Decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia

Purpose: To describe factors influencing decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia. Design and Methods: Individual interviews were used to collect data with 30 Chinese family caregivers of older adults with dementia in Taiwan. Data were analyzed using thematic analysis. Results: Factors influencing caregivers' decisional conflict included the Chinese value of filial piety, limited financial resources and information, placement willingness of the older adult, family disagreement, distrust of nursing home care quality, and limited nursing home availability. Factors influencing caregivers' decisional conflict post placement included disappointment with nursing home care quality and self-blame for the placement decision. Implications: Findings resulting from this study indicate that Chinese family caregivers experience decisional conflict during the nursing home decision making process as well as after the placement decision. It is important to provide appropriate decision support beginning before admission and across the trajectory of the older person's nursing home stay in order to decrease decisional conflict and facilitate a more positive decision making process for caregivers, family members, and older adults with dementia.     

Factors Associated With Caregivers’ Use of Support Services and Caregivers’ Nonuse of Services Sought

Informal caregivers may face barriers accessing services like respite care, training, and support groups. Using multinomial logistic regression, I modeled caregivers’ probability of using all services sought (“all services used”) and nonuse of any services sought (“any unused services”) as a function of caregiver and care-recipient characteristics. Care-recipient health and function, especially dementia and need for medical task assistance, were associated with all services used and any unused services, and any unused services were more likely among adult children caring for their parents, caregivers of Black and Hispanic older adults, caregivers providing intensive care, caregivers living in metropolitan areas, and residents of states that spend more on increasing access to caregiver services under the National Family Caregiver Support Program. Regularly scheduled caregiving was associated with higher likelihood of all services used, but not with any unused services. Steps should be taken to increase access for caregivers who provide intensive care, care to dementia patients, or assistance with medical tasks and for Hispanic families.     

Cognitions and Distress in Caregivers after Their Child's Sexual Abuse Disclosure

The impact of child sexual abuse on children is well documented, but few studies have examined the impact of a child's sexual abuse disclosure on maternal caregivers. The studies that have been conducted suggest that parental response postdisclosure is variable. The present study examined the association between maternal attributions and abuse-specific cognitions with depression and trauma symptoms postdisclosure. Participants included 68 nonoffending maternal caregivers of children between the ages of 3 and 17 years who experienced child sexual abuse. Findings indicated that caregivers' abuse-specific cognitions were the best predictor of self-reported symptoms of depression after controlling for general negative attributions. These findings suggest that in order to reduce caregivers' distress and to enhance their support of their children, it is important to assess and treat caregivers' abuse-specific cognitions.

     

Use of the Internet by Informal Caregivers Assisting People with Multiple Sclerosis

The Internet is used to help informal caregivers provide assistance to people with chronic illness and disability. We identified factors associated with Internet use by informal caregivers assisting people with multiple sclerosis (MS) using a logistic regression model. Duration of MS in the person receiving care and caregiver age predicted lower Internet use. More hours per week providing care and higher caregiver educational level increased odds of Internet use. The Internet can be a low-cost service delivery option to provide education and support to caregivers assisting people with MS.     

An Exploration of Adjustment Needs and Efforts of Persons with Dementia After Relocation to a Residential Care Facility

This study examined the adjustment needs and efforts of individuals with dementia after relocation to a residential care facility. This was a qualitative prospective study that involved in-depth face-to-face interviews with 16 individuals with dementia and their family caregivers at 2 and 6 months post-relocation. In their efforts to recreate a sense of home, individuals with dementia had to meet three major highly interrelated and overlapping categories of needs to settle in, fit in, and find meaning in this transition. The satisfactory fulfillment of these adjustment needs resulted in a sense of comfort, connection, and continuity associated with feeling at home. Participants’ efforts to place themselves in their new living environments created a simultaneous need to integrate relocation into their overall sense of self. The results support earlier research indicating that place making is a critical process in the overall psychosocial adjustment to old age. The findings inform supportive interventions to assist individuals with dementia to reconstruct home in a residential care environment.     

