Finding meaning through caregiving: development of an instrument for family caregivers of persons with Alzheimer's disease

Development of a conceptual framework of positive aspects of caregiving in dementia

Research on family caregivers usually focuses more on stress and burden, especially in the context of looking after a person with dementia. This leads to fewer considerations of positive aspects of caregiving. Thus enhancing these positive aspects represents an innovative approach to caregivers’ support. Furthermore, these aspects need more conceptualization to underpin the development of such an approach. This article proposes a conceptual framework of the positive aspects of caregiving based on an integrative literature review. This conceptual framework provides a comprehensive model that should improve understanding of positive aspects of caregiving. It could also contribute to the development of innovative support programs based on the positive aspects instead of the negative aspects of caregiving.

Caregiver experience in mental illness: a perspective from a rural community in South Africa

After the democratization of South Africa in 1994, the health-care system was reorganized in accordance with the primary health-care philosophy advocated by the World Health Organization. This was accompanied by a process of deinstitutionalization of mental health-care services, which has led families to become the main providers of care to individuals with mental illness. This study explores the experiences of informal family caregivers of persons with mental illness in a rural area in South Africa. Data were collected through eight individual semistructured interviews of informal caregivers who cared for relatives with mental illness and collect medications monthly at a community clinic in the Makhuduthamaga local municipality in Limpopo, South Africa. A qualitative research design was used, which was explorative, descriptive, and contextual. The data analysis revealed four major themes: (i) experiences of providing for physiological/physical needs; (ii) experiences of providing for emotional needs; (iii) experiences of providing for security needs; and (iv) experiences associated with the medical health-care programme. The study revealed that the experiences of family caregivers were conceptualized negatively, although the interview questions were intentionally neutral. This is believed to be due to the cultural explanatory models of mental illness prevalent in this region of South Africa. It is suggested that to increase compliance with medication, reduce relapse, and mitigate stigma associated mental illness, medical professionals need to incorporate aspects of cultural explanatory models into their explanations of the causes of illness.

Evaluating Differential Item Functioning of the CES-D Scale According to Caregiver Status and Cultural Context in Korean Women

BACKGROUND

Proper evaluation of the generalizability of an instrument is critical for its use across different social contexts such as caregiver status.

OBJECTIVE

To examine the differential item functioning of the Center for Epidemiologic Studies Depression (CES-D) Scale, patterns of response to each item of the CES-D Scale attributable to caregiver status was assessed.

STUDY DESIGN

Using a cross-study comparison method, a sample of 58 matched pairs of Korean American caregivers and noncaregivers was used for matched moderated regression analysis on the CES-D Scale.

RESULTS

The authors identified three items that vary according to caregiver status in the present study: Item 2 (My appetite was poor), Item 4 (I felt that I was as good as other people), and Item 14 (I felt lonely).

CONCLUSIONS

Beyond assessing the level of depression through total CES-D scores, it is important to examine variations in the items of the CES-D Scale across different social contexts. J Am Psychiatr Nurses Assoc, 2009; 15(4), 240-248. DOI: 10.1177/1078390309343713.

A Chinese version of the Meaning in Caregiving Scale: an assessment of its reliability and validity

PURPOSE

To evaluate the reliability and construct validity of the Meaning in Caregiving Scale (MICS) by confirmatory factor analysis and to explore whether the MICS meets the goodness-of-fit criteria for the 3-factor model.

DESIGN AND METHODS

Four hundred and eighty subjects in Taiwan were recruited. The hypothesized confirmatory factor analysis model specifies the items to measure the reordering priority, relationship fidelity, and transcendent belief as indicators of latent factors.

FINDINGS

The data show that the hypothesized 3-factor model does not fit the data well and indicate that the 3 factors might share a high-order common factor. Cross-cultural issues may account for this shortcoming.

PRACTICE IMPLICATIONS

This scale offers better understanding around caregivers for psychiatric patients and the issues they face.

