each type of self-harm whilst maternal separation is not correlated with highly lethal self-harm. Except for highly lethal self-harm, the other four subtypes of self-harm demonstrate a relation with both length of paternal separation and maternal separation with aOR ranging from 1.02 to 1.06. Individuals who suffer parental separation prior to the age of three were at a higher risk for four types of less-lethal self-harm. The association of parent-child separation with self-harm deserves our attention, and future research is needed to identify the underlying mechanisms.

Perceptions of Weight Loss in Older Adults Following a 6-Month Weight Loss Program: A Qualitative Research Study

BACKGROUND

Obesity in older adults contributes to increasing comorbidities and decreased quality of life. There is limited research that includes older adults' perspectives on weight loss.

OBJECTIVE

The purpose of this qualitative study was to gain a better understanding of older adults' perceptions and experiences related to weight loss immediately after a 6-month weight loss intervention.

DESIGN

A qualitative research design using semi-structured interviews conducted as part of a larger research study exploring weight loss and/or aerobic exercise on muscle inflammation.

PARTICIPANTS/SETTING

A sample of community-based older adults (n = 11) in Southwestern Ohio were recruited from September 2018 through August 2019 after completion of a 6-month weight loss intervention. Eligible participants were older than 58 years, with a body mass index (calculated as kg/m²) >27, and sedentary with no cognitive deficits. Exclusions included cancer, heart disease, diabetes, and tobacco use.

ANALYSIS

Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Descriptive statistics were used for demographic data.

RESULTS

Three emergent themes included barriers and challenges to weight loss, which included caregiving roles, challenges with increasing protein intake, and ambivalence to change; personal strategies for success (eg, portion control and meal flexibility); and external strategies for success (eg, visual graphs as feedback measures, alternate measures of success, and social support).

CONCLUSIONS

The results of this qualitative study provide insight into older adults' experiences with weight loss, which may be considered when designing weight management interventions. However, more research is needed to examine strategies to address the challenges identified by participants in this research study. Future qualitative research should also focus on weight loss perspectives of older adults in other racial and ethnic groups.

Grandparenthood and risk of mortality: Findings from the Health and Retirement Study

Grandparenthood constitutes a significant role for older adults and may have important health implications. Our study examines the grandparenthood-mortality nexus, controlling for an array of potentially confounding variables. Longitudinal survey data from the Health and Retirement Study (HRS) were used, comprising twelve biennial waves from 1992 to 2014 with linked data on vital status derived from the National Death Index. The sample included 27,463 participants aged ≥51 years with at least one child. Cox proportional hazard models tested the association between grandparenthood and mortality risk with adjustment for socio-demographic variables, for social variables including characteristics of and contact with children, and for health variables, including measures of general, functional and mental health. Grandparenthood overall was unassociated with mortality risk in both women and men. However, the subpopulation of younger, partnered grandmothers with a larger number of grandchildren tended to exhibit a substantial increase in mortality risk as compared to women without grandchildren.

Compounding Complexity: Examining Multiple Factors Leading to Challenges Within Grandfamilies

BACKGROUND AND OBJECTIVES

Grandparents who are raising their grandchildren in the absence of the biological parents, often referred to as custodial grandparents, are prevalent across the United States. The objective of this project was to establish a grounded theory as a tool for practitioners and researchers to understand the experiences of members of grandfamiles.

RESEARCH DESIGN AND METHODS

In-depth, unstructured interviews with custodial grandparents and grandchildren from 15 grandfamilies were conducted. Classic grounded theory was the methodology used to ask the question, "What are the challenges within grandfamilies and how do they respond to these challenges?"

RESULTS

The theory emerging from the data, Compounding Complexity, provides an explanatory framework of three interrelated categories of factors that affect complexity in grandfamilies: situational, relationship, and emotional complexity. Conflict and change were found to be consistent across the categories of Compounding Complexity.

DISCUSSIONS AND IMPLICATIONS

Next steps include adding data from interviews with biological parents to Compounding Complexity and applying the theory. Understanding relationship, situational, and emotional complexity in the context of conflict and change enables practitioners to advance their work with grandfamiies.

