Health practices of adults with elder care responsibilities

The positive impact of informal spousal caregiving on the physical activity of older adults

Introduction

Although physical activity (PA) is crucial for health, the literature is mixed about how individuals' PA decisions are affected by their spouses. To fill this gap, we examined the extent to which providing care for one spouse affects the PA of the other spouse among those aged 50 or older in the United States.

Methods

We analyzed 9,173 older adults living with their spouses or partners from the 2004 to 2016 waves of the Health and Retirement Study. To identify the causal effect of spousal caregiving on the PA of older adults, we estimated individual-fixed effects models using a two-stage least squared instrumental variable approach with spousal falls as our instrument. We also estimated the models by splitting the sample by gender and race/ethnicity to identify heterogeneous impacts of spousal caregiving on PA decisions among subgroups.

Results

We found that a one percentage point increase in the probability of providing care to spouses led to an increase in the probability of initiating moderate or vigorous PA (MVPA) by 0.34-0.52 percentage points. This effect was salient, especially among female and non-Hispanic white older adults.

Discussion

Caregiving experience might provide opportunities to learn about caregiving burdens and trigger an emotional response about the salience of an event (i.e., they need care in the future). Older caregivers might start MVPA in an effort to improve or maintain their health and avoid burdening their families for caregiving in the future. This study demonstrated spousal influence on PA. Instead of delivering PA-promotion information (e.g., the harm of sedentary lifestyle and benefits of regular PA) to individuals, risk communication and education efforts on PA promotion might be more effective considering the family context. Family events such as health shocks or the emergence of caregiving needs from family members provide windows of opportunities for intervening. Subgroup differences should also be considered in targeted interventions.

Predicting personal self-care in informal caregivers

Caregiver research often focuses on negative health outcomes, yet little is known about the self-care practices of caregivers. The present study investigates self-care practices among family caregivers and the relationships between personal self-care, perceived stress, and other health variables. Data were collected from informal caregivers through self-administered Internet and paper surveys that included the Medical Outcomes Study Short Form 36-item Health Survey, Perceived Stress Scale, and Self-Care Practices Scale. Personal self-care was most strongly associated with emotional well-being, pain, perceived stress, and general health. The relevance of study findings to strengthening family caregiver programs and future research is discussed.

Association of care recipients' care-need level with family caregiver participation in health check-ups in Japan

AIM

The public mandatory long-term care insurance system in Japan has supposedly mitigated the care burden for family caregivers of older adults, whereas family caregivers still play a considerable role in providing care. The effect of informal caregiving on the caregiver's health has been of great interest. We investigated the relationship between the amplitude of informal caregiving and caregiver participation in health check-ups in Japan.

METHODS

The present study was a cross-sectional analysis of nationally representative data in Japan (2010 Comprehensive Survey of Living Conditions). We investigated the relationship between care recipients' care-need level and in-home caregiver participation in health check-ups during the last year of the survey for caregivers.

RESULTS

A total of 3354 caregiver/recipient pairs were included in the study. Crude proportions of caregivers completing a health check-up by care-need level were 68.4% (support required 1 and 2), 63.5% (care required 1-3) and 60.3% (care required 4 and 5). Higher care-need level was negatively associated with caregiver participation in health check-ups (support required 1 and 2as reference, care required 1-3: odds ratio 0.82, 95% confidence interval 0.75-0.90), care required 4 and 5: odds ratio 0.76, 95% confidence interval 0.74-0.79) after adjustment for possible confounders. Inclusion of the caregiver time devoted to care per day and caregiver self-rating of health as independent variables did not change the result.

CONCLUSIONS

These results suggest that facilitating health check-up participation for family caregivers of care recipients with higher care-need levels might be an effective intervention for decreasing the gap in health behavior possibly caused by informal caregiving. Geriatr Gerontol Int 2018; 18: 26-32.

Preventive Services Use Among African American and Latino Adult Caregivers in South Los Angeles

BACKGROUND

The burden of informal caregiving is significant and well-documented, yet the evidence is mixed as to whether being a caregiver presents an additional barrier to receiving recommended preventive care.

OBJECTIVES

To determine whether (1) caregivers compared with noncaregivers were less likely to receive preventive health services; and (2) higher intensity caregivers were less likely to receive preventive health services than lower intensity caregivers.

RESEARCH DESIGN, SUBJECTS, AND MEASURES

Data were from a telephone survey of Latino and African American adults 50 years or older in South Los Angeles (n=702). Outcomes were flu vaccination, pneumococcal vaccination, and colorectal cancer screening. Logistic regression models adjusted for predisposing, enabling, and need factors according to the Andersen Model of Access to Health Care for Low-income Populations.

