Depression among recipients of informal care: the effects of reciprocity, respect, and adequacy of support

Emotional Support from Care Recipients, Caring Relationship Quality, and Caregiving Self-Efficacy among Family Caregivers of Older Adults

We analyzed 756 family caregivers (mean age = 62.3 years), investigating how emotional support from older care recipients was linked to caregivers' self-efficacy through caring relationship qualtiy. Results indicate a significant positive association between emotional support and caregivers' self-efficacy (r = 0.207, p < .01). Caring relationship quality positively correlated with emotional support (r = 0.292, p < .01) and caregivers' self-efficacy (r = 0.141, p < .01). Controlling for socialdemographic and care-related factors, relationship quality partially mediated the association between emotional support from care recipients and caregivers' self-efficacy. This suggests that interventions supporting caregivers' self-efficacy may benefit from considering both care recipients and dyadic relationships.

A study on the impact of the number of family generations on intergenerational support for centenarians: a study in a Chinese 'longevity city'

BACKGROUND

As a natural source of support for the elderly, the family is an important channel for achieving a sense of security, happiness, and worthiness in old age. In this study, we analysed the characteristics of intergenerational support in families of centenarians and explored the impact of the number of family generations on intergenerational support.

METHODS

We conducted a cross-sectional survey between April 2020 and January 2021 among 62 elderly people aged 99+ in Rugao, China, one of six 'longevity cities' in the world. Assisted by the researchers, centenarians completed questionnaires with details pertaining to general demographics, intergenerational support, and other aspects. We used a logistic regression model to analyse the influence of the number of family generations on intergenerational support that the centenarians received with respect to economic, living, and emotional aspects.

RESULTS

Centenarians were primarily recipients of care in their families, and received intergenerational support mainly for their declined physical functions and limited self-care ability. The study results revealed that the greater the number of generations comprising the family, the greater was the intergenerational life care and emotional comfort provided for centenarians by the family.

CONCLUSIONS

In this study, we found a positive effect of the number of family generations on intergenerational support for centenarians. The government and society should promote the tradition of respecting, caring for, and honouring the elderly while paying close attention to the dynamic changes in the family structure of centenarians in promoting high-quality and sustainable development of the people, economy, and society.

Gatekeepers: The Association of Caregiving Network Characteristics With Emergency Department Use by Persons Living With Dementia

OBJECTIVES

Caregivers are typically enmeshed in networks of family and friends who assist with care, yet this network is largely neglected in research. In light of the fact that caregivers are key medical decision makers and play a critical role in how persons living with dementia (PLwDs) interface with the health care system, this study explores how features of the caregiver network relate to PLwD emergency department (ED) use.

METHODS

Using 2015 National Health and Aging Trends Study data linked with fee-for-service Medicare claims, we examine ED use in a nationally representative sample of community-dwelling persons aged 65 and older with dementia and at least 1 caregiver. We consider aspects of the caregiver network including membership (e.g., daughter in network), network size, hours of care received, and the presence of generalists and specialists (i.e., broad vs narrow functional assistance) as predictors of ED encounters among PLwD.

RESULTS

PLwDs were 81.5 years old on average, 50% were female, and 33% were non-White. Care networks including nonimmediate family members involved in task sharing for mobility and self-care difficulties and those with more generalists had significantly higher odds of an ED visit. Networks that only consisted of specialist caregivers had significantly lower odds of an ED visit.

DISCUSSION

Greater complexity of care networks increases risk of presenting to the ED for care. Better understanding how caregiving networks help PLwD interact with the health care system can inform intervention design and targeting in order to help care networks improve care coordination, management, and shared decision making.

Informal Care and Subjective Well-Being among Older Adults in Selected European Countries

A person’s health status is one of the strongest determinants of well-being. The negative impact of poor health on subjective well-being may be moderated by providing care to individuals in need. In this paper, we investigate the relationships between receiving informal care and the amount of care received and subjective well-being among people aged 65 or older in selected European countries. Our analysis of data from the 6th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) showed that receiving regular informal care was associated with higher subjective well-being among older people in Northern European countries, and with lower subjective well-being among older males in Southern European countries. Moreover, we found that the perception of the amount of help received affected the subjective well-being of older people, as those who reported that the support they received was either insufficient or met their needs had lower subjective well-being than those who were not in need of care. Our results also showed that receiving formal care was negatively related with subjective well-being among older adults in Northern Europe and Central and Eastern Europe. In the context of population ageing and the growing need for care, social policies that support both sides of the caregiving relationship could enhance subjective quality of life.

Conceptualizing How Caregiving Relationships Connect to Quality of Family Caregiving within the Stress Process Model

Family caregivers provide the majority of care for older and disabled family members living with an illness or disability. Although most caregivers want to provide high-quality care, many report providing care that is potentially harmful. We apply the Stress Process Model to review the preponderance of literature implicating quality of the relationship between caregivers and care recipients as a factor contributing to quality of family caregiving. In drawing together literature on caregiving relationships and caregiving quality, this commentary identifies potentially modifiable intervention targets to develop programs to support high-quality caregiving to older adults living with a chronic illness or disability.

