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Hu M, Freedman VA, Patterson SE, Lewis N. Shared Care Networks Assisting Older Adults: New Insights From the National Health and Aging Trends Study. THE GERONTOLOGIST 2023; 63:840-850. [PMID: 36190818 PMCID: PMC10268586 DOI: 10.1093/geront/gnac155] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Caregiving research often assumes older adults receiving care have a primary caregiver who provides the bulk of care. Consequently, little is known about the extent to which care responsibilities are shared more evenly within a care network, the characteristics associated with sharing, or the consequences for meeting older adults' care needs. RESEARCH DESIGN AND METHODS We analyze a sample of U.S. older adults receiving care from the 2011 National Health and Aging Trends Study (n = 2,398). Based on variables reflecting differences in care hours, activities, and care provided by the whole network, we create network typologies for those with two or more caregivers (n = 1,309) using K-means cluster analysis. We estimate multinomial and logistic regression models to identify factors associated with network type and the association between type and unmet needs. We conduct analyses overall and for older adults living with and without dementia. RESULTS Analyses reveal four network types: Small, low-intensity shared care network (SCN); large, moderate-intensity SCN; small, low-intensity primary caregiver network (PCN); and moderate-sized, high-intensity PCN. Among all older adults receiving care, 51% have a sole caregiver, 20% have an SCN with no primary caregiver, and 29% have a PCN. Among older adults with dementia receiving intense care, unmet needs are lower among those with an SCN (vs. PCN). DISCUSSION AND IMPLICATIONS Findings underscore that the primary caregiver construct, although common, does not apply to a substantial share of care networks. Moreover, having an SCN when needs are high may be beneficial to meeting older adult's needs.
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Affiliation(s)
- Mengyao Hu
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah E Patterson
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Nora Lewis
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Chu CH, Yee AV, Stamatopoulos V. “It’s the worst thing I’ve ever been put through in my life”: the trauma experienced by essential family caregivers of loved ones in long-term care during the COVID-19 pandemic in Canada. Int J Qual Stud Health Well-being 2022; 17:2075532. [PMID: 35638169 PMCID: PMC9176373 DOI: 10.1080/17482631.2022.2075532] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Essential family caregivers (EFCs) of relatives living in long-term care homes (LTCHs) experienced restricted access to their relatives due to COVID-19 visitation policies. Residents’ experiences of separation have been widely documented; yet, few have focused on EFCs’ traumatic experiences during the pandemic. Objective: This study aims to explore the EFCs’ trauma of being locked out of LTCHs and unable to visit their loved ones in-person during COVID-19. Methods Seven online focus groups with a total of 30 EFCs from Ontario and British Columbia, Canada were conducted as part of a larger mixed-method study. We used an inductive approach to thematic analysis to understand the lived experiences of trauma. Results Four trauma-related themes emerged: 1) trauma from prolonged separation from loved ones; 2) trauma from uncompassionate interactions with the LTCH’s staff and administrators; 3) trauma from the inability to provide care to loved ones, and 4) trauma from experiencing prolonged powerlessness and helplessness. Discussion The EFCs experienced a collective trauma that deeply impacted their relationships with their relatives as well as their perception of the LTC system. Experiences endured by EFCs highlighted policy and practice changes, including the need for trauma-centred approaches to repair relational damage and post-pandemic decision-making that collaborates with EFCs.
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Affiliation(s)
- Charlene H. Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Amanda V. Yee
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Stamatopoulos
- Faculty of Social Science and Humanities, Ontario Tech University, Oshawa, Ontario, Canada
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3
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Gaugler JE, Statz TL, Birkeland RW, Louwagie KW, Peterson CM, Zmora R, Emery A, McCarron HR, Hepburn K, Whitlatch CJ, Mittelman MS, Roth DL. The ResidentialCare Transition Module: a single-blinded randomized controlled evaluation of a telehealth support intervention for family caregivers of persons with dementia living in residential long-term care. BMC Geriatr 2020; 20:133. [PMID: 32293314 PMCID: PMC7158110 DOI: 10.1186/s12877-020-01542-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/29/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Families do not fully disengage from care responsibilities following relatives' admissions to residential long-term (RLTC) care settings such as nursing homes. Caregiver stress, depression, or other key outcomes remain stable or sometimes increase following a relative's RLTC entry. Some interventions have attempted to increase family involvement after institutionalization, but few rigorous studies have demonstrated whether these interventions are effective in helping families navigate the potential emotional and psychological upheaval presented by relatives' transitions to RLTC environments. The Residential Care Transition Module (RCTM) provides six formal sessions of consultation (one-to-one and family sessions) over a 4-month period to family caregivers who have admitted a relative to a RLTC setting. METHODS In this embedded mixed methods randomized controlled evaluation, family members who have admitted a cognitively impaired relative to a RLTC setting are randomly assigned to the RCTM (n = 120) or a usual care control condition (n = 120). Primary outcomes include reductions in family members' primary subjective stress and negative mental health outcomes; secondary role strains; and residential care stress. The mixed methods design will allow for an analysis of intervention action mechanisms by "embedding" qualitative components (up to 30 semi-structured interviews) at the conclusion of the 12-month evaluation. DISCUSSION This evaluation will fill an important clinical and research gap by evaluating a psychosocial intervention designed for families following RLTC admission that determines whether and how the RCTM can help families better navigate the emotional and psychological challenges of residential care transitions. TRIAL REGISTRATION ClinicalTrials.gov (NCT02915939, prospectively registered).
