A two-factor model of caregiving appraisal and psychological well-being

Predictors of positive and negative appraisal among Cuban American caregivers of Alzheimer's disease patients

OBJECTIVE

This study investigated predictors of positive (satisfaction) and negative (burden) appraisal among Cuban American (CA) caregivers of Alzheimer's disease (AD) patients.

DESIGN

Cross-sectional study of AD patients and their family caregivers.

SETTING

A university-affiliated outpatient memory disorders clinic.

SUBJECTS

A convenience sample of 40 CA family caregivers of patients diagnosed with probable or possible AD according to NINCDS-ADRDA diagnostic criteria.

MEASURES

AD patients: Mini-Mental State Examination (MMSE), Blessed Dementia Scale (BDS) and the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Caregivers: Caregiving Burden Scale (CBS), Caregiving Satisfaction Scale (CSS), Perceived Emotional Support scale (PES) and the Short Form-36 Health Survey-General Health Index (GH).

RESULTS

Appraised burden was predicted by increased patient behavioral pathology, female caregiver gender and lower levels of perceived emotional support. The association between older caregiver age and increased burden approached significance. Older caregiver age and higher levels of perceived social support were shown to predict appraised satisfaction. Post-hoc analyses also indicated that length of residence in the United States, a measure of acculturation, was not associated with positive or negative appraisal.

CONCLUSION

Appraised burden and satisfaction represent important outcomes of dementia care that show relations with distinct factors among CA caregivers. It is clear that further research is warranted in order to ascertain the relationship of ethnicity or culture to the process and psychological consequences of dementia caregiving. Continued investigations into predictors of caregiving satisfaction are also recommended.

Gender differences in psychiatric morbidity among family caregivers: a review and analysis

The major goal of this article was to review and synthesize the empirical research on caregiver gender and psychiatric morbidity, with the aim of answering three questions: (a) Is there greater psychiatric morbidity among female than male caregivers, (b) is the excess psychiatric morbidity among female caregivers attributable to caregiving, and (c) what factors in the caregiving situation contribute to the excess psychiatric morbidity among female caregivers? In almost all studies reviewed, women caregivers reported more psychiatric symptoms than men caregivers. Comparisons with noncaregiving community samples suggest that female caregivers experience excess psychiatric morbidity attributable to caregiving. Using a stress process model as an organizing framework, the study demonstrated that at all stages of the stress process, women are at greater risk for psychiatric morbidity than men. Directions for future research and implications for interventions and public policy are discussed.

The dynamics of caregiving: transitions during a three-year prospective study

This prospective study (n = 476) examined 3 types of caregiving transitions experienced by wives and daughters of older persons: entry, institutionalization, and bereavement. Daughters were more likely to enter the caregiving role than wives, but the impact of entering the role was more pronounced for wives. After becoming a caregiver, wives decreased in their participation in leisure activities, perceptions of quality of family relations, and marital satisfaction. Daughter caregivers were more likely than wives to place their care recipient in an institution, and they increased in social participation and decreased in subjective burden after placement. Roughly the same percentage of wife and daughter caregivers were bereaved during the study period, and for wives bereavement was accompanied by an increase in social involvement and personal growth. The results underscore the highly dynamic nature of the caregiving career and the importance of the kinship relationship between caregiver and care recipient in conditioning the effects of caregiving transitions.

Nurse stress associated with aggression in people with dementia: its relationship to hardiness, cognitive appraisal and coping

This study examined the relationship between aggressive behaviour displayed by people with dementia and nurse stress. This was achieved by re-examining the relationships between the hardy personality (total hardiness), primary appraisal (challenge and threat appraisal), secondary appraisal (coping options available), and coping methods (action and palliative coping) from the perspective of nurse stress in response to aggressive behaviour displayed by people with dementia. One hundred and two nurses from 15 nursing homes and hostels were sampled by way of a questionnaire. Hierarchical regression was performed to analyse the strong hypothesized relationships between the variables examined. Results indicated that resident aggression was significantly related to an increase in nurse stress (M=34.79, SD=7.93). Of the variables examined, only threat appraisal was significantly related to nurse stress (beta[94]=0.48, P < 0.05). Perceiving the possibility of aggressive behaviour by the resident as threatening was found related to a high stress level in nurses sampled.

