Volunteerism and Older Adults

Abstract

This study was designed to examine differences in care-giver and care recipient characteristics, caregiving and work demands and resources, and role strain among Black, Hispanic, Asian, and White employed family caregivers. Significant differences were found with respect to caregiver and care recipient characteristics, types of assistance provided, and workplace support. Minority caregivers were economically disadvantaged and provided higher levels of care. Whites reported higher levels of role strain than Black and Hispanic caregivers, after controlling for caregiver and care recipient characteristics, demands, and resources. The findings indicate that care giving policies and programs must be broadened to incorporate the strengths and needs of ethnically diverse caregivers. Family practitioners need to be able to assess the applicability and differential impact of particular interventions, policies, and benefits, and to design relevant programs for ethnically diverse care-givers and their families.     

Supportive Group Interventions with Caregivers of Frail Older Adults

The use of supportive group interventions with caregivers of frail older adults is discussed in this article. Four categories of group interventions are described: (1) mutual support groups, (2) psychoeducational groups, (3) social, recreational and educational groups, and (4) service and advocacy groups. Research evidence on the efficacy of group interventions with this population is also considered. Recommendations are made on when to refer caregivers to support groups and on what type of support group is most appropriate. Consideration by practitioners and program planners of a broader range of types of supportive groups is also encouraged.     

Dementia Caregiving Outcomes: The Impact of Caregiving Onset,Cognitive Impairment and Behavioral Problems

With a projected increase in the prevalence of Alzheimer’s disease (AD) and related dementias, family caregiving is steadily increasing. Caring for an individual with AD is characterized as a “career,” and within this career are a number of key transitions, including the onset of caregiving. Research reveals a number of negative emotional health outcomes for AD caregivers, including depression and role overload, but less research has examined the influence of key transitions on the emotional adaptation of caregivers. The purpose of this study is to examine how different patterns of caregiving onset (gradual and abrupt) impact emotional health outcomes for AD caregivers. This study also explores how care-recipient cognitive impairment and behavioral problems moderate these relationships. Cross-sectional, quantitative data from 100 caregivers completing self-administered surveys were used. A series of one-way ANOVAs and multiple regression analyses were conducted to address study aims. Results indicate that care-recipient cognition and behavioral problems moderated the relationship between caregiving onset and emotional health outcomes for caregivers who experienced a more abrupt entry into the caregiving role. Results suggest the importance of considering different onset transitions and moderating factors within the caregiving career to target clinical interventions. Implications for social work practice are discussed.     

Chinese American Family Caregivers’ Perception of Program Use and Caregiver Stress

Caregiver programs provide specialized services and resources to reduce caregiver stress and improve family quality of life and health. Although there are resources and community services available, Chinese American family caregivers’ perceptions on caregiver programs and how specific services help to viably reduce their stress has yet to be examined. An in-depth interview was conducted with four Chinese American family caregivers in exploring their caregiving experiences and program service use; two of the caregivers were spouses and two were adult children. Content analysis revealed that their value of familial piety, and their need to ameliorate caregiver stress fueled their interest in new interventions to improve their quality of life and health. Spousal caregivers and adult children caregivers disclosed different needs due to caregiving, and adult children caregivers were less resistant to new interventions. The results of this study fill the knowledge gap on Chinese American family caregivers’ perception of caregiving in a cultural context as well as their needs. Suggestions for future research are to better understand the effectiveness of the specific services within caregiver programs that are effective in reducing caregiver stress among Chinese American family caregivers.     

Establishing Empirically-Informed Practice With Caregivers: Findings From the CARES Program

There is increasing interest in delivering efficacious interventions to caregivers. This study reports on the processes and findings from a modified approach of the Wraparound System of Care. The practice model is implemented over 4 phases and is based on 3 theoretical constructs and 10 principles. The evaluation utilized treatment fidelity measures and employed a quasi-experimental pretest/posttest design to examine caregiver outcomes (N = 120). Findings suggest significant improvement among caregivers’ self-reported health, life satisfaction, well-being, and quality of life, as well as a reduction in caregiver risk and burden. Delineation of the processes used in the model are presented.     

Relationships Among Caregiving,Income, Gender,and Health: A Cross-Sectional Examination of a Representative Sample of Older Americans

Although there is substantial evidence to support the effect of burden on caregivers, few studies have compared caregivers to their noncaregiving counterparts on the basis of health and well-being outcomes. This study examines the relationship between caregiving and health and whether other factors may have stronger influence on well-being measures. Using a nationally representative sample of older adults in the United States (N = 3,005), this study examines relationships between caregiving status, gender, and income, and 9 outcomes (self-rated physical and mental health, time since seeing a doctor, time since most recent pap smear or prostate-specific antigen [PSA] test, depression, loneliness, stress, anxiety), using logistic and linear regression models. Results support that paradoxically, caregiving was associated with increased likelihood of PSA test in male caregivers, although data also indicated higher levels of anxiety and stress, as might be expected. Income was associated with 8 of 9 outcomes, and gender predicted depression, anxiety, stress, and self-rated mental health. The study highlighted the importance of psychosocial stressors, such as income and gender, on the health outcomes of older adults who may be caregiving. Considering complexity of unique experience is necessary to accurately assess vulnerability to poor mental health or health-related outcomes.     

