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.     

Preferences for receipt of care among community-dwelling adults

Preferences for long-term care alternatives include both place of care and persons to provide care. In this analysis, these elements are separated for mature adults (N-1503, ages 40-70) regarding future care needs. Most adults preferred care in home/community settings by kin or non-kin, with few deeming nursing homes acceptable. Demographics and personal knowledge, experience, and expectations were marginally likely to influence preferences; males were more likely to prefer care in paid/professional settings. Women, who more often expressed preference for kin/home care, face demographic trends reducing available female kin who might be caregivers.     

Development and validation of the Mindful Parenting in Infancy Scale (MPIS)

Although mindfulness in parenting has been recognized as important for some time, there is a dearth of measurement tools, especially for caregivers of infants. Two studies were conducted: (1) developing and providing an initial psychometric evaluation of the Mindful Parenting in Infancy Scale (MPIS) and (2) reproducing initial findings with an independent sample of infants and caregivers. In Study 1, 37 caregivers of infants (3–12 months of age) responded to MPIS, providing indicators of parenting stress and infant temperament. Study 2 caregivers (N = 57) responded to identical measures, with infant electroencephalogram (EEG) recorded during the Still Face Procedure, along with a baseline condition. Study 1 results indicated good internal consistency, with Study 2 providing additional support for reliability. Correlations with parenting stress markers were also significant across both investigations, indicative of greater stress with lower levels of mindfulness. A number of correlations with temperament scores were also significant, and in the hypothesized direction, across both studies. Importantly, the MPIS score was predictive of infant frontal EEG asymmetry in a path model examined in the context of Study 2. Thus, the present investigation provides support for MPIS as a promising brief measurement tool based on results obtained with two independent samples.     

Factors affecting user participation for elderly people with dementia living at home: a critical interpretive synthesis of the literature

ABSTRACT

Professional caregivers are expected to facilitate user participation for people with dementia. At the same time, an increasing number of elderly people with dementia are now being cared for at their homes. Research is scarce on user participation for people with dementia, especially for people with dementia who live at home. This article aims to systematically and critically review the factors affecting user participation for elderly people with dementia living at home from the viewpoint of the patients, family caregivers, professional caregivers and researchers. A systematic literature search and critical interpretive synthesis were conducted. The search yielded 1,957 articles. In total, 112 full-text articles were retrieved, of which 27 met the inclusion criteria. Five broad analytical themes were identified during the analysis: individual characteristics, professional caregiver characteristics, decision characteristics, relational characteristics and organisational characteristics. The results show that the value placed on user participation can differ between family caregivers and professional caregivers. People with dementia still experience stigmatisation, preventing user participation, and relations with both family and professional caregivers play a key role in enabling user participation for people with dementia.     

Dressing for success. Promoting independence among cognitively impaired elderly

In demented persons, activities of daily living skills may deteriorate more quickly than their cognitive decline warrants because caregivers do not allow them to perform ADLs to the full extent of their abilities. Caregiver actions that promote independent behaviors were used with subjects in home and nursing home settings. Four of five home subjects showed decreased caregiver assistance and increased ability to dress more independently. Although nursing home subjects did not show a decrease in caregiver assistance, observation showed that some nursing home caregivers did incorporate behavioral strategies, suggesting potential clinical efficacy of the strategies.     

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.     

‘She is Too Young for These Chores’ — Is Housework Taking a Back Seat in Urban Chinese Childhood?

The child in contemporary urban China is experiencing an increasingly exclusive focus on academic achievement at the expense of non‐academic activities, particularly housework. In‐depth interviews with caregivers (including grandparents and parents) from 9 three‐generational families (n = 34) and parents from 10 nuclear families (n = 20) were conducted. Results show that although children from both family types were low in housework participation, children in three‐generational families were perceived by their caregivers to be less competent in performing self‐care and family‐care tasks. They were also less frequently assigned regular tasks as compared with children from nuclear families. Unlike caregivers from western societies, where children's participation in housework is seen as either a means of socialisation or a source of domestic labour, Chinese caregivers consider housework as a distraction, at best an addendum to academic work.     