Patterns of caregiving when family caregivers face competing needs

'Finding a balance point' is a process used by caregivers to achieve or preserve equilibrium in caregiving while facing competing needs. This paper describes different patterns of 'finding a balance point'. Interviews with 15 family caregivers receiving home nursing services and 14 family caregivers of hospitalized and discharged frail elders were analysed using constant comparison. Sources of competing needs and the strategies used to find a balance point were identified by participants. Findings suggest that caregivers in a stable situation maintain a balance point, caregivers experiencing major family change try to regain a balance point, and caregivers experiencing the transition from hospital to home work at establishing a balance point. These findings can sensitize nurses to family caregivers' needs and conditions.

Do cognitive processes predict mental health in individuals with rheumatoid arthritis?

The purpose of the present study was to assess the hypothesis that intellectual functioning affects the mental health of individuals with rheumatoid arthritis. Structural equation modeling techniques were used to assess the relative contributions of age, education, intellectual functioning, self-efficacy, and pain to mental health. It was hypothesized that individuals with rheumatoid arthritis who had higher intellectual functioning and higher self-efficacy would report better mental health than those with lower intellectual functioning and self-efficacy. One hundred twenty-one adults aged 34 to 84 with rheumatoid arthritis completed a battery of cognitive tasks, and multiple measures of self-efficacy, pain, and mental health, twice in 1 month. The data provided a good fit to the hypothesized model. Intellectual functioning was directly related to mental health and, also, indirectly related to mental health through self-efficacy and pain. Older individuals who performed poorly on cognitive tasks reported less self-efficacy, more pain, and poorer mental health than those individuals who performed well on cognitive tasks.

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

Systematic assessment of the positive aspects of caregiving has been limited by the lack of comprehensive, theoretically based, and psychometrically sound measures. This study developed and tested a measure primarily designed to assess positive aspects and ways that caregivers find meaning through their experience of caring for a person with dementia. The measure has three subscales: Loss/Powerlessness, which identifies difficult aspects of caregiving; Provisional Meaning, which identifies how caregivers find day-to-day meaning; and Ultimate Meaning, which identifies philosophical/religious/spiritual attributions associated with the experience of caregiving. The measure is useful for understanding the close relationship between both the difficult and positive aspects of caregiving and also may be used to identify a caregiver's strengths in clinical and research settings.

Is there a difference between family caregiving of institutionalized elders with or without dementia?

Based on the stress and coping model of Lazarus and Folkman, the aim of this comparative study was to determine whether the caregiving experience of the caregivers of an institutionalized demented relative is different from the one of the caregivers whose relative does not suffer from dementia. Five dimensions of the caregiving experience were considered: stressors, cognitive appraisal of the stressors, social support, coping strategies and well-being. The sample consisted of primary caregivers of a demented and a nondemented relative. Results revealed that the caregivers of a demented relative were exposed to more stressors than the caregivers of a nondemented relative. Functional impairment as well as depressive behaviors were appraised as more disturbing. According to MANCOVA analysis, formal and informal social support seems to play a protective role in the psychological distress of the caregivers of a demented relative. There was no difference between the two groups with regard to their coping strategies. Overall, the caregivers of a demented relative seemed to experience some dimensions of caregiving in a different way compared with their counterparts, and the nature of dementia in itself helps to explain this difference.

Respite--a coping strategy for family caregivers

The caregiver respite experience is seen as one way to moderate the negative consequences of caregiving. From an interpretivist research orientation, this study explored how 10 family caregivers of persons with dementia experienced respite. From a coping theoretical perspective, the caregiver respite experience is discussed as a process of "getting out" of the caregiver world, and is linked to avoidance strategies of emotion-focused coping. The following three phases within the coping dimension of the respite experience were found: caregivers recognizing their need to get out of the caregiver world, giving themselves permission to actually get out from it temporarily, and having the appropriate social support resources available to facilitate the getting out. The critical practice and research implications linked to caregivers' ability to acknowledge their need for respite are described.

Intervention effects on dementia caregiving interaction: a stress-adaptation modeling approach

OBJECTIVES

Our purpose was to evaluate the adequacy of a stress adaptation framework for guiding intervention research on caregivers and patients coping with Alzheimer's disease, and to test the effect of a cognitive stimulation intervention as an interactive outcome.

METHODS

Using a repeated measures design, 87 caregiver-patient dyads were randomized to one of three conditions: active cognitive stimulation, passive stimulation, or control. Assessments occurred at preintervention, postintervention (3 months), and 9 months.

