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Biomedical subjects

S H Zarit

Publications and source records attributed to S H Zarit.

At least 37 records · Page 2Linked to original sources
PubMed1999

How many elders receive assistance? A cross-national comparison.

OBJECTIVES: To examine models of informal support received by elders in the United States and Sweden and to test whether differences in informal support appear to stem from demographic differences between the nations alone or whether cultural and historical differences must also be considered. METHODS: Samples with similar functional dependence, age 75 and older in the United States (n = 4,677) and Sweden (n = 1,378), were used to model cross-national differences in the association between country, age, sex, potential availability of kin support, and receipt of informal assistance. RESULTS: Patterns of informal help were higher in the United States than in Sweden but were qualified by higher order interactions among age, sex, and availability of kin support. DISCUSSION: Cultural differences predating current policies in both countries appear to influence informal support over and above what can be accounted for by demographic differences alone.

Age Factors↗
PubMed1999

Caregiving and institutionalization: perceptions of family conflict and socioemotional support.

This study examines the impact of family conflict and socioemotional support among caregivers who institutionize their relatives. Fifty-two wives, forty-three husbands, and sixty-seven daughters were interviewed before and after the placement of a cognitively impaired relative. A repeated measures ANOVA was performed to examine differences in reports of family conflict and socioemotional support among caregivers. Husbands reported greater increases in family conflict than wives or daughters during the institutionization process. Conversely, wives and daughters indicated higher levels of socioemotional support than husbands. Hierarchical regression equations were then calculated to assess the independent contributions of family conflict and socioemotional support to postplacement adaptation. Decreases in socioemotional support during institutionalization significantly predicted postplacement anger among husbands and increases in family conflict significantly predicted postplacement depression among wives. Overall, family conflict and socioemotional support have important implications among caregivers who institutionalize their relatives.

Adaptation, Psychological↗
PubMed1999

Useful services for families: research findings and directions.

A major tenet of gerontological practice and policy has been that community-based services relieve stress on family caregivers and delay or prevent institutionalization of frail elders. Evidence for benefits of community-based services is examined from four perspectives: (1) relief for family caregivers; (2) benefits to older clients; (3) delay or prevention of institutionalization; and (4) cost-effectiveness or cost-benefits of a service. Studies are grouped according to the type of service (in-home respite, adult day care, overnight respite, case management and multicomponent programs) and type of clients (dementia only or mixed). There are surprisingly few empirical studies overall and the reported benefits typically are modest. Methodological problems as well as providing relatively small amounts of service may have accounted for these findings. Studies in which clients and/or their families received adequate amounts of help showed more consistently positive outcomes. There is little evidence, however, to suggest that community services delay placement. More needs to be done to examine the benefits of innovative programs, and particularly to incorporate the dementia patient's perspective into these evaluations.

Aged↗
PubMed1999

Formal and informal support: the great divide.

As we approach the next century, it is clear that neither formal services nor informal family caregivers can meet the needs of a growing population. It is therefore pertinent to reconceptualize the linkages between formal and informal care and move towards an integrative model. This paper explores several models of such an interface that exist in the literature and proposes that many of these overlap. Various predictors of formal service use are also explored, with an emphasis on the outcomes of both the informal caregiver and the care recipient. Implications for future research include further exploring and understanding the link between formal and informal support and the need to increase receipt of formal care among family caregivers.

Aged↗
PubMed1998

Adult day care for dementia: a comparison of programs in Sweden and the United States.

Adult day care is regarded as an important respite service to family caregivers of dementia patients to assist the patient to remain in the community. This study includes 178 Swedish and 86 American day care centers serving cognitively impaired clients. Client, staff and organizational characteristics were surveyed. Although the two countries have quite different systems of elder care, client characteristics were similar, suggesting that adult day care centers are a convergent solution to a common problem of supporting disabled elderly. Differences were found between the USA and Sweden in the staff, structure, and services of the programs. The study raises questions about day care centers' goals and organization. Results provide a clearer understanding of the optimal role and function of adult day care centers.

Journal Article↗
PubMed1998

Stress reduction for family caregivers: effects of adult day care use.

OBJECTIVES: This study reports the findings of an evaluation of the psychological benefits of use of adult day care by family caregivers assisting a relative with dementia. METHODS: The study used a quasi-experimental design in which caregivers in the treatment group used substantial amounts of services, whereas caregivers in a control group did not use day care at any point during the evaluation and only small amounts of other respite services. The evaluation was guided by the stress process model of caregiving which distinguishes between appraisals of primary stressors and well-being. RESULTS: Results after 3 months of day care use showed that the treatment group had significantly lower scores than the control group on two of the three measures of primary appraisals (overload and strain) and two of the three measures of well-being (depression and anger). Findings at one year showed that the treatment group had significantly lower scores on overload and depression than the control group. DISCUSSION: These results demonstrate that use of adult day care by caregivers of dementia patients results in lower levels of caregiving-related stress and better psychological well-being when compared to that of controls.

