Attitudes toward decision making and aging, and preparation for future care needs

The relationship at the heart of the experience of daughter caregivers of a parent with dementia: An interpretative phenomenological analysis

BACKGROUND

Parents with dementia require emotional, physical, psychological and financial support from their child caregivers to continue living at home. Daughter caregivers have been shown to be more involved in self-care and household tasks and to experience higher levels of distress than son caregivers.

OBJECTIVE

The aim of this study was to investigate the experience of daughter caregivers who provide informal care for a parent with dementia living in their own home.

METHOD

Semi-structured interviews were conducted with 11 daughter caregivers of a parent with Alzheimer's disease. Interviews were analysed using Interpretative Phenomenological Analysis.

RESULTS

Three axes emerged from the analyses: [1] the before conditions the after: the quality of the previous relationship with the parent with Alzheimer's disease is a determining factor and allows the identification of three profiles of daughter caregivers: 'the grateful', 'the resentful' and 'the ambivalent', [2] when the relationship protects against the sense of burden: the feeling of being invaded by the caregiving situation is influenced by the quality of the relationship with the parent with Alzheimer's disease, and [3] alone or almost: the support network is desired when it is absent but kept at arm's length when it is present.

DISCUSSION

The results underline the importance of assessing the quality of attachment and supporting the relationship with the parent (especially when the relationship prior to the disease was difficult). Daughter caregivers should also be encouraged to delegate tasks and refocus their actions related to their values. Family mediation sessions may be planned to improve the organisation of care and set up an efficient collaboration.

A Systematic Review of Literature on Caregiving Preparation of Adult Children

With the increasing life expectancy and ageing population, long-term care has become an urgent policy issue worldwide. The informal care provided by family members, particularly adult children, is a key aspect of long-term care. However, socioeconomic transformations have resulted in changing family and demographic structures and increased geographic mobility, reducing the capacity of families to provide informal care and meet the caregiving needs of older adults. For ageing families, care preparation can be an effective method for coping with eldercare challenges, and care preparation is attracting increasing attention from researchers. This study seeks to conduct a systematic review for studies on caregiving preparation by adult children that were retrieved from six databases, to synthesise the available evidence, and to identify knowledge gaps and opportunities for future investigations. The characteristics and main themes of eighteen reviewed articles were identified and analysed. This study discussed various conceptualisations of caregiving preparation by adult children, the prevalence of caregiving preparation, the factors related to caregiving preparation, and the related consequences. On the basis of the systematic review findings, several limitations of the literature and directions for future research were proposed to promote care preparedness and the well-being of ageing families.

Modeling the Distress of Adult-Child Caregivers of People with Dementia: The Mediating Role of Self-Efficacy

BACKGROUND

The increased tasks and responsibilities involved in supporting a parent with dementia (PWD) can induce distress in adult-child caregivers. Previous studies have shown that distress can be influenced by PWD and caregiver determinants, but few studies have considered the associations between these variables.

OBJECTIVE

This study tested a complex model of adult-child caregiver distress in which PWD and caregiver determinants and their associations are considered.

METHODS

159 adult-child caregivers participated in this online study. PWD and caregiver determinants were assessed using questionnaires and their associations were investigated using the partial least squares path method.

RESULTS

The model showed a significant partial mediation through self-efficacy (confidence in one's ability to organize and manage caregiving situations) between poor self-rated health and distress. Self-efficacy was a significant mediator of the relationship between informal social support and distress, and between preparedness and distress. The direct path between parental overprotection and distress was significant. The association between care and distress was significantly stronger for adult-child caregivers not living with their PWD.

CONCLUSION

The model revealed the important mediating role of self-efficacy. Clinical interventions should improve the preparedness of adult-child caregivers and the quality of social support. The positive perception of their self-rated health may thus be promoted.