RESULTS

The LISREL model was entirely satisfactory by the chi-square goodness-of-fit criteria. However, the coefficients associated with the paths between the mediating concepts and the dyadic interaction differed significantly at 3 months and 9 months. The intervention group caregivers were shown to be more satisfied with their interaction with the impaired member.

DISCUSSION

The improvement in caregiver satisfaction was attributed to an attenuation of the behavioral stressor effects through increased use of a problem-focused coping strategy, namely, positive reappraisal of the stressful situation.

Elder-proxy agreement concerning the functional status and medical history of the older person: the impact of caregiver burden and depressive symptomatology

OBJECTIVES

To examine the influence of caregiver burden and depressive symptomatology on elder-proxy response concordance regarding the older person's functional status and medical history.

DESIGN

Cross-sectional study via telephone interviews.

SETTING

Community-dwelling older people and caregivers in North Carolina.

PARTICIPANTS

340 matched pairs of frail persons aged 65 and older and their respective caregivers.

MEASUREMENTS

Multidimensional Functional Assessment: The OARS methodology

RESULTS

Percent agreement on the ADL items ranged from 97.6% on personal hygiene to 99.7% for toileting, with moderate kappa coefficients. IADL percent agreement ranged from 71.5 to 93.7%, with fair to moderate kappa coefficients. Agreement among the medical history items ranged from 76.3 to 98.5% (kappa = .138-.831). Response bias for the IADL composite measure is influenced marginally by caregiver burden (F[259] = 1.751, P = .098). Five of the individual IADL bias items are influenced significantly by burden, such that an increase in burden results in a greater likelihood that the caregiver will overstate disability compared with the rating by the older person. Response bias on the ADL scale was increased among persons who experienced more caregiver burden (OR = 1.096, 95% CI = 1.000, 1.192) and those who spent more hours providing care (OR = 1.012, 95% CI = 1.001, 1.024). Additionally, black caregivers were more likely than white caregivers to disagree with the older people on the ADL scale (OR = 2.73, 95% CI = 1.642, 3.809). A composite of the medical history items is influenced by the relationship of the caregiver to the older person; bias is more likely among adult children ((F[227] = 1.56, P = .081).

CONCLUSION

Elder-proxy concordance is highest among ADL items, followed by medical history items and IADL items. Caregiver depressive symptomotology had no significant impact on elder-proxy response concordance on any of the three outcomes of interest: IADL and medical history bias and ADL disagreement. However, caregiver burden was marginally predictive of bias on the total ADL and IADL scales. Additionally, increased burden was significantly predictive of bias on five of the seven individual items of the IADL scale, suggesting that the more burden a caregiver feels, the greater likelihood that s/he will overstate the older person's disability compared with self-report. These findings suggest that clinicians and researchers who use proxy reports to determine treatment regimens and complete data collection efforts may do so with confidence on ADL individual items and medical history items when the older person's frailty is marginal. However, caregiver burden may result in misleading representation of the older person's functional status, specifically in regard to IADL items.

Emotional vitality among disabled older women: the Women's Health and Aging Study

OBJECTIVE

To examine correlates of high overall level of emotional functioning (emotional vitality) in disabled older women.

DESIGN

A community-based study: The Women's Health and Aging Study.

POPULATION

A total of 1002 moderately to severely disabled women aged 65 and older living in the community.

MEASUREMENTS

Emotional vitality was defined as having a high sense of personal mastery, being happy, and having low depressive symptomatology and anxiety. Correlations with demographics, health status, and social context were examined.

RESULTS

Despite their physical disabilities, 35% of the 1002 disabled older women were emotionally vital. The percent of emotionally vital women declined with increasing severity of disability. After adjustment for disability status, a significantly increased likelihood for being emotionally vital was found for black race (OR=1.69) and for having higher income (OR=1.77), better cognition (OR=2.36), no vision problems (OR=1.61), adequate emotional support (OR=2.54), and many face-to-face contacts (OR=1.64). Having more than one negative life event reduced the likelihood of emotional vitality (OR=0.57).

CONCLUSION

A substantial proportion of even the most disabled older women can be described as emotionally vital. Findings also suggest that emotional vitality is not solely a function of stable, enduring individual characteristics but that health status, disability, and sociodemographic context also have an influence on emotional vitality.

Depressive symptoms of Alzheimer caregivers are mainly due to personal rather than patient factors

OBJECTIVES

To investigate the predictors of caregiver's depressive symptoms in a sample of community-dwelling Alzheimer's patients.