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Affiliation(s)
- Joseph E Gaugler
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA.
| | - Tamara L Statz
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Robyn W Birkeland
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Katie W Louwagie
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Colleen M Peterson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Zmora
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ann Emery
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Hayley R McCarron
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | | | - Mary S Mittelman
- Department of Psychiatry, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
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Miller VJ. Investigating Barriers to Family Visitation of Nursing Home Residents: A Systematic Review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019; 62:261-278. [PMID: 30412036 DOI: 10.1080/01634372.2018.1544957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 11/02/2018] [Indexed: 06/08/2023]
Abstract
Families are integral in helping nursing home residents maintain feelings of social inclusion and an overall sense of belonging, thus reducing consequences of social exclusion. Preliminary research, particularly of the culture change movement in long-term care, shows there are barriers to family engagement and visitation of residents. The objective of this study is to: (1) identify and summarize the barriers most reported to family visitation and (2) synthesize the findings to determine which barriers are most often reported in literature, and which may pose the greatest challenges to family involvement. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a final sample of 15 articles across 11 databases report seven barriers to visitation: psychological, health, staff to family member relationship, employment/finances, travel time, access to transportation, and other. Findings suggest barriers to family visitation and point toward a need for further research as relationships between resident and family member is complex and warrants attention across professions. Interprofessional efforts between social work, allied professionals, and transportation planners are necessary to address this pressing concern experienced by residents in nursing homes, with the ultimate goal of lessening such barriers.
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Affiliation(s)
- Vivian J Miller
- a School of Social Work , University of Texas at Arlington , Arlington , TX , US
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5
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Diaz LJR, Cruz DDALMD, Silva RDCGE. CONTENT VALIDATION OF NURSING OUTCOMES IN RELATION TO FAMILY CAREGIVERS: CONTENT VALIDATION BY BRAZILIAN AND COLOMBIAN EXPERTS. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017004820015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: this study's aim was to estimate the content validity of nursing outcomes in relation to family caregivers. Method: eleven Brazilian and Colombian experts participated in the study. None of the 61 indicators of the four nursing outcomes were considered irrelevant; 42 (68.9%) were considered primary and 19 (31.1%) were considered secondary. Results: the indicators with higher validity scores were: family share care responsibilities for Caregiver well-being (CVI=0.85); disruption of family dynamics to Caregiver lifestyle disruption (CVI=0.85); perceived spiritual well-being and anger for Caregiver emotional health (CVI=0.79) and perceived general health to Caregiver physical health (CVI=0.79). Conclusion: the nursing outcomes studied had adequate content validity. It is recommended that content validation followed by clinical and construct validation of the nursing-sensitive outcomes be given in different cultures and care settings.
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Shippee TP, Henning-Smith C, Gaugler JE, Held R, Kane RL. Family Satisfaction With Nursing Home Care. Res Aging 2016; 39:418-442. [PMID: 26534835 DOI: 10.1177/0164027515615182] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores the factor structure of a new family satisfaction with nursing home care instrument and determines the relationship of resident quality of life (QOL) and facility characteristics with family satisfaction. Data sources include (1) family satisfaction interviews ( n = 16,790 family members), (2) multidimensional survey of resident QOL ( n = 13,433 residents), and (3) facility characteristics ( n = 376 facilities). We used factor analysis to identify domains of family satisfaction and multivariate analyses to identify the role of facility-level characteristics and resident QOL on facility-mean values of family satisfaction. Four distinct domains were identified for family satisfaction: "care," "staff," "environment," and "food." Chain affiliation, higher resident acuity, more deficiencies, and large size were all associated with less family satisfaction, and resident QOL was a significant (albeit weak) predictor of family satisfaction. Results suggest that family member satisfaction is distinct from resident QOL but is associated with resident QOL and facility characteristics.
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Affiliation(s)
- Tetyana P Shippee
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Carrie Henning-Smith
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Joseph E Gaugler
- 2 School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Robert Held
- 3 Minnesota Department of Human Services, Minneapolis, MN, USA
| | - Robert L Kane
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Abstract
Dementia is estimated to affect up to 15 percent of the US population. Most of these individuals receive much needed emotional and physical support from family caregivers, with 10–12 percent being primary caregiving sons. However, this role of caregiver places a significant amount of psychological distress on an individual. This study investigates the use of the Parental Bonding Instrument (PBI) as a tool to predict distress in primary caregiving sons of a parent with dementia. Based on these findings, implications for counseling and future research are presented. With the incidence of dementia on the rise, it is important for clinicians to be aware of different and cost effective (free) diagnostic tools that are available.
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8
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Gaugler JE, Zarit SH, Pearlin LI. Family Involvement Following Institutionalization: Modeling Nursing Home Visits Over Time. Int J Aging Hum Dev 2016; 57:91-117. [PMID: 15151186 DOI: 10.2190/8mnf-qma3-a5tx-6qq3] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Gerontological research has emphasized family members' continued involvement in the lives of loved ones following institutionalization. However, many of these studies are cross-sectional in design and do not ascertain how family members' visits change over time. The present study utilized a growth curve analysis to examine preplacement and postplacement predictors of nursing home visits over a two-year period among a sample of 65 caregivers of dementia patients. Intraindividual patterns of change suggested considerable heterogeneity in family visits. Several variables were also significantly predictive ( p < .05) of change in nursing home visits. Spousal caregivers were more likely to report increased visits. Care recipients with greater cognitive impairment following institutionalization experienced increased visits. Caregivers who perceived respect and support from their social network following institutionalization also reported increased visits over the two-year study period. Caregivers who engaged in socially restorative activities after institutionalization reported decreases in visits. The findings provide a more refined understanding of the long-term involvement process following institutionalization.
