Predictive Factors of Negative Spillover From Caregiving to Employment Among Japanese Family Caregivers With Older Relatives in a Care Facility

This cross-sectional study included 211 employed family caregivers with older relatives living in care facilities in Japan. Using multiple linear regression analysis, we examined the caregiving context after institutionalization of an older family member. Specifically, we examined predictors of negative spillover from caregiving to employment among family caregivers. The outcome was the extent of negative spillover. Primary predictors included caregiver characteristics and postinstitutionalization caregiving contexts such as caregiving tasks and dissatisfaction with institutional care services. Among all caregivers, 134 (63.5%) were female, and approximately half of all caregivers reported satisfaction with institutional care services. We found that dissatisfaction with institutional care services and being a female each had a main effect on greater negative spillover. However, they did not have any interacting effect on negative spillover after the institutionalization. Negative spillover did not terminate when older family members were institutionalized. Higher satisfaction with institutional care may reduce negative spillover.

Empathy and support exchanges in couples coping with early-stage Alzheimer's disease

OBJECTIVES

Research has extensively examined spousal caregiving in Alzheimer's disease (AD), but it remains unclear how people with AD help spousal caregivers. We aimed to describe emotional and practical support that people with AD and their spouses provide to each other and test the role their empathy plays in these support experiences.

METHODS

Seventy-two people with early-stage AD and their spousal caregivers independently reported empathy (personal distress, empathic concern, perspective taking) and the frequency and appraisal of support provision. Caregivers reported both partners' sociodemographic characteristics.

RESULTS

People with early-stage AD and their spousal caregivers provided support to each other often. Caregivers provided more support but people with AD appraised support provision as more pleasant and less stressful. Lower personal distress in both partners and greater caregiver empathic concern were associated with more frequent caregiver support to people with AD. Greater empathic concern and perspective taking were associated with more pleasant appraisals of helping. Personal distress was positively associated with stress of helping.

CONCLUSION

Findings describe support reciprocity in early-stage AD and debunk the myth of people with AD being only recipients of care. We identify risk and resilience in couples per empathy and inform the design of dyadic interventions to promote mutually beneficial relationships in AD.

The Changing Demography of Late-Life Family Caregiving: A Research Agenda to Understand Future Care Networks for an Aging U.S. Population

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

Temporal Patterns of Behavioral and Psychological Symptoms of Dementia and Caregiver Distress: Associated Daily and Individual Factors

This study examined daily occurrences of behavioral and psychological symptoms of dementia (BPSD) and whether caregivers' perceived distress towards BPSD varies throughout four phases of the day (i.e., morning, daytime, evening, and night). Family caregivers residing with relatives who were using adult day services (ADS) participated in an 8-day daily diary study (caregiver N = 173; caregiver-day N = 1,359). BPSD occurred most frequently in the evenings. ADS use, sleep disturbances, and dementia severity were significantly associated with BPSD occurrence for some phases of the day. Caregivers' distress towards BPSD occurrences increased throughout the day (i.e., most stressful at night). However, caregivers showed lower reactivity to BPSD at night on days when their relatives used ADS. Evidence of temporal patterns of BPSD in community-dwelling older adults and caregiver distress demonstrated the importance of ADS use for BPSD reactivity and identified potential target windows and associated contextual factors for individualized interventions.

Sequential multiple assignment randomised controlled trial protocol for developing an adaptive intervention to improve depressive symptoms among family caregivers of people with dementia

OBJECTIVES

Family caregivers of people with dementia (FC-of-PWD) suffer from a high level of stress and depressive symptoms, which usually require different interventions at different stages. Although some standalone interventions such as behavioural activation (BA) and mindfulness practice (MP) have been shown to be potentially effective at reducing depressive symptoms, the best sequence and combination of these interventions for caregivers are unknown. This study aims to develop and identify a two-stage adaptive intervention with prespecified rules guiding whether, how or when to offer different interventions initially/over time to reduce depressive symptoms in FG-of-PWD.

METHODS

A sequential multiple assignment randomised trial design will be adopted. 272 FG-of-PWD with mild to moderate depressive symptoms will be recruited from the community. Four two-stage, embedded adaptive interventions involving BA and MP of different sequences and dosages (eg, 8 weeks of BA followed by booster sessions for responders and 8 weeks of MP for non-responders) will be assigned to the participants following a set of decision rules. The primary outcomes will be depressive symptoms (measured using the Patient Health Questionnaire-9), assessed after the second stage of the intervention. Other outcomes, such as positive aspects of caregiving (measured using the Positive Aspects of Caregiving Scale), sleep quality (measured using the Pittsburgh Sleep Quality Index) and time points will also be assessed. The analyses will follow the intention-to-treat principle. Several process indicators (eg, engagement in meaningful activities and level of mindfulness) will also be assessed. The findings will have strong implications for the further development of psychosocial adaptive interventions to reduce depressive symptoms among FC-of-PWD.

ETHICS AND DISSEMINATION

This study has received ethical approval from the Human Research Ethics Committee at The Hong Kong Polytechnic University (HSEARS20211223001). The findings will be presented at academic conferences and submitted to peer-reviewed journals for publication.

TRIAL REGISTRATION NUMBER

NCT05634317.

Developing a Framework for the Support of Informal Caregivers: Experiences from Sweden, Ireland, and the United States

Policies and services to support informal caregivers vary considerably across countries. This paper examines the role of caregivers and how perspectives on that role may influence the availability of benefits and services in three countries that differ considerably in their care systems - Sweden, Ireland and the United States. We developed a nine-dimensional framework for examining differences, including policies and how the role of caregiver is conceptualized. We found differences in the three countries in how services are organized, which reflected assumptions about the caregiver role. There were also similarities in the three countries. Caregivers held an ambiguous position within each social system and there was little concern for equity in the delivery of support services. Increased clarity about the role of caregivers may facilitate development of policies that more effectively meet their varied needs.

Development and Psychometric Validation of the 27 Item Zarit Caregiver Interview for Alzheimer's Disease (ZCI-AD-27)

BACKGROUND

Caring for an individual with Alzheimer's disease (AD) is an allencompassing challenge that affects daily life. Assessment of the care partner experience is needed to support the development and evaluation of successful interventions for people with AD and their care partners. We developed the 27-item Zarit Caregiver Interview for Alzheimer's Disease (ZCI-AD-27) to assess the impact of informal caregiving in the context of AD.

OBJECTIVE

We assessed the psychometric validity of the ZCI-AD-27 in a population of care partners for individuals with moderate AD, and established thresholds for meaningful score change.

METHODS

Secondary data were obtained from informal care partners of participants in a clinical trial (NCT01677754). Psychometric analyses were conducted to assess validity, reliability, and responsiveness of the ZCI-AD-27. Anchor-based and distribution-based methods were performed to determine clinically meaningful score change.