Becoming parents again: Challenges affecting grandparent primary caregivers raising their grandchildren

Background

A growing number of Canadian children live in the care of their grandparents, called skip-generation families. Reasons for this include teen pregnancy, death of a parent, mental/physical illnesses, and addictions. These grandparents and grandchildren are at increased risk of physical and mental illness, yet have few resources available to them.

Objective

Our study aims to describe the lived experiences of skip-generation families to better identify their needs.

Methods

We conducted semistructured interviews of grandparent primary caregivers from ten households in our community to chronicle their experiences raising their grandchildren. Participants were recruited by paediatricians using convenience sampling. Interviews were recorded, transcribed, and coded using Atlas Ti software, and classified into themes by consensus.

Results

Five primary themes emerged from the interviews: (1) Changes in family dynamics, (2) Psychosocial impact on grandchild and grandparent, (3) Lack of resources for grandparent caregivers, (4) The challenges of parenting later in life, and (5) Resilience inspired by the love of family. Many participants (n=10) described feeling unsupported after assuming care of their grandchildren and identified a need for additional counselling services, financial support and respite care. All (n=11) highlighted that caring for their grandchildren changed their lives in positive ways.

Conclusion

When grandparents are prioritized as primary caregivers for their grandchildren, our study suggests they receive insufficient community resources to meet their emotional, respite and financial needs. Further research involving this population in Canada is required. Paediatricians can play an essential role in recognizing these vulnerable families and advocating for additional supports and services.

Acculturative Stress as Experienced by Filipino Grandparents in America: A Qualitative Study

The aim of this qualitative study was to describe the factors that contribute to acculturative stress among recent older adult immigrants (N = 40) who co-reside with their children in the USA. Results of the qualitative analysis yielded three main themes with corresponding subthemes. The main themes were (a) aging in America, (b) losing sense of agency, and (c) feeling alienated/Being needed. Nurses and practitioners who interact with grandparents who are recent immigrants need to explore issues related to isolation and emotional distress. Assisting these individuals in the development of supportive environments may help moderate their acculturative stress.

General health perception, depression and quality of life in geriatric grandmothers providing care for grandchildren

AIM/BACKGROUND

To investigate levels of depression, quality of life, general health perception, and factors affecting these in grandmothers providing care for their grandchildren.

MATERIAL/METHOD

One hundred two family physicians from four cities (Samsun, Amasya, Canakkale, and Izmir) in Turkey investigated 2859 women older than 65 years on their patient lists. Of these, 282 (9.8%) had spent at least 50 h caring for their grandchildren in the previous three months, and these were selected as the study group, while the remaining 2563 (89.6%) were enrolled as the control group. After all participants' demographic variables had been investigated, they completed the Beck Depression Inventory (BDI), Self-Function 12 (Mental and physical component score) (SF-12), and the Visual Analog Scale of EQ-5D (VAS). The participants in the study group also completed a questionnaire investigating features of their grandchild care.

RESULTS

The study group (with the exception of custodial grandmothers) scored better on the SF-12 (PSC = 50.60 ± 6.96 vs 48.24 ± 8.12), (MCS = 49.70 ± 7.77 vs 45.48 ± 7.61), VAS (60.44 ± 23.5 vs 54.16 ± 19.5), and BDI (13.97 ± 0.3 vs 19.49 ± 0.2) compared to the control group (p < 0.0001 for all). Age, monthly income, mean length of education, duration of care, mean hours spent caregiving per week, being a custodial grandmother, presence of more than one chronic disease, and caring for more than one grandchild at a time were identified as factors affecting SF-12, VAS and BID in the study group.

CONCLUSION

Grandchild care positively affected the grandmothers' quality of life, depression levels, and general health perception, with the exception of custodial grandmothers.

