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PubMed1989

The impact of religious orientation in conjugal bereavement among older adults.

Despite the importance of religious faith to many older adults and the predictability of spousal death as an extremely distressful life experience, only a few studies have seriously focused on the relationship between religious commitment and adaptation to widowhood. The present study addressed this issue by surveying 159 elderly widowed involved in southern Californian support groups. Grief, depression, and intrinsic-extrinsic religiousness were assessed and then analyzed via hierarchical multiple regression procedures. Higher extrinsicness was found with higher levels of distress across sex, suggesting that an extrinsic orientation may set the stage for a poorer adjustment. Widowers tending to be more indiscriminately proreligious also showed higher distress levels. Greater distress was associated with poorer health after spousal death for widows and before spousal death for widowers.

Aged↗
PubMed2003

Can burdened caregivers be effective facilitators of elder care-recipient health care?

BACKGROUND: Caregiving by informal family caregivers of dependent older people in the community may be affected by burden and by the personal and social resources available to the caregiver. Given the increase in the dependent older population, study of factors affecting informal caregiving is necessary. AIMS: To examine caregiver resources, burden and competence as predictors of health-care facilitation on behalf of older patients. DESIGN: Cross-sectional data were collected by an interview schedule from 240 randomly sampled spousal and filial caregivers in Jerusalem. Study variables included caregiver background variables, general self-concept and feelings of caregiver competence, informal and formal social support, burden and levels of health-care facilitation. Path analysis was performed to clarify the direct and indirect predictors of health-care facilitation. RESULTS: Caregiver facilitation of health-care was positively related both to the presence of personal and social resources and to burden levels. The results suggest that quality caregiving can coexist with burden, provided that ample caregiver resources are present. The most important resources were caregiver sense of competence and support from the professional health-care provider. DISCUSSION: Caregiving burden is not readily reducible, given the chronic nature of older people's health problems. However, caregiver resources can be bolstered, particularly by health professionals. Nurses, who are orientated to holistic family centred care, are especially well-suited for this important intervention.

Aged↗
PubMed2003

Family involvement following institutionalization: modeling nursing home visits over time.

Gerontological research has emphasized family members' continued involvement in the lives of loved ones following institutionalization. However, many of these studies are cross-sectional in design and do not ascertain how family members' visits change over time. The present study utilized a growth curve analysis to examine preplacement and postplacement predictors of nursing home visits over a two-year period among a sample of 65 caregivers of dementia patients. Intraindividual patterns of change suggested considerable heterogeneity in family visits. Several variables were also significantly predictive (p < .05) of change in nursing home visits. Spousal caregivers were more likely to report increased visits. Care recipients with greater cognitive impairment following institutionalization experienced increased visits. Caregivers who perceived respect and support from their social network following institutionalization also reported increased visits over the two-year study period. Caregivers who engaged in socially restorative activities after institutionalization reported decreases in visits. The findings provide a more refined understanding of the long-term involvement process following institutionalization.

Aged↗
PubMed1998

Supporting carers: is practice still sexist?

Informal carers are central to the community care policies which have emerged during the last two decades. However, research has suggested that caring is a gendered activity, disproportionately expected of women with consequent disadvantage in terms of physical and mental health and material well-being. Moreover, evidence has been presented that, in the past, women carers were less likely to be offered the support of public services than their male counterparts. A research project designed to test whether this pattern still applied in service provision to male and female spousal carers was carried out in an assessment and care management team working with older people. The results suggested that differences in professional responses to female and male carers still persist and that some workers may be unaware of the gap between their intentions and their actions in assessing and planning services. This evidence implies the need for further attention to be paid to these issues in training care managers and the importance of monitoring the outcomes of assessment along gender lines.

Journal Article↗
PubMed1990

Homeless and housed families in Los Angeles: a study comparing demographic, economic, and family function characteristics.

We studied 196 homeless and 194 housed poor families in Los Angeles, California to gain an understanding of events that precipitate family homelessness. Both homeless and housed poor mothers averaged 29 years old and were accompanied by two or three children. Three-fourths of both the homeless and housed families had income below the poverty level, and both groups expended almost two-thirds of their income on housing. Mothers in homeless families more commonly reported spousal abuse (35 vs 16 percent), child abuse (28 vs 10 percent), drug use (43 vs. 30 percent), or mental health problems (14 vs 6 percent) and weaker support networks. Homeless mothers more commonly came from homes where their parents abused drugs or alcohol (49 vs 34 percent) or more commonly lived outside the home or in foster care (35 vs 25 percent). Homelessness was reported as due primarily to economic pressures of housing costs, but personal and family problems frequently played a contributing role, especially for single parent families. Burdens of increasing housing costs and family dysfunction among housed poor families place many at risk for homelessness.

