Psychological, social, and health impact of caregiving: A comparison of Black and White dementia family caregivers and noncaregivers.

Psychological, social, and health variables were compared in 175 Black and White family caregivers of patients with dementia and 175 Black and White noncaregivers. Caregivers and noncaregivers did not differ within race on demographic variables. Caregiving was associated with increased depression and decreased life satisfaction only in White families. However, caregiving appears to have similar social consequences for Black and White families, including restriction of social activity and increased visits and support by family from outside of the home. Race, but not caregiving, was associated with physical health variables. Methodological issues in comparing well-being in Black and White caregivers, in particular the importance of including noncaregiving comparison subjects, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latent growth models of the longitudinal effects of dementia caregiving: A comparison of African American and White family caregivers.

Self-report measures of depression, physical health symptoms, and life satisfaction were collected over a 2-yr period from 197 family caregivers of dementia patients and 218 noncaregivers (controls). Latent growth models were used to compare changes across time for African American and White caregivers, with gender, age, and socioeconomic status serving as covariates. Results indicated that White caregivers sustained higher levels of elevated depression and decreasing life satisfaction over time compared with African American caregivers. Both groups of caregivers reported increases in physical symptoms over time. These results indicate worsening difficulties over time for many White caregivers. African American caregivers show more resilience on measures of depression and life satisfaction but are still vulnerable to increases in physical symptoms over time. Implications for additional research and clinical intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Compound caregiving: When lifelong caregivers undertake additional caregiving roles.

Objective: Lifetime parental caregivers of adults with intellectual disabilities (ID) may also become caregivers to other family members. This study investigated caregiver experiences of compound caregiving (i.e. additional caregiving roles) and its association with caregiver quality of life. Participants: Ninety-one older caregivers living with their adult son/daughter with ID were interviewed. Mean age of the caregivers was 60 years and their sons'/daughters' mean age was 29 years. Main Outcome Measures: Compound caregiving status, physical and mental health, life satisfaction, depressive symptomatology, and desire for alternative residential placement for their co-residing son/daughter. Results: Thirty-four (37%) reported being current compound caregivers to an additional care recipient, predominantly a mother, father, or spouse. Caregivers averaged 39 hours per week fulfilling their primary caregiving tasks, an additional 12 hours per week on the compound caregiving role, and the median duration of compound caregiving was 3 years. Compared with the non-compound caregivers, the compound caregivers had increased desire to place their son/daughter into residential care, though no group differences were apparent in life satisfaction, depressive symptomatology, physical health, or mental health. The most problematic issues reported by compound caregivers were having little personal time and a lack of adequate help from others. Conclusion: Compound caregiving was often experienced, and may galvanize these lifetime caregivers to start making future plans for their sons/daughters. Future research is warranted to refine more homogeneous groupings of compound caregivers, who may be at greater risk for adverse outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term caregiving: What happens when it ends?

Data from a longitudinal study were used to examine what happens to caregivers in the years after their cognitively impaired spouse dies. Comparisons of 42 current caregivers, 49 former caregivers, and 52 noncaregivers over a 4-year period showed that former caregivers did not improve on several measures of psychological well-being. Although former caregivers experienced decreases in stress and negative affect, their scores on depression, loneliness, and positive affect did not rebound to levels comparable to noncaregivers and, in fact, remained similar to those of current caregivers up to 3 years after caregiving had ceased. The most consistent predictors of postcaregiving outcomes were social support and intrusive–avoidant thinking about caregiving. The data suggest that some consequences of long-term caregiving may be long-term as well. The needs of former spousal caregivers warrant greater attention both in research and in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A stress process model of caregiving for individuals with traumatic brain injury.

Objective: To test a stress process model of caregiving for persons with traumatic brain injury. Design: A correlational study using path analysis. Participants: One hundred eight caregivers affiliated with community- or Web-based support groups. Main Outcome Measures: The Modified Caregiver Appraisal Scale, the World Health Organization Quality of Life-Brief Version, the Interpersonal Support Evaluation List, and the COPE. Results: The normed fit index, comparative fit index, and parsimony ratio indicated a good fit for the model, suggesting that coping, social support, and caregiving appraisal contribute to quality of life. A more parsimonious model was respecified and achieved a better fit with fewer paths and variables. Conclusions: Empirical support was found for the proposed caregiving stress process model, which appears to provide useful information for future research and clinical interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers.