RESULTS

Caregiver type (eg, adult child, nonrelated) was associated with varying odds of receiving a preventive service. Caregivers had lower odds than noncaregivers of receiving preventive services although odds of receiving a flu vaccination improved slightly for caregivers of persons with memory loss compared with other caregivers. More weekly caregiving hours was associated with higher odds of receiving flu vaccination (adjusted odds ratios, 1.1; 95% confidence interval=1.0, 1.1) or colorectal cancer screening (adjusted odds ratios, 1.1; 95% confidence interval=1.0, 1.1). Caregivers and noncaregivers age 65 and older or with chronic conditions were more likely to receive vaccinations.

CONCLUSIONS

Preventive service use was influenced by characteristics of the caregiving situation. An opportunity may exist to leverage care recipients' ongoing contact with health care providers to increase caregivers' own access to preventive services.

Experiences of Family Caregiving among Middle-Aged Australian Women

Family caregiving is an unpaid activity that falls inequitably on women. As one component of the Women's Health Australia survey, this article uses quantitative and qualitative methods to examine the impact of family caregiving among middle-aged women. Of 13,888 women, 1775 responded to specific items about caregiving and 185 made openended comments about their experiences. Quantitative analyses showed that caregivers experienced more financial difficulties, poorer physical and psychological health, higher levels of stress and higher use of health care services. Content analysis of comments supported these findings, and in addition identified emerging themes including difficulties with travel, inadequacies in health and welfare systems, a sense of exploitation and fear for the future. These findings support the view that interventions to assist family caregivers must address systemic in addition to individual factors.

Health, Stress and Coping among Women Caregivers

Informal family-based care of dependent adults places a significant burden on caregivers. The impact of caregiving on subjective wellbeing, preventive behaviours, lifestyle and employment is well documented, and there is good evidence for increases in risk factors for serious illness, although evidence on actual incidence of major illness varies between studies. The individual-based focus of much research on this topic has tended to obscure the social and cultural forces underlying the fact that the majority of family caregivers are women, and to ignore the gender inequities which are perpetuated by an assumption that family caregiving is naturally the work of women. This article reviews evidence on the burden of caregiving, and argues for psychological research which addresses issues of public policy rather than the individual woman and her personal ability to cope.

Dyadic associations between cancer-related stress and fruit and vegetable consumption among colorectal cancer patients and their family caregivers

This study examined how stress from cancer affects fruit and vegetable consumption (FVC) in cancer patients and their family caregivers during the year following diagnosis. Colorectal cancer patients and their caregivers (92 dyads) completed questionnaires at two (T1), six (T2), and 12 months post-diagnosis (T3). Individuals reported perceived cancer-related stress (CRS) at T1 and days of adequate FVC at T1 through T3. Both patients and caregivers reported inadequate FVC during the first year post-diagnosis. Latent growth modeling with actor-partner interdependence modeling revealed that, at T1, one's own greater CRS was associated with one's partner having fewer concurrent days of adequate FVC (ps = .01). Patients' greater CRS predicted their own more pronounced rebound pattern in FVC (p = .01); both patients' and caregivers' CRS marginally predicted their partners' change in FVC (p = .09). Findings suggest that perceived stress from cancer hinders FVC around the diagnosis, but motivates positive dietary changes by the end of the first year.

The impact of preventive health behaviour and social factors on visits to the doctor

BACKGROUND

The aim of this study is to examine the joint impact of preventive health behavior (PHB) and social and demographic factors on the utilization of primary and secondary medical care under a universal health care system, as measured by visits to the doctor, who were categorized as either a General Practitioner (GP) or Specialist Doctor (SD).

METHODS

An ordered probit model was utilized to analyze data obtained from the 2009 Israeli National Health Survey. The problem of endogeneity between PHB factors and visits to GP was approached using the two-stage residuals inclusion and instrumental variables method.

RESULTS

We found a positive effect of PHB on visits to the doctor while the addition of the PHB factors to the independent variables resulted in important changes in explaining visits to GP (in values of the estimates, in their sign, and in their statistical significance), and only in slight changes for visits to SD. A 1% increase in PHB factors results in increasing the probability to visit General Practitioner in the last year in 0.6%. The following variables were identified as significant in explaining frequency of visits to the doctor: PHB, socio-economic status (pro-poor for visits to GP, pro-rich for visits to SD), location (for visits to SD), gender, age (age 60 or greater being a negative factor for visits to GP and a positive factor for visits to SD), chronic diseases, and marital status (being married was a negative factor for visits to GP and a positive factor for visits to SD).