Predictors of Quality-of-Care Provided by Migrant Live-In Caregivers of Frail older Persons: A Cross-Sectional Study

We examined the association between employment-related characteristics and the quality-of-care migrant live-in caregivers provide to older care-recipients. Structured interviews were conducted with 115 migrant live-in caregivers, 72 older care-recipients, and 117 relatives of care-recipients. We conducted correlations among dependent (quality-of-care), independent (quality of relationship between caregiver and informant, caregiver perception of work, and problematic employment conditions), and demographic variables, and performed a path analysis by conducting a series of multiple regressions. Quality-of-care was most highly correlated with quality of relationship between informant and caregiver. Quality of relationship was predicted by caregiver perceptions of work, which was negatively predicted by problematic employment conditions. In the relatives-based model, quality of relationship was significantly better when the care-receiver was female and the care-recipient needed more assistance with activities of daily living. The study clarifies the role of caregiver work characteristics for quality-of-care and highlights the crucial role of the relationship with the care-recipient.

Regulatory focus and perceptions of ageing: exploring the connections

Objectives:Perceptions of ageing can become a self-fulfilling prophecy for older adults, with those who hold more negative views of ageing experiencing more negative consequences of the ageing process, including poorer health and cognitive declines. Exposure to negative stereotypes about their group can also affect older adults performance in cognitive tests, as they are more likely to adopt a prevention focus to avoid mistakes, therefore, performing poorly in tasks requiring them to adopt a gains-oriented focus. Based on regulatory focus theory, we hypothesised that negative perceptions of ageing and stereotype threat may be connected, specifically we hypothesised that those with more negative perceptions of ageing would also have a stronger trait prevention focus.Method: Two hundred adults aged 60+ took part in an online questionnaire examining their perceptions of ageing and their trait regulatory focus.Results and Conclusion: Results indicated that negative perceptions of ageing were predictive of a stronger trait prevention focus in a hierarchical multiple regression model. This provides evidence that older adults with more negative perceptions of ageing may adopt a stronger prevention focus, potentially influencing psychological attitudes to everyday tasks and behaviours. Perceptions of ageing and regulatory focus can have implications for the efficacy of health messaging for older adults.

Dyadic effects on depressive symptoms of spouse caregivers and their care recipients: evidence from China

OBJECTIVES

The likelihood of providing care to a spouse in middle and older ages has increased as life expectancy increases, but knowledge about how the caregiver and care recipient influence each other's mental health is limited. This study examined whether a partner's physical, cognitive, and mental health in a spousal caregiving dyad are associated with the other partner's depressive symptoms in China and whether the dyadic effects vary by gender.

METHODS

This study used data from Wave 3 (2015) and Wave 4 (2018) follow-up surveys of the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample featured 1,245 dyads of care recipients aged 45 or older and their spouse caregivers. The Actor-Partner Interdependence Model was used to test the dyadic effects among all couples in the analytic sample, couples with wife caregivers and couples with husband caregivers, respectively.

RESULTS

We found that caregiver's depressive symptoms at Wave 3 were significantly associated with care recipient's depressive symptoms at Wave 4 in the full sample. Regardless of caregiver or care recipient roles, wives' mental health was impacted by their husbands' depressive symptoms, but not vice versa. Wife recipient's cognitive impairment was associated with husband caregiver's lower depressive symptoms.

CONCLUSION

This study sheds light on the mental health of couples in the context of caregiving in China. The findings indicate that interventions to support couples in a caregiving dyad need to consider the influence they have on each other, and the gender and health conditions of each in the dyad.

The role of care-giver and mental health for older adults with disabilities: a mixed-method study

Because of the exacerbation of population ageing, more family members are involved in the informal care-giving for older adults with disabilities to cater to their long-term care needs. As informal care-givers are associated with the mental health of the care recipient, this study, based on the theoretical framework of the Actor–Partner Effect, utilises a mixed method composed of quantitative and qualitative strategies to identify the relationship among gender and type of both care-giver and care recipient, and mental health of the recipient and explain its internal mechanism. In the quantitative research, ordinary least squares (OLS) regression results based on the basis of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data corroborate the existence of actor and partner effects within the care-giving dyad. The qualitative analysis further explains the socially constructed differences in gender role, trust relationship and perception towards filial piety of adult care-givers playing their role in the emergence of the Actor–Partner Effect. Finally, this study proposes a developed Actor–Partner Effect analysis framework, advocating to destigmatise disability and construct social support networks for the older adults with disabilities who receive informal care to promote their mental health based on the reflection of socially constructed gender difference.

Resilience and Social Support-Giving Scales: Conceptual and Empirical Validation

OBJECTIVES

This report introduces National Social Life, Health, and Aging Project (NSHAP) data users to 2 new measures-one that assesses older adults' resilience, defined as personal attributes that indicate an adaptive reserve that can be drawn on during adversity, and a second that expands on existing measures of social support received from others to also assess social support given to close others.

METHOD

Data from 4,604 NSHAP respondents born 1920-1965 were used to conduct psychometric analyses and validation of our measures of resilience and social support-giving.

RESULTS

Scale reliabilities were acceptable for the 4-item resilience scale, and the 2-item scales for family support-giving and friend support-giving. The 2 spousal support-giving items did not cohere well as a single scale. The resilience scale exhibited significant correlations with criterion validation variables, even after adjusting for correlated personality traits. The support-giving scales, and the spousal support-giving items, also exhibited significant correlations with criteria, and with the resilience scale, even after adjusting for social support receipt. Scale means exhibited demographic differences.

DISCUSSION

The resilience and social support-giving measures have acceptable psychometric characteristics (with the exception of spousal support-giving), convergent validity, and predictive utility net of related variables. NSHAP data users are offered several suggestions (key points) in the use of these measures in future research.