RESULTS

The ZCI-AD-27 had a 12-domain factor structure, including a second-order domain termed Humanistic impact that included four key domains (Physical, Emotional, Social, and Daily life) as confirmed by confirmatory factor analysis with the adequate fit. Internal consistency (Cronbach's alpha ranging from 0.66 to 0.93 for domains), convergent validity, and discriminant validity indicated the good performance of the ZCI-AD-27. Known-groups validity analyses showed a greater impact on care partners with increasing disease severity. Responsiveness results demonstrated that the ZCI-AD- 27 is sensitive to change over time and meaningful change analyses indicated a range of meaningful score changes in this population.

CONCLUSION

The ZCI-AD-27 is a comprehensive, psychometrically valid measure to assess the impact of caring for individuals with moderate AD.

Daily sleep, well-being, and adult day services use among dementia care dyads

OBJECTIVES

The study aimed to describe daily sleep characteristics for dementia care dyads in the context of adult day services (ADS) use and examine the associations with sleep quality and daytime functioning (fatigue, affect, and behavior problems).

METHODS

Caregivers (CG; N = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons living with dementia (PLWD) across 8 consecutive days (N = 1359), where PLWD attended ADS at least 2 days of the week. On each day, caregivers also reported their own fatigue and affect and PLWD's daytime behavior problems and nighttime sleep problems. Considering the context of ADS use, we compared mean differences in bedtime, wake time, and total time in bed on nights before versus after ADS use. We estimated multilevel models to examine daily sleep-well-being associations.

RESULTS

On nights before an upcoming ADS day, care dyads went to bed and woke up earlier, and spent less time in bed. Further, PLWD had better sleep quality the night before an upcoming ADS day. Using ADS during the day buffered the negative impact of PLWD's sleep problems in the previous night, reducing daytime negative affect for caregivers. For caregivers, using ADS yesterday attenuated the association between shorter than typical time in bed and daytime fatigue; it also attenuated the association between PLWD's nighttime sleep problems and lowered daytime positive affect.

CONCLUSIONS

Regular ADS use may promote earlier sleep timing and protect against the adverse impact of sleep disturbances on daytime functioning for dementia care dyads.

Daily Social Interactions and HPA Axis Activity Among Midlife and Older Adults

BACKGROUND AND OBJECTIVES

Older people experience fewer negative interactions and report less stress in response to interpersonal tensions. Less is known, however, about the implications of daily social interactions for biological stress responses. We evaluated links between daily positive and negative interactions and 2 key biomeasures of the hypothalamic-pituitary-adrenal axis: salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S). We also considered the moderating effects of age.

RESEARCH DESIGN AND METHODS

Participants included a random sample of 93 individuals aged 40-95 who completed 14 days of daily diary interviews and provided saliva samples during 4 of those days.

RESULTS

Three-level piecewise models showed that individuals had higher sustained DHEA-S levels on days after reporting more positive interactions. Young-old adults (60-79) had lower overall DHEA-S on days when they had more negative interactions than oldest-old adults (80 and older). Oldest-old adults showed a flatter decline in DHEA-S on days after they reported more negative interactions compared to midlife adults (40-59). Daily social interactions were not significantly associated with cortisol.

DISCUSSION AND IMPLICATIONS

Strategies to increase positive interactions may help to build physiological resilience to stress, particularly among midlife and young-old adults.

Family caregivers' distress responses to daily behavioral and psychological symptoms of dementia: The moderating role of relationship quality

OBJECTIVES

Behavioral and psychological symptoms of dementia (BPSD) are associated with distress among caregivers of persons with dementia (PWD), but less is known about how relationship quality may buffer this association. This study examines the association between daily BPSD and daily perceived distress among family caregivers and the moderating role of relationship quality.

METHODS

Data were from 173 family caregivers of PWD from the Daily Stress and Health study. Relationship quality was assessed at the baseline interview; then on each of the 8 following consecutive days, caregivers reported frequency of daily BPSD (six domains) and their respective distress (calculated as daily distress sum and daily distress mean scores) through daily evening phone interviews at home. A 2-level multilevel model approach was employed to differentiate within-person (WP) and between-person (BP) effects.

RESULTS

Greater daily BPSD occurrence was associated with higher daily distress (sum and mean scores) at WP and BP levels. However, relationship quality moderated the association between daily BPSD occurrence and daily distress sum scores at both WP and BP levels. Caregivers who reported better relationship quality with the PWD had lower levels of daily distress sum scores in response to daily BPSD occurrence, compared to their counterparts with poorer relationship quality.

CONCLUSIONS

This study revealed that relationship quality attenuated the effect of daily BPSD occurrence on caregivers' distress. Future dementia caregiver education and support programs should consider building relationship quality into the personalized program design to improve caregiver mental health and well-being.

Rehabilitation of persons with dementia: using technology to improve participation

OBJECTIVES

The current study examined how a technology system, "It's Never 2 Late" (iN2L), may help augment traditional rehabilitation strategies for older adults with dementia by improving engagement in therapy sessions and achieving better functional outcomes.

METHOD

The study used a two group quasi-experimental design. Older adults with dementia (N = 96) were recruited from two rehabilitation departments housed within residential care communities. Participants received daily occupational and physical therapy sessions using treatment as usual (TAU) at one site (n = 49) or treatment with iN2L (n = 47) at the other site. A goal attainment approach was used to assess functional outcomes. It was hypothesized that patients whose therapists used iN2L in treatment will show greater attainment of therapy goals and greater engagement during OT and PT sessions than patients receiving TAU. It was also hypothesized that levels and improvement in engagement will mediate the association of treatment type (iN2L or TAU) with greater goal attainment.

RESULTS

Participants in the iN2L treatment had significantly higher goal attainment than TAU, significantly higher levels of engagement at baseline, and significantly steeper increases in engagement over the course of therapy. The effects of treatment on goal attainment was significantly mediated by increases in engagement.

CONCLUSION

Findings suggest that iN2L technology has the potential to increase treatment engagement and enhance rehabilitation outcomes among older adults with dementia.

Positive and negative experiences of caregiving in dementia: The role of sense of coherence

OBJECTIVES

Sense of coherence (SOC) is increasingly recognized as an important health determinant, particularly for mental health. Part of the evidence comes from informal caregivers in diverse clinical conditions. The extent to which SOC influences caregiving outcomes, however, is relatively under-researched in dementia, particularly regarding positive experiences. We analysed the association of SOC with dementia caregivers' subjective burden, psychological distress and positive aspects of care.

METHODS/DESIGN

This is a secondary analysis of cross-sectional data from the Lisbon study of Families of Persons with Dementia, involving a convenience sample of 99 primary caregivers of community-dwelling patients of neurology and psychiatry services. SOC was assessed with the Orientation for Life Scale. Measures of caregivers' outcomes were: the Zarit Burden Interview, the General Health Questionnaire for psychological distress and the Positive Aspects of Caregiving scale. Analyses controlled for demographics, caregiving arrangements, objective burden, social support, patients' neuropsychiatric symptoms and dementia stage.

