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Biomedical subjects

D Gallagher-Thompson

Publications and source records attributed to D Gallagher-Thompson.

At least 19 recordsLinked to original sources
PubMed1999

The psychological impact of genetic testing for Alzheimer disease.

Information regarding one's genetic risk for a particular disease might effectively inform medical, financial, and reproductive decisions and perhaps promote established risk reduction behaviors. However, genetic testing may also lead to significant levels of anxiety, depression, or other forms of distress, especially when psychological coping strategies and social reserves are not adequate to manage positive or inconclusive results. This paper focuses on the psychological impact of predisposition genetic for Alzheimer disease (AD). We present stress and coping models that capture the essence of this impact and discuss the potential role of counseling and follow-up interventions. The discussion draws primarily from the experiences of professionals working with other diseases, and seeks to expand that experience into the AD arena. In addition, we emphasize two issues we believe need additional attention in the psychological literature regarding genetic testing and counseling: (i) the psychosocial vulnerability of individuals being tested and, (ii) the sociocultural context of the AD patient and their family members.

Alzheimer Disease↗
PubMed1998

Standards for psychological services in long-term care facilities.

Psychologists in Long-Term Care (PLTC), a national network established in 1983, has developed, with input from colleagues and consumers, standards for psychological practice in long-term care facilities. These standards address provider characteristics, methods of referral, assessment practices, treatment, and ethical issues. This article describes the document's development and offers suggestions for its use.

Geriatric Assessment↗
PubMed1998

Hopelessness and suicidal ideation in older adults.

This study examined the role that hopelessness plays in geriatric suicidal ideation. Sixty institutionalized elderly males were recruited. Multiple regression analyses revealed that while hopelessness was strongly related to suicidal ideation, the relationship between hopelessness and suicidal ideation was dependent on level of depression. Participants who reported moderate or higher levels of depressive symptoms were more likely to have suicidal ideation with increasing hopelessness, whereas hopelessness had little effect on level of ideation at mild or lower depressive symptom levels. Unlike previous studies in younger adults, hopelessness did not predict suicidal ideation better than depressive symptoms, although the relationship between depression and suicidal ideation was stronger within higher levels of hopelessness. These findings highlight the importance of considering depression and hopelessness simultaneously when assessing and treating geriatric suicidal ideation.

Aged↗
PubMed1997

Patterns of coping preferences for male and female caregivers of frail older adults.

The similarities and differences in male and female caregivers' preferred strategies for coping and the perceived helpfulness of these strategies in managing caregiving stressors were examined in this study. Respondents were 170 caregivers (139 women and 31 men) who were primary caregivers for an elderly adult relative who was either cognitively impaired or physically frail. Results provide preliminary evidence that gender is related to frequency of use but not to the perceived helpfulness of specific coping strategies.

Adaptation, Psychological↗
PubMed1997

No association between the alpha 1-antichymotrypsin A allele and Alzheimer's disease.

The alpha 1-antichymotrypsin (ACT) A allele was recently associated with Alzheimer's disease (AD), and the ACT AA genotype was reported to be more frequent in AD subjects with the apolipoprotein E (APOE) epsilon4 allele. We examined ACT and APOE genotypes in a sample of 160 subjects with probable AD and in 102 elderly control subjects. ACT A allele frequencies were similar in AD subjects (0.503) and elderly controls (0.519). In addition, we found no evidence that in AD the AA genotype is more frequent in subjects with the APOE epsilon4 allele than in those without it. Our results do not support an association between the ACT A allele and AD.

Adult↗
PubMed1996

Issues and recommendations for the recruitment and retention of older ethnic minority adults into clinical research.

A burgeoning literature indicates that treatment of mental disorders offsets mortality, morbidity, and poor quality of life in senior citizens. Unfortunately, ethnic minority senior citizens, who are in most need of mental health services, have not been well represented in psychosocial research. This lack of attention is due, in large part, to difficulties that may arise in recruitment and retention of older ethnic minority adults in research studies. The purpose of this article is to discuss successful methods for recruiting older ethnic minority adults into psychosocial research and to offer specific suggestions for keeping this population involved in longitudinal studies. Also included is a discussion of past research and present data from treatment studies that used the methods discussed in this article.

Aged↗
PubMed1996

Strategies for increasing participation of ethnic minorities in Alzheimer's Disease Diagnostic Centers: a multifaceted approach in California.

A unified, state-wide effort to increase outreach activities targeted to ethnic minority families with a demented relative is described. A variety of strategies are reported, along with data supporting the effectiveness of these outreach efforts. At present, it appears that the three major ethnic minority groups in the State of California (i.e., Hispanic, African American, and Asian) are utilizing the network of state diagnostic centers at a rate proportional to their representation in the population.