Navigating Infodemics, Unlocking Social Capital and Maintaining Food Security during the COVID-19 First Wave in the UK: Older Adults' Experiences

In March 2020, a national UK lockdown was implemented in response to rapidly rising COVID-19 infections. Those experiencing the most severe public health restrictions were ‘shielding’ groups as well as those over 70 years of age. Older age adults, many of whom were active, independent, and socially connected were immediately instructed to stay at home, to limit all external social contact and consider contingency for maintaining personal food security and social contact. The purpose of this qualitative study was to explore the experiences of older adults during the first UK lockdown (March–June 2020), specifically how our sample reacted to public health messaging, staying food secure and drawing on available social capital within their community. Semi-structured telephone interviews were conducted with eight participants. In addition, twenty-five participants completed a qualitative ‘open-ended’ survey. The data was collated and analysed, adopting a Thematic Analysis informed approach. Three themes were identified: (1) Too Much Information, (2) The Importance of Neighbours and Connections and (3) Not Wishing to be a Burden. These findings offer a rich insight into how early lockdown measures, never witnessed since World War 2, exposed existing pre-pandemic inequalities and concerns relating to loneliness, isolation and wellbeing. The findings are of relevance to researchers, older adult advocate groups and policy makers to inform post COVID-recovery within communities to ensure healthy ageing.

Pensions and Depressive Symptoms of Older Adults in China: The Mediating Role of Intergenerational Support

This study aimed to investigate the relations between pensions and depressive symptoms of Chinese older people, and whether intergenerational support mediated such association. Secondary data was drawn from Chinese Longitudinal Aging Social Survey (CLASS) 2014 (N = 6687). Depressive symptoms were measured by 12-item version of the Centre for Epidemiological Studies Depression scale (CES-D). Intergenerational support was measured by financial, instrumental, and emotional support. About 80.1% of the participants had pension and the mean score of depressive symptoms of the participants was 17.10 (SD = 4.35) with a range from 12 to 36. The results from hierarchical linear regression revealed that there was significantly association between pensions and lower levels of depressive symptoms (B = -0.645, p < 0.000). Findings of mediation analyses also indicated that financial support from adult children played a mediating role between pensions and depressive symptoms (B = -0.039, 95% CI [-0.064, -0.018], z = -3.082, p = 0.002). Findings from this study enrich our theoretical and practical understanding of the roles of intergenerational support, and offer implications for social insurance policy, social work, and family support interventions for Chinese older adults.

Community attachment and emotional well-being: an empirical study of an online community for people with diabetes

Purpose

The purpose of this study is to investigate how community attachment to an OHC reduces the OHC users' emotional distress and therefore improves their emotional well-being.

Design/methodology/approach

A survey study was conducted in one of the largest online health communities (OHC) for people with diabetes.

Findings

OHC participants are likely to experience reduced emotional distress when they have developed an attachment to the community. This attachment is, in turn, positively associated with the normative expectations of reciprocity and the affective feeling of gratitude. However, some commonly used behavioral measures of community participation, such as visit frequency and membership tenure, have little to do with either community attachment or reduced emotional distress.

Research limitations/implications

The research highlights the pivotal role of community attachment in appraising the much-debated benefits of OHCs. However, the cross-sectional survey study has its limitations in terms of establishing causality.

Practical implications

OHC managers need to look beyond some of the commonly used metrics, such as monthly visits and number of new postings, and focus on fostering a sense of attachment among existing users in order to fulfill the OHC's potential of emotional support. Our study implies that design features facilitating reciprocation and gratitude expression among users can lead to a strong emotional bond.

Originality/value

This is one of the first studies on the antecedents of community attachment and the relationship between community attachment and emotional distress in the context of OHC.

Daily Stressors Facilitate Giving and Receiving of Emotional Support in Adulthood

The aims of the present study were to examine whether daily stressors are associated with engagement in emotional support and whether these associations differ by gender. Analyses were conducted using Wave 2 of Midlife in the United States data and its subproject National Study of Daily Experiences. The sample consisted of adults aged 33 to 84 (N = 1,622). Using multinomial multilevel analysis, we looked at the associations between lagged and concurrent daily stressors with engagement in emotional support. For concurrent associations, people who experienced stressors were more likely to both give and receive, solely give, and solely receive emotional support compared with those who did not have any stressors. Women were more likely to engage in both giving and receiving of emotional support compared with men when they experienced stressors during the same day. In terms of the lagged associations, both men and women who experienced stressors during the previous day were more likely to both give and receive emotional support the next day compared with those who did not experience any stressors during the previous day. These results suggest that experiencing daily stressors facilitates giving and receiving of emotional support at daily level in adulthood.

Testing the suitability of the ACCOM tool to measure outcomes of care for Culturally and Linguistically Diverse older people

The Australian Community Outcomes Measurement (ACCOM) uses a standardized set of instruments to measures functional, health, and social care-related quality of life (SCRQoL) among older people receiving services at home. One of its key components is the use of modified ASCOT SCT4 survey developed by The University of Kent PSSRU. This paper presents the preliminary findings of a pilot testing of ACCOM with CALD clients in South West Sydney using face to face interviews conducted by bilingual workers as a novel approach to administering the tool. The paper will argue that some of the domains in ASCOT SCT4 survey pose unique challenges for culturally diverse groups that highlight the ethnocentric nature of some of the questions. It also discusses some of the strategies the service provider used to address these concerns and be able to utilize the tool in a culturally effective manner.

Visual impairment and the use of formal and informal home care in Canada: the Canadian Longitudinal Study on Aging

OBJECTIVE

To determine the use of home care services in those with and without visual impairment in Canada.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

Participants came from the baseline examination of the Canadian Longitudinal Study on Aging Comprehensive Cohort. Inclusion criteria included age between 45 and 85 years, community dwelling, and living near one of the 11 data collection sites across 7 Canadian provinces. People were excluded if they were in an institution, were living on a First Nations reserve, were full-time members of the Canadian Armed Forces, did not speak French or English, or had cognitive impairment.

