Medication management and adherence among cognitively impaired older adults

This study examined the relationship between patients' cognitive status, deficit awareness, medication management skills, and actual medication adherence. Twenty-seven persons with Alzheimer's disease and 20 healthy controls were evaluated for their predicted and objective performance on tasks related to medication management. Caregivers were also evaluated for their prediction of the care recipient's management abilities. A pill count was taken at the initial interview and 30 days later. MMSE and deficit awareness were related to amount of help received from a family member, suggesting that caregivers tend to accurately assess their relatives' medication management abilities. Adherence rates were acceptable, but some intervention strategies selected by caregivers were not effective in assuring adequate adherence. Additional study is needed to determine the effectiveness of various strategies adopted by informal caregivers.     

Patterns of practice: An exploratory factor analysis of child and family social worker skills

There is relatively little research on the communication skills that social workers use in direct practice with families. This study explores patterns of practice skill found in child and family social work home visits. The study analysed 127 practice interactions in family homes, coding for seven dimensions of worker skill using a coding framework drawn from motivational interviewing. Exploratory factor analysis was employed to establish patterns of skill within the data and to group key dimensions of skill. The findings make two contributions. First, three fundamental dimensions of good practice emerged, which we characterize as care and engagement, good authority, and support for behaviour change. Second, in exploring the relationship between “care” and “control” elements of social work, skilled social workers were able to combine good authority and empathic engagement, whereas those who were less skilled in use of authority were also less good at engagement. This contributes to debates about care and control in social work. The usefulness of these dimensions for conceptualizing practice in child and family social work is discussed and directions for further research are suggested.     

Observing Women Caregivers’ Everyday Experiences: New Ways of Understanding and Intervening

This article discusses the practice implications of videographic research examining the everyday lived experiences of 5 women family caregivers of older adults with chronic illness. The women’s nonverbal expressions and gestures revealed how caregiving is accomplished and lived on a daily basis, in particular through emotion and body management, abnegation, and performance. The findings from this microethnographic study suggest that observing women caregivers’ everyday experiences can open new avenues for holistic intervention with this population. Observing nonverbal cues can offer a way for practitioners to better understand women caregivers’ realities, to question their practice, and to adapt their interventions accordingly.     

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.     

Challenges to Successful Community-based Integrated Approach to Dementia: A Qualitative Study

The aim of this study is to identify key challenges to successful community-based integrated team approach to the management of older adults with dementia. A nationwide community-based qualitative research strategy was applied. We purposively recruited 24 health-care providers and 13 family caregivers from selected 8 prefectures among 47 prefectures. Face to face interviews were conducted from May to September 2017. Qualitative content analysis was used to analyze the qualitative data. Ten themes regarding the challenges were emerged: Ignored wishes, Family caregivers’ full responsibilities, Encouragement, Practical and easy-to-understand information, Essential skills of dementia diagnosis and assessment, Gratitude by helping others, Difference between being kind and overly-kind, Legal barrier against information sharing, Coordination between volunteers and clients, and Conflict avoidance in multidisciplinary collaboration. The findings highlight the need to provide practical and easy-to-understand information for family caregivers, educate physicians in dementia diagnosis and assessment, share personal dementia care information among health-care providers, promote platforms which aim to match dementia care volunteers with older adults with dementia and their families in need of help, and raise awareness of advance care planning among both older individuals and health-care providers.     

Social worker decision-making in court

The current study aimed to explore the factors that influence how social workers make decisions and develop their decision-making skills in care proceedings, and to identify effective support and intervention to develop social worker decision-making skills. The study employed a mixed thematic approach across two phases of study: an initial inductive thematic analysis of responses to an online qualitative questionnaire and then a mixed thematic analysis of follow-up focus groups and interviews with social workers working in various social work roles within England and Northern Ireland. The findings identified a number of themes that help to understand the decision-making skills of social workers; thorough assessment skills, relationship-based anti-oppressive practice, being mindful of the lived experience of the child and using critical reflection to make complex decisions. Wider structural factors that support or hinder decision-making, particularly in respect of organizational support and management supervision were also identified. Social workers can be supported to develop decision-making skills through additional training, reflective learning and management support to develop their practice wisdom within this field.     