CONCLUSIONS

There is a need for allowing for endogeneity in examining the impact of PHB, social and demographic factors on visits to GP in a population under universal health insurance. For disadvantaged populations with low SES and those living in peripheral districts, the value of IndPrev is lower than for populations with high SES and living in the center of the country. Examining the impact of these factors, significant differences in the importance and sometimes even in the sign of their influence on visits to different categories of doctors - GP and SD, are found.

Is There a Trade-off Between Parent Care and Self-care?

Caregiving for family members is often described as a 36-hour day. Previous literature has suggested that family caregivers have little time to attend to their own health needs, such as participating in leisure-time physical activity. Using data from the Health and Retirement Study, we analyze whether time-allocation decisions reflect a conflict between time devoted to informal care and time devoted to self-health promotion through physical activity. The empirical model is a system of four correlated equations, wherein the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, or in hours of work, among either men or women.

Decreased mental health care utilization following a psychosocial intervention in caregivers of hematopoietic stem cell transplant patients

Caregivers are known to experience increased morbidity when compared to noncaregivers. Does an intervention targeting caregiver distress affect their health care utilization? One hundred forty-eight caregivers of allogeneic hematopoietic stem cell transplant patients were randomized to treatment as usual (TAU) or a psychoeducation, paced respiration, and relaxation (PEPRR) intervention. Assessments of caregivers’ service utilization were collected at baseline and 1, 3, and 6 months post-transplant. During the first 30 days after patient transplant, caregiver medical and mental health professional service use decreased while support group attendance peaked. Mixed model regressions showed a significant decrease in mental health service use by the PEPRR group (P=0.001). At six months caregivers in TAU had predicted marginal probabilities of mental health services utilization over 10 times as high as caregivers in PEPRR (18.1% vs 1.5%). Groups failed to differ in medical service (P=0.861) or support group (P=0.067) use. We can conclude that participation in PEPRR compared to TAU was associated with reduced mental health service utilization. Caregiver psychosocial support services are critical to improve caregiver outcomes.

Informal caregiving and the risk for coronary heart disease: the Whitehall II study

BACKGROUND

The stress associated with informal caregiving has been shown to be associated with poor health, including coronary heart disease (CHD). However, it is unclear if the risk of CHD is attributable to caregiving or prior poor health of the caregiver.

METHODS

We used data from the Whitehall II cohort study. Caregiving and caregiver's health (using 3 measures: self-rated health, mental health using the General Health Questionnaire, and physical component score of the SF-36) were assessed in 1991-1993 among 5,468 men and 2,457 women aged 39-63 years. CHD (fatal CHD, clinically verified nonfatal myocardial infarction, and definite angina) incidence was recorded for a mean 17 years; sociodemographic variables, health behaviors, and cardiovascular risk factors were included as covariates.

RESULTS

Cox regression showed the risk of CHD in caregivers not to be higher (hazard ratio = 1.18; 95% CI: 0.96, 1.45) compared with noncaregivers. Analyses stratified by health status showed that compared with noncaregivers in good health, caregivers with poor self-rated (hazard ratio = 2.00; 95% CI: 1.44, 2.78), mental (hazard ratio = 1.63; 95% CI: 1.16, 2.30), or physical (hazard ratio =1.87; 95% CI: 1.34, 2.62) health had greater risk of CHD. A similar elevated risk was observed in noncaregivers with poor health; no excess risk was observed among caregivers reporting good health, and the combined effect of poor health and caregiving did not exceed their independent effects.

CONCLUSIONS

Caregiving in midlife is not in itself associated with greater risk of CHD, but it is associated with increased risk for CHD among caregivers who report being in poor health.

Caregiving associated with selected cancer risk behaviors and screening utilization among women: cross-sectional results of the 2009 BRFSS

BACKGROUND

Informal caregiving is increasingly common as the U.S. population ages, and there is concern that caregivers are less likely than non-caregivers to practice health-promoting behaviors, including cancer screening. We examined caregiving effects on cancer risk behaviors and breast and cervical cancer screening in the 2009 Behavioral Risk Factor Surveillance System.

METHODS

Women age ≥ 41 with data on breast and cervical cancer screening were included (weighted frequency 3,478,000 women). Cancer screening was classified according to American Cancer Society guidelines. We evaluated the association of caregiving with cancer risk behaviors (obesity, physical activity, alcohol intake, smoking status, and fruit/vegetable consumption) and cancer screening (mammography, clinical breast exam [CBE], and Pap test) using logistic regression overall and with stratification on age (<65, ≥ 65) or race (white, non-white).

