Internet-Based Clinical Services: Virtual Support Groups for Family Caregivers

ABSTRACT

Objectives: An internet-based psychotherapeutic support group intervention for family caregivers of persons with neurodegenerative diseases was developed in a series of pilot studies and subsequently evaluated in a feasibility study with 34 participants. The aim was to duplicate online group interactions typical of face-to-face support groups. Methods: A user-friendly web site was developed according to usability criteria for older adult users. Unique features of the web site included video conferencing in two formats, one-on-one and a group format with up to 6 participants and a facilitator. Following ten professionally facilitated sessions, each group evolved into a web-based self-help support group facilitated online by a group member. Results: Qualitative analyses of early, middle and late group video conferencing sessions yielded themes congruent with face-to-face group process. Follow up interviews six months following the initiation of the online groups showed overall positive participant responses in each of the following areas: learning to use computers, negotiating the web site links, obtaining disease-specific information from the website, using technology to communicate, bonding with group members, providing mutual guidance and support, and benefiting in terms of coping with the stresses of caregiving.     

A Qualitative Study on Home Modification of Rural Caregivers for People with Dementia

Opinions about the responsibility for procuring sheltered housing in Norway have been studied among people 50 and older. Until recently, Norway offered standard public provision, where the state has been the central provider and organizer of care for the elderly. The results indicate great support for public responsibility for providing sheltered housing for the frail elderly, which is only marginally affected by background characteristics. However, older people's attitudes as to whether they would choose private housing provision are affected by income, age, and knowledge of the market, and many are uncertain. Women and low-income groups are overrepresented among those who are uncertain.     

Drawing Family Boundaries: Children's Perspectives on Family Relationships in Rural and Urban Ethiopia

This article explores how children conceptualise and practice family relationships in two social settings in Ethiopia. Based on ethnographic data, it discusses (i) how urban and rural children construct family; (ii) what family activities children do and which social positions they assume; and (iii) the convergence and divergence of meanings and practices of family relationships between urban and rural Ethiopia. The analysis demonstrates how ‘normative family’ and actual ‘family practices’ are shaped by socio‐cultural, material and spatial contexts. Insights drawn also reveal the complex ways in which access to material resources, geographical distance, rural‐urban locations and cultural traits such as patterns of marriage and child relocation practices shape family relationships.     

Mothers of Children With Physical Disabilities: Influence of Family Processes on Mothers' Depressive Symptomatology

This study examines how family processes, or specific behaviors and relationships within the family, influence the risk of depression in mothers of children with disabilities. Specifically, the collective influence of children's maladaptive behavior problems, father involvement, and coparental conflict on the risk of depression among 60 married mothers of children with physical disabilities is examined. Based on data from the National Survey of Families and Households, findings showed that these mothers perceived the child's behavioral problems as less influential when they were more satisfied with the father's parenting. Furthermore, coparental conflict appeared to mediate the influence of the child's behavior and her satisfaction with the father's involvement on the mother's risk of depression.     

The Impact of a Substance Abuse Disorder on the Well-Being of Family Caregivers of Adults With Mental Illness

ABSTRACT

The impact that substance use has on an individual with mental illness has been documented; however, little is known about the impact that this may have for a family caregiver. Data was collected in a cross sectional study using mailed questionnaires to a convenience sample of family members of persons with mental illness (n = 110). Hierarchical linear regression analysis was used to determine the impact of substance use status upon four measures of well-being within a stress-coping model. The variables within the model were able to account for a significant proportion of the variance in each of the measures: perceptions of burden, depression, anxiety and physical health status (R² = .419 to .202). However, substance use status was not a significant predictor in any of these equations. Symptomatology and a measure of specific social support were the most significant predictors of burden (β = .345, p < .001 and β = .330, p < .001). Perceptions of caregiver burden were found to be the most significant predictor in each of the other three analyses (β = .515, p < .000; β = .511, p < .000; β = ? .571, p < .000). Results of this study suggest that substance use may not be as important as the other predictors included in the model in determining the well-being of family caregivers.     

Family support in late life: A review of the literature on aging,disability, and family caregiving

ABSTRACT

For older adults and people with disabilities in the United States, family caregiving is an important part of remaining at home and in the community. As care recipients and caregivers age, family dynamics change, and the health, social, and financial impacts of this (largely unremunerated) work have implications for individuals, families, and social policy. In this review, the authors map the literature across multiple fields related to disability and aging to understand caregiving in late life, what it means to be an older caregiver and/or to care for older people. The authors summarize the findings of 97 articles to address the care, services, and supports family caregivers provide for older adults; negative and positive impacts for caregivers serving in this role; supports that family members use or need; and societal impact of family caregiving. Much of the literature describes the work family caregivers provide and negative impacts of caregiving. Less attention is devoted to caregiving benefits, supports used by family caregivers, and societal impacts. The authors conclude with an agenda for future research that attends to the need for research that includes: more diverse samples, new types of caregivers, longitudinal data, qualitative data and analysis, and comparative research.     

Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

Social Support and the Mental Health of Family Caregivers: Sons and Daughters Caring for Aging Parents in Japan

The prevalence of depressive symptoms among family caregivers has been documented as a serious social problem that could threaten the lives of the elderly and their family caregivers. Social support is considered to be a promising remedy for this problem, although a comprehensive examination of the availability and effectiveness of social support that includes both formal and informal support across multiple dimensions remains limited. In addition, little research has been conducted in Japan on gender differences in stress processes. This study tried to fill those gaps by analyzing recent survey data on sons and daughters who are caring for their elderly parents. The results indicate that sons and daughters have similar levels of formal and informal support for daily care and advice, while there are some gender differences in regard to the availability of other types of social support. It was also found that many types of informal support were significantly associated with a lower caregiver burden for daughters, although this was not necessarily the case for formal support. General instrumental support from formal sources was even associated with higher levels of distress. For sons acting as caregivers, daily caregiving support was the only formal support that was significantly associated with their lower level of distress. Issues of formal support are discussed, in order to reduce the psychological burdens borne by sons and daughters who care for their parents at home.     

Family and Friends as Respite Providers

Abstract

Consumer-directed service options in home- and community-based care are increasingly available to adults with chronic conditions and cognitive impairments and to their family caregivers. Few studies, however, examine the experience of family caregivers who, when given a choice of providers of respite assistance (i.e., relief from the stress of providing constant care), prefer to hire family or friends rather than service providers. This study describes the in-home respite experience of family caregivers served by California's Caregiver Resource Centers “direct-pay” program who hire family or friends (n = 39) or service providers (n = 77) to provide in-home respite assistance. Findings revealed similarities between the two groups with few exceptions: caregivers who hired family or friends reported poorer physical health, were slightly more satisfied with the respite assistance, and received more hours of respite at a lower unit cost. These findings lend support to consumer-directed respite service options where family caregivers are given flexible alternatives that may act to remove barriers to respite service availability and use.     

农村留守儿童家庭教育的现状、问题及对策

随着中国社会经济的飞速发展,城市里的农民工越来越多,留守儿童的数量也随之增加,由于留守儿童在家庭教育中存在一些问题,导致各类相关问题也日渐突出。文章阐述了农村留守儿童家庭教育的现状,分析了留守儿童家庭教育中存在的问题,提出了解决的对策。     

农村留守儿童的家庭教育

本文采用问卷调查与个案访谈相结合的方法,对鄂西北农村208名留守儿童的家庭教育状况进行了研究探讨。文章从当前家庭教育“喜”与“悲”二个方面对留守儿童的家庭教育状况进行了全面分析,并在此基础上提出了针对留守儿童家庭教育中存在问题的主要对策。     

Intergenerational Coresidence and Nearness in Korea and Japan: Unbalanced Aspects of Family Changes

Abstract  This study aims to explain similarity and difference in geographic proximity between elderly parents and their children in Korea and Japan. Using data sets from two nationally representative surveys conducted in Korea and Japan, this study examines the extent to which needs and kinship of elderly parents and regional constraints influence intergenerational coresidence and nearness.
Results highlight a complex feature of intergenerational relationship in Korea and Japan. Advanced economic and health conditions of Korean elderly parents increase the likelihood of living with children. For Japanese elderly parents, however, coresidence with children is significantly likely to occur in response to their disadvantaged economic status. These results suggest that the elderly Korean are more likely than the elderly Japanese to lack not only economic and health resources but also opportunities in obtaining family support in a time of need.
Characteristics of children, however, show a similar trend between the two societies. Both societies maintain a strong son preference for extended family living arrangement. Eldest children in both societies are more likely than their siblings to live with or near elderly parents. However, children of younger cohorts in both societies are significantly more likely than those of older cohorts to maintain a disperse geographic network indicating a significant change in family attitude among different cohorts.
Finally, this study finds a more disperse family network among rural elderly parents than urban elderly parents in both societies reflecting the fact that massive rural-to-urban migration of young population has contributed to geographic segregation of kinship in these societies.     

We’re Decent People: Constructing and Managing Family Identity in Rural Working‐Class Communities

Using grounded theory methodology, I establish family identity management as an important type of invisible work that connects women's household‐based domestic activities with community members’ perceptions and treatment of them and their family members. Detailed observations of household routines and family interactions, as well as in‐depth interviews with working‐class women living in two rural trailer park communities, provide insight into the meanings women assign to this labor, and their motivations for performing this work. I describe the strategies that women use to accomplish the work, examine how the work supports family life and child development, and explain how the residential environment influences the organization and accomplishment of this work.     