RESULTS

Lower SOC was associated with higher psychological distress (p = 0.001). No significant associations were found for subjective burden (p = 0.081) or positive aspects of caregiving (p = 0.688). Additional analyses showed that lower SOC was associated with less emotional support (p < 0.001) and past psychiatric illness (p = 0.044).

CONCLUSIONS

These findings support previous research suggesting that SOC is protective for psychological distress, and extend evidence to the positive aspects of care in dementia. The cross-sectional design and small-scale convenience sampling preclude both causality presumptions and generalizability. SOC assessments may be useful to define subgroups of dementia caregivers at risk for anxiety and depression.

Adult day services and dementia caregivers' daily affect: the role of distress response to behavioral and psychological symptoms of dementia

Adult day services (ADS) provide respite for dementia caregivers and directly reduce exposure to behavioral and psychological symptoms of dementia (BPSD). This study examines the psycho-behavioral mechanism on how daily ADS use may benefit caregivers' daily affect through its impact on the distress associated with BPSD stressor exposure. The sample consists of dementia caregivers (N = 173) who participated in an ADS intervention across 8 days. Multilevel structural equation modeling was conducted to examine the within- and between-person mediating effects of BPSD distress on the direct associations between daily ADS use and daily negative and positive affect. ADS days were associated with lower daily negative affect and higher daily positive affect; the significant within-person effect of ADS use on daily affect was mediated by daily BPSD distress. Findings highlight the association between daily ADS use and caregiver affective well-being. This understanding is important for designing respite and other interventions to help dementia caregivers manage the daily stress of caregiving.

Midlife Children's and Older Mothers' Depressive Symptoms: Empathic Mother-Child Relationships as a Key Moderator

OBJECTIVE

This study aimed to evaluate the link between midlife children's and older mothers' depressive symptoms, whether this link is exacerbated in highly empathic mother-child relationships (i.e., shared strong feelings of being loved, cared for, and understood in the mother-child tie), and whether these associations vary by children's gender.

BACKGROUND

Empathic mother-child relationships in later life may intensify the link between midlife children's and older mothers' depressive symptoms. Yet little is known about the emotional implications of the mother-child tie for midlife daughters and sons.

METHOD

The sample included 234 midlife children (M = 49.75 years) and their mothers (M = 75.27 years) from Wave 1 of the Family Exchanges Study. Linear regressions were estimated to determine the link between midlife children's and older mothers' depressive symptoms and the potential moderating role of highly empathic mother-child relationships.

RESULTS

Midlife children had greater depressive symptoms when their mothers had greater depressive symptoms in the context of highly empathic mother-child relationships. This association was not moderated by children's gender.

CONCLUSION

These findings underscore the enduring emotional salience of the mother-child tie and emphasize the importance of relationship characteristics that may heighten the link between midlife children's and their mothers' depressive symptoms.

IMPLICATIONS

Interventions to prevent or treat depressive symptoms among midlife adults may benefit from accounting for the role that their mothers' depressive symptoms might play in maintaining these symptoms, particularly when mother-child ties are highly empathic.

Taking a Break: Daily Respite Effects of Adult Day Services as Objective and Subjective Time Away From Caregiving

BACKGROUND AND OBJECTIVES

Adult day services (ADS) can provide emotional and physical relief for caregivers of persons with dementia. While prior studies conceptualized ADS use at the aggregate level as a dichotomous construct, little is known about objective and subjective respite as distinct constructs. This study investigated how objective and subjective breaks from caregiving were associated with caregivers' daily emotional well-being.

RESEARCH DESIGN AND METHODS

Family caregivers (N = 173) whose relatives were using ADS at least twice a week participated in daily interviews over 8 consecutive days (day N = 1,359). Participants provided information on daily respite hours and daily affect. They also reported perceived frequency of breaks from caregiving responsibilities and primary and secondary caregiving stressors (i.e., overload and work conflict). Multilevel models were used to examine the research questions.

RESULTS

On average, caregivers reported 7.12 respite hours on ADS days and 1.74 respite hours on non-ADS days. Having more objective respite was associated with higher positive affect, whereas more subjective respite was associated with lower negative affect, after controlling for ADS use and other covariates. Further, caregivers with greater work conflict experienced more benefits to their positive affect as a result of objective respite.

DISCUSSION AND IMPLICATIONS

Objective and subjective respite are unique aspects of caregiving that may have varying impact on caregivers. Respite may be especially beneficial for caregivers experiencing conflict between work and caregiving.

Creation and Initial Validation of the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) Screening Tool

Purpose Dysphagia is a debilitating condition with widespread consequences. Previous research has revealed dysphagia to be an independent predictor of caregiver burden. However, there is currently no systematic method of screening for or identifying dysphagia-related caregiver burden. The aim of this study was to develop a set of questions for a dysphagia-related caregiver burden screening tool, the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES), and pilot the tool to establish preliminary validity and reliability. Method The questionnaire was developed through an iterative process by a team of clinical researchers with expertise in dysphagia, dysphagia-related and general caregiver burden, and questionnaire design. A heterogenous group of 26 family caregivers of people with dysphagia completed the CARES, along with the Eating Assessment Tool (EAT-10), the International Dysphagia Diet Standardisation Initiative Functional Diet Scale (IDDSI-FDS), and the Zarit Burden Interview (ZBI). Information on construct validity, item fit, convergent validity, internal consistency, and reliability was determined via Rasch analysis model testing, Cronbach's alpha, and Spearman's rho calculations. Results The final CARES questionnaire contained 26 items divided across two subscales. The majority of the questionnaire items fit the model, there was evidence of internal consistency across both subscales, and there were significant relationships between dysphagia-specific burden (CARES) and perceived swallowing impairment (EAT-10), general caregiver burden (ZBI), and diet restrictiveness (IDDSI-FDS). Conclusions Results from the current study provide initial support for the validity and reliability of the CARES as a screening tool for dysphagia-related burden, particularly among caregivers of adults with swallowing difficulties. While continued testing is needed across larger groups of specific patient populations, it is clear that the CARES can initiate structured conversations about dysphagia-related caregiver burden by identifying potential sources of stress and/or contention. This will allow clinicians to then identify concrete methods of reducing burden and make appropriate referrals, ultimately improving patient care.

Health-Promoting Self-Care in Family Caregivers of People With Dementia: The Views of Multiple Stakeholders

BACKGROUND AND OBJECTIVES

Family carers often experience difficulties managing their own needs, which can lead to ill health. This study aimed to explore the views of carers and other stakeholders about the factors related to health-promoting self-care behavior in family carers of people with dementia.