Perspectives on Aging-Related Preparation

When older adults face age-related life challenges, anticipating what to expect and how to access potential coping strategies can both prevent and provide the possibility of easier recovery from crises. Aging-Related Preparation (ARP) is defined as the continuum of thoughts and activities about how to age well, often beginning with the awareness of age-related changes, or the anticipation of retirement, and concluding with specifying end-of-life wishes. In the current paper, we introduce the concept of ARP and related formulations regarding plans for aging well, describe both predictors and outcomes of ARP for several the domains of ARP, and consider the elements of ARP within the context of existing social policy. We conclude that ARP is determined by a variety of influences both intrinsic to the older person (e.g., personality, cognitive ability, beliefs about planning, problem-solving skills), linked to social class and education, as well as dependent on family structures, access to and knowledge of options, services, and local community resources, and social policy. We further provide evidence that ARP has positive effects in the domain of pre-retirement planning (for retirement adjustment), of preparation for future care (for emotional well-being), and of ACP (for a good death). However, other domains of ARP, including planning for leisure, housing, and social planning are under-researched. Finally, we discuss policy implications of the existing research.

Does Caregiving Influence Planning for Future Aging?: A Mixed Methods Study Among Caregivers in Canada

A mixed method design was used to examine how caregiving and transitioning a family member into long-term care (LTC) influence planning. Participants, aged 50+ from the community, completed self-report questionnaires. Quantitative data evaluated differences between three groups (non-caregivers, caregivers, caregivers with experience in assisting with a LTC transition); and predictive effects of caregiving, care expectations and social support to planning. Interviews among a subsample of caregivers examined how experiences of caregiving, including assisting in a transition to LTC, and social support influenced planning. Results indicated that: (1) caregivers with LTC transition experience planned significantly more than non-caregivers, (2) caregiving, care expectations, and social support significantly predicted of planning, and (3) future care expectation was an important mechanism in the relationship between caregiving and planning. These findings underscore the impact of caregiving experiences on expectations of future care needs and preparation for future care needs, and the importance of social support.

Late-Life Preparedness and Its Correlates: A Behavioral Perspective on Preparation

OBJECTIVES

The present study examined the extent of late-life preparedness and its correlates. In accordance with behavior theories, we postulated that those who have prior experience with caregiving and who perceive such activities as more useful and less risky are more likely to engage in late-life preparatory activities. Because the perceived distance until aging-related life challenges become prevalent may play a role in late-life preparedness, we hypothesized that the effects of the correlates would vary depending on one's subjective remaining life expectation (SRLE).

METHODS

Building upon cross-sectional data including 581 German adults from 18 to 93 years, we fitted a hurdle model that separately analyzes the presence and variety of self-reported action engagement to better handle the zero-inflated count measure of preparatory activities.

RESULTS

The results revealed that the effects of perceived utility, caregiving experience, and SRLE were significant for both the presence and variety of activities. SRLE was found to moderate the observed effects in the models: The effect of perceived utility on the presence of at least one late-life preparatory activity was larger for those with lower SRLE. In contrast, among those with higher SRLE, having provided care increased the variety of preparatory activities.

DISCUSSION

Findings suggest that some of the examined psychosocial factors are similarly associated with both the presence of at least one and the variety of late-life preparatory activities, although the extent of their effects varies depending on one's subjective life stage.

The Decision: A Creative Autoethnographic Account with Poetry

This is the story of my decision to place my mother in a continuing-care facility. It is interwoven with the experiences of 32 residents of two continuing-care communities. Their stories are presented as a poem, short conversation, and dramatic monologue. The poem describes what it means to be healthy. The short conversation elucidates the decision-making process of a couple and the monologue of a widow or single individual in moving to one of these facilities.

Involvement of Family Members and Professionals in Older Women's Post-Fall Decision Making

This exploratory, descriptive study examined involvement of family members and professionals in older women's post-fall decision making. We conducted semistructured interviews with 17 older women who had recently fallen and 11 individuals these women identified as being engaged in their post-fall decision-making processes. Qualitative data analysis involved open and axial coding and development of themes. After experiencing a fall, these older women's openness to others' opinions and advice; their assessments of types and credibility of potential information sources; and the communication practices they established with these sources influenced how they accessed, accepted, or rejected information from family members and professionals. Increased awareness of the involvement of others in post-fall decision making could enhance communication with older women who fall. Developing and implementing practical strategies to help family members and professionals initiate and engage in conversations about falls and their consequences could lead to more open decision making and improved post-fall quality of life among older women.