A stress and coping model was used to study predictors of individual differences in caregiver adaptation. A total of 54 family caregivers of elderly dementia patients completed interviews and questionnaires assessing the severity of patient impairment and caregiving stressors; caregiver appraisals, coping responses, and social support and activity; and caregiver outcomes, including depression, life satisfaction, and self-rated health. Correlational and regression analyses supported the utility of the stress and coping model. Appraisal, coping responses, and social support and activity were significant predictors of caregiver outcome, even when severity of caregiving stressors was statistically controlled. The importance of a multidimensional approach to assessing caregiver outcomes was supported by regression analyses indicating that each caregiver outcome was predicted by different patterns of stressors, appraisal, coping, and social support and activity. Results are discussed in terms of a stress and coping model of caregiving, and clinical implications for work with caregiving families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stressful situations in caregiving: Relations between caregiver coping and well-being.

We examined ways in which caregivers cope with stressful caregiving situations and the relations between coping strategies and caregivers' psychosocial well-being. Respondents were 58 family caregivers to patients discharged from a rehabilitation hospital. Caregivers identified a recent stressful event in caregiving and indicated strategies used to cope with this event. After controlling for patients' impairment level, analyses indicated that caregivers engaging in more escape–avoidance coping reported greater depression and more conflict in their personal relationships. Those using more positive reappraisal demonstrated greater positive affect. Younger caregivers, many of whom were women, used more avoidance strategies. Results have implications for therapeutic interventions with family caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women's responses to young infants' cries.

Women's caregiving and perceptual responses to young infants' cries were assessed as a function of parity and cry cause. Ss cared for a crying infant manikin in a simulated baby-sitting situation. Mothers and nonmothers were quite similar in basic features of their caregiving behaviors, suggesting that the effects of parity may be to fine-tune skills that many women bring to the task of caring for young infants. The specific cause of the cry (hunger or pain) was associated with few differences in caregiving behavior, even though a subsequent perceptual task showed that Ss reliably discriminated the two cries. Further analyses of the perceptual data indicated that cry sounds communicate information about the general distress level of the infant better than information about specific causes. Thus, although the sound of the cry may inform caregivers about overall distress level, caregiving behaviors appear to be determined by additional factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of dispositional coping strategies on physical complaints and life satisfaction in the elderly

Well-being and mental and physical health in old age are influenced in a significant way by the fact that it is possible to cope successfully with ongoing hazards, threats and problems. In recent years coping research has shown increasing interest in coping processes in the elderly. Most of the studies are focused on age-related differences in coping processes and on the issue of change or stability of coping in old age. However, the goal of our study was to examine the impact of dispositional coping strategies, conceptualized as consistent personality characteristics, on physical complaints and life satisfaction among the elderly. We recurred on the model of coping modes by Krohne, which postulates two statistically independent person-specific coping dimensions named "vigilance" and "cognitive avoidance". Based on this model it is possible to identify the "classical" coping styles of "sensitization" (high vigilance and low cognitive avoidance) and "repression" (low vigilance and high cognitive avoidance). In our study, including 766 subjects older than 60 years, we found a higher frequency of "repressors" than of "sensitizers". Results show that dispositional coping strategies are significant moderator variables of both physical complaints and life satisfaction: Older people who prefer a cognitive-avoidant coping strategy ("repressors") are more satisfied with their life and have less complaints than "sensitizers".     

Stress appraisal in women with spinal cord injury: Supplementary findings through mixed methods.