Identity cues and dementia in nursing home intervention

This study examines the identity cues that family caregivers and healthcare personnel use with seniors living with dementia and living in nursing homes. The identity cues represent biographical knowledge used to stimulate the dementia sufferer, trigger signals and incite interaction. Our grounded approach hinges on three objectives: to identify and categorize identity cues; to document their uses; and to gain a better understanding of their effectiveness. We interviewed nine family caregivers and 12 healthcare workers. Qualitative data indicates that the participants use identity cues that evoke seniors' sociological, relational and individual characteristics. These identity cues play a central role in communication and constitute important information that the family caregivers can share with healthcare personnel. They sustain memory, facilitate care and reinforce seniors' self-value. These results help to define identity, foster a greater role for family caregivers, and constitute a sound basis for the implementation of personalized interventions.     

Ratings of social functioning in outpatients with schizophrenia: Patient self-report versus caregiver assessment

Patients with schizophrenia often have deficits in day-to-day functioning that are central to their disability. The ability of patients to rate their own social functioning, however, has not been established. In this study we examined the concordance between the ratings on the Social Functioning Scale of 58 outpatients with schizophrenia and their caregivers. We found a high level of overall concordance between the self and informant ratings. Items measuring the frequency of behaviors were among those with the highest concordance, while ratings of ability or social skill showed lower correlations. On only nine of 73 items did patients rate themselves significantly higher than did caregivers. There was no difference in concordance between family and nonfamily caregivers. These findings indicate that outpatients with schizophrenia can provide self-report ratings that are consistent with the ratings of their caregivers.     

Factors Associated with Depressive Symptoms Among Latino Family Dementia Caregivers

ABSTRACT

Caregiving to a person affected with an irreversible, late onset dementia can be an arduous challenge. Utilizing Pearlin and colleagues' (1990) and Lawton and colleagues' (1989; 1991) stress process model of caregiving, the factors associated with depressive symptoms among Latino¹ family dementia caregivers were examined. Problematic behavior of the dementia-affected person was found to be the most important factor associated with depressive symptoms, followed by poor self-reported health of the caregiver. Human service providers are advised to include depression screening tools at the time of assessment of Latino caregivers and to offer behavioral management interventions and self-care strategies.     

“No Matter What I Do They Still Want Their Family”: Stressors for African American Grandparents and Other Relatives

Grandparents and other relatives increasingly assume the role of primary caregiver to minor children. This study interviewed family members caring for children whose parents were not available due to parental incarceration, other involvement in the criminal justice system, and substance abuse-related issues. Interviews with 25 African American women examined the impact of caregiving including stress and depression. Stress included caregiver issues related to finances, time allocation, care responsibilities, and concerns about the absent parent, as well as issues specific to the children related to school concerns, child behavior, and emotional problems. These stresses were examined along with caregiver depression scores using the Center for Epidemiological Studies Depression Scale, which indicated more depression related to caregiver illnesses, older caregivers, and care for older and a larger number of children. This study suggests that caring for these children is both challenging and stressful, and caregivers are at risk for depression and other mental health concerns. Health and service providers should carefully assess the needs of caregivers when determining the needs of families where children are under care of nonparental relatives. Family-based services are needed that include caregiver supports as well as support for children.     