RESEARCH DESIGN AND METHODS

This multimethod qualitative study involved three consultation events with multiple stakeholders (n = 46) and four focus groups with carers (n = 27). Anonymous notes were collected from the consultation events. Focus group discussions were tape recorded and transcribed verbatim. Inductive thematic analysis was used to analyze the data.

RESULTS

Two overarching themes were identified and labeled "Services" and "Individual factors." Poor service organization and coordination, lack of respite breaks, lack of continuity of care, poor staff attitudes, as well as difficulty to prioritize own needs, health impact, financial impact, and relationships and feelings were related poorer carer health-promoting self-care behavior. Limited health-promoting self-care often led to situations of crisis, which were related to carers' health issues, need for emergency services, and unanticipated care home placement. Carers require high-quality respite to have more time to themselves, support from better coordinated and compassionate services, and more education and awareness about their own needs.

DISCUSSION AND IMPLICATIONS

There are several factors that may limit carers' involvement with health-promoting self-care activities, which may affect their own health, on the care provided to their relatives and on service use. Future research and policy need to consider how to better support cares to manage their own health issues.

Typology of parent-child ties within families: Associations with psychological well-being

Middle-aged adults often have relationships with multiple family members (e.g., children and parents). The constellation of parent-child relationships within families may have implications for individuals' psychological well-being. This study created typologies of parent-child ties by combining multiple dimensions of relationships and examined the extent to which middle-aged adults showed variability across typologies of parent-child ties within multigenerational families. Using 2,252 parent-child ties across three generations from 633 middle-aged adults, this study identified typologies of parent-child ties based on 5 indicators (i.e., contact, downward and upward support, and positive and negative relationship qualities), and examined the associations of specific typologies of parent-child ties as well as within-family variability in typologies with middle-aged adults' psychological well-being. This study found 7 types of parent-child ties as distinct combinations of contact, support exchanges, and relationship quality. Within-family variability in these types was associated with more depressive symptoms, and having types characterized by conflicted ties was associated with more depressive symptoms and lower life satisfaction. Middle-aged adults seem to be happiest when they are able to maintain homogeneous, harmonious patterns of relationships with their parents and grown children. Findings were discussed with regard to factors that also may predict greater variability in family relationship patterns. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Aging Parents' and Middle-Aged Children's Evaluations of Parents' Disability and Life Problems

This study examined discrepancies in aging parents' and middle-aged children's evaluations of aging parents' problems and how these discrepancies were associated with relationship characteristics. Using data from the Family Exchanges Study (dyad N = 331 ), discrepancies in the parents' disabilities and life problems reported by parents and their offspring were examined. Children reported a greater number of disabilities and life problems in their parents' lives than parents did. The discrepancy in the number of disabilities was associated with the frequency of phone contact, but not the frequency of in-person contact between generations. Findings confirm the gap in the evaluations of parents' problems between generations, indicating that children may overestimate their parents' problems, whereas parents may underreport their own problems. Frequent phone calls between aging parents and middle-aged children seem to play a positive role in conveying aging parents' problems. The gap in knowledge of parents' problems may lead to unmet needs and/or undesirable support exchanges between parents and offspring. Future research needs to consider both generations' reports and to develop reliable methods to assess parents' problems.

Revisiting Intergenerational Contact and Relationship Quality in Later Life: Parental Characteristics Matter

Contact and relationship quality between adult children and aging parents are two widely used indicators of intergenerational solidarity and are often assumed to be positively correlated. However, the association between the two may depend on characteristics of the parent involved. Using Family Exchanges Study Wave 1, this study assessed whether parental difficulties-measured as functional limitations and life problems-and gender moderated the associations between middle-aged adults' contact and relationship quality with their parents. We found that more frequent email or phone contact was associated with worse relationship quality for fathers who had functional limitations. For life problems, however, more contact was not related to relationship quality for fathers with life problems. The associations did not differ by mother's difficulties. These results suggest that frequent contact between middle-aged adult children and aging parents does not uniformly reflect better relationship quality but rather depends on parents' characteristics.

Unpaid Caregiving Roles and Sleep Among Women Working in Nursing Homes: A Longitudinal Study

BACKGROUND AND OBJECTIVES

Although sleep is a critical health outcome providing insight into overall health, well-being, and role functioning, little is known about the sleep consequences of simultaneously occupying paid and unpaid caregiving roles. This study investigated the frequency with which women employed in U.S.-based nursing homes entered and exited unpaid caregiving roles for children (double-duty-child caregivers), adults (double-duty-elder caregivers), or both (triple-duty caregivers), as well as examined how combinations of and changes in these caregiving roles related to cross-sectional and longitudinal sleep patterns.

RESEARCH DESIGN AND METHODS

The sample comprised 1,135 women long-term care employees who participated in the baseline wave of the Work, Family, and Health Study and were assessed at three follow-up time points (6-, 12-, and 18-months). Sleep was assessed with items primarily adapted from the Pittsburgh Sleep Quality Index and wrist actigraphic recordings. Multilevel models with data nested within persons were applied.

RESULTS

Women long-term care employees entered and exited the unpaid elder caregiving role most frequently. At baseline, double-duty-child and triple-duty caregivers reported shorter sleep quantity and poorer sleep quality than their counterparts without unpaid caregiving roles, or workplace-only caregivers. Double-duty-elder caregivers also reported shorter sleep duration compared to workplace-only caregivers. Over time, double-duty-elder caregiving role entry was associated with negative changes in subjective sleep quantity and quality.

DISCUSSION AND IMPLICATIONS

Simultaneously occupying paid and unpaid caregiving roles has negative implications for subjective sleep characteristics. These results call for further research to advance understanding of double-and-triple-duty caregivers' sleep health and facilitate targeted intervention development.

Multiple Chronic Conditions in Spousal Caregivers of Older Adults With Functional Disability: Associations With Caregiving Difficulties and Gains

OBJECTIVES

Multiple chronic conditions (MCCs) are common and have harmful consequences in later life. Along with managing their own health, many aging adults care for an impaired partner. Spousal caregiving may be more stressful when caregivers have MCCs, particularly those involving complex management. Yet, little is known about combinations of conditions that are most consequential for caregiving outcomes.

METHOD

Using a U.S. sample of 359 spousal caregivers and care recipients from the 2011 National Aging Trends Study and National Study of Caregiving, we examined three categories of MCCs based on similarity of management strategies (concordant only, discordant only, and both concordant and discordant) and their associations with caregiving difficulties and gains. We also considered gender differences.

RESULTS

Relative to caregivers without MCCs, caregivers with discordant MCCs reported fewer gains, whereas caregivers with both concordant and discordant MCCs reported greater emotional and physical difficulties. Wives with discordant MCCs only reported a trend for greater physical difficulties. Caregivers with concordant MCCs did not report more difficulties or gains.