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Affiliation(s)
- Joseph E Gaugler
- Department of Behavioral Science, University of Kentucky, Lexington 40536-0086, USA.
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Stirling C, Mclnerney F, Andrews S, Ashby M, Toye C, Donohue C, Banks S, Robinson A. A tool to aid talking about dementia and dying--development and evaluation. Collegian 2015; 21:337-43. [PMID: 25632731 DOI: 10.1016/j.colegn.2013.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Health professionals often avoid talking about death and dying with patients and relatives, and this avoidance is compounded in cases of dementia by lack of knowledge of trajectory and prognosis. Unfortunately, this impacts on care, with many terminally ill dementia clients receiving inadequate palliation and excessive intervention at end-of-life. This study developed and evaluated a tool to facilitate conversations about death and dying in aged care facilities. METHODS This study utilised available best-practice evidence, feedback from aged care facility nursing and care staff and specialist input to develop the 'discussion tool', which was subsequently trialled and qualitatively evaluated, via thematic analysis of data from family interviews and staff diaries. The study was part of a larger mixed method study, not yet reported. The tool provided knowledge and also skills-based 'how to' information and specific examples of 'what to say'. RESULTS The tool facilitated a more open dialogue between dementia palliation resource nurses (a role specifically developed during this project) and family members. Both resource nurses and family members gained confidence in discussing the death of their relative with dementia, and in relevant cases discussed specific decisions around future care. Family members and nurses reported satisfaction with these discussions. CONCLUSION Providing specific skills-based support, such as the 'discussion tool' can help staff to gain confidence and change practice in situations where unfamiliar and uncomfortable practices might normally be avoided. As our populations age, health professionals will increasingly need to be able to openly discuss care options towards end-of-life.
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Abstract
One in 15 Australians over 65 experience dementia, and are commonly supported by spouses. Evidence demonstrates declining wellbeing for these caregivers as their role continues. There are indications of improvement once caregivers transition out of the role (recovery) but alternate suggestions that caregiving stress may be too damaging to be appeased (wear and tear). It seems plausible that reason for transition (care recipient's move into residential care or death) will affect caregivers' outcomes. A synthetic cohort method compared caregivers' stress and wellbeing prior to, and one and two years post-transition. There was evidence of wear and tear for physical wellbeing but recovery for psychological wellbeing over time; with little difference based on reason for transition. Caregiver outcomes seem to be a function of the action rather than the reason for transition, but factors such as age must be considered when designing methods to support post-transition wellbeing.
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Affiliation(s)
- Lynsey J Brown
- Discipline of General Practice, Flinders University, Australia
| | - Malcolm J Bond
- Discipline of General Practice, Flinders University, Australia
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11
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Family involvement in decision making for people with dementia in residential aged care. INT J EVID-BASED HEA 2014; 12:64-86. [DOI: 10.1097/xeb.0000000000000003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Tsai HH, Tsai YF. Prevalence and factors related to depressive symptoms among family caregivers of nursing home residents in Taiwan. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1145-52. [PMID: 23340771 DOI: 10.1007/s00127-013-0652-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 01/05/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this cross-sectional study was to understand the prevalence and risk factors for depressive symptoms among nursing home residents' family caregivers in Taiwan. METHODS Family caregivers (n = 191) of nursing home residents were recruited by stratified random sampling from 16 nursing homes throughout Taiwan. Data were collected from caregivers in face-to-face interviews on depressive status (using the Center for Epidemiologic Studies Depression Scale; CES-D), on meaning ascribed to visiting nursing home residents (using the Family Meaning of Nursing-Home Visits scale), and on demographic data. Factors related to depressive symptoms were analyzed by multiple logistic regression. RESULTS The prevalence of depressive status among family caregivers was 29.8 % as determined by the CES-D cutoff score of ≥10. The non-depressed group (CES-D <10) tended to visit residents for emotional maintenance (odds = 0.54), while the depressed group (CES-D ≥10) tended to visit due to sense of responsibility for monitoring care quality (odds = 3.25). These results demonstrate that risk factors for depressive symptoms in family caregivers were their age, self-perceived health status, education level, and being the resident's main caregiver before admission. CONCLUSION These results fill a gap in knowledge by providing detailed, evidence-based data on family caregivers' priorities for visiting nursing home residents and it is related to depression. These results also provide useful information for designing intervention protocols to reduce depressive symptoms in family caregivers of nursing home residents, not only in Asian countries, but also in western countries with many Chinese/Asian immigrants.
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Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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13
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Abstract
RÉSUMÉD’ici à 2038, le nombre d’heures de soins non rémunérées aux aînés offert par les membres de la famille devraient tripler. Les membres des familles sont souvent suppliés d’aider dans le processus parce que vivre avec la démence peut inhiber la capacité pour prendre une décision. Cette étude ethnographique a soumis les relations au sein de soins de la démence à domicile à un examen critique par le biais des entrevues face-à-face et les observations des participants des clients, des aidants naturels et des prestataires de soins à domicile. Les résultats ont révélé comment les décisions sont imposées dans le contexte du système de soins à domicile formels, et ont mis en évidence trois thèmes: (1) L’accommodation de la compétence/incompétence, comme définie cliniquement; (2) La prise de décisions inopportunes; et (3) Le renforcement de l’exclusion des déments dans la prise de décision. Ces thèmes illuminent la façon dont les valeurs culturelles (la compétence), les croyances (l’immuabilité du système) et les pratiques (le réglage des décisions) dans le système de soins à domicile sont finalement déterministes dans la prise de décisions pour les déments et leurs aidants. Afin d’optimiser la santé des déments qui se font soignés à domicile, il faut accorder d’attention supplémentaire aux pratiques collaboratives et inclusives des membres des familles.