Providing regular care for grandchildren in Thailand: An analysis of the impact on grandparents' health

One of the many roles of grandparents is the role as caretaker for their grandchildren. Studies looking into the situation of older adults providing care for their grandchildren have found that care responsibilities can have beneficial effects but can also pose challenges to those providing it, depending on individual and societal circumstances. The objective of our study is to shed light on the health effects of providing care for grandchildren younger than 10 years of age on grandparents. Whether this experience has positive or negative effects on the caretaker's health depends on a range of factors that we explore here in the context of Thailand. The study is based on the quantitative analysis of the 2011 round of the National Survey of Older Persons in Thailand. In order to control for endogeneity between health status and the provision of care, we apply several instrumental variable (IV) approaches in addition to regular regressions. In terms of health status, we make use of four health-related variables: self-reported health status, functional limitations, happiness level and information about negative feelings. The observed positive impact of grandparenting on three health outcomes that we find with non-endogeneity-controlled OLS analyses is likely due to reverse causality or self-selection into becoming a grandparent who provides care. The unbiased results imply that regularly taking care of young grandchildren does not provide any physical health benefits; to the contrary, it seems to have a negative impact on self-rated health, functional limitations and psychological well-being, supporting the role strain theory.

Perceptions of Successful Aging among Older Adults in Bangladesh: An Exploratory Study

To analyze older adults' definitions of successful aging in Bangladesh. The purposively selected study sample comprised twelve participants who were aged over 60. Interviews using in-depth semi-structured questionnaires were conducted based on participants' chosen mode, either face-to-face, or by phone. Findings of this study support that successful aging is multidimensional - that is - for Bangladeshis successful aging encompasses dimensions such as adaptation to an aging body, financial security, family and intergenerational care, and social participation. Older adults' emphases on all these dimensions were qualitatively different from those relevant in western societies. Bangladeshis see disease and disability as a normal part of aging and do not emphasize freedom from disease or longevity as much as North Americans and the US-focused successful aging discourses do. Family care is a key component of successful aging in Bangladesh. While in western models functional independence has been emphasized, for Bangladeshi older adults' adaptations to changing body, co-residing with children, being financially, physically, and emotionally dependent on family and receiving their care are viewed as normal and appropriate. Cross-cultural comparisons in this study suggest that what it means and entails to age well differ across cultures. This study highlights the need among health professionals to understand Bangladeshi culture, with its specific beliefs and values, as it relates to the views of aging well.

The transition to grandparenthood: a prospective study of mental health implications

OBJECTIVES

This study investigated the mental health of a cohort of 262 female and 168 male grandparents across the first two years of their transition to grandparenthood, with particular focus on the impact of providing childcare for the grandchild.

METHOD

Baseline assessments were made during the pregnancy with the first grandchild, and subsequent assessments were at one and two years after the birth. The influence of demographic and psychosocial variables which could be expected to influence change in mental health from baseline was explored.

RESULTS

The lack of change in mental health measures in this cohort was more prominent than change. Specifically, there was a small significant decrease in anxiety over the first year for females, and a small significant increase in depression for males. Other variables, not unique to the transition to grandparenthood such as physical health and adverse life events, were strongly associated with changes in mental health. Notably, more time spent babysitting the grandchild was associated with improvement in mental health.

CONCLUSION

The transition to grandparenthood did not have any substantial adverse impact on five well-validated measures of mental health, in contrast to earlier American findings of adverse effects which implied that childcare was burdensome.

Investigating the associations between productive housework activities, sleep hours and self-reported health among elderly men and women in western industrialised countries

BACKGROUND

After retirement, elderly men and women allocate more time to housework activities, compared to working-age adults. Nonetheless, sleep constitutes the lengthiest time use activity among the elderly, but there has not been any study on the associations between time spent on housework activities, sleep duration and self-reported health among the older population. This study not only examined individual associations between self-reported health and both housework activities and sleep duration, but it also explored self-reported health by the interaction effect between housework activities and sleep duration separately for men and women.