DESIGN

A cross-sectional study was conducted in an Alzheimer's unit specifically devoted to the care of demented patients in Brescia Province (Italy). One hundred and three dyads were consecutively recruited between July 1994 and July 1995. Caregivers were sons/daughters (65%) or husbands/wives; mean age was 54.6 +/- 13.2. Alzheimer's patients Mini Mental State Examination score was 11.3 +/- 8.3; patients were equally distributed among disease severity levels. The following variables have been collected: (a) background and context variables (caregiver's age, gender, marital status, education, relationship and cohabitation with the patient, employment status, satisfaction with household income);(b) caregiver's personal resources (health, social relationships and social interactions, formal supports use, assistance and vigilance); (d) primary stressors (patient's age and gender, cognitive status, functional status, frequency of behavioural disturbances). Caregiver's depressive symptoms represented the main outcome measure.

RESULTS

Being husband or wife, low self-rated health and caregiving competence, high numbers of hours for assistance and patient's behavioural disturbances and younger age were associated caregiver's depressive symptoms. With multivariate analysis only relationship to the patient, caregiver's health and competence were independent predictors of caregiver's depressive symptoms.

CONCLUSION

Factors related to the caregiver--relationship, health and competence--rather than to the patient constitute the main risk factors for caregiver's depressive symptomatology.

Psychological distress of caregivers: the mediator effect of caregiving appraisal

This study concerns the role of caregiving appraisal, whether it explains why stressors in the caregiving situation affect caregivers' psychological distress. This putative mediator effect of caregiving appraisal is separately tested for spouse and non-spouse caregivers of demented elderly persons. Caregiving appraisal is operationalized by a measure of pressure from informal care as perceived by the caregiver. For spouse caregivers, perceived pressure explained the association between their caregiving tasks and psychological distress. However, the strong association found between behavioral problems and psychological distress was not explained by perceived pressure in spouse caregivers. Furthermore, results showed clear mediator effects of perceived pressure for associations between stressors (both behavioral problems of the demented elder and caregiving tasks) and non-spouse caregivers' psychological distress. Thus, it is inadequate to focus interventions merely on stressors in the caregiving situation, for non-spouse caregivers in particular. A reduction of perceived pressure from informal care is also needed.

Control and the elderly: "goodness-of-fit"

The present study is an investigation of the effects of person-environment fit on control in an elderly population. Person-environment fit theory predicts that a fit or a match between the characteristics of the person and the characteristic of the environment is important in determining positive outcomes. In the present study, a measure of the misfit (i.e., the mismatch) between an individual's perceptions of control and that individual's desire for control was used to predict life satisfaction, depression, and self-reported health. The misfit between these constructs was found to be a significant predictor of depression, suggesting that a person-environment fit model may be important in explaining this outcome variable. In contrast to the hypothesis, misfit did not significantly predict life satisfaction, and only approached significance in the physical health model. Possible interpretations and implications of these findings were discussed, and potential future research directions were suggested.

Cancer and caregiving: the impact on the caregiver's health

A diagnosis of cancer affects not only the patient but also their significant others, especially when a lot of care tasks are involved. Some caregivers perceive the care as a burden, while others consider it a challenge. In this article, findings concerning the impact of cancer caregiving on informal caregivers will be described. No consistent results are reported, and little is known about patterns of caregiving changes in relation to the course of the patient's illness. Attention will be given to factors which have been identified as influencing the course and consequences of caregiving. These factors form the basis of a conceptual research model for caregivers of cancer patients. As cancer progresses, care tasks are generated, which can be perceived by the caregiver as either negative (i.e. burden) or positive. Furthermore, these caregiver experiences may lead to negative as well as positive effects on the caregiver's health and these relationships can be assumed to be bidirectional.

An exploration of attachment styles and personality traits in caregiving for dementia patients

The present study examined the influence of caregivers' Attachment Styles (Anxious-ambivalent and Avoidant factors) and personality traits (Neuroticism, Extraversion, Agreeableness, and Conscientiousness) on their experiences of caring for dementia dependents. A total of 126 caregiver-dependent pairs participated in the study. Support was found for the contribution of the attachment style factors in explaining aspects of caregiver experiences. Those who chose to institutionalize dependents were higher on the Avoidance factor than those choosing to maintain them in the community. Less Anxious-ambivalent caregivers reported larger social support networks, and more satisfaction with the support received than those lower on this factor. The caregiver Anxious/ambivalence and Neuroticism dimensions seemed to function as generalized responses reflected in perceptions and appraisals of the stressful situation.

