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Kin AL, Griffith LE, Kuspinar A, Smith-Turchyn J, Richardson J. Impact of care-recipient relationship type on quality of life in caregivers of older adults with dementia over time. Age Ageing 2024; 53:afae128. [PMID: 38941118 PMCID: PMC11212494 DOI: 10.1093/ageing/afae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Dementia caregiving is a dynamic and multidimensional process. To gain a comprehensive understanding of informal caregiving for people living with dementia (PLWD), it is pivotal to assess the quality of life (QoL) of informal caregivers. OBJECTIVE To evaluate whether the care-recipient relationship type predicts changes in the QoL of informal caregivers of PLWD over a two-year period. METHODS This was a secondary analysis of longitudinal data. The data were drawn from two waves of linked data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) (2015: NHATS R5 & NSOC II; 2017: NHATS R7 & NSOC III). Caregivers were categorized into spousal, adult-child, "other" caregiver and "multiple" caregivers. QoL was assessed through negative emotional burden (NEB), positive emotional benefits and social strain (SS). Generalized estimating equation modelling was used to examine changes in caregivers' QoL outcomes across types of relationship over time. RESULTS About, 882 caregivers were included who linked to 601 PLWD. After adjusting caregivers' socio-demographics, "other" caregivers had lower risk of NEB and SS than spousal caregivers (OR = 0.34, P = 0.003, 95%CI [0.17, 0.70]; OR = 0.37, P = 0.019, 95%CI 0.16, 0.85], respectively), and PLWD's dementia status would not change these significance (OR = 0.33, P = 0.003, 95%CI [0.16, 0.68]; OR = 0.31, P = 0.005, 95%CI [0.14, 0.71], respectively). CONCLUSIONS The study demonstrates that spousal caregivers face a higher risk of NEB and SS over time, underscoring the pressing need to offer accessible and effective support for informal caregivers of PLWD, especially those caring for their spouses.
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Affiliation(s)
- Aiping Lai Kin
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario L8S 1C7, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 1C7, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario L8S 1C7, Canada
| | - Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario L8S 1C7, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario L8S 1C7, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 1C7, Canada
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Su Q, Wang Y, Fan L. The Impact of Informal Care on Healthcare Utilization of Older Adults with Functional Limitations in China. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-16. [PMID: 38600766 DOI: 10.1080/01634372.2024.2338061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
Our study examines the impact of informal care on healthcare utilization, focusing on caregiver types, urban-rural, and gender differences. Analyzing data from the China Health and Retirement Longitudinal Study and using fixed effects models, we discovered complementary effects between informal care and healthcare. Specifically, spousal care increased inpatient care use, adult child care boosted both inpatient and outpatient use, and dual care from children and spouses showed the most significant impact on healthcare use. The association between informal care and healthcare use varied across gender or urban-rural residence. Our findings highlight the importance of caregivers in accessing healthcare services.
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Affiliation(s)
- Qing Su
- School of Public Health, Southeast University, Nanjing, China
| | - Yanshang Wang
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Lijun Fan
- School of Public Health, Southeast University, Nanjing, China
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Koehly LM, Manalel JA. Interconnected social convoys: Understanding health and well-being through linked personal networks. ADVANCES IN LIFE COURSE RESEARCH 2023; 56:100541. [PMID: 38054886 DOI: 10.1016/j.alcr.2023.100541] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 12/07/2023]
Abstract
The convoy model of social relations describes how social relationships contribute to an individual's health and well-being from a life course and lifespan perspective. In large part, this model focuses on the unique, personal experiences of an individual, without due consideration of the reciprocal and shared relationships among those whose lives are inextricably linked. Here, we extend the convoy model to directly integrate Elder's concept of linked lives by considering the composition, structure, and function of linked personal networks, or social convoys, among close others, and the important implications of these network characteristics on the health of all involved. We illustrate this extension within the context of family, one of the most pivotal social contexts that can shape an individual's life course. Features of interconnected social convoys can help improve our understanding of how social ties shape and are shaped by life events not just for individuals, but for larger units of inquiry - such as, couples, parent-child triads, and nuclear families. Importantly, the interconnected convoy includes both family and non-family ties, providing a framework that considers how peoples' social spheres are linked as they jointly experience shared situations. Using informal caregiving as an example, we highlight the advantages that interconnected convoys bring to the concept of linked lives and provide direction on how this framework can advance our understanding of how social relationships influence either directly or indirectly health and well-being of individuals and families across the life course.