Adult↗
PubMed2004

Psychological, neuroendocrine and immune measures in non spousal carers of disabled elderly in Italy.

OBJECTIVES: The purpose of this study was to determine whether psychological well being as well as metabolic, neuroendocrine and immune functions were different in non spousal primary caregivers of disabled elderly than in controls. SETTING AND DESIGN: We randomly recruited 38 primary family carers of over 65 year old recipients of health home care services and 37 controls stratified according to sex and age. METHOD: Data were collected on psychological wellbeing (including anxiety, depression and self-perceived quality of life), on neuroendocrine and immune conditions (haemanalysis and metabolic signs, plasma ACTH, cortisol, prolactin, intra-lymphocyte content of beta-endorphins, NK cell activity and number), as well as on the incidence and severity of influenza disease during previous winter. RESULTS: Caregivers showed greater anxiety, although mean scores did not reach pathological levels. Neither depression nor satisfaction on quality of life did differ significantly, nor differences in haemanalisis and metabolic signs were found, apart from leukocyte and lymphocyte number, which was significantly lower in carers. Plasma levels of ACTH, cortisol and prolactin, the intra-lymphocyte content of beta-endorphins as well as the NK cell number and cytotoxicity did not show significant differences. Incidence and severity of influenza episodes was also similar, whereas the duration of influenza disease showed to be significantly longer. CONCLUSIONS: Non spousal caregivers of disabled elderly suffer from only slight alterations of psychological, endocrine and immune parameters, and do not respond very differently to influenza disease. This does not support therefore any generic privilege for them in the allocation of public support or respite services.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Impact of a psychoeducational intervention on caregiver response to behavioral problems.

BACKGROUND: Eighty percent of persons with Alzheimer's disease and related disorders are cared for by family members who often lack adequate support and training for this all-consuming job. OBJECTIVE: To evaluate the efficacy of a longitudinal, multisite, community-based intervention designed to teach home caregivers to manage behavioral problems in persons with Alzheimer's disease. METHODS: Usable data were analyzed from 237 caregiver/care recipient dyads (n = 132 Experimental; n = 105 Comparison). The experimental group received a psychoeducational nursing intervention that was conceptually grounded in the Progressively Lowered Stress Threshold model (Hall & Buckwalter, 1987). The comparison group received routine information and referrals for case management, community-based services, and support groups. Although a variety of psychosocial outcomes were compared between caregivers in the two groups, this article focuses on frequency and response to behavioral problems and functional decline. RESULTS: The Progressively Lowered Stress Threshold intervention had a statistically significant effect on spousal response to memory/behavioral problems (p <.01) for all caregivers and on response to activities of daily living problems (p <.01) for spousal caregivers. In addition, nonspouses in the experimental group reported a reduction in the frequency of memory/behavioral problems (p <.01). No intervention effect on reports of activities of daily living frequencies was found for either spouses or nonspouses. CONCLUSIONS: This Progressively Lowered Stress Threshold-based intervention had a positive impact on both the frequency of and response to problem behaviors among spousal caregivers.

Activities of Daily Living↗
PubMed2002

Predictors of burden for caregivers of patients with Parkinson's disease.

Parkinson's disease (PD) is a chronic, progressive neurological disease that affects an estimated 1 million Americans each year. Its progressive nature leads to increased burden for the caregiver. This study explored factors that contribute to the perception of burden in caregivers of individuals with PD using a cross-sectional design. The sample consisted of 41 caregivers who were married to or cohabitating with individuals with PD. Questionnaires were mailed to spousal caregivers and returned via mail. Burden was determined by utilizing the Zarit Burden Inventory. The independent variables that were measured were activities of daily living (ADLs), perceived social support, psychological well-being, and marital satisfaction. All four factors were found to significantly predict perceived burden. Multiple regression analysis showed that ADLs and perceived social support were significant predictors of caregiver burden, accounting for 44.3% of the variance. The implication for healthcare professionals is that they should provide information on PD symptom management, thus promoting independence in performing ADLs, identifying appropriate resources to reduce caregiver burden, and using support groups.

Activities of Daily Living↗
PubMed2001

Social impact of atopic dermatitis.