Aged↗
PubMed1997

Early cognitive markers of the incidence of dementia and mortality: a longitudinal population-based study of the oldest old.

This study examines whether cognitive markers at prior examinations are indicative of subsequent dementia and mortality. The sample was composed of subjects aged 84-90 at baseline who were reexamined three times over a 6-year period on a comprehensive biobehavioral battery. Dementia was evaluated at each examination using DSM-III-R criteria. Results indicated that incident cases of dementia had lower cognitive scores both 2 and 4 years prior to diagnosis, compared to non-demented survivors. Evidence for terminal decline was also found, as people who subsequently died also had lower cognitive performance at prior examinations, compared to non-demented survivors. The findings suggest that mild cognitive dysfunction is an important clinical finding among the oldest old and may herald either the onset of dementia or mortality.

Aged↗
PubMed1997

Self-reports on memory functioning in a longitudinal study of the oldest old: relation to current, prospective, and retrospective performance.

Self-evaluation of memory performance, one aspect of metamemory, may be an important indicator of concurrent, retrospective, or future decline in memory functioning. The relationships among self-evaluations, cognition, and outcome were investigated in the OCTO study, a longitudinal, population-based panel of the oldest old. Using concurrent data, results indicated that overall cognitive ability, depression, gender, and education were associated with self-reports of memory for the entire sample. The relation of perception of decline to actual decline was also examined. Self-reported decline over a 2-year period was associated with actual decline in performance on three tests of memory. Finally, self-reported memory function was investigated as an indicator of future cognitive decline and diagnosis of dementia. These self-evaluations predicted decline on specific tests of memory over 2 years and subsequent diagnosis of dementia after 2 and 4 years. The amount of variance accounted for by self-evaluations, however, was relatively small, suggesting that complaints reflect different processes, only one of which is the pathological decline involved in dementia.

Aged↗
PubMed1997

Predicting change in activities of daily living: a longitudinal study of the oldest old in Sweden.

We examined predictors of stability and decline in activities of daily living (ADLs) and mobility in a population-based sample of the oldest old. Respondents were people aged 84 to 90 living in South Central Sweden. Predictors were drawn from three domains: sociodemographic variables, vitality, and physical and psychological health. Using a logistic regression model, we sought to identify variables that were associated with changes in functioning. Over the 2-year interval, we found significant main effects for stability in ADL functioning for three variables: residential status (e.g., living in the community), subjective health, and mastery (n = 142). For mobility, we identified three variables associated with stability: lung function, subjective health, and mastery (n = 137). Over the 4-year period we found that residential status was significantly associated with stability in ADL performance (n = 89), while age, marital status, grip strength, and mastery were significant predictors for stability in mobility (n = 90). The findings can direct researchers toward interventions within particular residential environments that maintain a sense of mastery and an individual's aggressive attitude toward challenging situations.

Activities of Daily Living↗
PubMed1997

Selection bias in samples of older twins? A comparison between octogenarian twins and singletons in Sweden.

Twin studies are a powerful approach for estimating genetic and environmental influences in later life, but the usual requirement that both twins are alive may introduce a selection bias in gerontological studies relative to representative samples of nontwins. In the present study, samples of older twins and nontwins in Sweden were compared across the domains of vitality, well-being, physical and cognitive functioning, and health utilization to evaluate possible selection bias. One member of each twin dyad in the OCTO-Twin Study of intact twin pairs older than age 80 was randomly selected (N = 128) and compared with a population-based sample of nontwins (N = 324) from the OCTO Study. Multiple regressions adjusting for differences in demographic variables showed significant effects for twin status in only 3 of 20 comparisons. The results suggest that twin pairs surviving into very late life are similar to a representative sample of nontwins of the same age in health status and biobehavioral functioning. These findings support the generalizability of twin studies for understanding genetic and environmental influences on aging, health, and behavior.

Aged↗
PubMed1996

A measurement model of cortisol reactivity of healthy older adults.

Research on the physiological adaptation process has found that stress is associated with the rate of cortisol secretion, the main hormone that reflects stress. However, considerable variation among subjects has been reported. Using a sample of older adults (N=46), we tested the hypothesis that cortisol reactivity is composed of (1) a situation-related component representing hypothalamic influence on cortisol secretion observed on three different occasions, and (2) a stable component representing a general trait responsible for cortisol responses observed from occasion to occasion. LISREL VIII was used to test this hypothesis. Results indicated that a homogeneous reliability model was not supported by the data. A congeneric measurement model represented a better fit to the data. Results suggest that subjects have consistent patterns of response during separate experimental occasions. However, results do not suggest a consistent pattern of response over time. The main implication of these results is that salivary cortisol measures are sensitive to experimental stress situations. As such, this noninvasive method may be useful in examining adaptive responses to stress.