METHODS

Pooled data from the Multinational Time Use Study (MTUS) on 15,333 men and 20,907 women from Germany, Italy, Spain, UK, France, the Netherlands and the US were analysed. Multiple binary logistic regression models were used to examine the associations between three broad categories of housework activities ((1) cooking, cleaning and shopping, (2) gardening and maintenance; (3) childcare) and health. We further investigated the extent to which total housework hours and sleep duration were associated with self-reported health for men and women separately.

RESULTS

We found a positive association between time devoted to housework activities, total housework and health status among elderly men and women. Compared to those who spent 1 to 3 h on total productive housework, elderly people who spent >3 to 6 h/day had higher odds of reporting good health (OR = 1.25; 95% CI = 1.14-1.37 among men and OR = 1.10; 95% CI = 1.01-1.20 among women). Both short (<7 h) and long (>8 h) sleep duration were negatively associated with health for both genders. However, the interactive associations between total productive housework, sleep duration, and self-reported health varied among men and women. Among women, long hours of housework combined with either short or long sleep was negatively associated with health.

CONCLUSIONS

Although time allocation to housework activities may be beneficial to the health among both genders, elderly women have higher odds of reporting poor health when more time is devoted total housework combined with either short or long sleep duration.

Interventions to Improve Grandparent Caregivers’ Mental and Physical Health: An Integrative Review

The aim of this integrative review is to appraise grandparent caregiver interventions that are designed to improve their physical and mental health. A database search was performed to identify relevant studies published between January 1, 1980, and December 31, 2014. Thirteen publications, including 11 studies, met all inclusion and exclusion criteria. All studies included grandparent mental health outcomes with fewer focusing on physical health and social relations. Improvements were found in all three areas with fewer improvements seen in physical health. However, small effect sizes were seen with most measures of these outcomes. Although the interventions led to positive grandparent caregiver outcomes, the studies were limited by their design, only one of which was a randomized controlled trial. Also, interventions did not consider variations in the grandchild’s or parent’s ages or if the grandparent provided primary or shared care. These gaps should be addressed in future research.

The effect of patient anxiety and depression on motion during myocardial perfusion SPECT imaging

Background

Patient motion during myocardial perfusion SPECT imaging (MPI) may be triggered by a patient’s physical and/or psychological discomfort. The aim of this study was to investigate the impact of state anxiety (patient’s reaction to exam-related stress), trait anxiety (patient’s personality characteristic) and depression on patient motion during MPI.

Methods

All patients that underwent MPI in our department in a six-month period were prospectively enrolled. One hundred eighty-three patients (45 females; 138 males) filled in the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), along with a short questionnaire regarding their age, height and weight, level of education in years, occupation, and marital status. Cardiovascular and other co-morbidity factors were also evaluated. Through inspection of raw data on cinematic display, the presence or absence of patient motion was registered and classified into mild, moderate and severe, for both phases involved in image acquisition.

Results

The correlation of patient motion in the stress and delay phases of MPI and each of the other variables was investigated and the corresponding Pearson’s coefficients of association were calculated. The anxiety-motion (r = 0.43, P < 0.0001) and depression-motion (r = 0.32, P < 0.0001) correlation results were moderately strong and statistically significant for the female but not the male patients. All the other variables did not demonstrate any association with motion in MPI, except a weak correlation between age and motion in females (r = 0.23, P < 0.001).

Conclusions

The relationship between anxiety-motion and depression-motion identified in female patients represents the first supporting evidence of psychological discomfort as predisposing factor for patient motion during MPI.

Chronic Pain in Older African American Grandparent Caregivers

African American grandparent caregiving is increasing, and evidence shows that grandparent caregiving influences health and its management. As older adults age, their potential of experiencing chronic pain increases, and this is profound given that physiological research shows that African Americans, aside from aging, may have a predisposition for developing chronic pain. Research shows older African Americans experience significant chronic pain, but few have discussed the implications of managing chronic pain in older African Americans who have added parental responsibility. Many older African Americans receive home healthcare services and there is a unique role for home healthcare clinicians in caring for this vulnerable population. This article discusses the impact of pain on caregiving, challenges in pain management, and practice and policy implications to assist home healthcare clinicians maintain the safety and protection of both the older grandparent and grandchildren.