DISCUSSION

Spousal caregivers with MCCs involving discordant management strategies appear to be at risk for adverse care-related outcomes and may benefit from support in maintaining their own health as well as their caregiving responsibilities.

Tonight's Sleep Predicts Tomorrow's Fatigue: A Daily Diary Study of Long-Term Care Employees With Nonwork Caregiving Roles

BACKGROUND AND OBJECTIVES

Long-term care employees and employees with nonwork caregiving roles are at high risk for sleep problems and fatigue. Little is known, however, about relationships between sleep and fatigue among long-term care employees who occupy nonwork caregiving roles. This study examined whether longer sleep duration and better sleep quality reduce fatigue occurrence and severity within and between long-term care employees with nonwork caregiving roles, and investigated nonwork caregiving role occupancy as a moderator of these relationships.

RESEARCH DESIGN AND METHODS

The sample comprised 166 women working in U.S.-based nursing homes. All women had children aged 9-17 years and some also had nonwork caregiving responsibilities for adult relatives. Sleep (duration and quality) and fatigue (occurrence and severity) were assessed via telephone interviews for eight consecutive evenings. Multilevel modeling was used to examine within-person and between-person associations.

RESULTS

At the within-person level, nights characterized by longer-than-usual sleep duration or better-than-usual sleep quality were followed by days with lower odds of reporting fatigue; these same sleep characteristics predicted less severe next-day fatigue. At the between-person level, employees with better average sleep quality, but not longer sleep duration, had lower odds of experiencing fatigue. Relationships between sleep and fatigue were generally similar regardless of nonwork caregiving responsibilities for children or for both children and adults.

DISCUSSION AND IMPLICATIONS

Findings suggest that tonight's sleep predicts tomorrow's fatigue. Given the serious and wide-ranging consequences of fatigue, sleep constitutes a worthwhile intervention target with potential benefits for employees, care recipients, and organizations.

DAILY SOCIAL INTERACTIONS AND BIOLOGICAL STRESS REACTIVITY: ARE THERE AGE DIFFERENCES?

Older people experience fewer negative social interactions and report less anger and stress when faced with interpersonal tensions. Little is known, however, about age differences in biological responses to social interactions. We evaluated how salivary DHEA-S, a key indicator of stress reactivity, is associated with daily positive and negative social interactions among midlife and older adults. Participants were drawn from the Daily Health, Stress, and Relationship Study, which includes 93 adults age 40 to 95 who completed 14 days of daily diary interviews and provided saliva samples on four of those days. Multilevel models showed that people had higher DHEA-S on days in which they reported more positive interactions. Older respondents were less reactive to negative interactions relative to younger respondents. These findings indicate that positive social interactions may benefit biological stress reactivity regardless of age, whereas older adults are more resilient to the adverse effects of negative social interactions.

FAMILY CAREGIVERS’ RESPONSES TO DAILY BEHAVIORAL SYMPTOMS OF DEMENTIA: THE MODERATING ROLE OF RELATIONSHIP QUALITY

Providing care for persons with dementia (PWD) is frequently regarded as highly stressful, but how caregivers perceive care-related stressors depends on a variety of contexts. Research has demonstrated that relationship quality between the caregiver and receiver – as an important dyadic context – can influence the magnitude of this perceived distress. Using 8-day diary data from 173 family caregivers of PWD (day N = 1,359), this study examined the moderating effect of relationship quality on caregivers’ stress responses to daily behavioral and psychological symptoms of dementia (BPSD), comparing within- and between-person effects. Multilevel models suggested differences in the association between BPSD occurrence and perceived distress of BPSD (i.e., negative within-person association, but positive between-person association). However, we found that both associations were moderated by relationship quality; that is, better dyadic relationship quality seemed to be protective against distress at both within- and between-person levels.

MIDDLE-AGED ADULTS’ BEREAVEMENT RESPONSE TO PARENT DEATH: THE ROLE OF PRE-LOSS RELATIONSHIP QUALITY

The bereavement literature in adulthood has largely focused on spousal loss. Yet the death of a parent is an influential – and expected – loss experience in middle and later life. This study analyzed prospective data from two waves of the Family Exchanges Study (2008 and 2013) to explore adults’ (N = 192; Mage = 56.76) experience of a recent parent death in the past 5 years, including grief responses and positive memories of the deceased parent. We examined how pre-loss relationships with the deceased parent (e.g., positive and negative relationship quality, relationship importance) are associated with different bereavement responses among the bereaved children. Findings showed that the levels of grief were higher for children who placed more importance on the parent prior to that parent’s death. Positive relationship quality was associated with positive memories after a parent’s death. However, negative relationship quality was not associated with any bereavement responses.

Purpose in Life Among Family Care Partners Managing Dementia: Links to Caregiving Gains

BACKGROUND AND OBJECTIVES

Purpose in life is associated with better health and has been found to minimize caregiving stress. Greater purpose may also promote caregiving gains (i.e., rewards or uplifts from providing care), yet the implications of purpose for positive aspects of the care role are largely unknown. The present study determined how perceptions of purpose in life among persons with dementia (PWDs) and their family caregivers are linked to caregiving gains.

RESEARCH DESIGN AND METHODS

This cross-sectional study examined 153 co-resident family caregivers drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate associations between caregivers' and PWDs' reports of their own purpose in life and caregivers' perceived caregiving gains, along with whether these associations vary by caregiver gender. Models controlled for caregivers' sociodemographic characteristics, relationship to the PWD, care tasks, role overload, negative caregiving relationship quality, and both care partners' chronic health conditions.

RESULTS

Caregivers' higher purpose in life was significantly linked to greater caregiving gains. Beyond this association, PWDs' higher purpose in life was significantly associated with greater caregiving gains for women but not for men.

DISCUSSION AND IMPLICATIONS

Purpose in life is a psychological resource that contributes to positive caregiving outcomes. Interventions to improve caregiver well-being could benefit from strategies that strengthen and maintain feelings of purpose among caregivers and PWDs.

Financial Strain, Employment, and Role Captivity and Overload Over Time Among Dementia Family Caregivers

BACKGROUND AND OBJECTIVES

This study examined how financial strain and changes in employment status affect subjective stressors over 12 months in 184 family caregivers of individuals with dementia.

RESEARCH DESIGN AND METHODS

Subjective stressors of role overload and role captivity, and employment status were measured at baseline, 6-, and 12-months. Self-reports on financial strain were measured at baseline only. Caregivers were categorized into 3 groups based on changes in their employment status during the study over 12 months: (a) who were never employed, (b) who experienced some sort of employment status change, either going from employment to unemployment or vice versa, and (c) who were always employed. Growth curve analyses were conducted to examine within-person changes in role overload and role captivity, and associations with employment and financial strain.