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Affiliation(s)
- Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-2073, USA.
| | - Jasmine A Manalel
- Brookdale Center for Healthy Aging, Hunter College, New York, NY 10035, USA
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Wang F, Nguyen AW. Correlates of Physical and Emotional Strain Among Older Adult Caregivers. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:221-238. [PMID: 35791671 PMCID: PMC9816348 DOI: 10.1080/01634372.2022.2097755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Caregiving can be physically challenging and emotionally draining for older caregivers. The existing research on physical and emotional strain mainly focuses on the general caregiver population. Using the Stress Process Model, this study aims to expand on existing caregiving literature by identifying correlates of physical and emotional strain among older caregivers. Hierarchical OLS regressions were performed on data selected from the 2015 Caregiving in the U.S. Survey (N = 701). Several risk factors for physical strain and emotional strain were identified: Assistance with ADLs and IADLs, the number of health problems of the care recipient, and the receipt of formal support were positively associated with physical and emotional strain. Moreover, providing care to parents/parents-in-law was associated with higher levels of emotional strain than providing care to non-relatives. The number of care recipients was positively associated with emotional strain. Older African Americans experienced lower levels of physical strain than their white counterparts. The findings uncover the individual differences among older caregivers and provide insights into how these differences uniquely influence caregiving strain. Moreover, the study identifies a risk and protective profile of caregiving strain, which can help practitioners direct services and resources to older caregivers who are particularly at risk for caregiving strain.
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Affiliation(s)
- Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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5
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The impact of care-recipient relationship type on health-related quality of life in community-dwelling older adults with dementia and their informal caregivers. Qual Life Res 2022; 31:3377-3390. [PMID: 35969331 DOI: 10.1007/s11136-022-03203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To assess whether there was an association between care-recipient relationship type and health-related quality of life (HRQL) of older persons living with dementia (PLWD) and their informal caregivers, and whether this association was affected by PLWD' dementia severity. METHODS This was a secondary data analysis study. PLWD (n = 1230) and caregivers (n = 1871) were identified from participants in the National Health and Aging Trends Study (NHATS) Round 5 and the National Study of Caregiving (NSOC) II, respectively. A series of bivariate and multivariable regression models examined the associations among relationship type and HRQL in PLWD and caregivers, adjusted for socio-demographic variables and dementia severity. RESULTS PLWD and caregivers' HRQL outcomes varied by relationship type. PLWD cared for by an adult-child caregiver, or multiple caregivers experienced higher functional limitations than those cared for by a spousal caregiver (β = .79, CI [.39, 1.19]; β = .50, CI [.17, .82], respectively). "Other" caregivers, such as extended family members or friends, had lower odds of experiencing negative emotional burden and social strain than spousal caregivers (β = .79, CI [.39, 1.19]; β = .50, CI [.17, .82], respectively). Lower odds of experiencing negative emotional burden were also found with multiple caregivers. The effect of an adult-child caregiver on social strain was no longer significant when the dementia severity of PLWD was included in the analysis. CONCLUSION The type of care-recipient relationship impacts the HRQL in both PLWD and their informal caregivers. Dementia severity of the PLWD appears to affect this association.