Adaptation, Psychological↗
PubMed1996

Preparation for caregiving: a study of multigeneration families.

The impact of providing care to the frail elderly on individual caregivers and their families has been discussed at length, but few researchers have investigated the events and circumstances preceding the onset of caregiving. In addition, although there is evidence that several family members are usually involved in planning and decision making about caregiving, the majority of studies in this area include only one generation. Based on a larger theoretical framework of preparation for caregiving [1, 2], the extent to which family members anticipate and plan for future caregiving is investigated. In addition, the extent to which they are satisfied with these preparations is studied. Interviews were conducted with mothers, daughters, and granddaughters in thirty-three multigeneration families. While substantial numbers of both mothers and daughters anticipated the need for care for the oldest generation, few made concrete plans about how to organize future care provision. Planners were more satisfied with the amount of discussion and planning in their family than non-planners. Implications for future research and practice applications are discussed.

Activities of Daily Living↗
PubMed1995

Dimensions of social support and social conflict as predictors of caregiver depression.

The goal of this research was to examine the relationship of family social support and social conflict to stressors and depression. Fifty-seven caregiving women were interviewed regarding caregiving stressors, social support, and social conflict. Three dimensions of social support and social conflict were assessed: instrumental, informational, and affective. The findings supported the importance of distinguishing between social support and social conflict, and among the three dimensions of support and conflict. Respondents reported higher levels of support than of conflict, but consistent with earlier research, social support was not related as strongly to outcomes as social conflict was. Although instrumental support was related significantly to depression, informational and emotional support was not. Social conflict, however, was significantly related to depression. Both emotional conflict and informational conflict were significant predictors of depression. Implications for future research and interventions are discussed.

Activities of Daily Living↗
PubMed1995

Ecological measures of cognitive functioning: a validation study.

Observed cognitive decline in the elderly has been widely reported in the literature. The relation of experimental cognitive ability measures to real-world cognitive competence has been questioned. This research examines the validity of English-language versions of two measures of everyday competency: the Memory in Reality test involving object placement recall and the Coin Test, a money-sorting task. The measures were developed as part of a Swedish epidemiologic study. Validity was evaluated by comparison of these tasks with standard cognitive tests and with a measure of metamemory. It was expected that the ecological measures would have a stronger association with metamemory than the standard tests. Subjects were 93 community-dwelling women, aged 75 and older. The ecological tasks correlated positively with the standard tests, but there were inconsistent relations of both standard and ecological measures with metamemory. The results partly support use of these measures for evaluating everyday functioning.

Activities of Daily Living↗
PubMed1995

Changes in functional competency in the oldest old. A longitudinal study.

Changes in everyday functioning and cognitive abilities are studied longitudinally in a representative sample of the oldest old. Respondents were selected by using census records from all people aged 84, 86, 88, and 90 years old living in an area of South Central Sweden, and then were assessed at 2-year intervals. The findings show high base rates for disabilities and high incidence of cognitive and functional deficits among survivors. Mortality is associated with higher rates of disability at the previous time of assessment. Because of this increased mortality rate among disabled individuals, prevalence does not rise as much as would be expected from the high incidence. Instead, new cases of disabled are partly replacing disabled individuals who died since the previous evaluation.

Activities of Daily Living↗
PubMed1995

Variability in daily events and mood of family caregivers to cognitively impaired elders.

This study explores the relationship of daily mood and daily events in a caregiving context. Family caregivers to demented elders (N = 43) kept fourteen-day diaries of: 1) caregiving activities, 2) disruptive patient behaviors, and 3) daily mood. Independent raters and cluster analysis support the hypothesis of three mood patterns. Differences among the three clusters in the relationship of mood and daily caregiving events were explored. The findings indicate that some caregivers are highly distressed by caregiving demands, some report moderate levels of distress, and others show no relationship between mood and daily events. The varied patterns support an individual differences approach to understanding caregiving and in the design of interventions.

Adaptation, Psychological↗
PubMed1993

Group homes for people with dementia: a Swedish example.

We describe the development and evaluation of group homes for dementia patients in Sweden. Group homes have been established on a social model of care to provide a better quality of life than in institutional settings, while making a small savings on cost. An enriched program of activities uses familiar, everyday household tasks, with staff trained to model appropriate behaviors. An evaluation of four homes indicated that residents could be well accommodated in the setting, even as their disabilities increased. Although there were some initial problems, staff satisfaction was high and turnover low.

Aged↗