The mental health of informal caregivers in Ontario: an epidemiological survey

OBJECTIVES

This study describes the mental health status, disability, physical health, and mental health service utilization of informal care-givers under the age of 65 in the province of Ontario.

METHODS

The study analyzed data collected in the 1991 province-wide, population-based mental health supplement to the Ontario Health Survey. Diagnoses from the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised, were generated on the basis of a structured diagnostic interview. Caregivers and noncaregivers are compared here on past-year prevalence of psychiatric disorder, physical illness, disability, and utilization of mental health services. The possible confounding effects of age, sex, employment status, and economic disadvantage are explored.

RESULTS

Informal caregivers (n = 1219) constituted 15.0% of the sample. Caregivers had higher rates of affective (6.3% vs 4.2%) and anxiety (17.5% vs 10.9%) disorders than noncaregivers and used health services for mental health problems at nearly twice the rate.

CONCLUSIONS

Documentation of the prevalence of caregiving and the increased prevalence of psychiatric disorders, disability, and service utilization among caregivers is of critical importance as governments continue to move toward community-based care. To accomplish this goal, the needs of caregivers must be acknowledged and met by the establishment of appropriate and readily accessible support services.

Positive psychological states and coping with severe stress

Providing care to a spouse or partner who is dying and then losing that person are among the most stressful of human experiences. A longitudinal study of the caregiving partners of men with AIDS showed that in addition to intense negative psychological states, these men also experienced positive psychological state states throughout caregiving and bereavement. The co-occurrence of positive and negative psychological states in the midst of enduring and profoundly stressful circumstances has important implications for our understanding of the coping process. Coping theory had traditionally focused on the management of distress. This article describes coping processes that are associated with positive psychological states in the context of intense distress and discusses the theoretical implications of positive psychological states in the coping process.

Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses

This study describes the health behaviors (alcohol consumption, exercise, sleep patterns, smoking, and weight maintenance) of a sample of older adult spouse caregivers (N = 233) and investigates the predictors of decreased self-care since caregiving began. Multiple regression results indicate that caregivers who experience greater developmental burden, report a greater number of depressive symptoms, perform a greater number of activities of daily living (ADL) tasks in caregiving and spend more hours in a day providing care, and who have lower self-efficacy for both self-care and spouse care are at greater risk for negative health behavior change. Results have implications for the identification of caregivers who may be particularly vulnerable to the negative health impact of caregiving.

Race, finding meaning, and caregiver distress

This study investigated the relationship between race, finding meaning (as a positive psychological resource variable), and the outcomes of caregiver depression and global role strain among 77 African American and 138 White spouse caregivers of persons with dementia. Finding provisional meaning had a direct negative relationship with depression and global role strain. Although African American caregivers were less likely to report depression and role strain, there was no interaction by race in the process influencing caregiver distress.

Depression and life satisfaction in aging polio survivors versus age-matched controls: relation to postpolio syndrome, family functioning, and attitude toward disability

OBJECTIVE

To compare depressive symptoms and life satisfaction in aging polio survivors with age-matched controls and to relate these outcomes to scores to psychosocial and disability-related variables.

DESIGN

A planned medical, functional, and psychosocial study with multivariate analyses.

SETTING

A large, urban rehabilitation center.

PARTICIPANTS

A volunteer sample of 121 polio survivors and an age-matched control group of 60 people with similar sociodemographic backgrounds.

MAIN OUTCOMES

Depression as measured by the Geriatric Depression Scale and an 11-item life satisfaction scale.

RESULTS

The prevalence of depressive disorders was not significantly different in the two groups, although the postpolio group tended to have more symptomatology and an overall depressive disorder prevalence of 28%. Some life satisfaction scale scores were significantly lower in the postpolio group, especially those concerned with health. People with postpolio syndrome scored significantly higher on depression scales and lower on some life satisfaction scales than people with a history of polio but without postpolio syndrome. Several psychosocial variables, most notably family functioning and attitude toward disability, helped to mediate this effect. Among people with significant depression, there was little, evidence of adequate treatment in the community.

CONCLUSIONS

Postpolio by itself does not relate to higher depression scores or lower life satisfaction. Postpolio syndrome has some relation to depression, but family functioning and attitude toward disability are more important. There is a need for better community-based psychological services.

