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PubMed1996

Cognitively impaired spouses as primary caregivers for demented elderly people.

OBJECTIVE: To describe problems of dementia patients whose spousal caregivers are also cognitively impaired. DESIGN: Retrospective chart review. SETTING: The geriatric assessment clinic at University of California, San Diego, which is one center for the California State sponsored Alzheimer's Disease Diagnosis and Treatment Center Program. PATIENTS: During the period from January 1992 through May 1994, 65 patients completed the assessment and met the entry criteria of being demented and having a spousal caregiver. Twelve of the spouses scored six or more error points on the Katzman Short Orientation-Memory-Concentration Test. MEASUREMENTS: Patient data included age, living situation, other caregivers, use of formal and informal support systems, profiles of medical, cognitive, and functional ability, caregivers interactions, and recommendations from the evaluation. MAIN RESULTS: Dementia patients with cognitively impaired spouses utilized fewer community resources (P = .021) and experienced difficulty with medication compliance (P = .041) more often than those with cognitively normal spousal caregivers. CONCLUSIONS: Older caregivers of patients suffering from dementia should be screened for cognitive problems.

Aged↗
PubMed1986

Antinuclear antibodies in the relatives and spouses of patients with systemic sclerosis.

The families of 65 patients with systemic sclerosis were examined clinically and serum samples from each subject were tested for antinuclear antibodies (ANA) by immunofluorescence on HEp2 cells and for precipitating antibodies to soluble cellular antigens including Scl-70. Of 217 blood relatives, 58 (27%) had ANA (42 speckled, 13 nucleolar, one centromere, two homogeneous); 22 (10%) had precipitins, one anti-Scl-70, one anti-PM-Scl, one anti-nRNP, two anti-Ro(SSA), the remainder unidentified). Family members tended to share ANA patterns. Of 38 spouses, nine (24%) had ANA (all speckled) and two showed unidentified precipitins. This compares with an incidence of ANA and precipitins in a control population of 8% and 1% respectively. Antibodies were more common in female than male relatives (particularly in mothers and sisters of probands). Twenty one of the 58 family members with ANA had clinical features of connective tissue disease; the remainder were asymptomatic. The presence of genetic factors influencing autoimmunity is suggested by the incidence of autoantibodies in first degree relatives. Similar observations in spouses, however, indicate that environmental factors may also have a role in these immune abnormalities.

Antibodies, Antinuclear↗
PubMed1995

Helicobacter pylori reinfection with identical organisms: transmission by the patients' spouses.

Reinfection with Helicobacter pylori after eradication is responsible for the recurrence of duodenal ulcer disease. The mode of transmission has not yet been established. In this study, 18 patients with chronic duodenal ulcers in whom H pylori had been eradicated with amoxicillin and metronidazole were entered into a prospective follow up study. Control endoscopies were performed 4, 8, 14, 27, and 43 months after starting treatment and the results of direct tests were compared with the kinetics of H pylori specific IgG titres. After eradication there was a noticeable and consistent fall in anti-H pylori IgG, while reinfections were characterised by a significant increase in specific titres. Reinfection was detected in two patients after 14 and 43 months, respectively. The H pylori strains responsible for these reinfections, the corresponding pretreatment isolates, and the strains isolated from the spouses of these patients were examined by polymerase chain reaction based DNA fingerprinting. Analysis showed that reinfection had been caused by the same H pylori strain and identified the spouses of these patients as carriers of the identical strain. Considering the genomic diversity and the interpatient heterogeneity of H pylori these results suggest a person to person transmission of H pylori reinfection. By the end of the observation period reflux oesophagitis had developed in 10 of the 16 patients who had not been reinfected. This surprising finding may be explained by the changed eating habits of patients after healing of duodenal ulcer disease.

Adult↗
PubMed1979

Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part I. Views of surviving spouse on effects of the service on the patient.

The surviving spouses of 34 patients who died of cancer at St Christopher's Hospice have been interviewed about 13 months after the patient's death. The information given is compared with that obtained from 34 spouses of patients dying from cancer in other hospitals and matched with the St Christopher's group. Patients at St Christopher's were less often thought to have suffered severe pain and other distress than at other hospitals, but pain relief was not bought at the cost of drug-induced confusion and patients at St Christopher's remained more mobile than at other hospitals. Hospice patients were more aware of chapel services and prayers than at other hospitals. None was said to have been upset by these and 66% were glad of them. Despite the frequency of deaths in the Hospice, patients at St Christopher's were no more likely to be thought to have been 'upset' by such events than patients elsewhere or to have found their interactions with other patients anything but helpful.

Attitude to Death↗
PubMed2005

Spouses' quality of life 1 year after stroke: prediction at the start of clinical rehabilitation.