RESULTS

Caregivers with greater financial strain at baseline had higher levels of role overload and increasing role captivity over time. Caregivers who experienced a caregiving transition and had low financial strain at baseline showed greater decrease in role captivity over 12 months. Although caregivers who were consistently unemployed reported lower levels of role overload, they also showed steeper increase over time than those who were consistently employed.

DISCUSSION AND IMPLICATIONS

Caregivers' perceptions of financial strain add to the long-term stress of the caregiving role. Changes in caregivers' employment status may have complex associations with their feelings of stress over time.

Relationship Quality Between Older Fathers and Middle-Aged Children: Associations With Both Parties' Subjective Well-Being

Objectives

Relationships between fathers and their children are salient to both parties throughout the life course. Yet little is known about how these ties may affect well-being in later life. This study examined the implications of aging fathers' and middle-aged children's perceptions of father-child relationship quality for their own and the other party's well-being.

Method

Using a sample of 103 fathers (M = 77.88 years) and their children (M = 49.92 years) drawn from Wave 1 of the Family Exchanges Study, we estimated actor-partner interdependence models to evaluate associations between each party's perceptions of father-child relationship quality and their well-being.

Results

Fathers had elevated depressive symptoms when they reported more negative relationships with children. This association was exacerbated for fathers of daughters when daughters reported a highly negative relationship. Fathers had better self-rated health, however, when they reported more positive relationships with daughters. Children had elevated depressive symptoms and lower life satisfaction when they reported more negative ties with fathers. Finally, sons had lower depressive symptoms when they reported more positive ties with fathers.

Discussion

Findings suggest that father-child relationship quality has significant implications for the well-being of both aging fathers and middle-aged daughters or sons.

Early Parental Abuse and Daily Assistance to Aging Parents With Disability: Associations With the Middle-Aged Adults' Daily Well-being

Objectives

The current study examined the within-person association between providing daily assistance to aging parents with disability and adult children's daily mood in the context of early relationship with parents.

Methods

We used data from 782 participants and 5,758 daily interviews from the Midlife in the United States (MIDUS) Refresher, with 248 people self-reported providing daily assistance ranging from 1 to 8 days out of the entire daily-interview period. Multilevel models were fit to examine the moderating effect of physical and emotional abuse from parents in early life on the associations between daily assistance to parents today and yesterday and daily mood. Additional analyses were conducted to examine whether the moderating effect of parental abuse remained when the assistance was provided for other family members and friends.

Results

Providing assistance today and yesterday to parents had immediate and lagged associations with higher negative affect when adult children experienced childhood emotional abuse from parents. No significant findings were found for daily positive affect. The moderating effect of parental abuse became nonsignificant when the assistance was provided to other family members or friends.

Discussion

Daily assistance to parents with disability needs to be examined in the context of the relationship history with parents. The impact of childhood abuse can linger long after the actual incident. Frequent early emotional abuse from parents was associated with greater distress when the middle-aged provided daily assistance to their aging parents.

Midlife Adults' Daily Support to Children and Parents: Implications for Diurnal Cortisol

Objectives: We examined whether providing daily support to generations above and below has a differential impact on midlife adults' diurnal cortisol. Method: Midlife adults (N = 151) from the Family Exchanges Study Wave 2 reported daily practical support, emotional support, and advice to adult children and aging parents and collected saliva samples four times a day for 4 days. Results: Midlife adults experienced steeper cortisol awakening responses and steeper declines in cortisol (favorable cortisol functioning) on days when they provided support to children. Yet, they experienced higher overall cortisol levels (unfavorable cortisol functioning) on days when they provided support to aging parents. Discussion: Providing daily support to children may be rewarding to midlife adults, but support to parents may be associated with physiological stress. Findings advance understanding of midlife adults' helping behaviors to multiple generations and carry implications for older adults' well-being by encouraging effective support strategies.

Recent Parental Death and Relationship Qualities Between Midlife Adults and Their Grown Children

Objective

The death of a parent is considered a normative event in midlife, but little is known about how this loss could affect the relationship between bereaved middle-aged adults and their grown children.

Background

Family systems theory postulates that the death of a family member can have a significant impact on the individual and other family members. The death of a parent is one of the most common types of loss in adulthood, which may signal a final transition into adulthood. The death of an older parent may lead to a reevaluation of one's own relationships with grown children.

Method

By using prospective data from the two waves of the Family Exchanges Study, the authors examined middle-aged adults' experience of recent parental death and its impact on relationship qualities (i.e., negative, positive, ambivalent) with each of their grown children.

Results

When compared with the nonbereaved, bereaved participants who experienced the death of the last living parent reported increased positive relationship qualities with grown children. Among the bereaved participants, having more positive memories of the deceased parent was associated with decreased ambivalent relationship qualities with grown children.

Conclusion

The findings suggest that the death of an older parent is a significant turning point in the life course and highlights the role of positive reflection in the context of intergenerational ties.

Modeling Cortisol Daily Rhythms of Family Caregivers of Individuals With Dementia: Daily Stressors and Adult Day Services Use

Objectives

The study examined the typical diurnal cortisol trajectory and its differential associations with an intervention, the adult day services (ADS) use, among a sample of family caregivers who experienced high levels of daily stress.

Method

On hundred and sixty-five caregivers of individuals with dementia completed an 8-day diary on daily stressors, positive events, sleep quality, and ADS use. The caregivers also provided five saliva samples on each diary day. Daily cortisol trajectories were modeled as a function of time elapsed since awakening, and three spline growth curve models were fit to the cortisol data. Based on the best-fitting linear spline model, the effect of daily ADS use was examined at both daily and person levels. Covariates included daily experiences and other caregiving characteristics.

Results

On ADS days, caregivers had a steeper cortisol awakening response (CAR) slope and a steeper morning decline. ADS use remained significant after controlling for covariates at both daily and person levels.

Discussion

The findings suggested potential biophysiological benefits of daily ADS use for a sample that was under chronic stress and high levels of daily stress.

Daily Social Interactions and the Biological Stress Response: Are There Age Differences in Links Between Social Interactions and Alpha-Amylase?

Background and Objectives

According to the strength and vulnerability integration (SAVI) model, older people are better able to avoid negative social interactions than younger people, but when they do experience negative interactions, they are equally or more emotionally and physiologically reactive than younger people. Less is known about the links between daily negative and positive social encounters and the sympathetic adrenal medullary system (a key stress pathway) and whether there are age differences in these links. This study considers whether negative and positive social interactions are associated with diurnal alpha-amylase (a measure of the sympathetic adrenal medullary system) and whether there are differences in these links by age.

Research Design and Methods

Participants were from the Daily Health, Stress, and Relationship Study, which includes a random sample of 89 individuals (aged 40-95) who completed 14 days of daily diary interviews and provided saliva samples four times a day (wake, 30 min after wake, lunch, and bedtime) for four of those days that were assayed for alpha-amylase.