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Helgesen AK, Larsson M, Athlin E. How do relatives of persons with dementia experience their role in the patient participation process in special care units? J Clin Nurs 2012; 22:1672-81. [DOI: 10.1111/jocn.12028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Ann K Helgesen
- Department of Nursing; Karlstad University; Karlstad Sweden
- Faculty of Health and Social Studies; Østfold University College; Halden Norway
| | - Maria Larsson
- Department of Nursing; Karlstad University; Karlstad Sweden
| | - Elsy Athlin
- Department of Nursing; Karlstad University; Karlstad Sweden
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Williams SW, Zimmerman S, Williams CS. Family caregiver involvement for long-term care residents at the end of life. J Gerontol B Psychol Sci Soc Sci 2012; 67:595-604. [PMID: 22929400 PMCID: PMC3536551 DOI: 10.1093/geronb/gbs065] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 06/20/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine family caregiver involvement for long-term care (LTC) residents during the last month of life. Researchers examined direct (personal care and meals) and indirect (management and monitoring) types of caregiver involvement and the relationship between the type of involvement and predisposing, enabling, and need characteristics. Researchers also examined whether the frequency of involvement changed during the end-of-life (EOL) period. METHOD Researchers used an expanded version of Andersen's Behavioral Model to conceptualize predictors of family involvement for 438 residents in 125 residential care/assisted living and nursing home settings. Bivariate and multivariate analyses examined relationships among variables. RESULTS More than one-half of family caregivers monitored, managed care and assisted with meals, and 40% assisted with personal care tasks. The enabling characteristic of days visited and the need characteristic of caregiver role strain were related to each of the 4 types of involvement. However, the other correlates were distinct to the type of involvement. DISCUSSION Families are involved in EOL care in LTC settings. Higher role strain is related to more involvement in each of the 4 types of involvement, suggesting that whether involvement is by desire, perceived need, or both, there is cause to more critically examine the family caregiver's desired role and need for support.
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Affiliation(s)
- Sharon W Williams
- Department of Allied Health Sciences, Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, CB 7190, Chapel Hill, NC 27599, USA.
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16
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Tompkins CJ, Ihara ES, Cusick A, Park NS. "Maintaining connections but wanting more": the continuity of familial relationships among assisted-living residents. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2012; 55:249-261. [PMID: 22486400 DOI: 10.1080/01634372.2011.639439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Catherine J Tompkins
- Department of Social Work, George Mason University, Fairfax, Virginia 22030, USA.
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17
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Zhang Z, Schiamberg LB, Oehmke J, Barboza GE, Griffore RJ, Post LA, Weatherill RP, Mastin T. Neglect of Older Adults in Michigan Nursing Homes. J Elder Abuse Negl 2011; 23:58-74. [DOI: 10.1080/08946566.2011.534708] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Zhenmei Zhang
- a Department of Sociology , Michigan State University , East Lansing, Michigan, USA
| | - Lawrence B. Schiamberg
- b Department of Family and Child Ecology , Michigan State University , East Lansing, Michigan, USA
| | - James Oehmke
- c The George Morris Centre , Guelph, Ontario, Canada
| | - Gia E. Barboza
- d Department of Criminal Justice , California State University , Long Beach, California, USA
| | - Robert J. Griffore
- e Department of Family and Child Ecology , Michigan State University , East Lansing, Michigan, USA
| | - Lori A. Post
- f Department of Emergency Medicine , Yale School of Medicine , New Haven, Connecticut, USA
| | - Robin P. Weatherill
- g National Center for PTSD , VA Boston Healthcare System , Boston, Massachusetts, USA
| | - Teresa Mastin
- h College of Communication , DePaul University , Chicago, Illinois, USA
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18
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Gaugler JE, Mittelman MS, Hepburn K, Newcomer R. Clinically significant changes in burden and depression among dementia caregivers following nursing home admission. BMC Med 2010; 8:85. [PMID: 21167022 PMCID: PMC3012012 DOI: 10.1186/1741-7015-8-85] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 12/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although extensive research exists on informal long-term care, little work has examined the clinical significance of transitions in family caregiving due to a lack of established clinical cut-points on key measures. The objectives of this study were to determine whether clinically significant changes in symptoms of burden and depression occur among caregivers within 12 months of nursing home admission (NHA) of their relatives with dementia, and to identify key predictors of clinically persistent burden and depression in the first year after institutionalization. METHODS Secondary longitudinal analysis of dementia caregivers were recruited from eight catchment areas in the United States with 6- and 12-month post-placement follow-up data. The sample included data on 1,610 dementia caregivers with pre- and six-month post-placement data and 1,116 with pre-placement, six-month, and 12-month post-placement data. Burden was measured with a modified version of the Zarit Burden Inventory. Depressive symptoms were assessed with the Geriatric Depression Scale. RESULTS Chi-square analyses found significant (P < .05) reductions in the number of caregivers who reported clinically significant burden and depressive symptoms after NHA compared to pre-placement. Logistic regression models revealed that wives and daughters were most likely to experience clinically persistent burden and husbands were most likely to experience clinically significant depression after NHA. CONCLUSIONS In addition to suggesting that clinically significant decreases in caregiver burden and depression are likely to occur following institutionalization, the results reveal particular subsets of caregivers who are at continued risk of distress. Such findings can facilitate development of screening processes to identify families at-risk following institutionalization.
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Affiliation(s)
- Joseph E Gaugler
- School of Nursing, Center on Aging, University of Minnesota, Minneapolis, MN, USA.