Statewide Implementation of “Reducing Disability in Alzheimer’s Disease”: Impact on Family Caregiver Outcomes

There have been few replications of efficacious evidence-based programs for dementia caregivers offered in community settings. This study highlights the replication of the evidence-based Reducing Disability in Alzheimer’s Disease program and explores the changes in outcomes for participating caregivers and whether those changes are related to level of program utilization. With data from 219 caregivers, regression results indicate that more exercise sessions are associated with a decrease in caregiver strain and more behavior management sessions are associated with a decrease in unmet needs after 3 months. Findings demonstrate how a multicomponent program can have positive benefits for family caregivers.     

Decision Making in Long-Term Care

Abstract

This article reports findings from a qualitative study of approaches to long-term care decision making used by older adults (N = 52) who continued to reside long-term in the community following nursing facility pre-admission screening. Older adults used different approaches to decision-making (autonomous, collaborative, and delegated) while seeking the most appropriate care setting. Factors such as mental capacity, the role of family caregivers, and self-advocacy skills influenced the choice of decision-making approach. Findings also illustrate how older adults moved through multiple pathways in order to reach their eventual long-term residence. These findings are discussed in terms of their implications for clinical practice and research.     

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.     

Matching Practice Skills with Client Problems

Abstract

Despite the increasing pressure to measure social work practice skills and relate those activities to client outcomes and treatment costs, relatively little social work research has been devoted to the development of social work process instruments. The recent development of the Practice Skills Inventory has provided practitioners with a useful tool for measuring the frequency with which practitioners employ specific categories of common social work intervention skills. However, it is important to demonstrate that social workers employ these practice skills differentially depending on clients' presenting problems. The current study of 281 experienced MSW practitioners demonstrates that they, indeed, emphasize supportive, therapeutic, case management and insight facilitation skills differentially depending on the problems experienced by their clients. Implications for practice and evaluation research are addressed.     

Informal caregivers of cancer patients: perceptions about preparedness and support during hospice care

This study examined the perceptions of preparedness and support of informal caregivers of hospice oncology patients. Respondents included coresiding, proximate, and long-distance caregivers. Thematic analysis was used to analyze the qualitative data from 2 caregiver surveys, one administered prior to the care recipient's death and another completed 3 months postdeath. Respondents (N = 69) interpreted preparedness broadly and identified multiple sources of support including hospice personnel, family, friends, neighbors, and spiritual beliefs. Additionally, informational support, such as education, information, and enhanced communication were considered essential for preparing and supporting caregivers. Implications for social work research and practice are provided.     

Life after institutional care: Implications for research and practice

This study sought to investigate the lived experiences of care leavers from institutional care facility in Botswana. The study objectives were to explore the challenges faced by children after leaving the institutional care and to identify services that can be offered to them in preparation for life in a society in general. The study adopted a cross‐sectional qualitative research approach, and data were collected through in‐depth interviews that were qualitatively analysed. Thirty participants was sampled, and there were divided into 2 sections comprising care leavers and key informants who were part of the institutional care staff. They were selected using purposive and snowball sampling methods. The findings confirm that institutional care has both positive and negative effects on care leavers in the sense that it provides children with educational opportunities, family, and strong interrelation skills. Furthermore, the study findings show that during children's stay in the institutional care, they are sometimes neglected by housemothers that affect their transition into mainstream society. Moreover, the study findings reveal that care leavers encounter many challenges ranging from finance management to unemployment, discrimination from the society, and poverty. Lastly, future research, policy direction, and implications are discussed.     