Results

Days in which people reported more negative interactions were associated with flatter morning declines in alpha-amylase, indicating greater stress. Links between positive interactions and diurnal alpha-amylase varied by age group.

Discussion and Implications

Findings are consistent with the SAVI model indicating that older adults respond differently to social stimuli than younger people.

Intrinsic Emotional Fluctuation in Daily Negative Affect across Adulthood

Objectives

The study explored daily negative affect (NA) fluctuation, its associations with age, and its developmental characteristics.

Method

The sample (n = 790) was drawn from the Midlife Development in the United States; participants completed two 8-day daily diaries 10 years apart. Multilevel models were estimated within each diary component, where two single daily NA (depression and nervousness) and daily NA diversity were predicted separately by daily stressor exposures, physical health symptoms, age, gender, education, and neuroticism. The variances of within-person residual were output for single NA and NA diversity as intrinsic emotion fluctuation (IEF) within each diary component (i.e., controlled for within- and between-person contextual factors). Then multilevel growth models were fit to explore the developmental characteristics of day-to-day IEF across 10 years.

Results

At the daily level, older age was associated with less IEF in depression and nervousness. Over time, IEF in depression decreased. Additionally, IEF in NA diversity increased for older participants longitudinally.

Discussion

IEF represents a new conceptualization of midlife individuals' daily emotional ups and downs, specifically, the intrinsic within-person volatility of emotions. The magnitude of IEF and its longitudinal dynamics may have implications for health and well-being of middle-aged adults.

Longitudinal trajectories of subjective care stressors: the role of personal, dyadic, and family resources

OBJECTIVES

Stressors are critical to the caregiver stress process, yet little work has examined resources that contribute to longitudinal changes in subjective stressors. The present study examines a variety of factors that contribute to changes in subjective stressors across time.

METHOD

Dementia caregivers (N = 153) completed an in-person interview and eight daily telephone interviews at baseline, and follow up interviews at 6 and 12 months. Growth curve analyses examine how care- and non-care stressors, respite, dyadic relationship quality, family support/conflict and care transitions (e.g. nursing home placement) are associated with changes in role overload and role captivity across 12 months.

RESULTS

Caregivers who transitioned out of their role had higher overload and captivity at baseline. Among caregivers who transitioned out of caregiving, higher captivity at baseline was associated with declines in captivity and overload; more non-care stressors at baseline was linked to increased captivity and greater overload across time. Adult day service use and family support were associated with lesser captivity over time; taking more breaks from caregiving was linked to lower overload. Higher dyadic relationship quality was associated with lower captivity and overload.

CONCLUSION

Findings contribute to caregiver intervention efforts by highlighting important resources associated with subjective stressors across time.

Conflict Strategies in the Parent-Adult Child Tie: Generation Differences and Implications for Well-Being

Objectives

Irritations often arise in intergenerational ties. Middle-aged individuals report that their relationships with adult children are more important and more negative than ties with aging parents. However, it is unclear whether midlife individuals use different interpersonal conflict strategies with adult children compared to aging parents, and whether the strategies used have implications for psychological well-being.

Method

This study examined middle-aged individuals' reports of conflict strategies with their adult children and their aging parents and their own depressive symptoms. Participants were from the Family Exchanges Study; middle-aged adults (N = 365, ages 45 to 66 years) reported on the conflict strategies used with each of their adult children and their aging parents.

Results

Models revealed that middle-aged individuals use more active strategies (e.g., discussing problems) with their adult children than their aging parents. In contrast, individuals used more passive strategies (e.g., avoidance) with aging parents than adult children. Further, passive strategies used with adult children are associated with greater depressive symptoms.

Discussion

Findings are consistent with the intraindividual stake hypothesis and imply that conflict strategies used with adult children may be more consequential for psychological well-being than those used with aging parents.

Middle-Aged Children's Coping Strategies With Tensions in the Aging Parent-Child Tie

Middle-aged children may cope in different ways with interpersonal tensions with their aging parents. This study examined coping strategies as a function of parent's age and disability and children's emotions (i.e., guilty feelings and worry). Middle-aged children (N = 378) reported coping strategies when encountering interpersonal tensions with each of parents (N = 482): engagement, acceptance, avoidance, and confrontation. Middle-aged children also indicated how guilty and worried they felt about each parent. Multilevel models indicated that middle-aged children were most likely to use engagement and acceptance strategies, followed by avoidance, and least likely to use confrontation. Results also revealed that middle-aged offspring were more likely to use engagement toward their parents who were older and acceptance toward parents with more disabilities. Furthermore, when middle-aged children had stronger feelings of guilt toward parents, they were more likely to be avoidant and less likely to engage with parents. Worries about parents were positively associated with the use of engagement strategies.

Everyday Support to Aging Parents: Links to Middle-Aged Children's Diurnal Cortisol and Daily Mood

Purpose of the Study

Middle-aged adults are often called upon to support aging parents. However, providing support to an aging parent with health problems and disability may be a stressful experience. This study asked whether giving everyday support to parents in the context of health problems and disability has implications for middle-aged children's diurnal cortisol and daily mood.

Design and Methods

During four consecutive days, 148 middle-aged adults (mean age = 55) reported the support they gave to their parents and provided saliva 4 times a day (wake, 30 min post-wake, lunchtime, and bedtime). Multilevel models estimated within-person differences in positive affect (PA) and negative affect (NA), cortisol awakening response and area under the curve with respect to ground (AUC-G) as a function of giving same-day and previous-day support. We examined whether these associations are exacerbated when a parent has health problems or activities of daily living (ADL) needs.

Results

Middle-aged children had significantly higher next-day AUC-G on days after they gave support to parents with ADL needs. When participants gave support to parents with ADL needs, they had significantly greater same-day PA and lower next-day NA. Giving support to parents with health problems was associated with significantly higher next-day NA.

Implications

Giving support to parents is an ambiguous experience with implications for biological stress and daily mood. A biopsychosocial approach reveals under what conditions giving support to parents may become detrimental to health and well-being; this knowledge is essential for the development and implementation of interventions.

Are You Sleeping? Dyadic Associations of Support, Stress, and Worries Regarding Adult Children on Sleep

Purpose of the study

Sleep is a key factor in maintaining positive health and well-being throughout life. Although the negative outcomes of sleep problems are becoming better understood, less is known about how intergenerational relationships might affect sleep. Thus, this investigation examines the dyadic associations of support for, stress over, and worrying about adult children on sleep quality for husbands and wives.

Design and Methods

The sample included 186 heterosexual married couples drawn from the Family Exchanges Study. To account for nonindependence in the dyadic data and explore questions of mutual influence, we used actor-partner interdependence models.

Results

Husbands' and wives' reports of supporting their adult child and husbands' worry were associated with husbands' sleep quality. Conversely, wives' stress about supporting their adult child was associated with wives' sleep quality. Findings suggest that relationships with adult children have different associations for sleep quality among middle-aged husbands and wives.