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Gladstone JW, Dupuis SL, Wexler E. Ways That Families Engage with Staff in Long-Term Care Facilities. Can J Aging 2010; 26:391-402. [DOI: 10.3138/cja.26.4.391] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ABSTRACTThe purpose of this qualitative study was to explore styles of engagement used by families with staff in long-term care facilities. Data were gathered through personal interviews with 35 family members. Five styles of engagement were identified: positive, negative, peremptory, cautious, and limited. Factors associated with these different styles were also identified. Implications for practice are discussed.
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Coordinating the Roles of Nursing Home Staff and Families of Elderly Nursing Home Residents. J Nurs Care Qual 2009; 24:332-9. [DOI: 10.1097/ncq.0b013e3181a8b257] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Majerovitz SD, Mollott RJ, Rudder C. We're on the same side: improving communication between nursing home and family. HEALTH COMMUNICATION 2009; 24:12-20. [PMID: 19204854 DOI: 10.1080/10410230802606950] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Good communication between families and care providers is central to quality care, providing valuable insight into medical history and preferences, increasing family involvement and satisfaction, and reducing complaints. Two studies offer insight into sources of family-staff miscommunication and conflict. The Nursing Home Family Study (Study 1) interviewed 103 family caregivers to nursing home residents. The Long Term Care Community Coalition (Study 2) conducted focus groups and surveys with staff in six facilities: 323 certified nurse's assistants, 52 licensed practical nurses, and 71 registered nurses. Qualitative and quantitative data from both studies identified multiple barriers to good communication associated with both nursing homes and family caregivers. Institutional barriers include understaffing, turnover, inadequate training, policies based in a medical model, rigid routines, poor intrastaff communication, and work schedules that do not coincide with family visits. Psychosocial factors that hinder family communication include guilt, role confusion, clashes of culture and values, unrealistic expectations, and conflicting responsibilities. Specific communication problems identified by families were: making them feel guilty, criticism of their involvement, lack of information, changes made without consultation, staff have too little time to talk, high turnover, rotating shifts, and poor intrastaff communication. Similar issues were raised by nursing staff, who valued trusting, respectful relationships with supervisors and families, being consulted prior to changes, support in addressing racist or abusive comments, adequate staffing, and teamwork. Certified nursing assistants noted that family members are quick to complain but seldom offer praise, and that their intimate knowledge of the resident is rarely acknowledged. These data are applied to develop educational interventions to improve family-staff communication.
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Affiliation(s)
- S Deborah Majerovitz
- Department of Behavioral Sciences, York College, City University of New York, New York, NY 11451, USA.
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Pruchno RA, Brill JE, Shands Y, Gordon JR, Genderson MW, Rose M, Cartwright F. Convenience Samples and Caregiving Research: How Generalizable Are the Findings? THE GERONTOLOGIST 2008; 48:820-7. [DOI: 10.1093/geront/48.6.820] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wallace Williams S, Desai T, Rurka JT, Mutran EJ. Predictors of Satisfaction for African-American and White Family Caregivers of Adult Care Home Residents. J Appl Gerontol 2008. [DOI: 10.1177/0733464808317169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examines satisfaction with care for African-American and White family caregivers of assisted living (adult care and family care homes) residents. Demographic factors, particularly race, caregiving experiences, and structural characteristics, were analyzed. A regression model correcting for design effects was analyzed. Because of the number of significant interactions, separate analyses for each race were completed. Results support the conceptualization of satisfaction with long-term care as a multidimensional process, incorporating demographic characteristics of family caregivers, the caregiving experience, and structural characteristics of the facility. Findings also suggest that predictors of satisfaction with care differ by race. A focus by long-term care administrators and staff on aspects highlighted in this study could improve relationships with family members and marketability of their facility. Findings can also benefit potential residents of adult care homes and/or their family members who need to select a long-term care facility.
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Wilks SE, Croom B. Perceived stress and resilience in Alzheimer's disease caregivers: testing moderation and mediation models of social support. Aging Ment Health 2008; 12:357-65. [PMID: 18728949 DOI: 10.1080/13607860801933323] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The study examined whether social support functioned as a protective, resilience factor among Alzheimer's disease (AD) caregivers. Moderation and mediation models were used to test social support amid stress and resilience. METHOD A cross-sectional analysis of self-reported data was conducted. Measures of demographics, perceived stress, family support, friend support, overall social support, and resilience were administered to caregiver attendees (N=229) of two AD caregiver conferences. Hierarchical regression analysis showed the compounded impact of predictors on resilience. Odds ratios generated probability of high resilience given high stress and social supports. Social support moderation and mediation were tested via distinct series of regression equations. Path analyses illustrated effects on the models for significant moderation and/or mediation. RESULTS Stress negatively influenced and accounted for most variation in resilience. Social support positively influenced resilience, and caregivers with high family support had the highest probability of elevated resilience. Moderation was observed among all support factors. No social support fulfilled the complete mediation criteria. CONCLUSION Evidence of social support as a protective, moderating factor yields implications for health care practitioners who deliver services to assist AD caregivers, particularly the promotion of identification and utilization of supportive familial and peer relations.
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Affiliation(s)
- Scott E Wilks
- LSU School of Social Work, Louisiana State University, Baton Rouge, LA, USA.