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Maragh-Bass AC, Hendricks Sloan D, Aimone EV, Knowlton AR. 'The Woman Gives': Exploring gender and relationship factors in HIV advance care planning among African American caregivers. J Clin Nurs 2021; 30:2331-2347. [PMID: 33829592 DOI: 10.1111/jocn.15772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/24/2021] [Accepted: 03/17/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVE Advance care planning (ACP) is the communication process of documenting future healthcare preferences in case patients are unable to make healthcare decisions for themselves. Research suggests ACP discussions among persons living with HIV (PLHIV) are infrequent overall and may differ by gender and/or race. BACKGROUND Previous literature has displayed that African Americans are less likely than other racial groups to use advanced care planning, palliative care or hospice, but does not conclusively account for ACP among PLHIV. African American PLHIV rely on informal care that may be differ by gender and represents an important pathway to increase ACP. DESIGN The study was mixed methods and observational. METHODS Participants completed self-report surveys (N = 311) and were interviewed (n = 11). Poisson regression (quantitative) and grounded theory analyses (qualitative) were implemented, using COREQ checklist principles to ensure study rigor. RESULTS Less than half had discussed ACP (41.2%; N = 267). More ACP knowledge predicted 76% lower likelihood of ACP discussions among women. Men who spent more time caregiving in a given week were nearly 3 times more likely to discuss ACP than men who spent less time caregiving. Women were more likely than men to be caregivers and were also expected to serve in that role more than men, which was qualitatively described as 'being a woman'. CONCLUSIONS The present study is one of few studies exploring ACP among caregivers in African American populations hardest hit by HIV. Results suggest that ACP skill building and education are critical for African Americans living with HIV to promote ACP discussions with their caregivers. Knowledge about ACP topics was low overall even when healthcare had recently been accessed. Support reciprocity and gender-specific communication skill building may facilitate ACP in African American HIV informal caregiving relationships. RELEVANCE TO CLINICAL PRACTICE Results underscore the need for ACP education which includes healthcare providers and caregivers, given African Americans' preference for life-sustaining treatments at end-of-life. ACP is crucial now more than ever, as COVID-19 complicates care for older adults with HIV at high risk of complications.
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Affiliation(s)
- Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Danetta Hendricks Sloan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth V Aimone
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Namkung EH, Carr D. The Psychological Consequences of Disability over the Life Course: Assessing the Mediating Role of Perceived Interpersonal Discrimination. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2020; 61:190-207. [PMID: 32425066 PMCID: PMC7450392 DOI: 10.1177/0022146520921371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We examine whether perceived interpersonal discrimination mediates the association between disability and psychological well-being (depression, negative and positive affect) and how these processes differ across the life course. Data are from two waves (2004-2006; 2013-2014) of the Midlife in the United States (MIDUS; N = 2,503). Perceived discrimination accounts for 5% to 8% of the association between disability and the three mental health outcomes. Moderated mediation analyses reveal significant age differences; perceived discrimination is a stronger explanatory mechanism among midlife (ages 40-64) relative to older (age 65+) adults. Disability stigma takes a heightened psychological toll at midlife, a life stage when adults are expected to be able-bodied and interact with a diverse social network, which may be a source of interpersonal mistreatment. Among older adults, for whom impairment is expected and common, the psychological impact of disability may operate through other pathways. We discuss implications for research and practice.
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Ko M, Newcomer RJ, Bindman AB, Kang T, Hulett D, Spetz J. Changing home care aides: Differences between family and non-family care in California Medicaid home and community-based services. Home Health Care Serv Q 2019; 39:1-16. [PMID: 31826707 DOI: 10.1080/01621424.2019.1701601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In California Medicaid home-and-community-based services (HCBS), recipients' family members receive payment as home care aides (HCAs). We analyzed data on first-time HCBS recipients to examine factors associated with the likelihood of switching HCAs within the first year of services. Those with family HCAs were less than half as likely to change than those with non-family HCAs and racial/ethnic minorities with non-family HCAs had the highest switching rates. Lower wages and local unemployment were associated with switching of non-family HCAs but not family HCAs. Policymakers can foster continuity of home care by paying family members for home care and raising worker wages.
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Affiliation(s)
- Michelle Ko
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA
| | - Robert J Newcomer
- Department of Public Health Sciences, University of California, San Francisco, USA
| | - Andrew B Bindman
- Department of Public Health Sciences, University of California, San Francisco, USA
| | - Taewoon Kang
- Department of Public Health Sciences, University of California, San Francisco, USA
| | - Denis Hulett
- California Medicaid Research Institute, University of California, San Francisco, USA
| | - Joanne Spetz
- Department of Public Health Sciences, University of California, San Francisco, USA
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Shune SE, Namasivayam-MacDonald AM. Swallowing Impairments Increase Emotional Burden in Spousal Caregivers of Older Adults. J Appl Gerontol 2019; 39:172-180. [DOI: 10.1177/0733464818821787] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The aim of this study was to determine the type and extent of caregiver burden uniquely experienced by spousal caregivers of older adults with dysphagia. Method: Using the Round 1 surveys from the National Health and Aging Trends Study and the National Study of Caregiving, we analyzed data on 422 community-dwelling older adults and their spousal caregivers. Results: Approximately 17% of care recipients reported swallowing difficulties. Logistic regression analysis revealed that caregivers of spouses with dysphagia were significantly more likely to experience emotional burden, p = .038; odds ratio (OR) = 2.06; 95% confidence interval (CI): [1.04, 4.09]. Of those spouses caring for partners with dysphagia who reported emotional burden, nearly 70% rated the burden moderate to severe. Discussion: Dysphagia in community-dwelling older adults is associated with increased emotional burden among spousal caregivers. Given the intricate relationship between the health and well-being of both members of the caregiving dyad, these findings support the need for interventions that prioritize dyadic health.