The roles of social support and family resilience in accessing healthcare and employment resources among families living in traditional public housing communities

This study relied on theories of family resilience to examine and differentiate the roles of community social support and family resilience in regards to access and utilization of healthcare and employment resources for public housing residents. The study assessed 234 public housing residents and used structured regressions to test the role of family resilience, internal and external community social support on outcomes associated with economic mobility. Results suggest that external community social support is associated with increased access to and use of health and employment resources. Additionally, residents with higher levels of resilience sought social support from outside of their communities to a greater degree, thereby increasing their access and use of resources. Increases in internal community support were associated with increases in external community support, but alone, limited access to and use of resources. Implications of the findings for policy, interventions, and future research are discussed.     

Psycho-educational support groups for older women victims of family mistreatment: a pilot study

Few programs for domestic violence victims have been evaluated for effectiveness. This gap is even more pronounced for elder abuse service interventions. The study presented here is intended to address this gap by using an experimental research design to evaluate outcomes of an elder mistreatment psycho-social support group pilot for cognitively unimpaired older female victims of mistreatment by family members and significant others for whom they are providing care or support. The support group model used for the study adapts amodel designed by NOVA House, an elder abuse shelter program in Manitoba, Canada. The study was funded by the Hartford Foundation Geriatric Social Work Faculty Scholars Program. While the significance of study findings is limited by the small number of pilot participants, the model intervention and evaluation instrument developed for the study may be utilized for study replication.     

Online psychoeducation with parent management training: Examining the contribution of peer support

Psychoeducation is an empirically based intervention that is increasingly delivered online to individuals and groups. Low participation has been a problem for online designs that include peer support. New technology designs have been called for, and in response, we developed a model that synchronized the delivery of individual and group‐based psychoeducational activities for parent management training. We used a problem‐based learning strategy delivered to caregivers of youth demonstrating oppositional behaviours to encourage the development of helping processes and peer support. This mixed methods intervention study had high rates of participant retention and positive measurable changes for two of its three psychoeducational outcome measures. When we merged the study data, we observed that mutual aid—a frequently sought goal of group‐based interventions—contributed to participant outcomes.     

Developing Evidence-Based Interventions for Foster Children: An Example of a Randomized Clinical Trial with Infants and Toddlers

Children who enter foster care have usually experienced maltreatment as well as disruptions in relationships with primary caregivers. These children are at risk for a host of problematic outcomes. However, there are few evidence-based interventions that target foster children. This article presents preliminary data testing the effectiveness of an intervention, Attachment and Biobehavioral Catch-up, to target relationship formation in young children in the foster care system. Children were randomly assigned to the experimental intervention that was designed to enhance regulatory capabilities or to a control intervention. In both conditions, the foster parents received in-home training for 10 weekly sessions. Post-intervention measures were collected 1 month following the completion of the training. Outcome measures included children's diurnal production of cortisol (a stress hormone), and parent report of children's problem behaviors. Children in the experimental intervention group had lower cortisol values than children in the control intervention. Also, the experimental intervention parents reported fewer behavior problems for older versus younger foster children. Results provide preliminary evidence of the effectiveness of an intervention that targets children's regulatory capabilities and serve as an example of how interventions can effectively target foster children in the child welfare system.     

Social Support and Self-Rated Health of African American Women Informal Caregivers: Urban and Rural Differences

In this study, we examined how geographic location might differently influence social support and self-rated health for rural and urban African American women caregivers. We used cross-sectional data from 253 urban and 263 rural women primary caregivers. Controlling for key demographic factors, we regressed caregivers’ self-rated health on social engagement, structural, and functional aspects of social support for urban and rural caregivers separately. The perception of family functioning was positively associated with urban and rural caregivers’ self-rated health. Urban caregivers reported having significantly more contact with their family and more informal helpers compared to rural caregivers. Furthermore, church attendance, a measure of social engagement, was significant for urban caregivers’ self-rated health, but not rural caregivers. Our findings affirmed the importance of foregrounding context and disaggregating social support, and point to the need for interventions targeting family functioning and paying attention to geographic location.     

Social Support,Caregiver Burden,and Life Satisfaction in a Sample of Rural African American and White Caregivers of Older Persons With Dementia

This article reports the findings of a study of African American and White dementia caregivers (n = 141) living in rural areas of Alabama that examined the relations between the participants' receipt of informal social support, and their levels of caregiver burden and life satisfaction. The sample, as a whole, reported high levels of social support with no reported differences in social support by race. Female caregivers reported higher mean scores on 3 of the 4 dimensions of social support than their male counterparts. Two of the 4 dimensions of social support accounted for 32% of the variance of the caregivers' reported level of life satisfaction.     