AD most often arises in infants and children and can persist into adulthood. It is a common and important condition that can have a negative impact on quality of life by affecting psychosocial adjustment in children, creating embarrassment, disrupting sporting activities in older children, and by interfering with employment opportunities in adults. Substantial impact on family function can result from having a child with AD. Parents describe feelings of guilt, exhaustion, frustration and helplessness. AD disrupts sleep not only in patients but also in parents and family members. Parents can miss work or avoid outside work altogether due to a child with AD, and the caregiver's social functioning can be damaged. Spousal and other familial relationships can be affected along with parenting behavior. All of these challenges become even greater with low-income families, who often have minimal social support mechanisms. There is a profound need for enhanced and expanded efficacy and cost research regarding the treatment and control of AD. Informed and thoughtful changes of public policy could minimize its future socioeconomic toll on patients and their families.

Adaptation, Psychological↗
PubMed2006

Differential attrition in a caregiver skill training trial.

Participant attrition in randomized trials can reduce statistical power and bias outcomes. However, elective withdrawals are seldom discussed in trial reports. We examined factors associated with elective withdrawals for the first 131 Alzheimer's disease (AD) and Parkinson's disease (PD) caregiver participants that entered Project ASSIST (Assistance, Support and Self-health Initiated through Skill Training), an on-going trial of caregiver skill training interventions. After 20 months of recruitment, 14 (11%) of the 131 ASSIST participants had electively withdrawn before completing the final assessment. Survival analysis demonstrated AD caregivers and non-spousal caregivers dropped out earlier than PD and spousal caregivers, even after controlling for selected baseline covariates. Findings suggest caregiver trial contact strategies may need to be tailored to retain different caregiver groups.

Adaptation, Psychological↗
PubMed1984

The structure and function of social support networks in families with handicapped children.

Three structural characteristics of social support networks (size, density, and boundary density) and two relationship characteristics (reciprocity and dimensionality) were assessed in a sample of 56 families with a child with spina bifida and 53 matched comparison families. The results indicate that social networks of families with handicapped children tended to be smaller than the networks of comparison families, particularly with regard to mothers' total and friendship networks. The networks of families with handicapped children were more dense as well. As predicted, there was greater boundary density in spousal networks in families with handicapped children. Differences in network reciprocity were inconclusive while the results indicate that families with handicapped children tended to rely more heavily upon multidimensional network contacts than did comparison families. The results are discussed in light of our understanding of stress, social support, and the social ecological context of families.

Adolescent↗
PubMedDate not supplied

Perceived experience of caring for a wife with stroke.

This article presents a 55-year-old husband's perceived experience of caring for his wife with stroke, as learned from his 1 year of participation in a Web-based support intervention study. In a secondary analysis of data, his narrative entries (n = 213) were coded and drawn to Friedemann's framework of systemic organization. The themes that emerged from these data were that of the caregiver providing support, offering solutions, and taking control. Friedemann's system maintenance process dimension was the area that captured most of his experience, which indicated that this caregiver spent a significant amount of his energy in creating control and stability within his environment to maintain congruence or balance in his life. These findings can be used to identify and design interventions, which for male spousal caregivers, affect the quality of their lives.

Adaptation, Psychological↗
PubMed2001

Predictors of health-related quality of life perspectives, self-esteem, and life satisfactions of older adults following spousal loss: an 18-month follow-up study of widows and widowers.

PURPOSE OF THE STUDY: The overall purpose of the study was to examine the relationship between widowed persons' baseline assessments of self-efficacy beliefs and their ratings of perceived health-related quality of life, life satisfactions, and self-esteem obtained in an 18-month follow-up. DESIGN AND METHOD: At Time 1, a survey of sociodemographics, a multidimensional measure of global self-efficacy, and a domain-specific measure of self-efficacy, having eight subscales of self-efficacy (interpersonal, instrumental, emotional, social support, nutritional, physical, financial, and spiritual) were administered to a group of 231 widows and widowers to obtain baseline assessments of their self-efficacy beliefs. At Time 2, a follow-up of 211 widows and widowers was conducted to obtain their perceptions of health-related quality of life, life satisfactions, and levels of self-esteem 24 months following spousal loss and to assess whether self-efficacy beliefs play a predictive role in widowed individuals' perceptions of their health-related quality of life, life satisfactions, and self-esteem. RESULTS: A series of gender-specific multiple regression analyses models revealed that widows and widowers differ significantly with respect to the relationship between specific domains of self-efficacy and their perceived quality of life in the longer term following spousal loss. IMPLICATIONS: Implications of the findings are discussed for clinicians and health professionals working with bereaved spouses in terms of intervention programs for retraining of self-efficacy.