METHODS

Presenting visual acuity was measured using the Early Treatment of Diabetic Retinopathy Study chart at 2 meters. Visual impairment was defined as binocular acuity worse than 20/60. The use of formal, informal, and both types of home care was determined by questionnaire.

RESULTS

For 29 666 participants, the use of any home care was greater in those with visual impairment than in those without (28% vs 12%, respectively, p < 0.01). After adjusting for demographics and health, people with visual impairment were more likely to use informal home care (odds ratio [OR] = 1.89, 95% CI 1.35-2.63) and formal home care/both types of home care (OR = 2.70, 95% CI 1.79-4.07) than those without visual impairment. Marital status was a modifier.

CONCLUSION

Visual impairment is associated with use of home care services. These findings warrant further exploration and, if confirmed, have major health service implications, given the rising prevalence of visual impairment due to age-related eye diseases.

The Impact of Living Alone and Intergenerational Support on Depressive Symptoms Among Older Mexican Americans: Does Gender Matter?

The study examined gender differences in the impact of living alone and intergenerational support on depressive symptoms among Mexican American older adults. The sample included 335 parent-adult child pairs which are nested within 92 Mexican American respondents, because each respondent reported their specific relationships with each child. Clustered regression analysis showed gender differences in the impact of living alone and intergenerational support on depressive symptoms among Mexican American older adults. In general, older men provided and received less intergenerational support than older women, but their depressive symptoms were more susceptible to living alone and different types of intergenerational support. Factors such as living alone, receiving instrumental support were associated with more depressive symptoms in older men than inolder women, whereas older men benefited more from the emotional closeness with children than older women. The findings highlight the need for a gender-specific approach to future research on this topic.

Population Characteristics and Needs of Informal Caregivers Associated With the Risk of Perceiving a High Burden: A Cross-Sectional Study

This study explored the population characteristics and needs of informal caregivers reporting a low or high burden. A cross-sectional study was conducted in the Netherlands to explore the associations between the characteristics and needs of informal caregivers and the burden they perceive and to assess the variance in perceived burdens that is explained by these variables. Three thousand sixty-seven adult informal caregivers and 1936 senior informal caregivers participated, almost 15% of whom perceived a high burden. Particularly caregivers in the 40 to 54 age group perceived a high burden, while caregivers with an intermediate educational level reported a low burden. Higher burden was also reported by caregivers who spent more time on the care provision tasks, had a high level of depressive symptoms, or reported loneliness. The explored variables seem to be important to explain caregiver burden. Longitudinal research is warranted to establish the causal directions of these associations.

Frailty differences in older adults' use of informal and formal care

OBJECTIVES

This study examines different combinations of informal and formal care use of older adults and investigates whether these combinations differ in terms of need for care (physical and psychological frailty) and enabling factors for informal and formal care use (social and environmental frailty).

METHODS

Using cross-sectional data from the Belgian Ageing Studies (survey, N = 38,066 community-dwelling older adults), Latent Class Analysis (LCA) is used to identify combinations of informal and formal care use. Bivariate analyses are used to explore the relationship between the different combinations of care use and frailty.

RESULTS

Latent Class Analysis (LCA) identified 8 different types of care use, which vary in combinations of informal and formal caregivers. Older adults who are more likely to combine care from family and care from all types of formal caregivers are more physically, psychologically and environmentally frail than expected. Older adults who are more likely to receive care only from nuclear family, or only from formal caregivers are more socially frail than expected.

CONCLUSIONS

Older adults with a higher need for care are more likely to receive care from different types of informal and formal caregivers. High environmental frailty and low social frailty are related with the use of care from different types of informal and formal caregivers. This study confirms that informal care can act as substitute for formal care. However, this substitute relationship becomes a complementary relationship in frail older adults. Policymakers should take into account that frailty in older adults affects the use of informal and formal care.

Carers as partners in mental health services for older people

The role that carers play in supporting older people with mental health needs in the community is well recognised by professionals and in current government policy. This article promotes the view that a systematic planned approach that engages the carer as an integral part of the system of care has potential benefits for patients, carers and services. Ways of working in partnership are outlined and evidence that psychosocial interventions with carers are effective is briefly reviewed. Examples of individual and group interventions for dementia carers are given, drawing on clinical experience and research literature. Areas for further development are highlighted, including greater partnerships with carers in primary and continuing care, as well as at the level of planning and service development.

Informal Care Networks in the Context of Multimorbidity: Size, Composition, and Associations With Recipient Psychological Well-Being

OBJECTIVE

We evaluate how the size and composition of care networks change with increasing morbidity count (i.e., multimorbidity) and how larger care networks relate to recipient psychological well-being.

METHOD

Using the National Health and Aging Trends study (NHATS; N = 7,026), we conduct multivariate regressions to analyze size and compositional differences in care networks by morbidity count and recipient gender, and to examine differences in recipient psychological well-being linked to care network size.

RESULTS

Women report larger and more diverse care networks than men. These gender differences strengthen with increasing morbidity count. Larger care networks are associated with diminished psychological well-being among care recipients, especially as morbidity increases.

DISCUSSION

These findings reveal how increasing morbidity translates differently to care network size and diversity for men and women. They also suggest that having multiple caregivers may undermine the psychological well-being of care recipients who face complex health challenges.