RESULTS

Caregivers had greater odds of being obese, physically active, and current smokers. Subgroup analyses revealed that caregiving was associated with obesity in younger women and whites, and with less obesity in older women. Also, caregiving was associated with smoking only among younger women and non-whites. Caregivers had greater odds of ever having had a mammogram or CBE, yet there was no association with mammogram, CBE, or Pap test within guidelines.

CONCLUSIONS

Caregiving was associated with some health behaviors that increase cancer risk, yet not with cancer screening within guidelines. Effects of caregiving by age and race require confirmation by additional studies.

Health behaviors among Baby Boomer informal caregivers

PURPOSE OF THE STUDY

This study examines health-risk behaviors among "Baby Boomer" caregivers and non-caregivers.

DESIGN AND METHODS

Data from the 2009 California Health Interview Survey of the state's non-institutionalized population provided individual-level, caregiving, and health behavior characteristics for 5,688 informal caregivers and 12,941 non-caregivers. Logistic regression models were estimated separately for four individual health-risk behaviors-smoking, sedentary behavior, and regular soda and fast-food consumption-as well as a global health-risk measure.

RESULTS

Controlling for psychological distress and personal characteristics and social resources such as age, gender, income and education, work and marital status, and neighborhood safety, caregivers had greater odds than non-caregivers of overall negative health behavior and of smoking and regular soda and fast-food consumption. We did not observe significant differences in odds of negative behavior related to stress for spousal caregivers and caregivers in the role for longer periods of time or those providing more hours of weekly care compared with other caregivers.

IMPLICATIONS

Our study found evidence that Baby Boomer caregivers engage in poor health behaviors that are associated with exposure to caregiving. Baby Boomer caregivers may be at risk for certain behavioral factors that are associated with disability and chronic illness.

Work productivity and health of informal caregivers of persons with advanced cancer

The purpose of this study was to describe health promotion behaviors and work productivity loss in informal caregivers of individuals with advanced stage cancer. Using a cross-sectional, correlational design, 70 caregivers completed measures of health behaviors, mood, social support, and burden. Absenteeism and presenteeism were evaluated in employed caregivers (n = 40). Caregivers reported low levels of physical activity. The mean percentage of work productivity loss due to caregiving was 22.9%. Greater work productivity loss was associated with greater number of caregiving hours, higher cancer stage, married status, and greater anxiety, depression, and burden related to financial problems, disrupted schedule, and health. Nurses should assess caregivers and provide health promotion interventions, which may ultimately reduce the economic impact of caregiving.

Regular physical activity moderates cardiometabolic risk in Alzheimer's caregivers

INTRODUCTION

Dementia caregivers have an increased risk of cardiovascular disease, and it is possible that metabolic disturbances contribute to this risk. Regular physical exercise reduces cardiometabolic risk, but caregivers may have less opportunity to engage in such activity. We hypothesized that regular physical activity would moderate cardiometabolic risk in dementia caregivers.

METHODS

One hundred and fifteen Alzheimer's caregivers and 54 noncaregiving controls were assessed for medical history and health habits. Physical activity was defined as the number of days per week participants performed light (score = 0-4), moderate (score = 0-4), or vigorous (score = 0-4) exercise (total score = 0-12). A cardiometabolic risk score was calculated by adding standardized z-scores of five metabolic syndrome components: body mass index, triglycerides, HDL cholesterol, systolic blood pressure, and glucose.

RESULTS

Caregivers were less physically active than noncaregivers (mean ± SD = 5.1 ± 3.0 vs 6.3 ± 2.7, P = 0.008). A significant caregiver status × physical activity interaction was found for the standardized cardiometabolic risk score controlling for gender, age, education, smoking, alcohol consumption, health problems, cholesterol-lowering medication, negative affect, role overload, and fasting state (P = 0.035). Among participants with low levels of physical activity, caregivers had greater cardiometabolic risk score than noncaregivers (0.58 ± 0.31 vs -1.23 ± 0.54, P = 0.017); no group difference emerged in participants with high levels of physical activity (P = 0.81).

CONCLUSIONS

Cardiometabolic risk was particularly high in caregivers reporting reduced levels of regular physical activity. Intervention studies aimed at increasing physical activity in caregivers seem warranted to examine whether that would possibly lower cardiometabolic risk to the level of noncaregivers.

Competing demands for time and self-care behaviors, processes of care, and intermediate outcomes among people with diabetes: Translating Research Into Action for Diabetes (TRIAD)

OBJECTIVE

To determine whether competing demands for time affect diabetes self-care behaviors, processes of care, and intermediate outcomes.

RESEARCH DESIGN AND METHODS

We used survey and medical record data from 5,478 participants in Translating Research Into Action for Diabetes (TRIAD) and hierarchical regression models to examine the cross-sectional associations between competing demands for time and diabetes outcomes, including self-management, processes of care, and intermediate health outcomes.

