Providing Care for Persons with Dementia in Rural Communities: Informal Caregivers’ Perceptions of Supports and Services

Dementia is one of the costliest and most time-consuming diseases among older persons. Although informal caregivers provide the majority of care for persons with dementia, little is known about the self-perceived need for social services of caregivers of persons with dementia within rural areas. This pilot study examined the knowledge, access and intent of the practice-oriented service model of caregivers of persons with dementia in rural communities in the Midwest U.S. After a systematic training, researchers interviewed 11 rural caregivers of persons with dementia (n = 11). Data were analyzed using thematic analysis. Although similarities with other caregivers of persons with dementia were found, important differences suggesting unique issues among these rural caregivers of persons with dementia. Many participants found strength in their community, which often served as a safety net of support. Consistent with existing literature, participants expressed financial concerns, geographic barriers and lack of dementia-specific services when using formal services. The need for more specialized formal services in rural areas to supplement existing informal care networks is discussed. Policies and services based on rural caregivers’ unique concerns and challenges and that build upon their existing care networks are recommended.     

Measuring Self-Appraised Changes following Participation in an Intervention for Caregivers of Individuals with Dementia

This study examined the psychometric properties of the Self-Appraisal of Change Scale, a measure designed to capture domains that are subjectively relevant to caregivers, associated with overall well-being, and amenable to change upon engaging in an intervention. Data from 107 caregivers of veterans with dementia enrolled in a randomized controlled trial of a telephone-delivered caregiver psychoeducation and support group program (the Telehealth Education Program (TEP)) were analyzed. The TEP, which was delivered by master’s prepared social workers and a nurse dementia care manager, targeted caregivers’ dementia-related knowledge, attitudes, and self-management skills. Analyses were conducted to determine the factor structure, reliability, validity, and measurement invariance of the scale. Factor analyses yielded a single-factor solution for the scale’s nine items. The reliability and construct validity of the scale were also supported by the analyses. Multi-group analyses suggested that meaningful comparisons of scale items and total raw scores can be made across usual care (UC) and intervention groups. The findings offer preliminary support that the scale may represent a valid and reliable instrument that captures perceived changes in key domains (e.g. caregiving knowledge, attitudes, and skill) following participation in a psychoeducational and support intervention trial.     

Live Discharge from Hospice and the Grief Experience of Dementia Caregivers

When an individual has dementia, family members are involved in many care transitions in their roles as caregivers. One such transition is the ‘live’ discharge from hospice services. This occurs when an individual no longer meets eligibility criteria. This can be difficult for caregivers who have been anticipating an end to understand in the context of their grief process. This qualitative study (N = 24) explored the experience of caregivers of adults with dementia, including Alzheimer’s disease, who experienced a ‘live’ discharge from hospice. Specifically, the experience of grief is examined. Results from this study highlight the complexity of caring for someone with a terminal disease and the grief experience in end-of-life care as caregivers struggle to understand the individual’s terminal prognosis as temporary. This is further complicated for caregivers who must resume caregiving responsibilities or assume a new caregiving role after experiencing a loss of hospice services. Finally, hospice social workers are well positioned to offer emotional and other concrete support to caregivers who experience a ‘live’ discharge.     

Elder Abuse in Turkey and Associated Risk Factors

Abstract

Elder abuse is one of the most important problems encountered by the elderly. Health, economical and psychological dimensions of the experience of aging also pose risk for elder abuse. This study aims to determine the abuse to which elder people are exposed based upon their own evaluations and to investigate the risk factors associated with elder abuse. This is a cross-sectional study among quantitative designs. Population of the study comprises 309 outpatient elders over the age of 65 referring to Ayd?n Do?an Geriatrics Clinic of Ankara University, Turkey. Collected data were analyzed by chi-square test and logistic regression. In total, 70.9% of the elderly participating in this study experienced abuse more than once. Majority of the participants were victims of emotional abuse (64.1%), followed by neglect and abandonment (26.9%) and economic abuse (12.6%). There was significant relation between sex, marital status, health status of the elderly and being abused (p?p?相似文献   

Elder abuse and neglect among veterans in Greater Los Angeles: prevalence, types, and intervention outcomes

This study examined the prevalence, types, and intervention outcomes of elder abuse/neglect among a veteran population. A review of medical records of 575 veterans who had received services from the Veteran's Affairs Geriatric Outpatient Clinic in Los Angeles during a three-year period found 31 veterans (5.4%) who had an elder abuse report filed on their behalf. Prevalence of elder abuse/neglect was higher among older (80+) and Caucasian and African American veterans. Eight of 31 victims suffered from more than one type of elder abuse including self-neglect. Financial abuse and self-neglect were the most commonly reported types. Family members were perpetrators in the majority of the cases, excluding self-neglect. However, three-quarters of financial abuse cases were committed by non-family members. Almost one-half of the victims had dementia and eight were clinically depressed. The most common intervention was to move victims from their unsafe home into a nursing home or board and care facility, followed by conservatorship arrangement. These interventions were most frequently used for victims with dementia, and conservatorship was often arranged with another type of intervention, such as a move to a nursing home. Victims who remained at home received conservatorship or outside supportive services or a combination of both. This study calls for more comprehensive and systematic research on elder abuse/neglect at multi-settings in order to generate useful information for prevention and detection of, and effective intervention in elder abuse and neglect in the veteran population.     