Development of Infant Pointing from 10 to 12 months: The Role of Relevant Caregiver Responsiveness

Infants’ pointing frequency is a predictor of their later language abilities. Yet, predictors of pointing frequency in the first year of life are not well understood. Study 1 explored what factors in infants and caregivers at 10 months would predict the pointing frequency of infants at 12 months (N = 35). Infant‐driven predictors were infants’ fine‐motor skills and point‐following abilities. Caregiver‐mediated predictors were caregivers’ pointing frequency and responsiveness toward infants’ pointing. Relevant caregiver responsiveness at 10 months predicted infants’ pointing frequency at 12 months, controlling for the other factors and infants’ prior pointing frequency. Study 2 explored whether child‐level factors influence caregivers’ responsiveness (N = 49). We examined the hand shape of infants’ pointing (whole‐hand versus index‐finger) and the presence of point‐accompanying vocalizations. Infants’ vocalization‐accompanied points were more likely to elicit relevant responses from caregivers, while hand shapes played a less pronounced role. Together, the findings reveal an early emerging mutual relationship between infant pointing and caregiver behavior such that certain characteristics of infant pointing predict caregivers’ responsiveness, and relevant responsiveness toward infants’ pointing predicts the increase in infants’ pointing frequencies.     

Understanding Chinese-Canadian pathways to a diagnosis of dementia through a critical-constructionist lens

Efforts to understand pathways to a diagnosis of Alzheimer's Disease and Related Dementias (ADRD) are important in light of the benefits of early diagnosis to both patients and families, but very little is known about the ways in which persons with dementia and their family caregivers experience this pathway from the point of initial symptom recognition by family or friends to formal diagnosis seeking, particularly for immigrant older adults. Our team employed qualitative methods and a critical constructionist and intersectional framework to understand this experience from the perspectives of ten Chinese-Canadian dyads of persons with dementia and their caregivers. Situating the decisions made by these dyads relative to their intersecting identities and the power structures that inhibit them steered us away from essentializing attributions of their experiences to their ‘culture’ or ethnicity. Early signs of dementia were recognized as such in hindsight. There was no evidence of a strong link between culture and symptom appraisal. Knowledge about dementia, which may be influenced by culture, age, income, knowledge of English, and other determinants of health, played a role in symptom appraisal and help seeking. The role of family caregivers in care-seeking was more highly influenced by structural factors than by traditional Chinese cultural norms about family responsibilities and filial piety. Once caregivers realized that the symptoms and behaviors were ‘problematic,’ they quickly sought out additional information, usually from a family physician. At 1.5 years, the time between symptom onset and diagnosis is comparable to or shorter than that reported in research with other cultural groups. Gender-based power imbalance between female family caregivers and male Chinese-Canadian physicians appear to have contributed to delayed investigations and diagnosis. Sensitivity to such imbalances is important when working with older adults and those from more hierarchical cultures. Essentialized portraits of traditional family structures and cultural beliefs may not accurately reflect the variety of lived experiences of the dementia care-seeking by older Chinese immigrants in Canada.     

Consistent Assignment of Nurse Aides: Association With Turnover and Absenteeism

Consistent assignment refers to the same caregivers consistently caring for the same residents almost every time caregivers are on duty. This article examines the association of consistent assignment of nurse aides with turnover and absenteeism. Data came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The measures were from 2007 and came from 3,941 nursing homes. Multivariate logistic regression models were used to examine turnover and absenteeism. An average of 68% of nursing homes reported using consistent assignment, with 28% of nursing homes using nurse aides consistent assignment at the often recommended level of 85% (or more). Nursing homes using recommended levels of consistent assignment had significantly lower rates of turnover and of absenteeism. In the multivariate analyses, consistent assignment was significantly associated with both lower turnover and lower absenteeism (p < .01). Consistent assignment is a practice recommended by many policy makers, government agencies, and industry advocates. The findings presented here provide some evidence that the use of this staffing practice can be beneficial.     