Consumer Direction in Community-Based Long-Term Care

Abstract

Recently, a growing number of community-based long term care programs have been incorporating a concept of consumer direction (CD). Consumer Direction allows long-term care consumers to take more active roles in their care management, by hiring, training, supervising, and firing care providers. A limited number of existing studies show that CD consumers indeed feel they have more choice and control over their care compared to those under the traditional model. However, other studies show problematic working conditions for care providers under CD. Questions also remain unanswered regarding how CD effects different important stakeholders, including family caregivers, formal paid caregivers, and governments. More research, administrative, and practice efforts are needed to ensure CD can benefit all sectors of communities.     

Informal Caregivers of Cancer Patients: Perceptions About Preparedness and Support During Hospice Care

This study examined the perceptions of preparedness and support of informal caregivers of hospice oncology patients. Respondents included coresiding, proximate, and long-distance caregivers. Thematic analysis was used to analyze the qualitative data from 2 caregiver surveys, one administered prior to the care recipient's death and another completed 3 months postdeath. Respondents (N = 69) interpreted preparedness broadly and identified multiple sources of support including hospice personnel, family, friends, neighbors, and spiritual beliefs. Additionally, informational support, such as education, information, and enhanced communication were considered essential for preparing and supporting caregivers. Implications for social work research and practice are provided.     

Creating a better kinship environment for children in Ghana: Lessons from young people with informal kinship care experience

Traditionally, the involvement of the extended family in nurturing children is seen as an essential cultural practice in most communities in Ghana. Though not formally regulated, often in the absence of birth parents, kin and kith continue to be involved in the care of children to promote family relations and culture. Yet there is little empirical evidence on how to improve the well‐being and safety of children in informal kinship care in Ghana. Thus, this study reports findings from in‐depth interviews with 15 young people, 18 to 23 years, from Banda—an ethnic group where informal kinship care is an accepted cultural practice. Data from the interviews were subjected to the constructivist grounded theory analysis. Adequate income for provision of basic needs, education and training, and supervision emerged as useful measures to promote the safety and well‐being of children in kinship care. It was recommended that informal kinship caregivers must be registered with the Department of Social Welfare to enable them access support and training. Further, social workers should create awareness among kinship caregivers in Ghana about their availability to provide counselling services for caregivers facing challenges.     

Elderly African Americans as intragenerational caregivers

A growing number of older Americans serve as caregiving resources for their elderly spouses, partners, relatives, and/or friends. Yet, little research has addressed the impact and implications of this trend among African Americans. This article describes the results of a qualitative study examining the intragenerational caregiving experiences and perspectives of two cohorts of African Americans (urban and rural, N = 129) between the ages of 58 and 89. Its findings reveal important differences and commonalities associated with elderly African American caregivers and their care giving in urban and rural settings. Additionally, the study suggests that volunteer caregivers can often fill the void left by partners and relatives who predecease or fail to assume responsibility for the care of their elderly relatives. Their efforts do not displace those of friends and family members, but rather address unmet needs in available care. The discussion focuses on the implications of the study findings for public policy and practice.     

Using a Group Work Practice Standards Inventory to Assess the Impact of a “Social Work Practice with Groups” Course

This article describes the design and delivery of a group work course that has as its primary purpose the meeting of group work practice standards. This multisection course uses a common course syllabus and a team approach to ensure the fidelity of course implementation. The recent development of a standards-based inventory of competencies in social work with groups, which measures the perceived importance of, and confidence in performing practice standards, led to the decision to administer the inventory to the authors' students at the beginning and end of the course to see if students were in fact making significant progress in the group work practice skills articulated in the standards. The results indicated that students were significantly more confident in their group work practice skills; however a few areas, particularly the development of middle-stage skills, were in need of further attention.     

Access to Services by the Elderly:

Abstract

This analysis evaluated the hypothesis that comorbidity, as a measure of physical health status, would negatively impact the stress management capability of caregivers. To examine this relationship, data from 3,112 caregivers participating in the Uniform Caregiver Assessment through California's Caregiver Resource Center System in 2000 were used. Results indicated that comorbidity was not a significant predictor of caregiver inability to manage stress; however, high depression scores, disruptive behavior by the care receiver, and reduced social support from family and friends were significantly associated. Implications for social workers in these areas are discussed.