The hidden patient: addressing the caregiver

Premium caregiving is pivotal to achieve quality care for persons with chronic or disabling conditions. Unpaid informal caregivers currently provide for a substantial proportion of care recipient needs including 80% of long-term care needs in the United States. Within the next 2 decades, 78 million baby boomers will reach 65 years of age and older, creating unique and extensive challenges to an already flawed health care system; this older cohort will at minimum increase utilization of health care resources. On an individual level, care providers need to support and educate caregivers and make caregivers partners in the delivery of excellent care. To achieve this, health care professionals need to educate themselves regarding the caregivers' demographics, ethnicity, characteristics, effective interventions, and outcomes. From a health policy perspective, public, private, and community funding needs to be allocated to advocate for, encourage, and train these caregivers.

Personal growth and cognitive complexity in caregivers of patients with dementia

According to several theoretical models, crises or demands can result in enhanced cognitive maturity. Two studies examined whether demands on caregivers provide an opportunity to experience increased cognitive maturity (e.g., cognitive complexity, personal growth through caregiving). In Study 1 (126 relatives of dementia patients; cross-sectional design), personal growth through caregiving was associated with two specific caregiving demands: duration of caregiving and lack of social acknowledgment. Cognitive complexity correlated with duration of caregiving and crystallized intelligence. The caregivers in the second study (N = 321) were participants in LEANDER, The Longitudinal Dementia Caregiver Stress Study. Caregivers were examined in four waves over 27 months. The results indicated an increase in personal growth over time. Using latent growth models, we found that increases in personal growth through caregiving were predicted by increases in the objective caregiving tasks. Cognitive processes (e.g., ruminative thoughts, life reflection) provide a possible explanation for an increase in cognitive maturity.

An alternative framework for understanding women's caregiving stress: a qualitative application of the ways of coping model

In this article we present an alternative to inventory checklist approaches to measuring coping. We utilized a qualitative approach to explore themes of problem-focused, emotion-focused and meaning-focused coping in a sample of 98 women from diverse backgrounds and caregiving situations. Their narratives reflected the ;goodness of fit' coping framework; that different strategies are more effective for stress reduction in relation to the amount of perceived control. Using a narrative approach allowed us to situate coping within the context of the caregiving experiences that the women discussed. This permits a broader understanding of how coping strategies can help women to navigate caregiving and reduce stress.

Engagement in activities

This study identifies how persons with dementia and their caregiving spouses individually perceive their own, their spouse's and their mutual engagements in everyday activities. Fifty-two cohabiting spouses, half of whom were diagnosed with dementia, were interviewed. A qualitative constant comparative analysis was performed, identifying four major themes: perceived changes in activity engagements; consequences of experienced changes; dilemmas experienced by the caregivers; and management approaches to handle a changed everyday life. Each individual described their activities to include loss of social engagements and changes in the relationship. Dilemmas experienced by the caregivers included `interfering with the spouse's engagement or not' and `placing the spouse's or one's own needs first'. The caregiver management approaches identified included `taking over' or `encouraging initiative'; `lowering demands or avoiding problematic engagements'; and `managing through collaboration'. Findings provide insight into everyday engagements for persons with dementia and their caregivers, important to healthcare support providers.

Development and validation of an Eating Disorders Symptom Impact Scale (EDSIS) for carers of people with eating disorders

BACKGROUND

Family members of relatives with eating disorders experience high levels of distress due to the difficulties in their care giving role. However no measures have been developed to measure the specific impact that an individual with an eating disorder has on family life. The aim of this study was to develop a measure to assess the specific caregiving burden of both anorexia nervosa and bulimia nervosa. A secondary aim was to examine whether this measure was sensitive to change.

METHODS

A new scale, the Eating Disorders Symptom Impact Scale (EDSIS), was generated by a panel of clinicians and researchers based upon quantitative and qualitative work with carers and reviewed by a panel of "expert carers". A cross-sectional study was conducted among carers of relatives with an eating disorder to examine the properties of the new scale. In addition, participants from an ongoing pre-and-post design study completed several self-report questionnaires to assess the sensitivity of the EDSIS to change.