Mental Health Mobile Apps’ Instruction: Technology Adoption Theories Applied in a Mixed Methods Study of Counseling Faculty

This objective of this research was to determine factors influencing counselor educators’ behavioral intentions to teach counseling students about mental health mobile applications (MHMAs), factors influencing values of MHMAs as therapeutic tools, and to what extent counselor education programs are contributing to future counselors’ technological competence with regard to evaluating and integrating MHMAs. The conceptual basis was a theory triangulation approach using theories of technology use and acceptance and diffusion of innovations. Nine quantitative, two qualitative, and two mixed methods research questions served to guide the study. Participants were 132 faculty members from 99 university counseling programs. Participants completed an initial survey, an evaluation of an evidence-based mental health mobile application (app), and a postmeasure. Hierarchical multiple regression, analysis of covariance (ANCOVA), independent samples t-tests, and paired samples t-tests were used to analyze quantitative data. Results indicated that unified theory of acceptance and use of technology (UTAUT) variables along with anxiety/apprehension and ethical concerns are related to behavioral intentions to teach students about MHMAs. Semistructured video interviews were conducted and analyzed in the qualitative phase to add depth and explain quantitative findings. This study has implications for graduate counselor education programs and related accrediting agencies.     

The Role of Appraisal and Expressive Support in Mediating Strain and Gain in Hispanic Alzheimer's Disease Caregivers

Abstract

The purpose of this study was to examine how appraisal of burden and satisfaction, and perception of expressive support mediate the effects of caregiving on depression, somatic complaints, life satisfaction and personal gain with a sample of Hispanic Alzheimer's disease (AD) primary caregivers. A purposive-snowball sampling technique was used to identify 103 Hispanic caregivers, who completed a self-report questionnaire. A translation-back-translation process was used to translate the instruments into Spanish. Translated instruments were then pilot tested prior to being administered to the participants. Appraisal of burden was found to mediate the effects of caregiving on depression and somatic complaints and had significant direct effects on life satisfaction. Appraisal of satisfaction did not have a mediating effect on any of the measures, but did have a direct effect on depression and personal gain. Expressive support did have a mediating effect on depression, as well as direct effects on somatic complaints and life satisfaction. These findings suggest a need for improving outreach to older minorities and developing culturally sensitive interventions that can improve caregivers' understanding of problematic behavior, thereby altering appraisal of the situation, as well as developing extended systems of support.     

The genetic connections of Alzheimer's disease: An emerging source of caregiver stress

The purpose of this study was to expand and refine current theoretical conceptualization of dementia caregiving by identifying and analyzing new potential sources of stress. A qualitative analysis of unsolicited letters (N=51) written by family caregivers of persons diagnosed with Alzheimer's disease (AD) was conducted. Content analysis of the data confirmed that providing care for persons diagnosed with AD could impart emotional, physiological, and financial stress on caregivers. The data also revealed an emerging source of stress for family caregivers—fears and uncertainties regarding possible genetic connections between family caregivers and relatives suffering from AD. These results strongly suggest that concerns with genetic connections should be included in theoretical models of stress and dementia caregiving. Implications include the need for increased dissemination of information regarding genetic connections and AD, as well as increased support for family members if and when genetic connections are discovered.     

Posttraumatic Stress and Depression in the Nonoffending Caregivers of Sexually Abused Children: Associations With Parenting Practices

Caregiver mental health is a known correlate of parenting practices, and recent research indicated that parental depression following childhood sexual abuse disclosure is associated with concurrent parenting difficulties. The present study extended this line of research by investigating posttraumatic stress symptoms and depression in a sample of caregivers (N = 96) of children who experienced sexual abuse recruited from a child advocacy center as well as parenting practices reported by both caregivers and their children (mean age = 10.79 years, SD = 3.29; 79% female). Twenty-four percent of caregivers met criteria for presumptive clinical depression, clinically significant posttraumatic stress, or both. Results indicated elevated caregiver-reported inconsistent parenting in the context of clinically significant distress across symptom groups; children reported particularly elevated inconsistent parenting for caregivers with posttraumatic stress only. Caregiver depression was associated with low self-reported positive parenting and caregiver involvement in addition to self-reported inconsistencies. Directions for future research are offered to further elucidate the relationships between caregiver mental health and parenting practices following childhood sexual abuse.     