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Chen CK, Sabir M, Zimmerman S, Suitor J, Pillemer K. The Importance of Family Relationships With Nursing Facility Staff for Family Caregiver Burden and Depression. J Gerontol B Psychol Sci Soc Sci 2007; 62:P253-60. [PMID: 17906166 DOI: 10.1093/geronb/62.5.p253] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We explore the association between family caregiver depression and the quality of staff-family relationships, and we test burden as a mediator of this relationship. Using structural equation modeling, we used data from a representative sample of 932 family members from 20 nursing homes in Central New York to examine the association between staff-family relationship quality and family caregiver depression. We then tested family caregiver burden as a mediator of the relationship between staff-family relationship quality and family caregiver depression. Staff-family relationship quality, specifically perceived conflict with staff, is significantly associated with family caregiver depression. Further, caregiver burden mediates this relationship. Interventions to improve staff-family relationships may impact family caregiver depression by reducing the stress that family caregivers experience.
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Affiliation(s)
- Cory K Chen
- Carolina Program in Healthcare and Aging Research, University of North Carolina--Chapel Hill, Chapel Hill, NC 27514, USA.
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Gaugler JE, Duval S, Anderson KA, Kane RL. Predicting nursing home admission in the U.S: a meta-analysis. BMC Geriatr 2007; 7:13. [PMID: 17578574 PMCID: PMC1914346 DOI: 10.1186/1471-2318-7-13] [Citation(s) in RCA: 541] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 06/19/2007] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND While existing reviews have identified significant predictors of nursing home admission, this meta-analysis attempted to provide more integrated empirical findings to identify predictors. The present study aimed to generate pooled empirical associations for sociodemographic, functional, cognitive, service use, and informal support indicators that predict nursing home admission among older adults in the U.S. METHODS Studies published in English were retrieved by searching the MEDLINE, PSYCINFO, CINAHL, and Digital Dissertations databases using the keywords: "nursing home placement," "nursing home entry," "nursing home admission," and "predictors/institutionalization." Any reports including these key words were retrieved. Bibliographies of retrieved articles were also searched. Selected studies included sampling frames that were nationally- or regionally-representative of the U.S. older population. RESULTS Of 736 relevant reports identified, 77 reports across 12 data sources were included that used longitudinal designs and community-based samples. Information on number of nursing home admissions, length of follow-up, sample characteristics, analysis type, statistical adjustment, and potential risk factors were extracted with standardized protocols. Random effects models were used to separately pool the logistic and Cox regression model results from the individual data sources. Among the strongest predictors of nursing home admission were 3 or more activities of daily living dependencies (summary odds ratio [OR] = 3.25; 95% confidence interval [CI], 2.56-4.09), cognitive impairment (OR = 2.54; CI, 1.44-4.51), and prior nursing home use (OR = 3.47; CI, 1.89-6.37). CONCLUSION The pooled associations provided detailed empirical information as to which variables emerged as the strongest predictors of NH admission (e.g., 3 or more ADL dependencies, cognitive impairment, prior NH use). These results could be utilized as weights in the construction and validation of prognostic tools to estimate risk for NH entry over a multi-year period.
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Affiliation(s)
- Joseph E Gaugler
- Center on Aging, Center for Gerontological Nursing, School of Nursing, University of Minnesota, 6-150 Weaver-Densford Hall, 1331, 308 Harvard Street S.E., Minneapolis, MN, 55455 USA
| | - Sue Duval
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Division of Epidemiology & Community Health, 1300 South Second Street, Suite 300, Minneapolis, MN 55454-1015 USA
| | - Keith A Anderson
- Graduate Center for Gerontology, College of Public Health, University of Kentucky, 304H Charles T Wethington Building 0200, Lexington, KY 40506 USA
| | - Robert L Kane
- Division of Health Policy and Management, University of Minnesota School of Public Health, Mayo Mail Code 197, 420 Delaware Street SE, Minneapolis, MN 55455 USA
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Gaugler JE, Holmes HH. Families' experiences of long-term care placement: Adaptation and intervention. CLIN PSYCHOL-UK 2006. [DOI: 10.1080/13284200410001707463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Joseph E. Gaugler
- The University of Kentucky , USA
- Department of Behavioral Science, The University of Kentucky , 110 College of Office Medicine Building, Lexington, KY, 40536-0866, USA
| | - Heidi H. Holmes
- The University of Kentucky , USA
- Department of Behavioral Science, The University of Kentucky , 110 College of Office Medicine Building, Lexington, KY, 40536-0866, USA
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Newcomer R, Kang T, Graham C. Outcomes in a nursing home transition case-management program targeting new admissions. THE GERONTOLOGIST 2006; 46:385-90. [PMID: 16731878 DOI: 10.1093/geront/46.3.385] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The Providing Assistance to Caregivers in Transition (PACT) program offers nursing home discharge planning and case management for individuals in the transitional period following a return to the community. The PACT program targeted individuals newly admitted to nursing homes and worked with a family caregiver to develop and implement a nursing home discharge plan. DESIGN AND METHOD Reported are the results of a randomized control design evaluating the program's effectiveness. Those individuals randomly assigned to the intervention group (n = 33) received PACT case management in addition to their usual medical and nursing home care. The individuals in the control group (n = 29) continued their usual care. RESULT There were no statistical differences in the discharge rate (84% treatment vs 76% controls) or in the median length of stay (42 days vs 55 days) between the two groups of individuals. IMPLICATIONS Replications or extensions of a PACT-type intervention might consider a broader mix of nursing homes, working directly with the nursing home's admission Minimum Data Set coordinator in patient selection, or working with Medicare or Medicaid HMO plans.
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Affiliation(s)
- Robert Newcomer
- Department of Social and Behavioral Sciences, University of California, 3333 California Street, Suite 455, San Francisco, CA 94118, USA.