Exploring Family Support for Older Chinese Singaporean Women in a Confucian Society

This study investigated the functions of family support in older Chinese Singaporean women's daily health management in a Confucian cultural context, wherein family solidarity and women's caregiving responsibilities are emphasized. Thirty-eight interviews were conducted with ethnic Chinese women above the age of 60 in Singapore. Our thematic analysis showed that older women played dual roles as support providers and recipients in the family. Their caregiver identity and intent to preserve tradition resulted in a downward transmission of informational and physical support and their hesitance to accept resources provided by younger family members. The asymmetrical flow of family support generated mixed impacts on the women's daily health management. In their transition between tradition and modernity, older women fulfilled their family responsibilities but did not require their children to do so. Our findings suggested an integration of familial and institutional resources to meet older women's support needs and help them enhance their health behavior.

Subjective remaining lifetime and concreteness of the future as differential predictors of preparation for age-related changes

Demographic changes have been linked to the expectation of cuts in government-provided social security services, emphasizing individual responsibility to prepare for old age and concomitant challenges and changes. Accordingly, the identification of psychological variables predicting preparation is a matter of theoretical as well as practical importance. We thus consider different aspects of a person's future time as theoretically prominent psychological predictors of preparation. The subjectively perceived quantity of remaining lifetime, the concreteness of future time, and preparation for life domains indicative of an active third age as well as of a more dependent fourth age were assessed in a longitudinal study in a core sample of N = 593 participants (30-80 years old at T₁) at two measurement occasions 4 years apart. The quantity of subjective remaining lifetime predicted subsequent changes in preparation, but this effect was restricted to preparation for the fourth age. In contrast, a more open and concrete outlook on ones' personal future predicted changes in preparation for an active third age. Our findings highlight the importance of distinguishing between different aspects of future time-its quantity versus its relation to goals and action plans-when predicting specific facets of developmental self-regulation.

Memory banking: a life story intervention for aging preparation and mental health promotion

OBJECTIVE

The aim of this study is to examine the feasibility of Memory Banking (MB), a life story development intervention within the context of aging preparation. Individuals participate in MB to strategically document and share their life story, including mapping out future dreams, aspirations, plans, and decisions.

METHOD

Data (2010-2012) from eight MB workshops were examined to determine the impact of the intervention on mental health, social support, and quality of life.

RESULTS

Recruitment efforts resulted in n = 72 participants, primarily female (72%), White/Caucasian (93%), average age of 70 years. Data indicated intervention effects showing improvements in depression (p = .041), mood disturbance (p = .0067), and cognitive performance (p = .0045).

DISCUSSION

MB outcomes indicate that the intervention is promising and supports continued investigation and development in the area of life story development for aging preparation and improving late life mental health distress in a community setting. Future research is needed to examine the versatility and long-term effects of the MB intervention.

Older Women Discuss Planning for Future Care Needs

Objective: This study expands upon existing narrative data concerning health care preparation by developing a multi-theme framework of plans for future care needs. Method: Inductive content analysis was conducted on 185 interviews with European American and African American older women. Results: An explanatory framework emerged of five themes, describing varied approaches to planning for future care needs: (a) Autonomous Care Planners, (b) Externally Reliant Planners, (c) Aware of Preference, (d) Wishful Thinkers, and (e) Avoidant. A distinct group included women performing only end-of-life planning. Barriers to planning included low-perceived vulnerability, financial constraints, being uninformed of needed actions, and fear of burdening. Discussion: Although the majority undertook active steps to prepare for future care needs, many missed key steps or achievement of planning goals recommended by experts. Findings may be applied to long-term care planning research by providing added, rich detail on how aging women construct their options, make choices, and address this important area for future well-being.