Building a system-wide approach to community relationships with the findings of a scoping review in health and social care

Purpose For leadership and management of Western health systems, good quality relationships are a fundamental cornerstone of organising health and social care (H&SC) delivery, delivering benefits across organisations and communities. The purpose of this paper is to explore the extant management, H&SC literature, grounded in older people care, reveal behaviours, processes and practices that if readily identified across a context will support healthy relationships across the "whole system" of stakeholders. Design/methodology/approach An academic/practitioner group designed and guided a scoping literature review of the H&SC and broader management literature to identify and extract important behaviours, processes and practices underlying the support of high-quality relationships. A search strategy was agreed and key health and management databases were interrogated and 51 papers selected for inclusion. Working with the practitioners, the selected papers were coded and then organised into emergent themes. Findings The paper outlines the relational behaviours, processes and practice elements that should be present within an older peoples care community, to support a healthy relational environment. These elements are presented under the five emergent literature themes of integrity, compassion, respect, fairness and trust. These five topics are examined in detail. A way forward for building statements using the review material, that may be applied to reveal relational patterns within older people care, is also explored and outlined. Research limitations/implications All literature reviews are subject to practical decisions around time, budget, scope and depth restraints. Therefore potentially relevant papers may have been missed in the review process. The scoping review process adapted here does not seek to make any major considerations with regards to the weighting of evidence behind the primary research. Originality/value This paper contributes to a growing need for designers of health systems to more fully understand, measure and draw on the value of relationships to help bridge the gap between diminishing resources and the expanding demand on H&SC services.

Invisible Care: Friend and Partner Care Among Older Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults

OBJECTIVE

Lesbian, gay, bisexual, and transgender (LGBT) older adult caregivers may encounter obstacles in obtaining health and aging services due to discrimination in service and legal systems. The caregiving relationships in LGBT communities also differ from the general population in that friends are providing a large portion of informal care. This article examines how the relational context of caregiving relates to caregiving demands and resources, which in turn, influence perceived stress and depressive symptomatology among older LGBT caregivers.

METHOD

Using data from the National Health, Aging, and Sexuality Study: Caring and Aging with Pride, this study examines 451 participants who are providing caregiving to partners and friends. Structural equation modeling was applied to estimate the associations among the caregiver-care recipient relationship and caregiving demands, resources, perceived stress, and depressive symptomatology.

RESULTS

On average, as compared with those caring for partners, those who provided care to friends reported experiencing lower levels of caregiving demands and lower levels of social support. The lower caregiving demands correlated positively with both lower perceived stress and less severe depressive symptomatology; however, the lower levels of social support were related to higher perceived stress and higher depressive symptomatology.

CONCLUSIONS

Caregiving provided by friends, which has long been under recognized, plays an important role in the LGBT community. Because lower levels of caregiving demands are offset by less social support, LGBT friend-caregivers experience similar levels of perceived stress and depressive symptomatology to those providing care to spouses and partners. Policy and service reforms are needed to better acknowledge the continuum of informal caregiving relationships.

Receiving Instrumental Support in Late Parent-Child Relationships and Parental Depression

OBJECTIVES

This study investigates the role of gender, functional limitations, and social interaction in the association between instrumental support from adult children and parental depression. We apply self-determination theory to hypothesize about the role of physical needs and social resources on parental depression in a European context.

METHOD

A sample of 6,268 parents older than 65 who have nonresident children from the first wave of Survey of Health, Ageing and Retirement in Europe (2004) is analyzed. We estimate logistic regression models to test for the association between instrumental support and depression. Physical needs, gender, and social interaction are used as moderators.

RESULTS

Net of core factors that contribute to depression, including previous history of depression, there is a U-shaped pattern between receiving instrumental support and depression that persists across country regimes. For respondents with medium physical limitations, too little or too frequent support from children is associated with higher depression. For respondents with severe limitations, receiving at least some support is better than receiving none at all. The receipt of too frequent support from children increases the level of depression more for women than men. All interaction effects are comparable across country regimes.

DISCUSSION

Heterogeneity in physical needs and resources of older individuals must be taken into account when assessing the effects of instrumental support on mental health.

Examining the influence of family dynamics on quality of care by informal caregivers of patients with Alzheimer's dementia in Argentina

PURPOSE

This study examined the pattern of family dynamics of Argentinian individuals with dementia that most heavily influences the quality of care provided by family caregivers (CGs).

METHOD

One hundred and two CGs of individuals with Alzheimer's disease in Argentina participated in this study. The majority (75%) were female, with an average age of 57.8 years (standard deviation = 13.5) and had spent a median of 48 months (interquartile range [IQR]: 36.00-60.00) providing care to their family member with dementia, devoting a median of 60 hours (IQR: 50.00-80.00) per week to these duties. Caregivers completed Spanish versions of instruments assessing their family dynamics and quality-of-care provision.

RESULTS

Hierarchical regression analyses suggested that higher quality of informal care (Provide and Respect) was related to greater levels of empathy and reduced levels of overall dysfunction in CGs' families. Higher quality of care-Provide was also related to shorter duration of time (in months) spent providing care.

CONCLUSION

Dementia CG interventions in Latino populations would likely benefit from addressing difficulties experienced when providing care for a prolonged period of time, as well as programming or techniques to improve family dynamics, especially family empathy and general functioning, given the strong reciprocal influence of these factors on CG quality of care.