RESULTS

A sample of 196 carers of relatives with an eating disorder aged 25-68 compted the scale. A 24-item EDSIS scale was derived with four factors: nutrition, guilt, dysregulated behaviour and social isolation. These explained 58.4% of the variance in carer distress. Reliability was acceptable (Cronbach's alpha ranged from 0.84 to 0.90). The convergent validity of the EDSIS subscales was moderately supported by correlations with a general caregiving measure (Experience of Caregiving Inventory (ECI), r = 0.42 to 0.60), psychological distress (General Health Questionnaire (GHQ-12), r = 0.33) and perceived functioning of the relative (Children Global Assessment Scale (CGAS), r = -30). A sample of 57 primary caregivers completed pre-post intervention assessments and the overall scale (t = 2.3, p < 0.05) and guilt subscale (t = 3.4, p < 0.01) were sensitive to change following a skills training workshop.

CONCLUSION

The EDSIS instrument has good psychometric properties and may be of value to assess the impact of eating disorder symptoms on family members. It may be of value to highlight carers' needs and to monitor the effectiveness of family based interventions.

A review of instruments developed to measure outcomes for carers of people with mental health problems

OBJECTIVE

Community-based care for mental disorders places considerable burden on families and carers. Measuring their experiences has become a priority, but there is no consensus on appropriate instruments. We aimed to review instruments carers consider relevant to their needs and assess evidence for their use.

METHOD

A literature search was conducted for outcome measures used with mental health carers. Identified instruments were assessed for their relevance to the outcomes identified by carers and their psychometric properties.

RESULTS

Three hundred and ninety two published articles referring to 241 outcome measures were identified, 64 of which were eligible for review (used in three or more studies). Twenty-six instruments had good psychometric properties; they measured (i) carers' well-being, (ii) the experience of caregiving and (iii) carers' needs for professional support.

CONCLUSION

Measures exist which have been used to assess the most salient aspects of carers outcome in mental health. All require further work to establish their psychometric properties fully.

Meaning in life and personal growth among pediatric physicians and nurses

Studies examining medical teams indicate that exposure to the terminally ill often has detrimental effects on their physical and emotional well-being. However, recent theoretical developments suggest that this exposure might also have positive implications. The current study sought to examine 2 positive outcomes, meaning in life and personal growth, among physicians and nurses working with hospitalized children and exposed to different levels of patient mortality. In addition, the contribution of level of secondary traumatization and the personal resources of professional self-esteem and optimism were examined. The sample consisted of 58 physicians and 66 nurses working in pediatric hemato-oncology, pediatric intensive care units, and pediatric internal medicine wards in Israel. The findings indicate that a higher level of exposure to patient death, higher optimism, and professional self-esteem, and lower secondary traumatization predicted the sense of meaning in life, whereas occupation, as well as higher professional self-esteem and higher level of secondary traumatization, especially among lower professional self-esteem individuals, predicted a higher experience of personal growth. In addition, nurses reported higher levels of professional self-esteem, secondary traumatization, and personal growth than physicians. The theoretical and practical implications of the results are discussed.

Living with early-stage dementia: the perspective of older Chinese people

AIM

This paper is a report of a study to describe the lived experiences of people with early-stage dementia and their ways of coping with the illness.

BACKGROUND

Emerging models of subjective experience and coping with early dementia have been developed in Western cultures. Understanding how Chinese people with early-stage dementia adjust and cope is an important starting point in developing interventions that can enhance their adaptive coping.

METHOD

A convenience sample of 15 Chinese people in the early stages of dementia were interviewed and observed during home visits. The study involved in-depth transcribed interview data using a phenomenological approach. The data were collected in 2005.

RESULTS

Four themes were identified in the data: attribution of illness, experiencing losses resulting in frustration and uncertainty, adapting to a new role in relationships with family and friends and continuing to live. People with early dementia who adopted a positive outlook did so because they had made sense of and accepted the illness, received understanding and support from family and friends and were being listened to and respected.