Aged↗
PubMed2006

Depression and mental health among older Mexican American spouses.

Although the association between marriage and well-being is well established, few studies have focused on learning more about the context of marriage and mental health. Recent research studying the mechanisms of marriage and health has focused on contagion of well-being among spouses. This study examined the association of depression with self-esteem, social support, life satisfaction, concern for independence, and cognitive function using baseline data for 553 older, Mexican American couples. Overall, we found evidence to suggest an interdependent relationship between husbands' and wives' emotional states, but the association was not equal for couples. Husbands' depression was significantly associated with the well-being of their wife, but the wife's depression was rarely associated with the husband's well-being. The findings from this study add to the increasing literature on spousal contagion by focusing on an under studied minority group, examining how depression affects well-being, and highlighting unequal effects of marriage on spousal well-being.

Aged↗
PubMed2006

Evidence on spouse responses to illness as a guide to understanding and studying spouse responses to living organ donation.

Although living kidney donors receive praise from friends and coworkers for their selflessness, recent studies report that members of the immediate family may not be as supportive. Reports of conflict surrounding living organ donation include divorce between the donor and the donor's spouse. The purpose of this review of the literature is to (1) discuss the spousal role when confronted with a partner's illness, (2) explore the current research describing the spouses of patients with heart disease and cancer, various transplant recipients, and living organ donors, and (3) identify the need for future research to explore the experiences and needs of the spouses of living kidney donors. Because the attitudes of donor family members, especially spouses, may affect the decision to donate and the satisfaction with recovery from donation surgery, it is critical to know how the spouses of living kidney donors view kidney donation. This knowledge may be instrumental in promoting family harmony and donor recovery and wellness.

Adaptation, Psychological↗
PubMed2001

Location of family medicine graduates' practices. What factors influence Albertans' choices?

OBJECTIVE: To examine factors that influence family medicine graduates' choice of practice location. DESIGN: Cross-sectional, retrospective survey employing a self-administered, mailed questionnaire. SETTING: Family medicine residency programs at the University of Alberta (U of A) and the University of Calgary (U of C) in Alberta. PARTICIPANTS: Graduates (n = 702) who completed the family medicine residency program at U of A or U of C between 1985 and 1995. MAIN OUTCOME MEASURES: Current practice location; 23 factors influencing current practice location; physicians' sex; community lived in until 18 years of age. RESULTS: Response rate was 63% (442 graduates completed the questionnaire). Overall, the most influential factors in attracting graduates to their current practice locations were spousal influence, type of practice, and proximity to extended family. Type of practice, income, community effort to recruit, medical need in the area, and loan repayments had a substantial influence on family physicians' decisions to practise in rural areas. Male physicians ranked type of practice, whereas female physicians ranked spousal influence, as having the most influence on choice of practice location. Significantly more female than male physicians identified working hours, familiarity with the medical community or resources, and availability of support facilities and personnel as having a moderate or major influence on their decisions. CONCLUSION: Differences between rural and metropolitan residents and between sexes affect family medicine graduates' choices of practice location. These differences should be taken into account in recruitment strategies.

Adult↗
PubMed1990

Effects of alcohol, gender, and role of spouses on attributions and evaluations of marital violence scenarios.

The effects of spouses' alcohol consumption, gender, and role in a marital dispute on observers' attributions of responsibility and evaluations of the spouses were examined. A major goal of the investigation was to determine whether the effects of alcohol on attributions and evaluations are gender related or role related. Based on the participation of 115 male and 181 female undergraduate students, the results partly supported the role-related effects of alcohol consumption. Respondents rated both husband and wife more negatively when they were depicted as the perpetrators than as victims. Alcohol consumption did not affect evaluations of the spouses as perpetrators. However, drinking by the husband and wife before their victimization was associated with more negative evaluations than when their victimization was not preceded by drinking. It is argued that alcohol consumption of the victim and not the perpetrator may play a more significant legitimizing role for spousal violence.

Adult↗
PubMed1995

Is sporadic MS caused by an infection of adolescence and early adulthood? A case-control study of birth order position.

Birth order position was examined in 164 cases with sporadic multiple sclerosis (MS), i.e. no other family members with MS, and spousal controls, matched for sibship size, socioeconomic status and opposite sex. The results did not find an association between birth order position and the subsequent development of MS and thus do not support the concept of an infectious cause for MS where "early exposure" is protective and exposure to the infection is a single event of short duration.

Adolescent↗