RESULTS

Fifty-two percent of participants reported no competing demands, 7% reported caregiving responsibilities only, 36% reported employment responsibilities only, and 6% reported both caregiving and employment responsibilities. For both women and men, employment responsibilities (with or without caregiving responsibilities) were associated with lower rates of diabetes self-care behaviors, worse processes of care, and, in men, worse HbA(1c).

CONCLUSIONS

Accommodations for competing demands for time may promote self-management and improve the processes and outcomes of care for employed adults with diabetes.

Are caregiving responsibilities associated with non-attendance at breast screening?

BACKGROUND

Previous research showed that deprived individuals are less likely to attend breast screening and those providing intense amounts of informal care tend to be more deprived than non-caregivers. The aim of this study was to examine the relationship between informal caregiving and uptake of breast screening and to determine if socio-economic gradients in screening attendance were explained by caregiving responsibilities.

METHODS

A database of breast screening histories was linked to the Northern Ireland Longitudinal Study, which links information from census, vital events and health registration datasets. The cohort included women aged 47 - 64 at the time of the census eligible for breast screening in a three-year follow-up period. Cohort attributes were recorded at the Census. Multivariate logistic regression was used to examine the relationship between informal caregiving and uptake of screening using STATA version 10.

RESULTS

37,211 women were invited for breast screening of whom 27,909 (75%) attended; 23.9% of the cohort were caregivers. Caregivers providing <20 hours of care/week were more affluent, while those providing >50 hours/week were more deprived than non-caregivers. Deprived women were significantly less likely to attend breast screening; however, this was not explained by caregiving responsibilities as caregivers were as likely as non-caregivers to attend (Odds Ratio 0.97; 95% confidence intervals 0.88, 1.06).

CONCLUSIONS

While those providing the most significant amounts of care tended to be more deprived, caregiving responsibilities themselves did not explain the known socio-economic gradients in breast screening attendance. More work is required to identify why more deprived women are less likely to attend breast screening.

Loss of lifestyle: health behaviour and weight changes after becoming a caregiver of a family member diagnosed with ovarian cancer

PURPOSE

Little is known about how caring for someone affects the caregiver's health behaviours. We explore behaviour changes and their determinants in caregivers of women with ovarian cancer.

METHODS

Caregivers of 101 women with ovarian cancer completed a questionnaire 1.5-6 years after their family member's cancer diagnosis, providing information about their current health behaviours, height, weight and changes in these compared with pre-diagnosis. Information about the impact of ovarian cancer, other stressful events and distress was also collected for patients and caregivers. Logistic regression was used to determine characteristics associated with negative changes.

RESULTS

Half (54%) of caregivers did not meet Australian physical activity guidelines, 71% were overweight/obese, 40% ate <2 serves of fruit and 80% <5 serves of vegetables/day, 37% consumed >2 alcoholic drinks/occasion and 10% were smokers. Overall, 56% reported ≥ 1 negative change since their family member's diagnosis, with many decreasing their physical activity (42%) and/or gaining weight (35%). Caregivers were more likely to report negative changes if they had only school-level education (OR 3.0, 95%CI 1.1-8.4), they were unable to carry out usual daily activities due to caregiving (OR 2.0, 95%CI 0.7-5.4), they were clinically distressed (OR 3.4, 95%CI 1.1-10.1) or caring for a woman whose disease impacted on her usual daily activities (OR 4.3, 95%CI 1.4-13.2).

CONCLUSIONS

Many caregivers of women with ovarian cancer do not meet Australian health guidelines and more than half describe negative changes after becoming a caregiver. More attention should be given to cancer caregivers with high physical and emotional demands.

Behavioral risk factors and use of preventive screening services among spousal caregivers of cancer patients

PURPOSE

Caregiving of cancer patients is burdensome and is likely to affect health behavior and outcome of caregivers. However, there are only a small number of studies on lifestyle behavior and use of preventive services by caregivers of cancer patients, especially in Asian populations. The aim of this study was to compare the status of lifestyle behavior and use of preventive services in spousal caregivers of cancer patients and controls.

METHODS

One hundred pairs of cancer patients and their spousal caregivers who visited the Cancer Daycare Center of Seoul National University Hospital were requested to fill out constructed self-administered questionnaires. Four age- and sex-matched controls were selected randomly for each caregiver from the Korea National Health and Nutritional Examination Survey III (KNHANES III) (n = 400) in order to compare adherence to recommended health behavior and use of preventive services.