CONCLUSION

The themes emerging from the findings could be used as a framework in understanding how people cope with the onset of early dementia. The framework includes specific implications for the provision of intervention services and highlights the importance of understanding people's own constructions of their illness and how they adjust their lives in coping.

Correlates of physical health of informal caregivers: a meta-analysis

Effects of caregiving on physical health have received less theoretical and empirical attention than effects on psychological health. This meta-analysis integrates results from 176 studies on correlates of caregiver physical health. Caregiver depressive symptoms had stronger associations with physical health than did objective stressors. Higher levels of care recipient behavior problems were more consistently related to poor caregiver health than were care receiver impairment and intensity of caregiving. Higher age, lower socioeconomic status, and lower levels of informal support were related to poorer health. Predictors of physical health are not identical to predictors of psychological health. Associations of caregiving stressors with health were stronger among older samples, dementia caregivers, and men. In sum, negative effects of caregiving on physical health are most likely to be found in psychologically distressed caregivers facing dementia-related stressors.

Dementia care: mental health effects, intervention strategies, and clinical implications

Caring for elderly people with dementia is associated with well-documented increases in burden, distress, and decrements in mental health and wellbeing. More severe behavioural, cognitive, and functional impairments in a patient are associated with higher levels of burden and distress. Distress increases with care hours per week, number of tasks, and declining coping and support resources. Demographic factors also affect levels of burden and distress. Promising, evidence-based interventions exist, but substantial economic and policy barriers preclude their widespread dissemination. Health-care policy makers should consider addressing these barriers; clinicians and families must campaign for reimbursement; and clinical researchers must develop more potent preventive interventions. In this article we review how dementia care affects the mental health of the carer and identify interventions that might be useful in mitigating carer burden and distress.

Mental health and diurnal salivary cortisol patterns among African American and European American female dementia family caregivers

Using a sociocultural stress and coping model, this pilot study examines the influence of depressive symptoms and stress on diurnal salivary cortisol patterns among African American (N=30) and European American (N=24) female dementia caregivers and noncaregivers (African American, N=48; European American, N=15). Caregiving participants completed the Center for Epidemiological Studies Depression Scale (CES-D), Perceived Stress Scale (PSS), and Stress-Related Growth Scale (SRGS) as respective measures of depressive symptoms, stress, and stress resilience. Participants also collected five saliva samples daily for two consecutive days. African American caregivers scored significantly higher than European American caregivers on the SRGS, but they did not differ on the PSS and CES-D scales. Regression analyses with age, ethnicity, caregiving status, and depressive symptoms as predictors, and cortisol slope as criterion, showed that only age and ethnicity predicted cortisol slope. African Americans had flatter slopes than the European Americans sampled, regardless of caregiving status. Findings highlight the role of cultural beliefs and of ethnicity in explaining cortisol function.

Caring for the terminally ill: experiences of Latvian family caregivers

AIM

To increase understanding of the experiences and needs of family caregivers of terminally ill persons in Latvia.

BACKGROUND

Latvia has high death rates from cardiovascular disease and cancer, and families care for the terminally ill with little preparation and support. Health professionals also have little preparation in supporting these patients and families at the end of life.

METHODS

A qualitative study was carried out in the summer of 2004 in Latvia. Data collection was by semi-structured interviews with caregivers (n=18) whose care recipients died at least 1 year previously.

FINDINGS

The caregiver narratives addressed experiences that paralleled the trajectory of the patient's illness: the disruption of normal life patterns; taking on the caregiver role; establishing new patterns and learning role competencies; engaging in preparation for dying; and the gains and losses of the caregiving experience as seen in retrospect.

CONCLUSIONS

The caregiver narratives suggested a need for more education in practical caregiving; access to patient care equipment and supplies; and a need for ongoing support and guidance by knowledgeable medical personnel during caregiving.

Relational conversation as method for creating partnerships: pilot study

AIM

This paper reports a pilot study testing the intervention, Self-Care TALK, whose aim was to describe communication skills used by an advanced practice nurse to create partnerships with caregivers. The communication process and examples of skills used in creating partnerships are described.