Weight change: an indicator of caregiver stress

This study evaluated weight change and caregiver stress in 200 informal caregivers to elderly patients discharged from a rehabilitation hospital. Previous laboratory and epidemiologic studies have shown that stress predisposes to weight change. Nineteen percent of the caregivers had gained or lost at least 10 pounds since becoming caregivers. Weight change was significantly associated with higher scores on standardized measures of burden and stress (e.g., Burden Interview, Perceived Stress Scale, Geriatric Depression Scale) and with lower education, poorer self-rated health, more psychotropic medication use, and caring for patients with more ADL limitations who had been hospitalized for stroke or a frail elderly condition. Caregivers to patients with a stroke or frail elderly condition reported 2.8 times more weight change than caregivers to patients with a rehabilitation problem. These results suggest that weight change is a valid indicator of stress in caregivers, and they have public health, clinical, and research applications.

The Prince Henry Hospital dementia caregivers' training programme

OBJECTIVE

To describe the theory, elements and practice of a successful caregiver training programme; and report the 8-year outcome.

DESIGN

Prospective, randomized control trial and longitudinal follow-up over approximately 8 years.

SETTING

Psychiatry unit, general teaching hospital, Sydney, Australia.

PARTICIPANTS

96 persons less than 80 years old with mild to moderate dementia and their cohabiting caregivers.

INTERVENTIONS

All patients received a 10-day structured memory retraining and activity programme. Caregivers in the immediate and wait-list caregiver training groups received a structured, residential, intensive 10-day training programme, boosted by follow-ups and telephone conferences over 12 months. Those in the wait-list group entered the programme after waiting 6 months. The third group of caregivers received 10 days' respite (while patients underwent their memory retraining programme) and 12 months booster sessions as for the other groups.

MAIN OUTCOME MEASURES

Nursing home admission; time until patient death.

MAIN RESULTS

64% of patients whose caregivers were in the immediate training group, 53% of wait-list group patients and 70% of memory retraining patients had died. Nursing home admission had occurred in 79% of the immediate training, 83% of the delayed and 90% of the memory retraining group. Eight-year survival analysis indicated that patients whose caregivers received training stayed at home significantly longer (p = 0.037) and tended to live longer (p = 0.08).

CONCLUSIONS

Caregiver training programmes demonstrably can delay institutionalization of people with dementia.

The everyday impacts of providing informal care to dependent elders and their consequences for the care recipients

Longitudinal data were used to identify the relationship between different areas of negative impact and elder and caregiver characteristics. The extent and predictors of persistence and development of negative impact in different areas and the relationship between caregiving impact and subsequent caregiving patterns, including termination of care and institutionalization of the elder, were also examined. Caregiving exerted the greatest toll on a caregiver's personal life reported by 61%, in comparison to family life (18%), or employment (15%-20%). Those at particular risk of negative impact included offspring and other-relative caregivers who resided with the elder. All areas of negative impact persisted over time but did not result in any major disruption in care for the elder. However, those elders whose caregivers experienced personal impact were twice as likely to be institutionalized.

Caregiving and dementia: predicting negative and positive outcomes for caregivers

A sample of 118 caregivers, maintaining relatives with dementia at home, were interviewed and completed questionnaires at initial and follow-up assessment six months later. All dependents received a cognitive assessment. The results of LISREL analysis of the data supported a model of caregiving in which negative outcomes of burden and impaired health reduced positive outcomes of enjoyment of aspects of caregiving. Caregivers with larger social support networks were more satisfied with their support, reducing feelings of impaired health, although as caregiving became more difficult, satisfaction with support decreased. The retrospective perception of the premorbid relationship as more difficult lead to the appraisal of the patient's symptoms as presently being more extensive and increased burden. Women caregivers reported both greater feelings of burden and more aspects of caregiving as enjoyable.