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Social Class and the Subjective Adaptation of Caregivers to Institutionalization. ACTA ACUST UNITED AC 2006. [DOI: 10.1300/j181v03n03_05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Marziali E, Shulman K, Damianakis T. Persistent Family Concerns in Long-term Care Settings: Meaning and Management. J Am Med Dir Assoc 2006; 7:154-62. [PMID: 16503308 DOI: 10.1016/j.jamda.2005.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to understand institutional and family caregiver characteristics that contribute to the failure to resolve families' persistent complaints about nursing home care of their relatives. DESIGN AND METHODS Key informant interviews with 9 family members who had persistent concerns about the care of their relatives were conducted. Two focus groups with 5 nurse managers provided staff perceptions of families whose persistent concerns remained unresolved. Content analysis of both individual interviews and focus groups resulted in the extraction of salient themes. RESULTS Factors associated with persistent discord between families and staff included caregivers' perceptions of staff as incompetent, interfamilial conflicts, and unresolved psychosocial issues. Institutional factors contributing to persistent negative perceptions of care included staff's vulnerability in the face of challenges to their professional competence and stress due to disproportionate amounts of time spent educating and supporting health care aids to cope with distraught families. IMPLICATIONS The failure to settle, in a mutually satisfactory manner, the complaints of this subgroup of families is discussed in the context of unresolved family issues that interact with institutional failure to respond in a manner that conveys understanding of caregiver stress that is invariably exacerbated when a family member is placed in a long-term care facility.
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Graham C, Anderson L, Newcomer R. Nursing home transition: providing assistance to caregivers in transition program. ACTA ACUST UNITED AC 2005; 10:93-101. [PMID: 15815225 DOI: 10.1097/00129234-200503000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transition from a skilled nursing facility or rehabilitation center to the community can be fragmented and insufficiently case managed, resulting in inadequate care recommendations, patient-caregiver distress, a delay in discharge, and a higher risk of nursing home readmission. The Providing Assistance to Caregivers in Transition (PACT) program is an interdisciplinary case management program designed to enhance nursing home discharge planning and case management support for the transitional period following a return to the community. During the PACT program's initial 24 months of operation, 38 of 42 opened cases were assisted in a discharge to the community. Of these, 30 remained at home for at least 6 months, 5 were readmitted within 6 months, and 3 others died. Caregivers reported satisfaction with instrumental (e.g., information about care options, facilitation of referrals to services) and emotional support. Nursing home cooperation was mixed. More work is needed to develop a broader referral base for the program.
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Affiliation(s)
- Carrie Graham
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
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Abstract
The objective of this review is to critically synthesize the existing literature on family involvement in residential long-term care. Studies that examined family involvement in various long-term care venues were identified through extensive searches of the literature. Future research and practice must consider the complexity of family structure, adopt longitudinal designs, provide direct empirical links between family involvement and resident outcomes, and offer rigorous evaluation of interventions in order to refine the literature.
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Affiliation(s)
- J E Gaugler
- Department of Behavioral Science, The University of Kentucky, 110 College of Medicine Office Building, Lexington, KY 40536, USA.
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Reuss GF, Dupuis SL, Whitfield K. Understanding the experience of moving a loved one to a long-term care facility:family members' perspectives. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2005; 46:17-46. [PMID: 16338883 DOI: 10.1300/j083v46n01_03] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This project was designed to develop an understanding of family members' experiences of moving a loved one to a long-term care facility and to identify ways in which facilities might help ease this process. Twenty-one semi-structured interviews were conducted with family members who had recently moved a relative into one of three long-term care facilities in Southern Ontario, Canada. Several factors appeared to contribute to the overall experience of the move to long-term care and either served to impede or facilitate a positive transition for families. These factors included: the experience during the waiting process, preparation for the move, ease of the actual move, control over decisions, communication throughout the process, support from others, and family and resident perceptions and attitudes towards the move. Easing the difficult aspects of moving a loved one to a long-term care setting can be facilitated with better preparation and support from facilities and community services.
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Affiliation(s)
- Gillian Flynn Reuss
- Faculty of Applied Health Sciences, University of Waterloo,Waterloo, ON N2L 3G1, Canada
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Tornatore JB, Grant LA. Family Caregiver Satisfaction With the Nursing Home After Placement of a Relative With Dementia. J Gerontol B Psychol Sci Soc Sci 2004; 59:S80-8. [PMID: 15014095 DOI: 10.1093/geronb/59.2.s80] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This article examines family caregiver satisfaction after nursing home placement of a relative with Alzheimer disease or a related dementia. Determining what contributes to family caregiver satisfaction is a critical step toward implementing effective quality improvement strategies. METHODS A stress process model is used to study caregiver satisfaction among 285 family caregivers in relation to primary objective stressors (stage of dementia, length of stay, length of time in caregiving role, visitation frequency, involvement in nursing home, and involvement in hands-on care), subjective stressors (expectations for care), caregiver characteristics (education, marital status, familial relationship, workforce participation, distance from nursing home, and age), and organizational resources (rural/urban location, profit/nonprofit ownership, special care unit [SCU] designation, and custodial unit designation). SAS PROC MIXED is used in a multilevel analysis. RESULTS Higher satisfaction is associated with earlier stage of dementia, greater length of time involved in caregiving prior to institutionalization, higher visitation frequency, less involvement in hands-on care, greater expectations for care, and less workforce participation. DISCUSSION Multilevel analysis showed that primary stressors are the strongest predictors of satisfaction. Only one caregiver characteristic (work participation) and one organizational resource (rural/urban location) predict satisfaction. SCU designation was unrelated to satisfaction, perhaps because SCUs have less to offer residents in more advanced as opposed to earlier stages of Alzheimer disease. If family satisfaction is to be achieved, family presence in a nursing home needs to give caregivers a sense of positive involvement and influence over the care of their relative.