BACKGROUND

Decades of exploring nurse-client relationships provide a knowledge base for describing a structure and process for building partnerships. Self-Care TALK functions as a vehicle for an education and support partnership. Self-Care TALK, a theory-derived intervention, is based on the Self-Care for Health Promotion in Aging model. Implementation of the intervention was evaluated in a pilot study in 2003, with older spouse caregivers of persons with early dementia.

METHODS

Pilot testing of Self-Care TALK followed Lichstein's criteria of tracking three phases of intervention: delivery, receipt and enactment. Henson's communication elements for establishing partnership relationships provided a guide for advanced practice nurse communication. Self-Care TALK was delivered during six phone conversations with caregivers for a total of 36 phone conversations. All phone conversations were audiotape recorded. Field notes were taken during each conversation. Data analysis followed a qualitative descriptive process of comparative analysis in which communication skills were compared across conversations. Categories of skills were named based on communication elements that dominated the category. Communication skills were compared to literature addressing communication and nurse-client partnerships.

FINDINGS

Communication examples described the structure for interaction (Self-Care TALK protocol), process of interaction (relational conversation) and caregiver identified outcomes (intentions to enact self-care).

CONCLUSION

Conversations to create partnerships depended on one theme: language that supported relational conversation. Four communication skills illustrated the how of relational conversation: listening with intent, affirming emotions, creating relational images, and planning enactment.

Gender differences in caregiver stressors, social resources, and health: an updated meta-analysis

This meta-analysis integrates results from 229 studies on gender differences in caregiver psychological and physical health, caregiving stressors, and social resources. Contrary to common perceptions, gender differences in caregiving variables were small to very small. Women had higher levels of burden and depression, and lower levels of subjective well-being and physical health. They reported that their care recipient had more behavioral problems; they provided more caregiving hours, helped with more caregiving tasks, and assisted with more personal care. Women and men did not differ in the use of informal and formal support. Statistically controlling for gender differences in stressors and resources reduced the size of gender differences in depression and physical health to levels that have been observed in noncaregiving samples. The results support stress-and-coping theories on gender differences in caregiving.

Caregivers' perceptions of dementia patients' functional ability

Dementia patients' caregivers often provide information about patients' daily functioning, but little is known about factors influencing caregivers' perceptions. Baseline data from an intervention trial were used to compare caregiver estimates of dementia patients' performance with their actual performance of instrumental activities of daily living (IADLs) and to assess relationships between measures of caregiver responses to caregiving, self-perceived sense of self-efficacy, and depression. We also assessed patient cognition, overall function and behavioral disturbance, and caregivers' perceptions of their patients' behavior as manipulative or deliberate. Disparities between these estimates and actual patient performance on structured IADL tasks were unrelated to any caregiver, patient, or relationship factor that we measured

Caring for family with Alzheimer's disease and Parkinson's disease: needs, challenges and satisfaction

A convenience sample of 40 family members caring for an individual with either Alzheimer's disease (AD) or Parkinson's disease (PD) completed the Caregiver Assistance Measure (CAM) to identify the types of assistance that would be most helpful in caring for a family member at home. The CAM measures three categories or types of assistance: care knowledge and skills, self-care, and resource acquisition. Caregivers also completed open-ended questions about the difficulties and the satisfactions of caregiving. The PD and AD caregivers agreed on the importance of 75% of the assistance items on the CAM. In addition, both groups of caregivers identified issues related to care knowledge and skills and selfcare as the most difficult aspects of caregiving. These findings suggest many caregiver needs may be common across chronic illness populations and provide initial support for the development and testing of standardized interventions for caregivers.

Racial and ethnic differences in the relationship of caregiving stressors, resources, and sociodemographic variables to caregiver depression and perceived physical health

Racial and ethnic differences in the association of stressors, resources, and sociodemographic characteristics with depressive symptoms and perceived physical health were investigated. Data from 653 White non-Hispanic caregivers, 278 African American, and 218 Hispanic Alzheimer's caregivers (209 males, 940 females) who were assessed at the baseline data collection of the REACH study, a multisite trial of caregiver interventions, was obtained. Multiple sample analysis, which allows testing whether a pattern of relationships is invariant across different samples, was used. Results support the hypothesis that, despite significant differences in resources and stressors, the predictors of depression and health are relatively uniform across groups. Ethnic differences were found for the effect of age, income, gender, and care receiver's self-care impairments on caregiver depression. For perceived physical health, there were ethnic differences for the effect of income, gender, and type of caregiver relationships.