BACKGROUND AND PURPOSE: The purpose of this prospective study was to identify early predictors of spouses' quality of life at 1 year after stroke. METHODS: At the start of clinical rehabilitation patient and caregiver characteristics, psychological factors, harmony in the relationship and social support were assessed. One year after stroke, caregiver burden (Caregiver Strain Index), life satisfaction (Life Satisfaction Checklist) and depressive symptoms (Goldberg Depression Scale) were assessed in 187 participants. Multiple regression analyses were performed. RESULTS: About 80% of the spouses reported low quality of life on one or more of the measures; 52% reported depressive symptoms, 54% significant strain and only 50% was satisfied with life as a whole. The regression analysis identified 'passive coping strategy of the caregiver' as the most important predictor. ADL dependency was the only baseline patient characteristic significantly related to burden and life satisfaction, but explained just 0-4% of the variance. CONCLUSIONS: A large proportion of caregivers perceive impaired quality of life 1 year after stroke. Caregivers at risk should be identified at the start of rehabilitation by means of coping measurement instruments or selected anamneses on coping.

Aged↗
PubMedDate not supplied

Causal attribution by patients, their spouses and the physicians in relation to patient outcome after a first myocardial infarction: subjective and objective outcome.

Ninety-eight men <60 years of age with a first myocardial infarction (MI), their spouses and treating physicians were interviewed at the patients' hospitalization. The aim was to determine the three groups' perception of the causes of the patients' MI, and the importance of those for patient outcome 6 months after the MI. Patients and spouses agreed in general and attributed the MI to similar causes, while the patients and physicians had a lower level of agreement. The patients tended towards the more 'social' and 'psychological' items, while the physicians relied on medical information. The causal attributions of each of the groups were more important than background variables when subjective and objective outcome measures were estimated.

Adaptation, Psychological↗
PubMed1984

Teaching brief psychotherapy for spouses of cancer patients: us of a codable supervision format.

While there has been increasing recognition of the psychosocial needs of cancer patients, the plight of the patient's spouse has been less well addressed. As part of an ongoing study in this area, we have developed a counseling manual which defines the parameters of a therapy intervention for cancer patients' spouses with problematic adjustment. In order to monitor the consistency of the therapy, we have also developed a codable supervision rating sheet, which is the topic of this report. All therapist communications are rated on a three-dimensional format which specifies general content area, level of intervention, and the presence of a focus specific to the therapy. This codable rating sheet is used in a group supervision process. It provides an innovative method to teach and supervise therapy, helps delineate specific elements of therapy judged to be important, and also has implications for psychotherapy research which extend beyond this specific project.

Adaptation, Psychological↗
PubMed1990

The effects of help patterns on the mental health of spouse caregivers.

Investigated were the patterns of task assistance and social support received by 315 people who were the primary caregivers to spouses suffering from Alzheimer's Disease. Despite the fact that spouse caregivers themselves are old and frail, they continue to provide the bulk of care required by their impaired partner. When help is forthcoming from any source, it is minimal. Contrary to the hypothesis that back-up sources of support or confidants should buffer the primary caregiver from negative mental health effects, there was no relationship between existence of either task support or social support and mental health.

Aged↗
PubMed2002

Active consideration: conceptualizing patient-provided support for spouse caregivers in the context of prostate cancer.

In this study, the authors examine the under-investigated topic of patient-provided support for spouse caregivers. Thirty-four men with prostate cancer and their female partners were interviewed separately three times: before the man's radical prostatectomy, 8 to 10 weeks postsurgery, and 1 year postsurgery. The core category of active consideration encompassed 4 dimensions: easing spousal burden, keeping us up, maintaining connection, and considering spouse. Patient-provided support entails two overlapping tasks: minimizing the practical and emotional impact of the illness and tending to the caregiver's social-emotional needs. A theory expounding on the double bind of being both a patient and an agent in light of masculine socialization practices is articulated and brought to bear on the phenomenon of patient-provided support.

Adaptation, Psychological↗
PubMed1979

The mortality of male old-age pensioners following spouse's death.

The effect of the death of the spouse on mortality of retired men was investigated. The material comprised 939 married men retired on old age pension, 174 of whom had lost their spouse after retirement. During the first six months following the wife's death, more than the expected number died, though no increase in mortality could be shown over a longer term. Circulatory diseases and tumours were over-represented as causes of death among those who died within six months of the wife's death. Loss of an important object relationship may lead to sudden cardiac death, or the development of a disease may be accelerated.

Aged↗
PubMed2000

Factors associated with strain in co-resident spouses of patients following stroke.