Aged↗
PubMed1996

Internal resourcefulness, task demands, coping, and dysphoric affect among caregivers of the frail elderly.

Internal resourcefulness is defined as the repertoire of skills and behaviors individuals employ to deal with negative affective states. The relationships among caregivers' internal resourcefulness, demands of the caregiving situation, and caregivers' self-reported coping behaviors were examined relative to changes in dysphoric affect over time. Primary caregivers of the frail elderly (N = 143) completed the following measures, at two time periods, approximately four months apart: Rosenbaum's Self Control Schedule, assessing internal resourcefulness; Poulshock and Deimling's list of tasks carried out for the frail elder; Zarit et al.'s Memory and Behavior Problem Check List assessing caregiver burden; Moos et al.'s Indices of Coping; and Beck et al.'s Depression Inventory as a means of assessing dysphoric affect. Although caregivers' reactions to the care recipients' annoying behaviors predicted negative affect at time 1 and avoidant coping behavior predicted negative affect at times 1 and 2, internal resourcefulness was the only significant predictor of changes in dysphoric affect over time. Decreased dysphoric affect among caregivers was linked to possession of a larger initial set of internal resources to deal with negative internal experiences.

Adaptation, Psychological↗
PubMed1994

Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers.

Clinically depressed family caregivers (N = 66) of frail, elderly relatives were randomly assigned to 20 sessions of either cognitive-behavioral (CB) or brief psychodynamic (PD) individual psychotherapy. At posttreatment, 71% of the caregivers were no longer clinically depressed according to research diagnostic criteria (RDC), with no differences found between the 2 outpatient treatments. The results suggested therapy specificity; there was an interaction between treatment modality and length of caregiving on symptom-oriented measures. Clients who had been caregivers for a shorter period showed improvement in the PD condition, whereas those who had been caregivers for at least 44 months improved with CB therapy. These findings suggest that patient-specific variables should be considered when choosing treatment for clinically depressed family caregivers.

Adult↗
PubMed1994

"Coping with frustration" classes: development and preliminary outcomes with women who care for relatives with dementia.

We describe a novel intervention program in which wives or daughters who are caregivers are taught several specific skills to enable them to manage their frustrations more effectively. These skills include learning to relax in very stressful situations and learning to be appropriately assertive with their frail elder and with other family members. Class content and structure are presented, along with preliminary data on class efficacy that is based on an N of 48 caregivers who have currently completed this particular class series. We close by noting that this psychoeducational intervention has been very well received by colleagues in other agencies serving family caregivers. In fact, this class series is now being offered to a broad range of caregivers in the San Francisco Bay area.

Adaptation, Psychological↗
PubMed1993

Social support and caregiving burden in family caregivers of frail elders.

This study assessed the relationships between six different types of social support and five measures of caregiving burden. Two questions were addressed: Are all types of social support equally associated with burden, and do the same types of support correlate with different types of burden? Family caregivers (N = 217) to frail elders composed the sample. Multiple regression analyses demonstrated that all types of social support for caregivers of frail elders are not equal. Engaging in social interaction for fun and recreation appears to be the most important in diminishing the burden of caregiving. These findings are instructive both theoretically and clinically. The theoretical import of greater social participation under a condition of chronic stress is discussed. Further, interventions that focus on caregivers regularly experiencing pleasant activity with friends and other family would seem to go a long way toward managing the burden of caregiving.

Aged↗
PubMed1992

Applying cognitive-behavioral psychotherapy to the chronically ill elderly: treatment issues and case illustration.

A large percentage of older adults must endure at least one chronic medical illness. Clinically significant depression and anxiety are common among these patients. Specific psychotherapy approaches as well as adaptations required to address the unique issues of this population have not been delineated in the literature. We outline a cognitive-behavioral therapy approach and discuss five treatment issues we have found to be important for this population. These issues include: (1) resolving practical barriers to participation; (2) accepting depression as a separate and reversible problem; (3) limiting excess disability; (4) counteracting the loss of important social roles and autonomy; and (5) challenging the perception of being a "burden." A case study of a chronic obstructive pulmonary disease (COPD) patient with depression is presented and recommendations for future research are suggested.

Activities of Daily Living↗
PubMed1992

Endogenous depression in the elderly: prevalence and agreement among measures.

This article describes agreement among diagnoses made according to five definitions of endogenous depression in a sample of 99 depressed elders and discusses the relationship among these systems and selected demographic and clinical characteristics. Poor to fair agreement was generally demonstrated, except for Research Diagnostic Criteria (Spitzer, Endicott, & Robins, 1978) and Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev. (American Psychiatric Association, 1987), which demonstrated excellent agreement. Mostly, demographic and clinical variables (e.g., severity of depression) were unrelated to endogeneity diagnoses. The conclusion was reached that these criteria are not all measuring the same construct in older adults and that the relationship between depression severity and endogeneity should be discussed in terms of specific definitions rather than general terms.