A randomized, controlled study of an Alzheimer's caregiver skills training program

This study was an attempt to improve the quality of the relationship between dementia caregivers and their loved ones by decreasing the gap between caregivers' expectations and patients' actual functional abilities and by teaching supportive skills. Although a group of 49 caregiver-patient dyads were recruited, the outcome measures of only those dyads (47) that completed the week seven session were used for analysis. Half of the dyads were randomized to an intervention group and the other half to a waiting list. The intervention group (N = 24) completed a four-session caregiver training program in which caregivers first watched investigators administering to their loved ones the Texas Functional Living Scale and later progressed to helping their loved ones by appropriate cueing to perform the tasks involved. Comparisons were made between baseline scores, scores at seven weeks, and scores at the end of 17 weeks on the congruence between caregiver estimates and patients' actual performance on the Independent Living Scale and measures of cognition, function, preillness quality of relationship, caregiver mood, feeling of self-efficacy, and several other measures. We were not able to increase the congruence between caregiver estimates and patients' actual performance and found no change in any other measure. We didfind the expected relationship between depression and caregiver sense of self-efficacy.

Development of a brief assessment scale for caregivers of the medically ill

Studies have documented high degrees of burden and negative outcomes for caregivers. The present study sought to develop a brief instrument for caregiver burden. An item pool was administered to 102 caregivers of patients with chronic illnesses (cancer, 55%; neurological, 15%; psychiatric 12%), along with measures of caregiver burden and quality of life. Item reduction was accomplished through content review and factor analysis. This yielded a 14-item Brief Assessment Scale for Caregivers (BASC) and an eight-item subscale measuring negative personal impact (NPI). Cronbach's alpha was 0.70 for the BASC and 0.80 for the NPI. Construct validity was confirmed by appropriate patterns of intercorrelation with other measures of caregiver burden. Higher burden was found for caregivers expected to have higher levels of distress (adult children caring for parents, P<0.005; female caregivers, P=0.035). These results support the validity of the BASC as a brief instrument for caregiver burden.

Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison

The present meta-analytic study gives a systematic review of research on depression and the subjective well-being of caregivers. We integrate results from 60 studies on informal caregivers' subjective well-being (e.g., positive affect, life-satisfaction) and contrast them with the result of studies on caregiver depression. Analyses were based on a two-factor model of subjective well-being that distinguishes between positive and negative dimensions of well-being (e.g., happiness and depression). The strongest effects were domain-specific: uplifts of caregiving were associated with subjective well-being and caregiving stressors were associated with depression. In addition, weaker effects that crossed domains were present: uplifts were weakly associated with depressive symptoms. In addition, lower levels of caregivers' subjective well-being were weakly related to care receivers' physical and cognitive impairments, as well as behaviour problems, but not to the amount of caregiving. Type of care recipients' illness and the measure of well-being moderated, in part, the association between stressors/uplifts and subjective well-being.

Depression among Korean, Korean American, and Caucasian American family caregivers

This study compared depressive symptoms among Korean, Korean American, and Caucasian American female family caregivers of older persons with dementia. The sample included Korean caregivers living in Seoul, Korea (KK); Korean American (KA) caregivers living in the Chicago and Los Angeles areas; and Caucasian American (CA) caregivers from the Chicago metropolitan area. KK caregivers were more likely to be daughters-in-law, KA caregivers were more likely to be daughters, and CA caregivers were more likely to be wives or daughters. Overall, wives were more depressed than daughters and daughters-in-law. KK caregivers were the most depressed of the three cultural groups. When caregiver relationship and cultural group were examined simultaneously, KK and KA wives were most depressed, and KA daughters-in-law were least depressed. Differences in culture and social role appeared to affect depressive symptoms among these caregivers. The findings suggest a need to further examine the associations between caregivers' relationships with their care recipients and their own emotional status.

