Living arrangements of ever-married older Lebanese women: is living with married children advantageous?

Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial

BACKGROUND

Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa.

OBJECTIVE

This study aims to evaluate 2 brief internet-based treatments in terms of efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD and adapted to the specific research question. The first treatment comprised self-confrontation and social sharing (exposure treatment; 6 sessions); the second comprised cognitive restructuring and social sharing (cognitive restructuring treatment; 6 sessions). The 2 treatments were compared with each other and with a waitlist control group.

METHODS

In total, 365 Arabic-speaking participants from the Middle East and North Africa (mean age 25.49, SD 6.68 y) with PTSD were allocated to cognitive restructuring treatment (n=118, 32.3%), exposure treatment (n=122, 33.4%), or a waitlist control group (n=125, 34.2%) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed via self-report at baseline and after treatment or waiting time. PTSD symptom severity was also measured throughout treatment or waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the 2 treatment conditions using appropriate statistical tests (eg, chi-square and Welch tests). Multiple imputation was performed to address missing data and evaluate treatment-associated changes. These changes were analyzed using multigroup change modeling in the completer and intention-to-treat samples.

RESULTS

Overall, 200 (N=240, 83.3%) participants started any of the treatments, of whom 123 (61.5%) completed the treatment. Treatment condition was not significantly associated with the proportion of participants who started versus did not start treatment (P=.20) or with treatment completion versus treatment dropout (P=.71). High treatment satisfaction was reported, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased, and quality of life improved significantly from baseline to the posttreatment time point (P≤.001 in all cases). Compared with the baseline assessment, overall PTSD symptom severity decreased significantly after 4 sessions in both treatment conditions (P<.001). Moreover, both treatment conditions were significantly superior to the waitlist control group regarding overall PTSD symptom severity (P<.001) and most other comorbid mental health symptoms (P<.001 to P=.03). Differences between the 2 conditions in the magnitude of change for all outcome measures were nonsignificant.

CONCLUSIONS

Internet-based cognitive behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245.

Family Structure Transitions: Prevalence and Physical Health Effects in Ethiopia, India, Peru, and Vietnam

This study aimed to identify the prevalence and physical health consequences of family structure transitions among children in Ethiopia, India, Peru, and Vietnam. In many high-income countries, family structure transitions are common, and research suggests that they can lead to worse physical health for children. However, we know little about either the prevalence or consequences of family structure transitions for children in low-and middle-income countries, who make up the vast majority of the world's children. First, we estimated the number of family structure transitions by age 12 using four rounds of Young Lives data from four low-and middle-income countries (N = 8062, Ethiopia, India, Peru, and Vietnam) and validated our prevalence estimates with another dataset from these same countries. The proportion of children experiencing a family structure transition by age 12 was: 14.8% in Ethiopia, 5.6% in India, 22.0% in Peru, and 7.7% in Vietnam. We put these estimates in context by comparing them to 17 high- and upper-middle-income countries. Second, using linear mixed models, we found that family structure transitions were not directly associated with worse physical health for children in Ethiopia, India, Peru, and Vietnam. Children in Peru experienced higher rates of family structure transitions relative to children in the other Young Lives countries, and similar rates to many of the 17 comparison countries, yet physical health was unaffected. It is possible that in low-and middle-income countries, the environment may overwhelm family stability as a determinant of physical health.

Predictors of quality of life among older patients with cancer during treatment

Background

Improving quality of life in older patients with cancer has become an important goal of healthcare providers.

Aims

The purpose of this study was to identify the predictors of quality of life among older patients with cancer, aged 60 years and over during the treatment period.

Methods

A descriptive correlational study was conducted among 150 patients. The Functional Assessment of Cancer Therapy Scale, Herth Hope Index and Hospital Anxiety and Depression Scale were used.

Results

The results showed that the total quality-of-life mean score was 58.50 (SD = 7.44), indicating low overall quality of life. The social-family well-being subscale had the highest mean (20.50, SD = 3.79) among all subscales of quality of life, while the emotional well-being subscale had the lowest mean (8.06, SD = 4.23). Hope and educational level had statistically significant positive relationships with all subscales of quality of life. However, anxiety was associated negatively with physical, social-family and functional well-being subscales, but positively with the emotional well-being subscale. Anxiety, income, marital status, health insurance, duration of treatment, educational level, gender and hope were identified as predictors of quality-of-life subscales.

Conclusions

The results could help to develop specific programmes that may improve quality of life among older patients with cancer during treatment.

Theoretical Perspectives of Hospitalized Older Patients and Their Health-Related Problems and Quality of Care: Systematic Literature Review

Introduction:

The proportion of aged people is growing worldwide. Older persons are affected by a number of physical, psychological and social factors that influence their health and quality of life. These factors are usually multiple and are often masked by sensory and cognitive impairments.