Beginning street life: Factors contributing to children working and living on the streets of Khartoum, Sudan

Understanding why some children work on the streets while others live there, and how causal factors differ by gender, is important in developing effective services for them. This study examined these questions in Sudan using participant observation, qualitative interviews, and surveys of working boys (n = 1025), working girls (n = 192), street boys (n = 397), and street girls (n = 35). Street children were less likely than working children to have local families (66% and 77%, p < 0.001), and more likely to have experienced some prior hardships, e.g. a mother's death (17% and 10%, p < 0.001), or coming from the war-torn south (30% and 10%, p < 0.001). 70% of street children and 10% of working children had abused (i.e. sniffed and sucked) glue (p < 0.001); initiating glue abuse often coincided with a transition from working to living on the streets. Within groups, conditions ‘pushing’ girls to street life were often harsher than for boys. For working girls, these included death of both parents (10% and 3%, p < 0.001), and/or insufficient food at home (59% and 43%, p < 0.001). For street girls, they included having a homeless family (23% and 9%, p = 0.019), and/or insufficient food at home (63% and 40%, p = 0.008), but street girls also more often reported boredom at home (80% and 48%, p < 0.001). Services should be tailored to the particular needs of each group by gender, including community-based prevention, street-based health and safety interventions, and street child counseling and re-integration programs.     

Stress,satisfaction and role conflict in dual-doctor partnerships

Stress in doctors has major implications for themselves, their family and patients. In dual-doctor partnerships, stress may or may not be compounded. Previous studies have suggested that demands of work have a greater impact on home life than vice versa, and that there may be a gender difference in stress between work and home. This study compared perceived stress, satisfaction and conflict for professional males and females working in dual-doctor partnerships investigating the bi-directional relationship between work and home roles. A sample of 244 male and female doctors in dual-career partnerships working in the National Health Service in Scotland completed a self-report questionnaire. Male doctors perceived their work as more stressful and less satisfying than females. Work stress had a greater impact on home life than vice versa, but there were no gender differences in levels of stress from work to home (WH) or home to work (HW). However, more males than females, particularly younger males, reported that work was a source of conflict with their partner. WH stress predicted marital conflict for both male and female doctors, whereas HW stress predicted marital conflict only for females. Time on call out of hours, the ethical commitment to medicine, and work encroaching into family time were identified as major sources of conflict. These findings have implications both for the well-being of doctors and their families, and for patient care, and for other professionals in dual-career partnerships.     

Race/Ethnicity,Attitudes, and Living With Parents During Young Adulthood

Non‐White young adults are more likely to live with their parents throughout their 20s, more likely to return home after going away to college, and less likely to leave again after returning. Scholars have speculated that subcultural differences in attitudes toward marriage and family play a key role in generating racial/ethnic differences in rates of coresidence with parents among young adults. Data from the National Education Longitudinal Survey of 1988 (N = 11,228) were analyzed in order to test this hypothesis. Attitudes toward marriage and family were significantly associated with coresidence, especially among young men, but did not substantially account for racial/ethnic differences in living arrangements. Among young non‐White women and young Black men, higher rates of coresidence were related to differences from Whites in socioeconomic or marital status (and sometimes both) that were largely independent of differences in attitudes toward marriage and family.     

School counseling practices related to postsecondary STEM participation

This qualitative exploratory cross-case analysis analyzed the beliefs and practices of high school counselors related to science, technology, engineering, and mathematics (STEM) academic advisement, postsecondary planning, and career participation. Interviews were conducted with high school counselors (N = 13) who were purposively sampled to represent a diversity of schools in terms of demographic variables. Findings indicated that high school counselors perceived that (a) sociocultural factors influenced student preparation for STEM, career planning, and decision making; (b) students’ STEM-related career goals and academic behaviors were sometimes misaligned, and academic advisement often mediated this tension; and (c) their professional STEM knowledge, beliefs, and practices were influenced by professional preparation, workplace characteristics, and their academic experiences. Implications include the need for early, sustained high school STEM counseling and academic advisement; accessible professional development in STEM preparation and careers to promote multiple pathways and reduce school counselor bias; and encouraging family involvement in STEM career decision making.     