Later Life Care Planning Conversations for Older Adults and Families

While most older adults have thought about their future care needs, few have discussed their preferences with family members. We interviewed older persons (24), adult children (24), health professionals (23), and representatives of stakeholder associations (3) to understand their views and experiences on later life care (LLC) planning conversations, in terms of (a) their respective roles, and (b) barriers and facilitators that should be taken into account when having these conversations. Roles described included that of information user (older persons), information seeker (family members), and information provider (health care providers). The study identified practical and emotional considerations relevant to LLC planning conversations. This study found strong support for planning for LLC before the need arises, as well as important potential benefits for older adults, family members, and health professionals. There is interest in, and need for, resources to guide families in LLC planning.

Interpersonal conflict and health perceptions in long-distance caregiving relationships

With job markets expanding globally and life expectancy continually increasing, more demands are being placed on distant relatives to provide care for their aging family members, creating a health care situation known as long-distance caregiving. An online survey explored the relations between negative health perceptions by long-distance caregivers and conflict frequency and conflict strategy usage. The authors observed positive significant relations between distant caregiver negative health perceptions and conflict frequency and usage of the distributive and avoidance conflict strategies. However, they observed no significant associations between distant caregiver negative health perceptions and usage of the two integrative strategies. Implications for long-distance caregiving communication are discussed.

Trajectories of preparation for future care among first-degree relatives of Alzheimer's disease patients: an ancillary study of ADAPT

PURPOSE

 This study examines the longitudinal patterns of Preparation for Future Care (PFC), defined as Awareness, Avoidance, Gathering Information, Decision Making, and Concrete Plans, in first-degree relatives of people with Alzheimer's disease (AD). 

DESIGN AND METHODS

 Eight time points across 6.5 years from a subsample of adults aged 70 years and older who were participating in the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT) were analyzed using latent growth modeling. Baseline attitudes toward planning for future care and demographic variables functioned as predictors in the conditional analyses. 

RESULTS

 Awareness, Gathering Information, Decision Making, and Concrete Planning increased across time, but Avoidance did not. Covariates were more often associated with the initial levels of planning behavior than with change across time. Women engaged in more initial Decision Making than men. Education was associated with more initial Gathering Information, Decision Making, and less Avoidance. Favorable attitudes toward planning were more predictive of baseline Awareness, Gathering Information, Avoidance, and less so for Decision Making or Concrete Planning. 

IMPLICATIONS

 Older adults with an elevated risk for AD increase in positive PFC behaviors gradually across time. Demographic characteristics and attitudes predict initial levels of planning, making it possible to identify individuals who might need help progressing to more advanced levels of planning. Future studies are needed to understand rates of change in planning behaviors.

Decision making among older people with advanced heart failure as they transition to dependency and death

PURPOSE OF REVIEW

This review critically considers recent research, identifying patient experiences of, and preferences for, participation in decision making during the end-of-life transition.

RECENT FINDINGS

Clinicians typically experience significant difficulties in engaging older patients with advanced heart failure in discussions about palliative and end-of-life care and involving them in shared decision making. Advanced care planning is proposed as an approach to ensure greater patient involvement in end-of-life care management, although evidence regarding effective interventions in this area is limited. Policy initiatives and guidelines appear not to reflect clinical reality and healthcare professionals experience significant barriers in transferring the required knowledge and skills into their practice. The notion of transition itself as a process that healthcare professionals could use for assessment and management requires further research, but does offer more than just a focus on heart failure management at the end-of-life.

SUMMARY

This review indicates a need to think carefully about how policy recommendations and guidance relating to patient participation in decision making at the end-of-life can be effectively implemented in practice. The need for continuity of involvement from key health workers is identified as very important in this regard. 'Transition' is also considered as a concept that may offer health professionals a different approach for assessment and management of heart failure patients over a longer period and means of integrating heart failure management with palliative care.