Purpose:

The purpose of this study was to examine the available literature emphasizing older persons’ care, care-related problems, and older persons’ quality of healthcare. Also, the paper aimed at exploring the future direction of research needs.

Results:

Good quality older patients’ care involves safety, professional interventions, recognition and management of physical and emotional wellbeing. Care of older patients requires addressing the aging process itself, the expected decrease in functionality, and diminished cognitive ability. Little statistical data were found to address the quality of hospitalized elderly patients in particular as well as study on healthcare facilities and nursing homes. Literature does not provide much guidance to the effectiveness of care strategies.

Conclusion:

The results assert that elderly health care is a priority. However, health care systems are not specific about elderly patients’ needs, leading to low quality of elderly care. There is a need to use an integrated model of care to improve the quality of life and quality of care provided to hospitalized older patients.

Ageing and Elderly Care in the Arab Region: Policy Challenges and Opportunities

Populations are expected to age rapidly in the Arab countries during the coming few decades. However, the current evidence base indicates that many countries in the region are not paying attention to this demographic phenomenon. This is a particular concern as longevity is often accompanied by many years of ill health and disability and most of the countries in the region continue to rely on the family as the primary source of elder care. While the family, and particularly women, are expected to provide increasing support for longer, they are faced by a set of socio-demographic changes that may hinder their ability to provide such care. This paper focuses on the ageing demographics in the Arab region and reflects on the multiple-roles for women by utilising quantitative analysis of international population and socio-economic indicators as well as reviewing the background literature and current ageing policies in the region. The paper then discusses possible strategies to address increasing long-term care needs through a social capital lens, where support to informal carers particularly women is emphasised.

Aging in Lebanon: Challenges and Opportunities

This spotlight offers a unique window into factors affecting aging in Lebanon. As a bridge between east and west, both geographically and culturally, Lebanon has the fastest growing older adult population in the Arab region, but few societal resources to address its needs. In a country with a history of political instability and war, but also a culture with strong family values, aging adults in Lebanon are vulnerable in some ways and advantaged in others. Outmigration of youth is an important determinant of the wellbeing of the elderly. While often advantaged by remittances sent by their children, older Lebanese adults have less access to instrumental social and personal support previously provided by young adults in the family. How Lebanon manages these challenges is likely to foreshadow the future aging experience for much of the Arab region.

Social networks and health among older adults in Lebanon: the mediating role of support and trust

OBJECTIVES

Despite a growing body of literature documenting the influence of social networks on health, less is known in other parts of the world. The current study investigates this link by clustering characteristics of network members nominated by older adults in Lebanon. We then identify the degree to which various types of people exist within the networks. This study further examines how network composition as measured by the proportion of each type (i.e., type proportions) is related to health; and the mediating role of positive support and trust in this process.

METHOD

Data are from the Family Ties and Aging Study (2009). Respondents aged ≥60 were selected (N = 195) for analysis.

RESULTS

Three types of people within the networks were identified: Geographically Distant Male Youth, Geographically Close/Emotionally Distant Family, and Close Family. Having more Geographically Distant Male Youth in one's network was associated with health limitations, whereas more Close Family was associated with no health limitations. Positive support mediated the link between type proportions and health limitations, whereas trust mediated the link between type proportions and depressive symptoms.

DISCUSSION

Results document links between the social networks and health of older adults in Lebanon within the context of ongoing demographic transitions.

Survey methods and aging research in an Arab sociocultural context--a case study from Beirut, Lebanon

OBJECTIVES

In Arab countries, the proportion of older adults is rapidly increasing, highlighting the need to conduct research on factors that influence aging. We describe the context-specific challenges faced and the solutions negotiated during the conduct of a survey study on family relations and aging in Greater Beirut, Lebanon.

METHOD

Drawing on the experience of a recently completed survey study, we reflect on the context-specific challenges faced and the solutions negotiated during the phases of questionnaire construction, interviewer training, sampling, and participant recruitment as a means to contribute to the growing area of cross-cultural survey research.

RESULTS

The social context of family relations influenced the nature of questions that can be included to obtain valid information. The unavailability of demographic data and the presence of cultural norms that promote deference to older adults also presented methodological challenges to the sampling and recruitment of older adults.

DISCUSSION

We provided illustrative examples on the importance of learning about a country's social and cultural contexts, and the necessity of exercising flexibility in decision making to ensure the collection of valid data and the successful completion of the study. Lessons learned inform elements of the research process in an Arab country, as well as bring to light unusual, yet generalizable, circumstances that will inform experiences in other cultural settings.