Enlisting friends to reduce sexual victimization risk: There's an app for that… but nobody uses it

ABSTRACT

Objective: The Circle of Six (Co6) phone application (app), winner of the White House's Apps Against Abuse Challenge, seeks to incorporate friends into sexual victimization risk reduction. Despite its growing presence on college campuses, the feasibility/acceptability of the app to college women is unknown. This mixed methods study sought to fill this gap. Participants: College women (n = 44) participated in summer/fall 2015. Methods: Participants completed questionnaires, used the Co6 app for 2 months, and returned to report their experiences. Results: Consistent with the app's aim, women reported greater intentions to help friends versus strangers in sexually aggressive situations. However, app use was low over follow-up. Reasons women gave for not using the app included redundancy with existing smart phone features and discomfort with group messaging. Some saw the app as an emergency only resource. Conclusions: The Co6 app may not meet the real world needs of college women.     

Survivor Feedback on a Safety Decision Aid Smartphone Application for College-Age Women in Abusive Relationships

College-age women are at high risk for dating violence and tend to seek services at rates lower than older adults. Young women are more likely to look to their peers or to technology as a forum for accessing safety resources. This study explores a prototype smart phone application (“app”) that is a safety decision aid for female survivors of dating violence. The app is intended to assist young women to assess the danger in their abusive relationship, set priorities for safety, and develop a personalized safety plan. Through focus group sessions and individual interviews, 38 female college students in 4 states (Arizona, Maryland, Missouri, and Oregon) who self-identified as survivors of abusive relationships reviewed and provided feedback on the usefulness, understandability, appropriateness, and comprehensiveness of the app. The focus group sessions and interviews were transcribed and analyzed. Participants were positive about the potential of the app to provide personalized information about abusive dating relationships and appropriate resources in a private, safe, and nonjudgmental manner. Detailed feedback from survivors and recommendations for further development of the app are discussed.     

Self-efficacy and social support for psychological well-being of family caregivers of care recipients with dementia with Lewy bodies,Parkinson’s disease dementia,or Alzheimer’s disease

The study identified factors associated with depressive symptoms in family caregivers of persons with dementia with Lewy bodies, Alzheimer’s disease, or Parkinson’s disease dementia. An Internet-based survey generated 606 response sets. Regression analysis indicated that care recipients’ memory and behavioral problems, caregivers’ self-efficacy, grief, and tangible, emotional, and affectionate support were significantly associated with caregivers’ depressive symptoms. Self-efficacy mediated caregiver burden to improve psychological well-being. Social support mediated the association between caregiver grief and psychological well-being. Social workers can provide psychoeducational interventions to help caregivers to manage emotional distress and improve capacity to manage tasks related to the dementia.     

Alzheimer's Disease Caregiver Burden: Does Resilience Matter?

Caring for an individual with Alzheimer's disease is at times challenging and can lead to caregiver burden. Resilience is a personality characteristic that has emerged as a protective factor among aging individuals. This study was conducted to examine the moderating effect of resilience between caregiver stressors and caregiver burden. The results indicate that resilience was not identified as a moderator between stressors and caregiver burden; however, a relationship exists between resilience and caregiver burden. Specifically, as resilience in Alzheimer's disease caregivers increases, their caregiver burden decreases. These findings highlight the importance of supportive interventions that will increase resilience in Alzheimer's disease caregivers.     

What Does it Mean to Listen to People with Dementia?

A total of 19 people with dementia were interviewed as part of a study into unmet respite care need amongst caregivers and day-care attenders in Sheffield. Some important contextual debates associated with conducting social research with people with dementia are considered. These include informed consent, competency, and how the interests of caregivers and people with dementia are bound together. A form of process consent was used in conducting semi-structured interviews with day-care attenders. Day-care attenders spoke about 'being here' in a number of ways. These include their initial experiences, their sources of satisfaction and their sense of being in families. These substantive findings and the associated methodological insights suggest day-care attenders have important things to say as service-users if appropriate strategies for listening are employed. Service-providers can collaborate imaginatively with day-care attenders to actively explore how care might be shaped by the experiences of persons with dementia.