The Impact of Family Functioning on Caregiver Burden among Caregivers of Veterans with Congestive Heart Failure

A cross-sectional study of 76 family caregivers of older veterans with congestive heart failure utilized the McMaster model of family functioning to examine the impact of family functioning variables (problem solving, communication, roles, affective responsiveness, and affective involvement) on caregiver burden dimensions (relationship burden, objective burden, stress burden, and uplifts). Regression analyses indicated that the five dimensions of family functioning were significantly related (p < 0.01) to relationship burden (R ² = .27) and uplifts (R ² = .29). More specifically, increased relationship burden was associated with problems in family roles, and increased uplifts was related to higher levels of affective responsiveness.     

Factors Affecting Subjective Weil-Being for Rural Elderly Individuals

Abstract

A cross-sectional survey design was used to examine the relationships between spirituality, religiousness, social support, and the subjective well-being in a sample of 215 elderly individuals in the rural counties of West Virginia and North Carolina. The Brief Multidimensional Measures of Religiousness/Spirituality (BMMRS) was used to measure various domains of religiousness/spirituality, including daily spiritual experiences, values/beliefs, forgiveness, private religious practice, religious/spiritual coping, and religious support. Multivariate analyses found social support was positively related to life satisfaction and spirituality/religiousness was inversely related to depression. These findings provide health/mental health care providers and social workers with information that can increase their awareness of and sensitivity to services or programs that are congruent with religious/spiritual values and beliefs in order to enhance quality of life among rural elderly individuals.     

Family caregivers of the elderly: quality of life and coping in Estonia

The purpose of the study was to analyse the assessments of elderly people aged 65 and more about family caregiving as a factor influencing their quality of life and coping. The study is based on the project SUFACARE—‘Supporting family carers and care receivers in Estonia and in Finland’—in the framework of which the Institute of Social Work of Tallinn University carried out postal surveys in 2010. The Estonian survey was conducted in Tallinn and Lääne-Viru County. The total number of respondents was 581 (70% female and 30% male), of whom 98 (n=74 female and n=24 male) were family caregivers. Caregiving has not influenced the physical and mental health of caregivers, the reason being that many people who receive care are not of very ill health or suffer from dementia. People mostly take care of their spouses. Based on the Estonian Family Law Act (RT I 2009, 60, 395), adult descendants are required to provide maintenance if their relatives are not able to care for themselves. Caregivers whose health is below average consider caring to be physically demanding. We cannot speak of the social isolation of respondents who have care duties—they communicate actively and do not feel lonely. Women report caregiving to be physically strenuous more often than men. The mental health of male caregivers is better—fewer male respondents claimed to feel unhappy or depressed compared to female respondents.     

Family Support for the Elderly in Korea

Abstract

This article discusses major issues and concerns regarding family support for parents and elderly people in industrialized and urbanized Korea. It summarizes new trends in family support for elderly members, continuing influences of the traditional value of family support (filial piety), growing needs for public services for elderly people and their families, urgent calls for the state to assume greater responsibilities for providing social security and services for the elderly, needs for cross-cultural studies of family support, and certain cultural similarities and differences to be considered. The article concludes with some suggestions for future research.     

Training for Abusive Caregivers:

This article proposes a model for elder abuse intervention based on a recently implemented caregiver training program. Caregivers at-risk for abuse were offered traiing through mental health centers on biopsychocosil issues in aging, problem-solving, stress and anger management, and utilization of community resources. Participants were compared with similar caregivers on measures of psychosocial well-being to examine the efficacy of training. Participants experienced some reduction in symptoms of psychological distress and caregiving burden over time while symptoms worsened or remained unchanged for non-participants. Suggestions are made for utilizing this approach in cases of founded abuse.     

Issues of Elder Care and Elder Abuse in the Indian Context

Summary

With 7% of the population of India being elderly, two-thirds of whom live in villages and nearly a half of them in poor conditions, the care of the elderly is a difficult problem to be tackled. The dwindling of the joint family, the rise of dual-career families, a possible shift in filial piety values, the increasing life expectancy with greater chances of a prolonged old age characterized by poverty, degeneration, more empty-nest years, and dependency, have all added to the seriousness of the problem and made the elderly more susceptible than ever to abusive treatment. This paper examines these issues as well as the issue of elder abuse in light of available data and suggests some strategies to meet the problem. Also discussed are the problems, stresses, and strains of caregivers of the elderly. A greater role is envisaged for Non-Governmental Organizations (NGOs) than the state in the care of the elderly, particularly in providing support services to family caregivers.