The impact of inheritance experiences in orphans and vulnerable children support in Zimbabwe: A caregivers' perspective

Despite the predominant contemporary and traditional coping strategies adopted in Zimbabwe in the past three decades and beyond, challenges and issues related to inheritance continued to affect the livelihood of both orphans and vulnerable children (OVC) and their caregivers. This article is a qualitative phenomenological study seeking to examine the perceptions, views, and feelings of the OVC and their caregivers on their lived experiences in OVC care and support in Zimbabwe. The study focusses on the caregivers' perspectives of the impact of the inheritance experiences in OVC care and support within their tribal local rural communities. In‐depth narrative interviews were conducted with 30 caregivers, corroborated with 10 OVC purposively sampled in the Gutu District of Zimbabwe. The results showed that although the caregivers are doing their best in executing their strategies for OVC care and support, the manipulation and misappropriation of the inheritances from deceased parents or grandparents that were meant to benefit the OVCs are still widespread in the rural communities of Zimbabwe. In conclusion, the study recommends the need for an integrated stakeholders' approach in educating the local rural communities about their inheritance rights.     

Korean American Dementia Family Caregivers’ Experience of a Psychoeducational Support Group: Investigation of Role of Culture

Seven Korean American dementia family caregivers participated in a psychoeducational group. A focus group was conducted to explore the effectiveness of the group work model. Analysis of the focus group presented four themes: (1) importance of education about dementia, (2) social support from other Korean caregivers, (3) role of language and Korean culture, and (4) heterogeneity of caregivers' needs. Implications for social work practice, policy, and research are provided.     

Transitions in Caregiving: Evaluating a Person-Centered Approach to Supporting Family Caregivers in the Community

Caregivers of older adults provide a wide range of informal supports and services that enable older adults to continue living in the community. This study describes the use of a multicomponent intervention combined with a person-centered approach to assist caregivers of older adults in the community. Four hundred and eighteen caregiver and care recipient dyads participated in this study and their outcomes related to burden, depression, well-being, and care recipient functional status were evaluated. The findings suggest that adult child and spousal caregivers experience burden differently. Programs designed to support caregivers must tailor services to the unique needs of adult child and spousal caregivers.     

Effective interventions to promote child and family wellness: a study of outcomes of intervention through Children's Family Centres

This paper reports research carried out in Australia designed to evaluate the impact of family support interventions by comparing the views of families and their caseworkers with respect to the perceived benefits and outcomes of the interventions in the context of changes in family functioning and parent–child relationships, and the extent to which changes led to reduced involvement in protective services. The intervention was monitored over a six‐month period using a pre‐ and post‐test design, incorporating quantitative and qualitative approaches in the methodology. The paper discusses: problem domains identified; changes in caregivers’ level of distress, problem solving and learning ability, bonding style and use of discipline; parents’ and children's cooperation with the programme; and implications of the findings for policy and research methodology.     

Interactions and outcomes using the Social Relations Model in a healthcare group

Health care today necessitates a group effort, in part, due to the availability of complex interventions. Often measures of central tendency are used to examine groups which can result in misleading interpretations. Interactions within groups can influence outcomes so a multi-level approach to examining individual and dyad contributions is helpful to determine where interventions may be needed. The Social Relations Model (SRM) (Cook & Kenny, 2004) is a mathematical technique used for estimating the variances due to interaction effects from individuals and dyads within the group. This exploratory research used the SRM to examine 43 triads, composed of a patient, telehealth nurse and home helper, from three western U.S. Veterans Health Administration systems. The purpose of this research is to utilize the SRM to examine communication and information integration among individuals and dyads within groups that may influence outcomes in a health care example. Three triads with identical communication and information integration group scores were compared for Perceiver, Target and Relational Effect scores. Results identified individual and relational variances within the groups that may influence satisfaction and self-care outcomes. SRM techniques are beneficial not only to examine existing group interactions but to prevent potential group combinations that may inhibit desirable outcomes in a complex health care environment.     

A stress process model of family caregiver service utilization: factors associated with respite and counseling service use

This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.     

Familial caregivers of older adults

Caregivers of older adults face many obstacles as they balance family, career, and caregiving demands. Caregivers are at an increased risk for burden, stress, depression, and a variety of other mental and physical health complications. It is not uncommon for caregivers to receive some form of pharmacological therapy to treat the physical and mental health changes that may occur throughout their caregiving career. However, while pharmacological forms of treatment are invaluable, medications only may not be sufficient to treat the needs of caregivers. As such, geriatric professionals also have a responsibility to intervene with caregivers through psychosocial interventions. This paper provides an overview of caring, a summary of evidence-based psychosocial interventions for family caregivers of older adults, and recommendations for future interventions.