Implications

Our findings have implications for health-related research with couples and families and for providers who work with individuals struggling with sleep problems. Assisting aging parents to be aware of and manage ways that stress, support, and concern for adult children relate to their sleep may benefit them in multifaceted ways.

Aging Parents' Disabilities and Daily Support Exchanges With Middle-Aged Children

Background and Objectives

Aging parents often incur disabilities in activities of daily living, which may limit their ability to give support and necessitate increased support from middle-aged children. Research has predominantly assessed disabled parents' retrospective reports of receiving support, but we know little about their daily support exchanges with middle-aged children. This study examined practical support, emotional support, and advice that aging parents with and without disabilities provided and received from middle-aged children, and links between these support exchanges and parents' daily mood.

Research Design and Methods

Aging parents (N = 202, Mage = 79.86) from the Family Exchanges Study II indicated their disabilities and background characteristics. They also reported daily exchanges of practical, emotional support, and advice with each middle-aged child and their daily mood for 7 days.

Results

Multilevel models revealed that aging parents suffering disabilities were equally likely to provide each type of support but more likely to receive practical support. Aging parents' disabilities seemed to buffer the effects of these support exchanges, such that parents with disabilities versus parents without disabilities reported less negative mood when providing practical support or emotional support, and more positive mood when receiving practical support.

Discussion and Implications

Exploring the role of aging parents' disabilities in their daily support exchanges with middle-aged children expands on the literature of late-life disabilities and parent-child ties. Despite increasing disabilities, aging parents continue to engage in support exchanges with middle-aged children in daily life and these parents appear to benefit from such involvement.

Immediate and Lagged Effects of Daily Stress and Affect on Caregivers' Daily Pain Experience

Purpose of the Study

We examined the effect of daily stress, affect, and adult day service (ADS) use on the daily pain experience among caregivers of individuals with dementia (IWD). Participants were interviewed for 8 consecutive days. Caregivers utilized an ADS program on some days and provided care at home on other days. We hypothesized ADS use, care-related and noncare-related subjective stress, and affect would significantly influence and interact in ways to exacerbate or buffer the experience of daily pain.

Design

Participants were 173 family caregivers of IWDs using ADS more than 2 days per week. Participants with IWDs diagnosed with "mild cognitive impairment" were excluded. Daily telephone interviews assessed stress, affect, and pain.

Methods

Multilevel models were used to examine the relation between daily stress and daily pain and interaction effects of other daily experiences within the context of ADS use.

Results

Multilevel models revealed a significant relation between care-related subjective stress and daily bodily pain as well as an interaction between noncare-related subjective stress and daily bodily pain. ADS use and affect did not predict daily pain. Lagged effects revealed a significant interaction between yesterday's ADS use and today's positive affect on today's bodily pain.

Implications

Findings suggest that further studies are warranted for understanding and controlling pain among caregivers. Addressing the physical health needs through pain management interventions, positive affect maximization, and ADS use may improve the overall wellbeing of caregiving dyads.

Support Grandparents Give to Their Adult Grandchildren

Objectives

Many grandparents are involved in young grandchildren's lives, but we know little about grandparents' support of adult grandchildren. This study assessed frequency of different types of support that grandparents provided to adult grandchildren and examined potential explanations for such support (e.g., affection, grandchildren's needs, parents' support).

Method

Grandparents in The Family Exchanges Study Wave 2 (N = 198; Mage = 80.19) reported how often they provided six types of support to a focal adult grandchild.

Results

Multiple regressions revealed that grandparents' affective ties with an adult grandchild were associated with more frequent listening, emotional support, and companionship. Grandparents also provided more frequent emotional support to adult grandchildren when parents incurred life problems, and more frequent companionship and financial support when parents were not employed. Moreover, grandparents' listening, advice, and companionship with adult grandchildren were positively associated with the parents providing these types of support to grandchildren.

Discussion

Consistent with solidarity theory, grandparents experiencing greater affective ties with their grandchildren are invested in these ties regardless of family needs. Findings also offer limited evidence for the family watchdog model in that grandparents provide more support to grandchildren when parents incur problems, even though those parents may still provide support.

Parental Support of Adult Children and Middle-Aged Couples' Marital Satisfaction

Background and Objectives

Middle-aged adults commonly provide support to grown offspring. Yet little is known about how parental support may be related to parents' marital quality at midlife. This study explored couple patterns of support given to adult children and their implications for marital satisfaction.

Research Design and Methods

In a sample of 197 middle-aged couples from Wave 2 of the Family Exchanges Study, we estimated actor-partner interdependence models to evaluate the links between each spouse's reports of tangible and nontangible support given to adult children and their marital satisfaction.

Results

Wives and husbands were more satisfied with their marriage when they and their partner gave more frequent nontangible support to adult children. By contrast, wives and husbands were less satisfied with their marriage when they gave more frequent nontangible support to adult children and their partner gave low levels of this support.

Discussion and Implications

Findings shed light on the conditions under which support given to adult offspring may enhance or undermine marital quality. This study highlights the value of considering both individual and couple-level characteristics of parent-child relationships and their potential consequences for midlife couples.

Developing a Set of Uniform Outcome Measures for Adult Day Services

Adult day services (ADS) provide care to adults with physical, functional, and/or cognitive limitations in nonresidential, congregate, community-based settings. ADS programs have emerged as a growing and affordable approach within the home and community-based services sector. Although promising, the growth of ADS has been hampered by a lack of uniform outcome measures and data collection protocols. In this article, the authors detail a recent effort by leading researchers and practitioners in ADS to develop a set of uniform outcome measures. Based upon three recent efforts to develop outcome measures, selection criteria were established and an iterative process was conducted to debate the merits of outcome measures across three domains-participant well-being, caregiver well-being, and health care utilization. The authors conclude by proposing a uniform set of outcome measures to (a) standardize data collection, (b) aid in the development of programming, and (c) facilitate the leveraging of additional funding for ADS.

Past is prologue: how to advance caregiver interventions

OBJECTIVES

Research on caregiving interventions has increased substantially in recent years. Although many promising approaches have been tested, results are often modest. The goal of this paper is to identify conceptual and methodological issues that could lead to better treatment outcome.

METHOD

A critical review of the literature on interventions for caregivers of persons with dementia.

RESULTS

A fundamental issue in caregiver interventions is what are appropriate goals for treatment and what outcome measures should be used to address those goals. There also needs to be more testing of the mechanisms by which treatment leads to improvement. Intervention studies should also more regularly examine fidelity of treatment implementation.

CONCLUSION

Recommendations are made for improving the design of future trials through better attention to the heterogeneity of the caregiving population, improved conceptualization of goals and the use of innovative designs that accommodate differences in caregivers' needs and resources.