Family Caregiver Communication in the ICU: Toward a Relational View of Health Literacy

We interviewed 18 family caregivers about their communication experiences in the ICUs at an urban hospital. Analysis of their narratives suggests health literacy is important in family caregiver/healthcare provider communication, especially as complicated illnesses move the caregiver deeper into decision making. Using the domains of Yuen et al.’s conceptual model of caregiver health literacy (2015), we identified three themes within the context of ICU communication: agency, coordinated communication, and caregiver’s evolving role. We saw family caregivers negotiating domains of health literacy as they built upon knowledge of the patient’s needs, their rights as family caregivers, and the hierarchy of the professional staff. We found that these narratives represent co-created, or relational communication, rather than individual health literacy skills. Conceptualized in the transaction of relationship, health literacy is enacted; it is socially constructed and is the scaffolding upon which family caregivers make decisions, care for their loved one, and care for themselves.     

EVALUATING PDAS FOR DATA COLLECTION IN FAMILY RESEARCH WITH NON-PROFESSIONAL COUPLES

Repeated measures designs such as daily diary methods provide flexibility for examinations of fluid phenomena. The focus of this paper is to evaluate the effectiveness of Personal Digital Assistants (PDAs) as data collection tools with an end of the day (EOD) diary design and a non-professional sample. Participants reported the PDA was easy to use, convenient and enhanced the privacy of their responses. The PDAs minimized data entry errors and increased the data validity because responses were time stamped. Given the overall positive nature of participant reactions and the additional data PDAs make available to the researcher, the technology is recommended for further use in collecting data with non-professionals or in other couple or family research.     

Effectiveness of use of home health nurses to decrease burden & depression of elderly caregivers

The purpose of this research was to investigate the impact of home health nursing intervention on burden and depression of elderly caregivers who were caring for an ill relative in their home. Two groups of caregivers were compared for differences in caregiver burden and depression. The caregivers in the control group did not use the services of home health nurses, whereas the caregivers in the experimental group did use these services. Data were analyzed using the Burden Interview and the Center for Epidemiologic Studies Depression Scale. Multiple analysis of variance confirmed that caregivers who used the services of home health nurses were significantly less burdened and less depressed than caregivers who did not use these services.     

The Prevalence and Types of Gambling Among Undocumented Mexican Immigrants in New York City

Objectives To examine the prevalence of gambling and types of gambling activities in a sample of undocumented Mexican immigrants. Design Non-probability cross-sectional design. Setting New York City. Sample The 431 respondents ranged in age from 18 to 80 (mean age 32), 69.7% were male. Results More than half (53.8%) reported gambling in their lifetime and of those most (43.9%) played scratch and win tickets or the lottery. In multivariate analyses men reported gambling more than women [2.13, 95% CI = (1.03, 4.38)]. The odds of gambling in their lifetime were higher among those reporting sending money to family or friends in the home country [2.65, 95% CI = 1.10, 6.38)], and those who reported 1–5 days as compared to no days of poor mental health in the past 30 days [2.44, 95% CI = 1.22, 4.89)]. Conversely, those who reported entering the U.S. to live after 1996 were less likely to report gambling [0.44, 95% CI = (0.22, 0.89)] as compared to those who had lived in the U.S. longer. Conclusion There is a need to further explore both the prevalence and the severity of gambling amongst the growing population of undocumented Mexican immigrants in the U.S.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.     

Hostile home environment predicting early adolescent sexual harassment perpetration and potential school-related moderators

Using family systems theory, this longitudinal study of middle school youth examined the effects of abuse, family conflict, and sibling aggression on sexual harassment perpetration (N = 1563; M_age 11.2, 51% boys; 39% Hispanic, 29% Black, and 19% White). Boys reported more sexual harassment than girls; perpetration increased for both. The association between a hostile home environment and sexual harassment perpetration was moderated by school experiences. School belonging buffered effects of hostile home environment on baseline sexual harassment perpetration for boys who experienced abuse and White adolescents with high sibling aggression. Academic grades moderated change in perpetration over time, but effects differed by sex and race. It is important to understand how early violence exposures relate to sexual violence perpetration during early adolescence.