Transferring control to others: process and meaning for older adults in assisted living

This study examines qualitative data describing transfers of control over life tasks (e.g., managing money, overseeing care) to close others in terms of the control by and outcome for the older person. The extant caregiving literature includes limited focus on how such task transfers occur, who controls them, and the reactions of older adults. The literature on control, however, provides extensive data that declining control has negative outcomes. Employing data from interviews with 77 adults in assisted living settings, narratives were identified where task transfers were discussed. These 26 instances were reviewed by the authors and categorized as chosen or not chosen by the older adult and their reactions categorized as positive, negative or neutral; if the initial narrative segment was ambiguous, further reading of the informant's interview or that of a family member were added to better understand these cases. Findings show that chosen transfers of tasks to children or others were linked with a positive reaction in all instances identified, while a majority of cases where tasks were taken over by others, the reactions were negative. While literature suggests that declining control is linked to negative outcomes, our findings suggest that the process involved when tasks are transfer to others (delegated or taken by them) may be an important, under-investigated element with potential implications for future research and practice.

Physical activity and depressive symptoms in four ethnic groups of midlife women

The purpose of this study was to determine the associations between physical activity and depression and the multiple contextual factors influencing these associations in four major ethnic groups of midlife women in the United States. This was a secondary analysis of the data from 542 midlife women. The instruments included questions on background characteristics and health and menopausal status; the Depression Index for Midlife Women (DIMW); and the Kaiser Physical Activity Survey (KPAS). The data were analyzed using chi-square tests, the ANOVA, two-way ANOVA, correlation analyses, and hierarchical multiple regression analyses. The women's depressive symptoms were negatively correlated with active living and sports/exercise physical activities whereas they were positively correlated with occupational physical activities (p < .01). Family income was the strongest predictor of their depressive symptoms. Increasing physical activity may improve midlife women's depressive symptoms, but the types of physical activity and multiple contextual factors need to be considered in intervention development.

The association between social relationships and depression: a systematic review

BACKGROUND

Depression is one of the most prevalent mental disorders globally and has implications for various aspects of everyday-life. To date, studies assessing the association between social relationships and depression have provided conflicting results. The aim of this paper was to review the evidence on associations between social relationships and depression in the general population.

METHODS

Studies investigating the association of social support, social networks, or social connectedness with depression were retrieved and summarized (searches using Pubmed, ScienceDirect, PsycNet were conducted in May 2014).

RESULTS

Fifty-one studies were included in this review. The strongest and most consistent findings were significant protective effects of perceived emotional support, perceived instrumental support, and large, diverse social networks. Little evidence was found on whether social connectedness is related to depression, as was also the case for negative interactions.

LIMITATIONS

Due to the strict inclusion criteria relating to study quality and the availability of papers in the domain of interest, the review did not capture 'gray literature' and qualitative studies.

CONCLUSION

Future research is warranted to account for potential bias introduced by the use of subjective measures as compared to objective measures of received support and actual networks. Due to the heterogeneity between available studies on the measure of social relationships, the inclusion of comparable measures across studies would allow for more valid comparisons. In addition, well-designed prospective studies will provide more insight into causality. Future research should address how social support and networks interact and together affect risks for depression. Social connectedness and negative interactions appear to be underutilized as measures in population-based studies.

Est modus in rebus: a longitudinal study of intergenerational solidarity and Locus of Control

This study challenges the persistent assumption behind research on intergenerational relationships, wondering: ‘can there be too much of a good thing’? The guiding hypothesis states that intergenerational solidarity, although beneficial for older parents' wellbeing at moderate levels, may be negatively associated with their individual sense of control at high levels. In contrast to previous studies, fixed-effects regression models on panel data from the English Longitudinal Study of Ageing control for selection in solidarity and changes in health. The analysis of 4,811 women and 3,847 men above the age of 50 also accounts for intergenerational conflict. Using multiple dimensions of intergenerational solidarity, our findings offer insight into the different roles of the various types of solidarity and can aid the design of formal and informal social support interventions.

"Maintaining connections but wanting more": the continuity of familial relationships among assisted-living residents

Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities. Twenty-nine assisted-living facility residents were interviewed to understand the perceived continuity of relationships with family and friends. An inductive approach to thematic analysis revealed 1 main theme and 3 subthemes. The main theme that emerged was: maintaining connections but wanting more. Residents appreciated maintaining connections with family and friends, but often expressed feelings of discontentment with the continuity of former relationships. The subthemes included: appreciating family and friends, waiting for more, and losing control. Implications for research and practice are discussed.

Parents' depressive symptoms and support from sons and daughters in Rural China

This investigation examined how initial levels of elder parents' depressive symptoms influenced financial, instrumental, and emotional support from sons and from daughters in rural China. Data derived from a two-wave (2001, 2003) longitudinal survey of 1,324 parents aged 60 and over living in rural areas of Anhui Province, China. Structural Equation Modeling with latent difference score was used to estimate the reciprocal relatioships between children's support and elder parents' depressive symptoms. Results showed that older parents who had higher levels of depressive symptoms at baseline experienced reduced financial, instrumental, and emotional support from sons, but not from daughters. In rural China where the patrilineal family system has distinguished sons and daughters with respect to their functions in elder parents' support networks, the roles of sons and daughters warrant further examination, particularly when elder parents have some depressive symptoms, which elevates the needs of the parents and puts a strain on intergenerational relationships.

Does informal care attenuate the cycle of ADL/IADL disability and depressive symptoms in late life?

OBJECTIVE

Prior studies have extensively examined the reciprocal relation between disability and depressive symptoms in late life, but little is known about whether informal care attenuates the reciprocal relation over time. This study examined whether disability and depressive symptoms mobilize informal care and whether informal care, once mobilized, protects older adults against the progression of disability and depressive symptoms.