Aged↗
PubMed1992

Changes in grief and mental health of bereaved spouses of older suicides.

Comparisons are made of the impact of a suicide death on the surviving spouse (55 years and older) with that of a natural death on spouse survivors and a married nonbereaved control group over a bereavement period of 2 1/2 years after death. Regardless of mode of death, the loss of a loved one is a difficult psychological trauma, accompanied by depression, confusion, and pervasive feelings of emptiness. Few differences in the impact of the deaths in the early months of bereavement were reported, but changes appeared over the course of the 2 1/2-year measurement period. Compared with natural death survivors, the process of bereavement was found to be more difficult for the survivors of a suicide death, whose severe depressive feelings do not seem to lessen significantly and whose feelings of mental health do not seem to improve until after the first year. Women, in general, report greater feelings than men of anxiety, tension, and apprehension, especially within the first 6 months. By the end of the observation period, most of the differences between the two bereaved groups have disappeared, and both report functioning adequately despite continuing feelings of sadness and loss.

Aged↗
PubMed1992

The relations among caregiver stress, "sundowning" symptoms, and cognitive decline in Alzheimer's disease.

OBJECTIVE: To investigate the relations among the initial perceived stress of Alzheimer patients' caregivers, the rate of change of perceived stress, patients' sundowning behaviors, and patients' rate of cognitive decline. DESIGN: A longitudinal cohort study in which Alzheimer patients and their caregivers were assessed at 6-month intervals. SETTING: Hospital out-patient clinic. Patients and caregivers lived at home. SUBJECTS: Subjects were 35 patients (50-79 years) with Alzheimer's disease and their primary caregivers (24 males and 11 females); all caregivers were spouses. METHODS: At time of entry into the study, caregivers indicated which of seven behaviors indicative of sundowning were exhibited by the patient. Patients were evaluated successively using the Mini-Mental State Examination, whereas caregivers completed the Perceived Stress Scale, provided an index of social support utilization, and completed the Beck Depression Inventory. MAIN OUTCOME MEASURES: Caregivers' initial perceived stress and the rate of change of perceived stress, patients' sundowning behavior, and rate of cognitive decline. RESULTS: The pattern of correlations indicated that both rate of cognitive decline and initial sundowning behavior were significantly correlated with initial perceived caregiver stress. The average rate of increase of caregivers' perceived stress was positively correlated with the initial incidence of sundowning behaviors, even when controlling for the effects of caregiver depression and social support utilization. CONCLUSION: Sundowning behavior of Alzheimer patients is associated with an increased rate of change of caregivers' perceived stress. This association may be specific to sundowning behavior because there was no relation between the rate of change of perceived stress and morning agitation. The findings suggest that future caregiver intervention programs could profitably focus on sundowning behavior rather than general agitation.

Adult↗
PubMed1992

The role of social supports in the bereavement process of surviving spouses of suicide and natural deaths.

This report examines the changing role of social supports in the bereavement of spouses of elderly suicide and natural deaths, focusing on differences and similarities in relation to gender, time, and mode of death. Measurements were obtained 4 times after death (within 2 months, at 6 months, at 12 months, and at 2 to 2 1/2 years) on 79% of the 108 survivors of elderly suicide, 89% of the 199 natural death survivors, and 79% of the nonbereaved controls. The results indicated that the suicide survivors received significantly less emotional support for their feelings of depression and grief than the natural death survivors, and that they did not confide in the persons in their network any more than the nonbereaved controls did. Women report receiving more support overall than men. A low spot in social supports occurred at the 6-month point after loss for both bereaved groups, but primarily in practical help received by natural death survivors. By the end of the second year, both practical and emotional supports had increased to at least the same level as immediately after death.

Aged↗
PubMed1991

Dimensions of perceived social support in clinically depressed and nondepressed female caregivers.

The relationship between social support and depression was studied in 165 women caring for frail family members. The Arizona Social Support Interview Schedule (Barrera, Sandler, & Ramsay, 1981), which includes 4 dimensions of availability and use of resources and satisfaction with and need for support, was used to examine 7 categories of supportive activity. Depression was assessed according to Research Diagnostic Criteria (Spitzer, Endicott, & Robins, 1978) with the Schedule of Affective Disorders and Schizophrenia (Endicott & Spitzer, 1978). There were no differences in overall satisfaction with received support in comparisons of depressed and nondepressed caregivers. However, depressed caregivers (n = 87) reported a higher incidence of negative interactions with others. Both groups appeared to have equal access to social support, with nondepressed caregivers (n = 78) reporting significantly greater use of those resources.

Activities of Daily Living↗