RESULTS

Compared to controls, caregivers were more likely to receive all types of cancer screening: gastric (adjusted proportion, 53.8% vs 37.1%, p = 0.011), colorectal (adjusted proportion, 54.3% vs 20.5%, p = 0.002), cervical (adjusted proportion, 66.4% vs 46.5%, p = 0.006), and breast cancer (adjusted proportion, 62.9% vs 40.6%, p = 0.003). However, no differences were observed for health risk behaviors (current smoking, high-risk drinking, and physical inactivity) and screening for chronic diseases (hypertension, diabetes mellitus, and hypercholesterolemia).

CONCLUSION

Although spousal caregivers of cancer patients were more likely to use cancer screening services, their health behavior with regard to other aspects were not different from controls. There is a need to improve other types of health behaviors, especially lifestyle behavior, and balance these with cancer screenings in caregivers.

Enhancing caregiver health: findings from the resources for enhancing Alzheimer's caregiver health II intervention

OBJECTIVES

To examine the relationships between changes from baseline to post-Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self-reported health, burden, and bother.

DESIGN

Randomized, multisite clinical trial.

SETTING

CG and care recipient (CR) homes in five U.S. cities.

PARTICIPANTS

Four hundred ninety-five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls.

INTERVENTION

CGs were assigned to the REACH intervention or a no-treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months. Control subjects received two brief "check-in" telephone calls during this 6-month period.

MEASUREMENTS

The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention.

RESULTS

After the intervention, CGs reported better self-rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG-rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow-up, although differences between baseline and posttest did not vary according to race.

CONCLUSION

A structured, multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas, improved self-reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.

The Association between Membership in the Sandwich Generation and Health Behaviors: A Longitudinal Study

The current study examined the association between membership in the sandwich generation, defined as providing care to both children and parents or in-laws, and five health behaviors: checking the food label for health value when buying foods, using a seat belt, choosing foods based on health value, exercising regularly, and cigarette smoking. Participants (N=4943) were from a longitudinal study of a midwestern community-based sample. Regression analyses tested the unique effect of sandwich generation membership on health behaviors above and beyond demographic factors and prior levels of the same behavior. Compared to other caregivers and noncaregivers, multigenerational caregivers were less likely to check food labels and to choose foods based on health values. Multigenerational caregivers were less likely than noncaregivers and those who cared for children only to use seat belts, and they smoked marginally more cigarettes per day than those groups. Multigenerational caregivers were less likely than noncaregivers and those who cared for parents/in-laws only to exercise regularly. Thus, in general, healthy behaviors were diminished for multigenerational caregivers.

Rural family caregivers and health behaviors: results from an epidemiologic survey

This study examined health behaviors in a sample of rural family caregivers. In a community telephone survey of rural Missouri, Arkansas, and Tennessee, respondents were asked about their health, physical activity, nutrition, health providers, and family caregiving. Among 1,234 survey respondents, 12% self-identified as family caregivers. Caregivers reported lower fruit intake, more walking for exercise, and more provider advice about stress, fruits, and vegetables than noncaregivers. Groups did not differ in smoking, dietary fat, obesity, or self-rated health. Women caregivers reported more favorable patterns of physical activity, smoking, and provider interactions than men caregivers, and White caregivers had healthier reports of physical activity and body mass index than Black caregivers. These results provide new information about rural caregivers' health habits. Apart from nutritional intake, caregivers were not significantly different in most health behaviors. However, health providers seemed more attentive to caregivers regarding nutrition and stress.

Leisure-time exercise and overall physical activity in older women caregivers and non-caregivers from the Caregiver-SOF Study

BACKGROUND

Elderly caregivers report less leisure-time physical activity than same-aged non-caregivers. However, through caregiving tasks, caregivers may be as physically active as non-caregivers. This study compared leisure-time exercise and overall physical activity in elderly women caregivers and non-caregivers.

METHODS

The sample included 179 caregivers (153 cared for spouses and 26 for other relatives or friends) and 670 non-caregivers who were participants in the Study of Osteoporotic Fractures. Leisure-time exercise was based on respondents' report of walking for exercise or other regular exercise at least once a week. High overall physical activity included leisure-time exercise or being in the top quartile of walking and climbing stairs during one's daily routine.

RESULTS

Leisure-time exercise was lower in spouse caregivers (adjusted odds ratio (OR) and 95% confidence interval (CI) = 0.64, 0.41-1.00) and non-spouse caregivers (OR = 0.39, 95% CI = 0.16-0.95) than married non-caregivers. Differences in overall physical activity between caregivers and married non-caregivers were smaller and not statistically significant. Caregivers who climbed stairs at least 15 min/day during caregiving tasks reported more overall physical activity than non-caregivers (OR = 4.06, 95% CI = 1.23-13.36).