METHODS

The analysis was based on 6,454 community-dwelling older adults who were interviewed in one or more waves of the Health and Retirement Study between 1998 and 2006. Extending an autoregressive cross-lagged model, we constructed 3 cycles of the relations among disability, depressive symptoms, and informal care. Comparing the relations across 3 cycles informs us about the attenuating effect of informal care on the relation between disability and depressive symptoms over time.

RESULTS

Although older adults' disability and depressive symptoms mobilized informal care initially, worsening disability and depressive symptoms often exhausted support. Receipt of care generally increased, rather than decreased, disability and depressive symptoms, and the detrimental effects remained the same over time.

DISCUSSION

We need to better understand the linkage between disability and depressive symptoms and seek effective interventions to reduce caregiver strain and enhance care receivers' well-being.

The impact of informal caregivers on depressive symptoms among older adults receiving formal home health care

This study evaluated the association between presence and types of informal caregivers and the presence of depressive symptoms among older adults receiving formal home health care (HHC). A secondary analysis of data was conducted using a computerized patient care database, the Outcome and Assessment Information Set. Logistic regression analyses were used to examine the data of 8448 patients aged 65 years or older who had been admitted to an HHC agency from acute care hospitals between January 1, 2002 and June 30, 2002. The outcome variable was the presence of depressive symptoms. The primary predictor variable was the presence and types of informal caregivers. Covariates included demographic variables, health status, length of time enrolled in formal HHC, patient living arrangements, and the frequency and types of care received from informal caregivers. A lower percentage of older adults receiving care from both informal caregivers and a formal HHC agency (13.3%) had depressive symptoms than older adults receiving only formal HHC (14.9%) at the end of a 60-day episode in formal HHC. Older adults without an informal caregiver were more likely to experience depressive symptoms than those with an informal caregiver after a 60-day episode in HHC (odds ratio = 1.229, 95% confidence interval = 1.027-1.471). There was no significant association between the types of informal caregivers and the presence of depressive symptoms.

"You don't want to burden them": older adults' views on family involvement in care

Burden emerged as an important concept among older adults in a study of how older adults interact with their families around care. The authors conducted 50 semistructured interviews with adults older than the age of 65 years and a spouse or adult child. The sample was stratified by ethnicity thus giving the opportunity to explore both ethnic similarities and differences. Older adults who expressed the concept of burden were more likely to be White compared with older adults who did not express burden. Older respondents discussed burden in relation to not wanting to complicate the busy lives of adult children, guilt about health problems, and concern that children were overly worried about the care of their older family member. The expression and meaning of burden differed according to ethnicity. This study has implications for practice and policies to meet the needs of families and promote the independence of older persons.

The Relationship of Social Engagement to Psychological Well-Being of Older Adults in Assisted Living Facilities

The purpose of this study is to explore social engagement and its relationship to the psychological well-being of older adults residing in assisted living facilities (ALFs). Drawing on activity theory, the study focuses on the salience of social relationships on residents' life satisfaction and depressive symptoms. A total of 82 residents were interviewed face-to-face in eight ALFs in a southern state of the United States. The data were analyzed using hierarchical regression models in that demographic and health variables, site characteristics, and social engagement variables were entered into the model in successive steps. Results indicate that perceived friendliness of residents and staff was significantly associated with life satisfaction and depressive symptoms controlling for other variables, and enjoyment of mealtimes was related to low depressive symptoms. Findings suggest that ALFs could promote residents' psychological well-being by encouraging residents to develop meaningful relationships within the facility and by designing enjoyable mealtimes.

Sustaining a healthy work force in the 21st century--a model for collaborating through reciprocation

Occupational health nurses are positioned to restore and maintain worker health, well-being, and safety, thereby increasing productivity. A model of practice is needed that provides a comprehensive worker-environment perspective. A model that incorporates reciprocation and collaboration increases workers' engagement in their own health action plan. It empowers workers and provides a broader multidimensional perspective on factors affecting or influencing their health. The Reciprocation Model has been designed using the nursing process; it incorporates reciprocation and collaboration to assist occupational health nurses improve or maintain worker health and safety, as well as achieve corporate goals of reducing on-the-job lost time and increasing productivity.

Giving help in return: family reciprocity by older Singaporeans

Reciprocity is a powerful principle in social ties. The ethos of family reciprocity is especially strong in Asian societies. We study contemporaneous family exchanges, hypothesising that the more current help older Singaporeans receive from family, the more they give in return. Cross-sectional analyses were undertaken of data from two national Singapore surveys conducted in 1995 and 1999. The help received by older people is measured by income and cash support, payment of household expenses by others, having a companion for away-from-home activities, and having a principal carer. The help given by older people is measured by baby-sitting, doing household chores, giving financial help to children, and advising on family matters. Multivariate models are used to examine the factors that affect an older person's ability and willingness to give help. The results show that the more financial support Singapore seniors received from kin, the more baby-sitting and chores they provided. In their swiftly modernising society, Singapore seniors are maintaining family reciprocity by giving time in return for money. We discuss how during the coming decades, reciprocity in Southeast and East Asian societies may shift from instrumental to more affective behaviours.

Reciprocal affiliation among adolescent rats during a mild group stressor predicts mammary tumors and lifespan

OBJECTIVE

Although the detrimental physical health effects of social isolation have been known for three decades, the answers to how and why social relationships generally improve health remain elusive. Social relationships are not always beneficial, and we examined a structural dimension that may bring about their salubrious effects: affiliative reciprocity during a stressor.