Social support,self-efficacy and gender as predictors of reported stress among inpatient caregivers

The study examined the predictive role of social support, self-efficacy and gender on self-reported stress among inpatients’ caregivers. One hundred and sixty eight (36 males and 132 females) inpatients’ caregivers were sampled from University of Nigeria Teaching Hospital (97) and Niger Foundation Hospital (71) all in Enugu, Nigeria. Three instruments were used for the data collection, namely, Multidimensional Scale of Perceived Social Support (MSPSS), New General Self Efficacy Scale (NGSES), and the Perceived Stress Scale (PSS). The study adopted a cross sectional design and Multiple Regression was used for data analysis. Results showed that social support negatively predicted inpatient caregivers’ reported stress (β = ?.28, p < .001). Gender significantly predicted stress among the inpatients’ caregivers (β = .35, p < .001). Findings were discussed and implications of the study highlighted.     

Cross-Cultural Validation of the Child Abuse Potential Inventory in Finland: Preliminary Findings of the Study Among Parents Expecting a Baby

ABSTRACT

In order to decrease physical child abuse, measures to recognize parents' abuse potential are needed. In this article, cross-cultural validation of the Child Abuse Potential (CAP) Inventory, an American measure was used to screen child abuse potential in families. Data were collected in 2012 from Finnish families expecting a baby at maternity and child welfare clinics. The data come from 380 families, including 375 mothers and 303 spouses. The validation was conducted separately for mothers and spouses and was based on basic psychometric properties, such as reliability estimates, abuse scale construct validity, and the abuse scale factor structure. The internal consistency of the abuse scale was high among both the mothers and the spouses. There were some differences in abuse construct validity and the abuse scale factor structure compared to the original measure, which was written in English and tested in an American sample. Those differences were, however, similar to those found by other studies that used translated versions of the inventory. In summary, the CAP Inventory was found to be a valid screening tool for professionals to assess parents' child abuse potential in Finnish service settings, and therefore its implementation is recommended in maternity and child welfare clinics. The validation supports the cross-cultural use of the CAP Inventory and future research on the subject.     

The Process of Change in Complicated Grief Group Therapy for Bereaved Dementia Caregivers: An Evaluation Using the Meaning of Loss Codebook

ABSTRACT

Caring for a person with dementia has adverse health and mental health effects that, for 9–25% of caregivers, persist as complicated grief (CG). For bereaved dementia caregivers unable to satisfactorily grieve, specialized Complicated Grief Group Therapy (CGGT) can restore healthy grief. We investigated therapeutic change in CGGT participants, using an adapted version of the Gillies’ Meaning of Loss Codebook. Participants demonstrated positive gains in 16 thematic areas, notably in moving on with life, summoning pleasant memories, and ascribing bad memories to disease rather than decedent. Meaning transitioned from negative to positive interpretations of the death over the course of treatment.     

Mosaic of Difference

Summary

The professional literature has not adequately addressed the behavioral and social factors that contribute to different coping outcomes for African American elder caregivers as compared to non African Americans. Awareness and understanding of these unique experiences would better prepare professionals to work with such clients. This study examines the predictors of emotional distress among 46 African American women who provide care to dependent elderly parents. Multivariate statistical analyses show that elder caregivers' rating of quality of life, their years of caregiving, as well are their poor heath constitute significant predictors of risk for depression. The results of the study provide support for the inclusion of more culturally appropriate measures of caregiver distress, and provide insights to inform social work practice, policy and research concerning African American female elder caregivers in the 21st century.     

Korean Version of the Revised Problem-Oriented Screening Instrument for Teenagers Substance Use/Abuse Scale: A Validation Study

ABSTRACT

The objective of this study is to validate the Korean version of the revised Problem-Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse scale for measuring adolescent substance abuse problems. The Korean version of the revised POSIT was validated with a sample of 1,051 students in grades 7–12 in Korea. Exploratory factor analysis identified that the Korean version of the revised POSIT is a unidimensional screening instrument similar to the English version. The Korean version of the revised POSIT showed high internal consistency reliability and good convergent validity and demonstrated optimal performance at a cut-off score of 1, which was the score recommended by its developer. The Korean version of the revised POSIT is a reliable and valid instrument for measuring Korean adolescent substance abuse. However, validation with clinical samples is needed to improve its ability to correctly capture substance-abusing adolescents.     

Mosaic of difference: enhancing culturally competent aging-related knowledge among social workers

The professional literature has not adequately addressed the behavioral and social factors that contribute to different coping outcomes for African American elder caregivers as compared to non African Americans. Awareness and understanding of these unique experiences would better prepare professionals to work with such clients. This study examines the predictors of emotional distress among 46 African American women who provide care to dependent elderly parents. Multivariate statistical analyses show that elder caregivers' rating of quality of life, their years of caregiving, as well are their poor heath constitute significant predictors of risk for depression. The results of the study provide support for the inclusion of more culturally appropriate measures of caregiver distress, and provide insights to inform social work practice, policy and research concerning African American female elder caregivers in the 21st century.     