Foreign live-in domestic workers as caretakers of older Kuwaiti men and women: socio-demographic and health correlates

Ageing of the population is posing new challenges for caretakers. This paper aims to examine: (a) age and gender differences in care provided by a domestic worker versus a family member in the performance of activities of daily living (ADL); (b) socio-demographic correlates of care during illness; and (c) self-reported physical, functional, and psychological health status in relation to care-giver. A cross-sectional household survey was conducted among 2,487 Kuwaiti nationals aged 50 years or older. This paper focuses on persons aged 70 or more. We found that domestic workers provided care to 28 per cent of men and 58 per cent of women who needed assistance with ADL; and to 14 per cent men and 51 per cent women during illness. These respondents ranked poorer on several health indicators and reported higher depressive symptoms score than those looked after by a family member. Logistic regression indicated that care by a domestic worker was approximately seven times more likely for women than men, about 10.8 times more likely for those without co-resident children compared with those who had three or more co-resident children, and 44 per cent less likely for the poorest compared with the richest persons. It appears that reliance on domestic workers is increasing and such reliance will remain necessary in the absence of culturally acceptable alternative institutional arrangements.

Developing capacities in aging studies in the Middle East: Implementation of an Arabic version of the CANE IV among community-dwelling older adults in Lebanon

OBJECTIVE

To assess the feasibility, reliability, and construct validity of the Camberwell Assessment of Need for the Elderly (CANE) in identifying needs among community-dwelling older adults in South Lebanon with a view towards expanding ageing research in the country.

METHODS

A cross-sectional study was undertaken with 322 individuals, using the CANE, the EQ5d and a socio-demographic questionnaire. Reliability was determined through measuring internal consistency of the CANE. Construct validity was performed through examining CANE inter-item correlations, and comparing correlations with the EQ5d and socio-demographic indicators. A factor analysis was conducted using varimax orthogonal rotation.

RESULTS

Cronbach alpha was 0.71. For construct validity, correlations were highest in items measuring needs in looking after the house and food (r = 0.557); company and intimate relationships (r = 0.572); and medication and written/verbal information (r = 0.586). Moderate correlations were found with EQ5d items assessing the same measure, including: EQ5d 'problems taking care of self' and CANE self-care (r = 0.578) and daytime activities (r = 0.523); EQ5d 'problems performing usual activities' and CANE daytime activities (r = 0.553), self-care (r = 0.511) and mobility (r = 0.500); and EQ5d 'problems while walking' and CANE mobility/falls (r = 0.509). Corresponding items of the CANE and EQ-5d were significantly correlated with similar socio-demographic variables. The factor analysis supported results obtained in the CANE inter-item correlations.

CONCLUSIONS

The Arabic version of the CANE appears acceptable in assessing needs of older adults in South Lebanon. Given that the CANE is an interesting tool that promotes the integration of older persons' perspectives for appropriate interventions, further research is recommended to establish its validity and applicability in other communities in Lebanon and the region.

Decline in co-residence of parents and children among older Kuwaiti men and women: what are the significant correlates?

A trend towards decline in co-residence with children is apparent in several countries while it is absent in others. The objectives of this paper are to address the patterns of co-residence with children among older Kuwaiti men and women aged 60+ and to assess the determinants of such patterns within the context of rapid socioeconomic changes occurring in the country (n = 1588). The data for this paper were collected as part of a household survey on the psychosocial health and disability among 2487 older Kuwaitis aged 50+. Forward step-wise logistic regression was run to assess the significant socio-demographic and health related correlates of living without any co-resident children. We found that the percentage living without any co-resident children increased from 5% in 1999 to 24% in 2005/6. About 13% women and 1% men were living alone in 2005/6. In the multivariate analysis, older age, female gender, non-Bedouin cultural background, a smaller number of children, higher educational level, and the presence of one or more domestic helpers were positively associated with the absence of co-resident children. On the other hand, those who were not married were less likely to reside without co-resident children, as were those with higher family incomes. Except for self-rated health none of the health related variables, such as chronic illnesses or depressive symptom experience, emerged as significant. Modernization forces seem to be at the core of the observed decline in co-residence with children.

Socioeconomic resources and living arrangements of older adults in Lebanon: who chooses to live alone?

During recent decades, Lebanon has experienced demographic and social changes which, coupled with political instability, have led to waves of youth migration and a higher proportion of older adults living alone. This paper uses the 2004 data of the ‘Pan Arab Project for Family Health’ to assess the levels of various living arrangements and to examine the correlates of living alone, with a focus on economic resources. The findings reveal that 12 per cent of older adults in Lebanon lived alone (17.3 per cent of women and 6.2 per cent of men). Financially better-off older adults and those who reported being satisfied with their income were, respectively, 4.4 and 1.7 times significantly more likely to live alone than their counterparts. The incomes of Lebanese older adults were mainly provided by their children (74.8%) and a relatively small share derived from pension schemes. Contrary to findings from other Arab countries, variations in living arrangements among Lebanese older adults seem to follow the western model whereby wealthier older individuals are more likely to live alone and to be residentially independent. Further studies are warranted to examine to what extent this trend is the result of past migration of adult children who are now established elsewhere and sending remittances home.