A Systematically Tested Intervention for Managing Reactive Depression

BACKGROUND

Patients and family caregivers repeatedly experience reactive depression that leads to medication errors, mismanagement of chronic disease, and poor self-care. These problems place them at high-risk for malnutrition, infection, heart diseases, and psychiatric sequelae.

OBJECTIVES

A secondary data analysis compared findings across a series of studies to evaluate the acceptability, effectiveness, and cost of a therapeutic writing intervention to reduce reactive depression, a common and frequently recurring adverse symptom.

METHODS

Secondary analysis of data from the series of studies was conducted. Data came from patients requiring lifelong, daily central intravenous catheter infusion of home total parenteral nutrition necessitated by nonmalignant bowel disease and their family caregivers who assist with this complex home care. Variables combined across the studies were pre- and postintervention scores from the Center for Epidemiological Studies-Depression Scale (CES-D), the number of weeks patients wrote in their diaries (adherence), and the written content in the diaries. Content analysis was used to analyze written data. The intervention materials and nurses' time spent were averaged across studies to determine costs.

RESULTS

The weighted average baseline CES-D scores across studies for patients (17.94) and caregivers (15.75) showed the presence of depression. After journal writing had been used for an average of 10.4 weeks across studies, the effect sizes of the between (d =.27) and within (d =.65) patient group scores indicated moderate to large improvement in depression. Themes from written diaries showed that missing out on activities, financial worries, strain related to the severe illness, and the complexity of home care were related to depression across the studies.

CONCLUSIONS

The intervention was acceptable to participants, effective for managing reactive depression, and low in cost. The next steps will address testing for the longitudinal effects of the intervention.

Factors of positive appraisal of care among Japanese family caregivers of older adults

The purpose of this study was to examine factors of positive appraisal of care among Japanese family caregivers of older adults. The Positive Appraisal of Care (PAC) scale used in this study is a multidimensional Japanese measure and has four domains: relationship satisfaction, consequential gain, role confidence, and normative fulfillment. Three hundred and thirty-seven caregivers participated in this survey. Multiple regression analyses revealed that social support and caregiver belief in caregiving had a consistent impact on all domains of the PAC, whereas the impact of caregiver and care recipient characteristics varied among the domains. For example, caregiver age had a significant impact on role confidence and normative fulfillment but not on relationship satisfaction and consequential gain. The differential impact of caregiver and care recipient characteristics on the domains of the PAC underlines the usefulness of a multidimensional measurement.

Assessing the Cultural Appropriateness of the Finding Meaning Through Caregiving Scale for Korean Caregivers

Before psychometric instruments can be used for populations other than those for whom they were originally developed, validation of cultural appropriateness is essential. This article describes the assessment of the cultural appropriateness of the Finding Meaning Through Caregiving Scale (FMTCS) with Korean female family caregivers. The FMTCS measures finding meaning among caregivers from an existential perspective and has three subscales: Loss/Powerlessness, Provisional Meaning, and Ultimate Meaning. The instrument’s cultural appropriateness was examined through semistructured interviews with ten Korean-born female family caregivers, five caregivers living in Korea, and five living in the United States. The interview data are reported according to the three dimensions described by Flaherty and colleagues (1988): content, semantic, and conceptual equivalence. Although the majority of items of the FMTCS appeared applicable to Korean caregivers, items on the Loss/Powerlessness and Provisional Meaning subscales asking caregivers about feelings related to missing their past relationships or communications appeared inappropriate for many Korean daughters-in-law. Of equal importance, a unique source of meaning among Korean caregivers that is not assessed in the FMTCS is an interpersonal context, including the importance caregivers place on teaching children and feeling proud of one’s caregiving accomplishments in the eyes of other relatives. The addition of new items that address the interpersonal context is warranted to improve the instrument’s cultural appropriateness for Korean caregivers.