Life events as correlates of burden in spouse caregivers of persons with Alzheimer's disease

The first goal of this study was to examine the occurrence and appraised distress of 20 stressful life events in 175 spouse caregivers (mean age = 68.6) of persons with Alzheimer's disease and 92 age- and gender-matched controls (mean age = 68.5). The second goal was to determine whether, in the caregivers, life stressors were related to burden after controlling for caregiver age, gender, satisfaction with social supports, and care-recipient cognitive and activities of daily living functioning. Caregivers and controls had similar occurrences and appraisals for all but 3 events, which occurred more frequently in caregivers (i.e., "changes in your spouse's health," "changes in your relationship with your spouse," and "changes in the way you friends and family treat you (social relations)"). Only "changes in finances" was appraised as more distressing by caregivers. Six events explained burden in the regressions: "victim of crime," "age discrimination," "serious family arguments (not including spouse)," "change in caregiver's health," "trouble with Medicaid/Medicare or Social Security," and "move to retirement home (associated with less burden)." Age discrimination was related to burden only for the caregivers of the most impaired care recipients. Also, caregivers who experienced health problems and who had been victims of crimes were the most burdened. Caregivers are not immune to problems experienced by older adults, and these problems may exacerbate caregiver burden. Clinicians should consider the overall context of a caregiver's life when evaluating burden.

Personality traits as determinants of burden and health complaints in caregiving

This study tested predictions specifying the influence of caregiver personality traits on negative outcomes of caregiving, health complaints and burden. Two-hundred and thirteen caregivers, who were caring for family members with dementia, were interviewed and their relatives were assessed on cognitive status and aggression. At follow-up conducted twenty-four months later, forty-five caregivers were still continuing to provide home care for their dependents. Caregivers who scored higher on a measure of neuroticism experienced higher levels of burden and health complaints both at initial and follow-up assessment. Caregiver extraversion-introversion did not influence the experience of caregiving. At both initial and final assessment, the ability to enjoy some aspects of caregiving, recreational activities, and satisfaction with social support from family and friends mitigated negative outcomes of caregiving, while appraising the dependent as more troublesome increased negative outcomes. Caring for more cognitively impaired and more aggressive dependents and being female increased negative outcomes initially. Personality traits and most other study variables demonstrated significant continuity across time for caregivers continuing home care.

Caregiver role appraisal and caregiver tasks as factors in ending caregiving

This study focuses on factors related to why people with primary responsibility for providing care to ADL-impaired elderly persons ended their caregiving roles. Data are from the 1982 National Long-Term Care Survey and the Informal Caregiver Survey. Variables reflecting characteristics of care recipients and caregivers, caregiver role responsibilities, and appraisal of the caregiver role are investigated. Of particular interest is the influence of role responsibilities, such as number of ADL tasks, relative to appraisal of the caregiving role. The results indicate that factors other than role responsibilities are important in understanding who ends caregiving, and that risk factor profiles may prove a useful means of targeting caregivers at greatest risk of ending caregiving.

Predictors of family caregivers' physical and psychological health following hospitalization of their elders

OBJECTIVE

To identify characteristics present at the time of elders' (> or = 75 years of age) hospitalization that predicted care-givers' self-reported physical and psychological health 1 year later.

DESIGN

A prospective observational cohort study of 104 family caregivers followed for 1 year from the time of their elders' hospitalization.

SETTING

Urban community hospital with academic affiliation.

SUBJECTS

Caregivers of patients enrolled in an evaluation of inpatient interdisciplinary geriatric assessment who provided care for the entire year of follow-up and who participated in all interviews.

MAIN OUTCOMES

Self-reported physical and psychological health.

RESULTS

Caregivers' baseline self-reported physical health (AOR = 21.8; 95% CI = 4.65-102), the impact of caregiving on their social and leisure time activities (AOR = 9.93; 95% CI = 1.71-57.8), and their relationship to their elders (AOR = 6.50; 95% CI = 1.20-35.2) were all significantly associated with self-reported physical health at follow-up. Caregivers' baseline self-reported health (AOR = 3.70; 95% CI = 1.11-12.5), whether or not they had additional current caregiving responsibilities (AOR = 6.67; 95% CI = 1.89-25.0), and the interaction of perceptions of caregiving and the adequacy of family help were significant predictors of psychological health at follow-up, adjusted for baseline psychological health.

CONCLUSION

Information available at the time of elderly patients' admission to the hospital can help to differentiate those caregivers at risk for future physical and psychological distress from those who are likely to continue doing well.

Being in control: a note on differences between caregiving and noncaregiving spouses

Twenty-seven spouse caregivers of dementia patients and 33 noncaregiving (healthy) spouses, aged 54 to 90, described a stressful situation with their spouses and completed measures of perceived control and subjective well-being. Both groups were similar in their perceived lack of control over the spouse's behavior but differed in how control influenced positive affect. Perceived control over the spouse was negatively related to positive affect for the healthy couples but for caregivers it was positively related.