Validation of multidimensional scale of perceived social support in middle-aged Korean women with diabetes

Purpose: The purpose of this study was to validate the Multidimensional Scale of Perceived Social Support (MSPSS) among middle-aged Korean women with type 2 diabetes. Methods: Data were collected from 123 middle-aged Korean women with diabetes. Construct and concurrent validity were examined using factor analysis. Results: Factor analysis extracted three factors: spouse, family, and friends. The MSPSS had relatively good concurrent validity (r = .66, p < .0001), construct validity, and strong reliability (Cronbach's alpha = .90). Conclusion: We concluded that the MSPSS is a simple and well-established instrument to measure social support in middle-aged Korean women with diabetes.     

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.     

Service workers' responses to abuse of the elderly

The social service providers and physicians who encounter elder abuse have several potential avenues of intervention open to them in helping the elderly. Practice and training issues are discussed that are relevant for improving interventions and referrals in cases of family abuse of the elderly.     

Domestic abuse treatment perspective that builds client voice and skills in a court-ordered environment

Building client voice in men who abuse to reduce dropout and improve outcomes in domestic abuse treatment continues to challenge. This mixed-method study examined the implementation of the Outcome Rating Scale (ORS), a client feedback tool, as a component of an open-ended group domestic abuse program (N = 25). Additionally, the Social Empathy Index (SEI) was administered during pre- and posttreatment individual interviews. Further information about the treatment experience was gleaned from interviews of three treatment completers. More than three fourths of the participants (21 or 84%) completed the minimum of 18 weeks, more than one third (8 or 38%) of completers showed reliable or clinically significant change on the ORS, with a statistically significant increase on the SEI reflecting increases in empathy concurrent with their view of making progress in treatment. Building awareness of self and others’ points of view and applying relationship enhancement skills were key themes expressed during interviews.     

Challenges to and Strategies for Formal Service Utilization among Caregivers in an Underserved Community

Family caregivers face enormous challenges when attempting to oversee the medical, legal, financial, and daily affairs of loved ones with chronic or life-limiting illness. While formal services and agencies exist to assist caregivers with some of these tasks, caregivers in underserved communities do not utilize these services, or utilize them with unsatisfactory results. This study used focus groups (N = 5 groups) with underserved, minority caregivers (N = 22) to explore their experiences related to care provision, including barriers to support service use and challenges navigating systems related to the broad spectrum of caregiving demands. Thematic content analysis revealed three main themes: (1) prior difficulties with formal service use, (2) difficulties navigating financial, legal, and medical systems, and (3) caregivers’ personal strategies to address challenges associated with formal service use and systems navigation. Findings from this study identify underserved caregivers’ challenges in utilizing formal services, as well as caregiver-identified strategies for supporting their caregiving activities.     

Use of a single page elder abuse assessment and management tool: a practical clinician's approach to identifying elder mistreatment

Elder abuse is a growing, alarming public health issue. As health care professionals, our challenge is to balance our duty to protect the safety of the vulnerable elder with the elder's right to self-determination. Clinicians in busy practice settings across the continuum of care as well as community-based social workers, emergency medical system, police, and banking personnel are collaborative partners needing tools that focus on early recognition, assessment, intervention, and management of elder abuse. A simple one-page tool that provides principles of assessment and management, best practice guidelines and screening questions will hopefully serve to raise awareness of this important public health issue and maintain a high index of suspicion for elder abuse, neglect and financial exploitation.     

Primary Caregivers and Chinese Elders’ Demand on Community Services

Abstract

The most influential model explaining the elderly’s service use is Andersen and Newman's model. But the applicability of the model on elders’ demand on community services has not been tested, especially in developing countries such as China. This research tested the applicability of the model by studying how primary caregiver relations to the elderly influence Chinese community-dwelling elders’ demand on community services. With a total of 2,124 respondents aged 65 and older who reported primary caregivers, six primary caregiver relations were examined: son, spouse, daughter, daughter-in-law, unmarried son and daughter, and other. Data came from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results indicated that: (1) Elders cared for by daughters-in-law showed a significantly stronger tendency of expecting community services than elders cared for by other caregivers among both rural and urban areas. (2) Elders were least likely to expect community services in two cases: urban elders taken care of by daughters and rural elders whose primary caregivers were unmarried sons and daughters. Since Chinese elders cared for by different caregivers tended to seek community care in different manners, future research may study how suitable community service programs can be developed to well meet the needs of various elderly groups.     

An Ethical Dilemma in Elder Abuse

Abstract

While most elder abuse is perpetrated by family members, some may be performed by strangers. When the elderly victim reaches out to the social agency but then refuses services, an ethical dilemma is created for the social worker. Conflicts arise among social work values and the ethical principles of autonomy and paternalism, beneficence, and nonmaleficence. A model of ethical justification is applied that explains the possible decisions in this case. The actual resolution of the dilemma is accomplished through a social work practice principle.