METHODS

In a lifespan study, female rats lived with their sisters and were tested for temperament, affiliative reciprocity during an everyday stressor at puberty, corticosterone response to a stressor, mammary tumor development and diagnosis, and death.

RESULTS

Rats that affiliated more reciprocally during a mild group stressor survived longer (p = .0005), having exhibited a lower corticosterone peak in response to an acute novel stressor in late adulthood (p = .0015), and longer time to the development of spontaneous mammary tumors (p = .02). These effects could not be explained solely by the number of affiliative interactions or individual temperament. Indeed, affiliative reciprocity and neophobia were independent and predicted mortality additively (p = .0002).

CONCLUSIONS

Affiliative reciprocity during a stressor, a structural quality of social interactions, protected females from early mammary tumor development (the primary pathology in Sprague-Dawley rats) and early all-cause mortality. Conversely, lack of reciprocity (whether disproportionately seeking or receiving attempted affiliation) was as potent a risk factor as neophobia. Thus a social role increased risk additively with individual temperament. Our data indicate that affiliative reciprocity functions as a buffer for everyday stressors and are likely mediated by attenuated reactivity of the hypothalamic-pituitary-adrenal axis.

Relationship between anxiety level of patients and their satisfaction with different aspects of healthcare

OBJECTIVE

The objective of this study was to explore the possible association between the anxiety level of patients and their satisfaction with different aspects of healthcare.

METHOD

This analytical cross-sectional study included 301 patients undergoing scheduled trauma surgery from October 2004 to May 2005 at the Virgen de las Nieves University Hospital in Granada (Spain). They completed a sociodemographic and clinical questionnaire before their discharge and, at 15 days after discharge, they responded to an ad hoc questionnaire comprising three items (satisfaction with information received, privacy and comfort of the setting, and friendliness of healthcare professionals), and were scored on an interviewer-administered Zung anxiety scale. Descriptive analysis and unadjusted logistic regression were performed for each factor, followed by multivariate logistic regression to model the association between satisfaction and anxiety with study of confounding variables.

RESULTS

For each higher point in the Zung test, patients had a 4% higher risk of feeling dissatisfied with the information received, an 8% higher risk of dissatisfaction with the hospital setting and a 6% higher risk of dissatisfaction with the friendliness of healthcare personnel.

CONCLUSION

A higher anxiety level in the patient was associated with greater dissatisfaction with the three healthcare aspects studied.

Paying Friends, Family Members, or Strangers to Be Home-Based Personal Assistants

This study describes consumers who hire friends, family members, or strangers as paid personal assistants and compares service satisfaction among the three groups. From surveying 511 consumers of self-directed home care services, the authors found that consumers who hire friends as workers are younger and more educated than consumers who hire family members and strangers, and they are more impaired than consumers with strangers as workers. The friend cohort experiences more stability with their personal assistants than does the stranger cohort but not as much stability as the family cohort. On some dimensions of consumer satisfaction, friends as workers are perceived by consumers to be either the same as or better than strangers, but they also are perceived as either the same as or worse than family workers. Using friends as paid workers is an important resource. Researchers and policy makers should further explore this approach because the need for home-based personal assistance continues to increase.

The emotional needs of care recipients and the psychological well-being of informal caregivers: implications for home care clinicians

In this exploratory study, 77 informal caregivers of older persons in Ohio completed telephone interviews that included questions regarding their perceived difficulty providing emotional and physical care, perceived quality of care, demographic items including caregivers' health status, and a measure of their psychological well-being. Findings suggest that psychological well-being of informal caregivers is diminished when they experience greater difficulty meeting the care recipients' emotional care needs, are in poorer health, or are older. Suggestions for clinical implications and future research based on these findings are discussed.

Shared Care, elder and family member skills used to manage burden

AIM

The aim of this paper is to further develop the construct of Shared Care by comparing and contrasting it to related research, and to show how the construct can be used to guide research and practice.

BACKGROUND

While researchers have identified negative outcomes for family caregivers caused by providing care, less is known about positive aspects of family care for both members of a family dyad. Understanding family care relationships is important to nurses because family participation in the care of chronically ill elders is necessary to achieve optimal outcomes from nursing interventions. A previous naturalistic inquiry identified a new construct, Shared Care, which was used to describe a family care interaction that contributed to positive care outcomes.

METHODS

A literature review was carried out using the databases Medline, CINAHL, and Psych-info and the keywords home care, care receiver, disability, family, communication, decision-making and reciprocity. The results of the review were integrated to suggest how Shared Care could be used to study care difficulties and guide interventions.

RESULTS

The literature confirmed the importance of dyad relationships in family care. Shared Care extended previous conceptualizations of family care by capturing three critical components: communication, decision-making, and reciprocity. Shared Care provides a structure to expand the conceptualization of family care to include both members of a care dyad and account for positive and negative aspects of care.

CONCLUSIONS

The extended view provided by the construct of Shared Care offers practitioners and scholars tools to use in the context of our ageing population to improve the effectiveness of family care relationships.

Factors associated with depression experience of immigrant populations: a study of Korean immigrants

A correlational, cross-sectional study with multivariate analysis was conducted to identify factors that influence the depression experience in 154 Korean immigrants. Based on the stress-health outcome framework, four variables (i.e., sense of mastery, socioeconomic status, social support, and acculturation) were tested for their mediating effects between stress and depression experienced by Korean Americans. Path analyses showed that the negative effect of life stress on depression was buffered by higher levels of sense of mastery and social support in the Korean sample. Implications for future cross-cultural depression research and preventive strategies against depression in immigrant populations are discussed.