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Gaugler JE, Anderson KA, Zarit SH, Pearlin LI. Family involvement in nursing homes: effects on stress and well-being. Aging Ment Health 2004; 8:65-75. [PMID: 14690870 DOI: 10.1080/13607860310001613356] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
While it is clear that families remain involved in the lives of loved ones following placement in a nursing home, little research has examined whether visiting and the provision of care has effects on the emotional stress and psychological well-being of family members. Utilizing pre-placement and post-placement data from the Caregiver Stress and Coping Study (n = 185) as well as a theoretical framework to delineate the manifestation of caregiver stress (i.e., the stress process model), the goal of this analysis was to determine whether frequency of visits and provision of personal and instrumental activities of daily living assistance following institutionalization were related to post-placement emotional distress, family conflict, and psychological well-being among family members. Following control of a wide array of pre-placement and post-placement covariates, multiple regression models found that visiting was negatively associated with post-placement role overload; moreover, the provision of instrumental activities of daily living help was negatively related to loss of intimate exchange at post-placement. The results suggest that family involvement following institutionalization may operate differently than when in the community, and add to the literature emphasizing the positive implications of family involvement in residential long-term care.
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Affiliation(s)
- J E Gaugler
- Department of Behavioral Science, University of Kentucky, Lexington, 40536-0086, USA.
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Pillemer K, Suitor JJ, Henderson CR, Meador R, Schultz L, Robison J, Hegeman C. A cooperative communication intervention for nursing home staff and family members of residents. THE GERONTOLOGIST 2003; 43 Spec No 2:96-106. [PMID: 12711730 DOI: 10.1093/geront/43.suppl_2.96] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This article reports on a randomized, controlled study of Partners in Caregiving, an intervention designed to increase cooperation and effective communication between family members and nursing home staff. DESIGN AND METHODS Participants included 932 relatives and 655 staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Parallel training sessions on communication and conflict resolution techniques were conducted with the family and staff in the treatment group, followed by a joint meeting with facility administrators. RESULTS Positive outcomes were found for both family and staff members in the treatment group. Both groups showed improved attitudes toward each other, families of residents with dementia reported less conflict with staff, and staff reported a lower likelihood of quitting. IMPLICATIONS Multiple studies report significant interpersonal stress between family members of nursing home residents and facility staff members. Partners in Caregiving appears to be an effective way to improve family-staff relationships in nursing homes.
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Affiliation(s)
- Karl Pillemer
- Cornell Gerontology Research Institute and Department of Human Development, MVR G39, Cornell University, Ithaca, NY 14853, USA.
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Gaugler JE, Wackerbarth SB, Mendiondo M, Schmitt FA, Smith CD. The characteristics of dementia caregiving onset. Am J Alzheimers Dis Other Demen 2003; 18:97-104. [PMID: 12708225 PMCID: PMC10833668 DOI: 10.1177/153331750301800208] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the characteristics of entry into the caregiving role for family and friends of older adults suffering from dementia. Using data from a large community survey of informal caregivers of patients who visited the University of Kentucky's Alzheimer's Disease Research Center (n = 1055), respondents were classified into one of four onset sequences: recognition-diagnosis, care provision, recognition-care, and diagnosis dependent. A multinomial logistic regression identified several characteristics (i.e., caregiver income, time since onset, care recipient gender, care recipient living status, and primary caregiver identification) that were significantly associated with various caregiving onset patterns. The findings describe the complexity of the entry process and its potential association with health-related transitions in the caregiving career.
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Affiliation(s)
- Joseph E Gaugler
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
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Abstract
PURPOSE This article reviews the literature on "The Experience of Dying" and presents data from a larger, ongoing study of an ethnography of dying in nursing homes. The purpose of the ethnographic study was to investigate the process of providing end-of-life care to residents who were dying in nursing homes. DESIGN AND METHODS Participant observation, in-depth interviews, and event analysis were used to obtain data in three nursing facilities. RESULTS The review of the literature disclosed that research on the experience of dying is limited; most of the studies have been conducted in acute care hospitals among people who were dying of cancer. The ethnographic study found that lack of attention to cultural needs, cognitive status, inadequate staffing, and inappropriate and inadequate communication between health care providers and nursing home residents and their families were the predominant factors that influenced the experience of dying. IMPLICATIONS Future research is needed on: The experience of dying for patients with dementia, for people in a comatose state, and for non-English speaking patients; symptom management; health care provider/patient-family interaction; the burden of caregiving for families; and the consequences of the constraints within our health care system for people who are dying in various settings.
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Affiliation(s)
- Jeanie Kayser-Jones
- Department of Physiological Nursing, University of California, San Francisco, CA 94143-0610, USA.
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Gaugler JE, Kane RL, Kane RA. Family care for older adults with disabilities: toward more targeted and interpretable research. Int J Aging Hum Dev 2002; 54:205-31. [PMID: 12148687 DOI: 10.2190/fack-qe61-y2j8-5l68] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Family care of the elderly is key to the long-term care system, and its importance has led to an abundance of research over the past two decades. Several methodological and substantive issues, if addressed, could create even more targeted and interpretable research. The present review critically examines methodological topics (i.e., definitions of family caregiving, measurement of caregiving inputs) and conceptual issues (i.e., family involvement in long-term residential settings, and the care receiver's perspective on care) that have received insufficient attention in the caregiving literature. Throughout this review recommendations are offered to improve these areas and advance the state of the art.
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Affiliation(s)
- Joseph E Gaugler
- Ph.D. Program in Gerontology/Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington 40536-0230, USA.
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