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Suitor JJ, Gilligan M, Rurka M, Con G, Peng S, Pillemer K. Conflict with Mothers and Siblings During Caregiving: Differential Costs for Black and White Adult Children. J Gerontol B Psychol Sci Soc Sci 2018; 73:e86-e97. [PMID: 29267938 PMCID: PMC6146761 DOI: 10.1093/geronb/gbx149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/28/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives Family conflict has been found to play a role in caregivers' psychological well-being; however, few studies have considered race differences in the prevalence and consequences of caregiving conflict. In this paper, we use mixed-methods to examine differences in the experiences of conflict among Black and White adult children caring for mothers. Methods Quantitative and qualitative data were collected from 279 adult-child caregivers (213 White; 66 Black). Results Multilevel modeling revealed that conflict with mothers predicted depressive symptoms among Black, but not White caregivers, whereas there were not statistically significant race differences in the effects of conflict with siblings. However within-model tests showed stronger effects of conflict with mothers than siblings for Black caregivers, and stronger effects of conflict with siblings than mothers for White caregivers. Qualitative data revealed that Black caregivers' conflict with mothers resulted from their inability to meet their mothers' needs, inducing concern and sadness. White children's conflict stemmed from mothers' resistance to unwanted assistance and requests for support that children considered excessive, evoking irritation and frustration. Discussion This study highlights ways in which the experiences of caregivers reflect broader patterns of differences between Black and White families in both intergenerational cohesion and health disparities in midlife.
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Affiliation(s)
- J Jill Suitor
- Department of Sociology, Purdue University, West Lafayette, Indiana
| | - Megan Gilligan
- Department of Human Development and Family Studies, Iowa State University, Ames
| | - Marissa Rurka
- Department of Sociology, Purdue University, West Lafayette, Indiana
| | - Gulcin Con
- Department of Sociology, Purdue University, West Lafayette, Indiana
| | - Siyun Peng
- Department of Sociology, Purdue University, West Lafayette, Indiana
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
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Abstract
Family relationships are enduring and consequential for well-being across the life course. We discuss several types of family relationships—marital, intergenerational, and sibling ties—that have an important influence on well-being. We highlight the quality of family relationships as well as diversity of family relationships in explaining their impact on well-being across the adult life course. We discuss directions for future research, such as better understanding the complexities of these relationships with greater attention to diverse family structures, unexpected benefits of relationship strain, and unique intersections of social statuses.
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Affiliation(s)
- Patricia A Thomas
- Department of Sociology and Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Hui Liu
- Department of Sociology, Michigan State University, East Lansing
| | - Debra Umberson
- Department of Sociology and Population Research Center, University of Texas at Austin
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Koehly LM. It's Interpersonal: Family Relationships, Genetic Risk, and Caregiving. THE GERONTOLOGIST 2016; 57:32-39. [PMID: 27507685 DOI: 10.1093/geront/gnw103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/16/2016] [Indexed: 12/24/2022] Open
Abstract
My research program considers family relationships across the life course: in early life, with a focus on disease prevention-leveraging genetic risk information and relationships to motivate health-promoting behaviors-and in later life, with a focus on informal caregiving-identifying characteristics of those most vulnerable to, or resilient from, caregiver stress. It is fortuitous, if not tragic, then, that my research and personal worlds collided during my mother's final 8 months of life. Here, I discuss how this experience has shifted my thinking within both arms of my research program. First, I consider the state of the science in family health history, arguing that the current approach which focuses on an individual's first- and second-degree relatives does not take us far enough into the relational landscape to activate communal coping with disease risk. Second, I discuss caregiving from a family systems perspective. My family's experience confirmed the importance of using a systems approach and highlighted a need to identify underlying variability in members' expectations of caregiving roles. In so doing, I capture the significance of understanding the multiple perspectives that frame a context in which families adapt and cope with risk and disease diagnoses.
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Affiliation(s)
- Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland.
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