CONCLUSIONS

Studies comparing physical activity in caregivers and non-caregivers should assess activities performed during routine caregiving tasks.

Lower utilization of primary, specialty and preventive care services by individuals residing with persons in poor health

BACKGROUND

Since household time and financial resources for health care are primarily spent for those household members with the most urgent health needs, individuals residing with persons in poor health may be at risk of underusing health-care services. We examined whether these individuals had a lower use of primary, specialty and preventive care than those who did not reside with persons in poor health.

METHODS

Data collected in 2000 from a representative sample of 8,210 French individuals aged 18 years and older from 3,810 households were analysed with logistic regression models adjusted for health, demographic and socioeconomic variables.

RESULTS

We found that individuals residing with one other survey respondent had a higher risk of not using primary care, specialty care and preventive care in the 12 months preceding the study when the health status of the other survey respondent was poorer (fair or alternatively poor versus good). Furthermore, individuals residing with two other survey respondents had a higher risk of not using primary care, specialty care and preventive care in the 12 months preceding the study when they resided with a higher number of respondents in fair or poor health (one or alternatively two versus zero).

CONCLUSION

The lower use of health services by individuals residing with persons in poor health may signal a need for health practitioners to broaden the scope of care beyond their patients, and for policy makers to consider the long-term impact of this situation on the health-care system.

Spouses of persons with dementia: their healthcare problems, utilization, and costs

Spouses of persons with dementia (PWD) often experience poor health outcomes related to the experience of living with the afflicted spouse. Using the Anderson and Aday Healthcare Utilization Model, we conducted a retrospective review of an administrative database from a private healthcare insurer to compare health problems that precipitate utilization, patterns of utilization, and costs of care of spouses of PWD (n = 979) to those of spouses of persons without dementia (n = 979). Spouses of PWD were treated for more anxiety disorders (OR = 2.97; 95% CI = 1.63-5.44), falls (OR = 7.72; 95% CI = 2.73-21.84), rheumatologic diseases (OR = 2.5; 95% CI = 1.24-5.06), and diabetes with no complications (OR = 1.53; 95% CI = 1.06-2.22), but less pneumonia (OR =.55; 95%; CI =.35-.88) than comparison spouses. Spouses of PWD had a higher number of emergency room (ER) visits (p =.01). There were no differences in costs between the groups. The findings can be used to develop interventions for spouses of PWD.

Quality of preventive clinical services among caregivers in the health and retirement study

We examined the association between caregiving for a spouse and preventive clinical services (self-reported influenza vaccination, cholesterol screening, mammography, Pap smear, and prostate cancer screening over 2 years and monthly self-breast exam) for the caregiver in a cross-sectional analysis of the Health and Retirement Study, a nationally representative sample of U.S. adults aged > or = 50 years (N = 11,394). Spouses engaged in 0, 1-14, or > or = 14 hours per week of caregiving. Each service was examined in logistic regression models adjusting for caregiver characteristics. After adjustment for covariates, there were no significant associations between spousal caregiving and likelihood of caregiver receipt of preventive services.

Living arrangements and participation in leisure-time physical activities in an older population

OBJECTIVES

This is a cross-sectional investigation of living arrangements, social contacts, and level of leisure-time physical activity (LTPA) among residents of Sonoma, California, aged 55 and older.

METHODS

The odds of different levels of LTPA were assessed by living arrangements and social contacts following adjustment for measures of health, functioning, physical performance, selected health behaviors, and socioeconomic status for men and women separately (n = 2,073). Level of LTPA also was examined among married couples only (subset of sample, n = 511 spouse pairs).

RESULTS

The relationship between living arrangements, social contacts, and LTPA varied by gender and level of LTPA. Among married couples, the LTPA of the partner was the most significant predictor of the LTPA of the participant, with the exception of those who engaged in less than brisk activity.

DISCUSSION

Living arrangements and social contacts are important determinants of LTPA and should serve as the basis for future interventions.

An exercise program for women who are caring for relatives with dementia

OBJECTIVE

This study describes factors related to retention and adherence to an exercise program for women caregivers.

METHODS

One hundred sedentary women (average age = 62 years) caring for relatives with dementia were randomly assigned to an exercise program or an attention control (nutrition education) condition. Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week, for at least 30 minutes per session. Adherence was tracked through monthly exercise logs, validated in a subsample by ambulatory heart rate and motion monitors. Participants also completed a psychosocial questionnaire battery at baseline and 12 months after randomization.

RESULTS

Participants achieved a 12-month average exercise adherence rate of 74% (ie, three exercise sessions per week) with an average of 35 minutes per session. At 12 months, the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition. Both groups significantly improved in perceived stress, burden, and depression from baseline to posttest. Women who were older, less depressed, and more anxious at baseline showed better program retention, and lower baseline depression was associated with better exercise adherence.