A study was conducted to examine how women with spinal cord injury (SCI) perceive the stressors they encounter, and how cognitive appraisal is associated with coping and life satisfaction. Fifty women with SCI were interviewed regarding their experience with stress and coping. The interviews were then coded using a framework based on stress and coping theory (transactional model). The systematic application of quantitative methods to the coded interview data allowed for statistical analyses, which demonstrated that the context in which the women spoke about their experiences with various stressors was associated with coping strategies, time since injury, and life satisfaction. Although stress and coping are commonly seen as interacting constructs that influence quality of life outcomes, current findings suggest that appraisal of stressors in the context of loss (more common among women more recently injured) may have a direct impact on life satisfaction apart from any coping strategies put into effect. Interventions designed to facilitate coping with loss and enhance problem-solving skills, along with education about available resources, may foster a sense of empowerment after SCI and ultimately change how stressors are perceived and managed in order to dampen their negative impact on life satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality counts for a lot: predictors of mental and physical health of spouse caregivers in two disease groups

The purpose of this study were to examine the influence of personality on mental and physical health of spouse caregivers and to determine whether there were differences in such influences depending on disease context. The disease contexts compared were Alzheimer's disease (AD) and Parkinson's disease (PD; with no coexisting dementia)--both chronic, degenerative diseases of later life. It was predicted that personality would be related to mental and physical health, directly and indirectly, and that AD caregivers would have higher levels of perceived stress and worse mental and physical health outcomes. Participants in the study were 175 caregivers (88 AD; 87 PD) living at home with their ill spouses. The data provided an excellent fit to the hypothesized model of the relationships between personality, disease group, social support, perceived stress, and mental and physical health. Seventy-eight percent of the variance in mental health was accounted for and 35% of the variance in physical health was explained. Personality had significant direct and indirect effects on mental health and significant indirect effects on physical health. As predicted, AD caregivers had significantly worse mental health than PD caregivers; however, AD caregivers had better physical health than PD caregivers, controlling for other variables in the model. These results are discussed in relation to the existing caregiving and behavioral medicine literature. Future research should include different domains of personality--states and longer term self-regulatory processes in addition to traits--to advance models of caregiving processes further.     

Appraisal, coping, and social support as mediators of well-being in Black and White family caregivers of patients with Alzheimer's disease.

Family caregivers of patients with Alzheimer's disease (AD) commonly have high levels of psychological distress. Black caregivers often report less depression than White caregivers, but the process underlying this difference is poorly understood. With the use of a stress process model, 123 White and 74 Black family caregivers of patients with AD and other progressive dementias were studied. Black caregivers appraised patient problems as less stressful and reported higher self-efficacy in managing caregiving problems and less depression than did White caregivers. White and Black caregivers also differed significantly in coping responses but not in social supports. Structural equation analyses indicated that the correlational structure of the stress process was similar in White and Black caregivers. Caregiving stressors and race did not affect well-being through direct paths, but they were mediated by effects for appraisal, social support and activity, and coping. Possible cultural mechanisms explaining the better adjustment among Black caregivers are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symposium: Family caregiving to dependent older adults: Stress, appraisal, and coping.

Articles presented in this 1987 APA symposium adopt a stress, appraisal, and coping framework for conceptualizing the experience of family caregiving. Each article emphasizes 2 themes: (a) caregivers' adaptation to the chronic demands of in-home caregiving and (b) factors that mediate the relationship between caregiving stress and caregiver's adaptation. The articles presented in this symposium illustrate both the utility of this theoretical approach to studying caregiving stress and the difficulty inherent in its use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family health and the palliative care trajectory: a cancer research agenda

This article reviews the published literature related to families of palliative care patients with cancer within the context of the Cancer Control Framework of the National Cancer Institute of Canada. Three themes emerged: 1) the impact of terminal cancer on the family; 2) family functioning--responses to terminal cancer; and 3) quality of palliative care from the family perspective. The most substantial body of research describes family needs, family caregiving burdens, caregiving costs and the impact of the patient's terminal cancer on the health of family members. Small samples, high nonresponse rates, selection biases and a lack of standardized outcome measures have impeded the advancement of knowledge. Method development studies are warranted, including the development of instruments to measure family care constructs. Longitudinal studies to examine the long-term impact of the patient's functional status, mood, symptom distress and quality of life on family members are needed. Research should also explore the effects of family composition, socioeconomic factors, culture and spirituality on families' experiences with terminal illness. Identification of families at risk as well as development and rigorous testing of appropriate interventions should become priorities.     

