An Ecological Understanding of Caregiver Experiences in Palliative Care

Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner’s ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families.     

Family caregivers’ perceptions of maltreatment of older adults with dementia: findings from the northwest of Spain

Dementia is a neurocognitive disorder that implies a risk factor of maltreatment by family caregivers. In this study, we analyzed both informal caregiver’s perceptions of maltreatment and aspects of the caregiver and caregiving behavior that may be associated with maltreatment. We conducted five focus groups (FGs) in three Spanish cities: Segovia, Soria and León. The themes that were identified were related to two levels of maltreatment: (a) relational and (b) institutional. At the relational level, we observed the justification of maltreatment of Older Adults with Dementia (OAswD) by family caregivers during the occurrence of behavioral symptoms. At the institutional level, we noted that lack of support from the government was considered a type of maltreatment. These themes suggest that policy issues related to healthcare should be considered.     

Staff Member Reactions to Same-Gender,Resident-to-Resident Sexual Behavior Within Long-Term Care Facilities

The current study assesses ageism and heterosexism relating to older adult sexual activity within long-term care facilities. To assess caregiver reactions, 153 residential care facility staff members read one of three vignettes. Each vignette described a scenario in which a staff member walks in on two residents (male/female, male/male, or female/female) engaging in sexual activity. Although no main effects were discovered for vignette type, exploratory analyses revealed that the facility where participants were employed was significantly related to their ratings of approval. Furthermore, an interaction effect between vignette and facility types was also discovered for caregivers’ approval of sexual activity among residents. Additionally, a strong overall approval rating of older adult sexuality was reported by staff members. The results of this study warrant that further research is necessary regarding older adults’ perception of caregiver bias, as well as further investigation of caregivers’ perceptions of older adults’ sexual activity.     

The Effects of Nursing Home Placement on the Perceived Levels of Caregiver Burden

Providing care for an aging parent can be one of the most fulfilling life experiences for an adult child. It can also be one of the most exhausting physically, emotionally, and financially. A caregiver experiences psychological and emotional changes when their dependent parent or spouse is placed into formal care. This research project uses the Montgomery Borgatta Caregiver Burden Scale, amended with a questionnaire, in a self-administered, anonymous survey to explore perceptions of caregiving burden before and after the nursing home placement periods. This research showed that numerous factors influence caregivers' perceptions of burden and the quality of relationships among family members.     

SOCIOCULTURAL DIMENSIONS

No abstract available for this article.     

Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community

ABSTRACT

Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N = 1,670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates, underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical management of community-dwelling elder abuse victims.     

Weighing the Success of a National Alzheimer's Disease Service Demonstration

Summary

As the need for long-term care services within the United States has grown dramatically, Congress has consistently deflected the primary responsibility for such care to state governments, local organizations, and, ultimately, the family. This paper examines the impact of the Alzheimer's Disease Demonstration Grants to States (ADDGS) program, a small federally funded initiative within the context of this trend. Although the demonstration can be deemed a huge success relative to the goals of creating new services for an underserved target population, questions are raised about the merits of the program relative to the exploding need for an effective network of long-term care services.     

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.     

Examination of a Psychoeducational Intervention and a Respite Grant in Relieving Psychosocial Stressors Associated with Being an Alzheimer's Caregiver

Alzheimer's disease can be particularly devastating to those who are caring for their loved one with the condition. There have been recent calls for the tailoring of caregiving interventions to examine outcome differences between groups of caregivers and the reporting of effectiveness via longitudinal and specific outcomes. The purpose of this study was to examine 3 interventions (psychoeducational training, a respite voucher-type grant, or their combination) while looking for possible group differences. A total of 367 caregivers participated in the study. Participants completed surveys and questionnaires before the intervention and at a 6-month follow-up. Positive outcomes were found, including lower depression scores, increased support service use, and increased support group usage. Possible effectiveness of the 3 types of interventions and variation among caregiver characteristics are discussed along with implications for future research.     

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.