OBJECTIVE: To identify the factors associated with carer strain following stroke. DESIGN: Co-resident spouses of stroke patients were sent questionnaire measures of their perceptions of strain, stress, mood, handicap, adjustment, social support, life satisfaction and personality, and patient's mood and independence in activities of daily living. SETTING: Stroke spouses were identified from the stroke register at City Hospital, Nottingham. RESULTS: In a sample of 222 carers, 37% had significant strain. Strain was highly correlated with negative affectivity on the Positive and Negative Affectivity Scale, carer mood on the General Health Questionnaire-12 (GHQ-12) and carer's perceptions of patient's independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL). Logistic regression analysis of 96 of these carers supported the correlations and showed three factors, carer GHQ-12, patient EADL and negative affectivity, were independently associated with carer strain. CONCLUSION: The relationship between these factors and strain needs to be tested prospectively. Early identification of carers who may be at risk of strain later on will enable services to be targeted at prevention rather than cure.

Adult↗
PubMed1984

The spouse as co-therapist in the treatment of agoraphobia.

Involving the spouse as a co-therapist made no significant difference to the outcome of treatment in a controlled study of 19 married patients suffering from agoraphobia who were engaged in short-term home-based behavioural treatment. Improvement continued to 6-month follow-up. The marriages of those with some marital difficulties at the start tended to improve, whether or not the spouse was involved. Poor initial marital adjustment was not related to the degree of improvement in agoraphobic symptoms.

Adult↗
PubMed1987

Caring and its burdens. A study of the spouses of depressed patients.

Spouses of 24 patients suffering from persistent depression were interviewed to find out how they were affected by the patient's illness. These effects were marked, although mainly endured without complaint, and included restrictions in social and leisure activities, a fall in family income, and a considerable strain on marital relationships. Some of the behaviour shown by patients was hard to bear, and 'negative' symptoms such as misery, withdrawal, and worrying commonly caused problems. Few relatives, however, know how to deal with difficult behaviour. Despite this, the majority remained committed to staying with the patient. Spouses had a variety of complaints about the way they were handled by hospital staff, particularly about being deprived of information and advice. These results have considerable implications for the way in which relatives should be dealt with as part of the overall management of persistent depression.

Adaptation, Psychological↗
PubMed1996

The subjective experiences of spouse caregivers of persons with brain injuries: a qualitative analysis.

The subjective experiences of spouse caregivers were qualitatively examined in essays provided spontaneously by 27 spouses of persons with brain injuries These essay data appear to reflect issues most salient to caregivers and ideas that were not adequately tapped by the traditional empirical study of caregiver burden during which these data were provided Some themes present in the data provide support for findings of previous burden research, whereas others represent new areas for further investigation Of particular interest, there emerged among the themes a multifaceted picture of subjective burden highlighting the complexity of this phenomenon.

Journal Article↗
PubMed1994

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part VI. Family history assessment: a multicenter study of first-degree relatives of Alzheimer's disease probands and nondemented spouse controls.

Although familial factors in Alzheimer's disease (AD) are well established, uniform family-history assessment in genetic and epidemiologic studies of AD is needed to reconcile the divergent estimates of the cumulative risk of this illness among relatives of AD probands. To answer the need, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) has developed a standardized Family History Assessment of AD to identify the presence of AD, Parkinson's disease (PD), and Down's syndrome (DS) in family members. This paper describes the use of this new assessment instrument in 118 patients with AD (estimated mean age at onset [+/- SD] = 64.5 +/- 7.7 years) and their nondemented spouses who were enrolled in 11 different CERAD sites in the U.S. The first-degree relatives of the probands with AD had a significantly greater cumulative risk (p < 0.005) of AD or primary progressive dementia (24.8%) than did the relatives of spouse controls (15.2%). Furthermore, the cumulative risk for this disorder among female relatives of probands was significantly greater than that among male relatives. There were no differences between the families of probands and controls for the numbers of affected first-degree relatives with PD or DS. This is the first reported multicenter family-history study of AD, and it supports earlier reports of familial factors in AD and indicates a higher risk to female relatives of AD probands. The CERAD Family History Assessment instrument may be useful for further multicenter and epidemiologic studies designed to delineate familial factors associated with AD.

Age of Onset↗
PubMed1986

Modification of verbal behavior of the mentally impaired elderly by their spouses.

Speaking disorders frequently result in serious consequences for mentally impaired elderly people. Two examples are presented illustrating the modification of both excess and deficit rates of talking via differential reinforcement procedures. Two men exhibiting verbal disorders severe enough to impair social interactions and lead to possible nursing home placement were treated by teaching their spouses to reinforce positive and ignore undesired verbal responses. Problem behaviors were reduced sufficiently to permit continued home care, and alternative positive behaviors were increased. These findings suggest that verbal behavior of the mentally impaired elderly can be affected by applying systematic consequences and can be modified by relatively simple procedures. These procedures provide an alternative to the negative effects of labels associated with either aversive or deficient verbal behaviors, promote more positive activities, and enable continued residence at home. Further, this research provides support for the generality of the utility of training spouses to serve as behavior therapists for the impaired elderly.

Aged↗