Caring for a family member with a traumatic brain injury

The responses to a questionnaire on subjective burden are reported for 52 primary caregivers of a group of persons with traumatic brain injuries sustained an average of 6 years previously. The aim of the study was to examine satisfaction with social support, perception of coping skills, and appraisal of symptoms as predictors of strain in the carers. A range of responses, both positive and negative, to the work of caring for a relative with a head injury was reported. A high prevalence rate of emotional and behavioural changes in the persons with head injuries was found and the amount of distress caused by these symptoms was found to be predictive of burden. The other factor important in predicting burden was the carers' ratings of their satisfaction with their ability to cope with the work of caregiving. Social support, injury severity, and the demographic characteristics of the persons with head injury and their carers were not significant predictors. Depression in the carers was also investigated and the variable most predictive of elevated depression scores was coping satisfaction. These findings reinforce the importance of strengthening carers coping resources in rehabilitation work with head injured persons and their families.     

Distinguishing optimism from pessimism in older adults: Is it more important to be optimistic or not to be pessimistic?

Confirmatory factor analysis revealed that the Life Orientation Test (LOT) consisted of separate Optimism and Pessimism factors among middle-aged and older adults. Although the two factors were significantly negatively correlated among individuals facing a profound life challenge (i.e., caregiving), they were only weakly correlated among noncaregivers. Caregivers also expressed less optimism than noncaregivers and showed a trend toward greater pessimism, suggesting that life stress may affect these dispositions. Pessimism, not optimism, uniquely predicted subsequent psychological and physical health; however, optimism and pessimism were equally predictive for stressed and nonstressed samples. By exploring optimism and pessimism separately, researchers may better determine whether the beneficial effects of optimism result from thinking optimistically, avoiding pessimistic thinking, or a combination of the two. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work ability of young adults

This paper reviews the themes related to work ability of young adults. Premature working discapacity causes significant economical and social costs in Finland compared to other Nordic countries and has for that reason been studied most intensively there. Work ability is an interaction of social, environmental and individual factors such as physical fitness, coping skills, social support behaviour and health behaviour. Environmental factors influencing work ability can be concrete, like physical and chemical exposures or more abstract like unemployment. The work ability of ageing people has been studied intensively, while work ability of young adults has not been properly evaluated so far. The worsened economic situation in Finland has meant an excessive work load for those who still have work. At the same time the risk of permanent unemployment is increasing. This polarizationing affects especially the young because they may fail to enter the working life. Also factors related to childhood may affect and even determine work ability in adulthood.     

When primary and secondary caregivers disagree: Predictors and psychosocial consequences.

The purpose of this study was to investigate primary caregiving spouses' and their lay helpers' divergent opinions about the caregiving environment. Through parallel assessments, both primary and secondary caregivers of a patient with Alzheimer's disease were asked to rate the degree of patient problem behaviors; the degree of strain the primary caregiver was experiencing; and primary caregiver efficacy, or perceived ability to cope with caregiving demands. Analyses concentrated on the general levels of disagreement in these domains, as well as on potential predictors and consequences of such disagreement. Results revealed a substantial divergence in perceptions across caregiving domains, with relatively less disagreement about patient problem behaviors and primary caregiver strain than about primary caregiver coping efficacy. Primary caregivers with relatively pessimistic secondary caregivers experienced relatively less psychosocial distress than primary caregivers with more optimistic helpers. These findings were strongest among female–female caregiving dyads. Theoretical implications and methodological limitations of the study are discussed, along with suggestions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Circle Model--support for relatives of people with dementia

Home care for cognitively impaired elderly puts tremendous stress and burden on their families. Therefore it is important to search for effective care models in order to provide support for this group. In this study, an intervention model--the Circle Model--was developed, tested and evaluated in six places in Sweden. The model is unique in that family caregivers and volunteers were trained together in study circles. After their training, the volunteers replaced the caregivers in the homes on a regular basis, which permitted the caregivers some relief from the demands of caregiving. Interviews were conducted with the participants to gather information about their training and relief care experiences. The caregivers reported that the study circle provided opportunity to exchange experiences with other people in similar situations. They felt a spirit of community with other relatives, and were able to increase their knowledge in care providing and coping strategies. The emphasis in temporary relief care by the volunteers was placed on providing the relatives with feelings of security and relaxation. The satisfaction among the Circle Model participants was reciprocal. The volunteers also reported high satisfaction and appreciation of the knowledge which they acquired from the caregivers. The Circle Model brings new dimensions to the home care situation and should be seen as a complement to social services support.