CONCLUSIONS

This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population. Given the independent risk factors of caregiving and physical inactivity on mortality, programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role.

When the caregiver needs care: the plight of vulnerable caregivers

OBJECTIVES

This study examined the characteristics, activities, and challenges of high-risk informal caregivers.

METHODS

Telephone interviews were conducted with a nationally representative cross-section of 1002 informal caregivers. Vulnerable caregivers with poor health or a serious health condition were compared with nonvulnerable caregivers.

RESULTS

Thirty-six percent of caregivers were vulnerable. Compared with nonvulnerable caregivers, vulnerable caregivers were more likely to have difficulty providing care, to provide higher-intensity care, to report that their physical health had suffered since becoming a caregiver, to be aged 65 years or older, to be married, and to have less than 12 years of education.

CONCLUSIONS

Reliance on informal caregivers without considering the caregiver's ability to provide care can create a stressful and potentially unsafe environment for the caregiver and the care recipient.

Caregiving, alcohol use, and mental health symptoms among HMO members

Using data from a survey of 5841 HMO members, we examined alcohol consumption, depression and anxiety symptoms, and health services use among 689 informal caregivers. Characteristics of caregivers included whom they cared for, types of care provided, number of people cared for, and whether care was provided in the caregiver's home. Outcome measures in hierarchical linear and logistic stepwise regression models included indicators of alcohol drinking pattern, symptoms of anxiety and depression, role limits due to emotional problems and self-reported doctor's visits. Adjusting for age and gender differences, caregivers reported more bodily pain, worse role functioning related to emotional problems, were more likely to screen as depressed, and were more likely to report symptoms of anxiety. Older caregivers, and those with greater vitality, had better mental health outcomes; caregivers with higher levels of education reported better psychological well-being and less interference with role functioning due to emotional problems. Caregivers did not make more doctor's visits than non-caregivers. No caregiving characteristics were consistently associated with both mental health and alcohol consumption outcomes. The relationship of the care recipient to the caregiver predicted mental health outcomes better than either the type of care, number cared for, or location of care. Both the type of care and relationship to the care provider were associated with alcohol consumption, and several gender interactions were identified. Our results confirm previous findings of greater mental health problems among caregivers, yet suggest that caregivers may not be seeking services commensurate to their needs.

Family issues in dementia: finding a new normal

Caring for individuals with dementia poses significant hazards and can have lasting effects on the health, well being, and quality of life of family members. Families need guidance from physicians to support and maintain the dignity of the patient with dementia throughout the degenerative disease trajectory. There is a rational basis for family education and counseling strategies aimed at increasing effectiveness and reducing risks to families who provide care. Family care for patients with Alzheimer's should be directed toward defining a "new normal."

Basic need status and health-promoting self-care behavior in adults

Health-promoting self-care behavior emphasizing positive lifestyle practices may improve the health and quality of life of adults. One variable that may influence health-related decisions is the status of basic needs as described by Maslow. The purpose of this study was to investigate the relationships among basic need satisfaction, health-promoting self-care behavior, and selected demographic variables in a sample of community-dwelling adults. A convenience sample of 84 community-dwelling adults was recruited to complete the Basic Need Satisfaction Inventory, the Health-Promoting Lifestyle Profile II, and demographic information. Results of the study indicated that self-actualization, physical, and love/belonging need satisfaction accounted for 64% of the variance in health-promoting self-care behavior. The findings of this study are consistent with Maslow's theory of human motivation and suggest that persons who are more fulfilled and content with themselves and their lives, have physical need satisfaction, and have positive connections with others may be able to make better decisions regarding positive health-promoting self-care behaviors.

Self-reported health-promoting behaviors of black and white caregivers

The purpose of this study was to describe the behaviors that caregivers report carrying out to maintain their own health, and to compare the health-promoting behaviors of Black and White caregivers. Although many studies have examined health-promoting behaviors, few have examined health promotion among caregivers. Reported studies of caregivers' health-promoting behaviors have not compared cultural groups. The sample for this study was selected by random digit dialing, and included 136 Black and 257 White caregivers of frail elders. Content analysis of respondents' answers to the open-ended question, "In general, what do you do to stay healthy?" was used to address the research questions. Most caregivers reported specific behaviors they engaged in for the purpose of staying healthy. Although most of their behaviors addressed physical health, caregivers also mentioned behaviors that contribute to mental and spiritual health. Both differences and similarities were found in Black and White caregivers' self-reported health behaviors, which have important implications for nursing practice and research in the future.