Spousal Caregivers of Coronary Artery Bypass Surgery Patients: Differences between Caregivers with Low vs. High Caregiving Demands

PURPOSE

Compared to non-caregivers, caregivers have higher rates of depressive symptoms, caregiver strain, less mutuality, and health care visits. However, few investigators have examined family caregivers after coronary artery bypass (CAB) surgery. The purpose of this study was to examine differences in caregiving difficulties, mutuality (i.e., open communication; avoiding sad thoughts), and depressive symptoms based on low vs. high caregiving demands among spousal caregivers.

DESIGN

A descriptive, comparative design was used to examine 33 spousal caregivers of CAB surgery patients (16 in low and 17 in high caregiving demand groups).

METHODS

Measures included: Caregiving Burden Scale, Mutuality and Interpersonal Sensitivity Scale, and Patient Health Questionnaire-9. Groups were compared using Mann-Whitney U statistics.

FINDINGS

It was found that caregivers with high caregiving demands reported more caregiving difficulties and more open communication about the surgery compared to caregivers with low demands.

CONCLUSION

Caregivers with greater caregiving demands may need additional support to assist them with the caregiving situation.

CLINICAL RELEVANCE

Priority should be given to family caregivers, who take care of patients in cardiac rehabilitation, with higher caregiving demand.

Evaluating Retrospective Measures in Gerontological Research

The purpose of the present study was to evaluate the quality of retrospective assessments of a number of commonly used measures in gerontological and caregiving research. Data were taken from interviews with 242 caregivers participating in a longitudinal study of caregiving. Results indicate moderate to high 1-year retrospective reliability for measures of ADL, obligation to the elder, affection for the elder, and global assessments of the caregiver's health. In contrast, retrospective assessments of objective and subjective burden were found to be of relatively low quality.

The Normative Anticipation of Retirement by Older Workers

The scope of explanation for retirement behavior could be greatly enlarged by acknowledging workers’ extended engagement with the question before the event—its “givenness” in their future, and their course of action toward it. This study provides evidence for such extended involvement among workers aged 51 to 61 in the 1992 Health and Retirement Study (HRS) who saw themselves being within 15 years of retiring. To the extent that workers foresaw less time left at work, they reported more frequent thinking and talking about retirement. This pattern was quite general. The consideration given to retirement was, as expected, more frequent in circumstances that might orient workers toward the future. However, even absent these circumstances, subjective proximity still predicted the topicality of retirement. Widely held, albeit individual, timetables for retirement demonstrate its embeddedness in the subjective life course of older workers.

Perceptions of Respite Services as Predictors of Utilization

The purpose of this study was to investigate the factors that influence the extent to which family caregivers of Alzheimer's patients use publicly subsidized respite programs. A model linking caregivers' attitudes concerning the convenience, quality of care, and perceived usefulness of a particular respite program to levels of respite use is hypothesized and tested. One hundred fourteen caregivers throughout Michigan who were eligible for respite services under the auspices of the Michigan Model Respite Program and caring for a noninstitutionalized elder with Alzheimer's disease participated in the study. Controlling for functional limitations of the elder, health of the caregiver, use of other support services, perceptions concerning the usefulness of respite, and the convenience of respite use were found to have significant direct effects on the level of actual respite use. Perceptions of program convenience affected service use indirectly by influencing caregivers' perceptions of program usefulness.

The Impact of Acculturation on Attitudinal Familism in a Community of Puerto Rican Americans

The goal of this study was to examine the relationship between acculturation and familism in a samnple of 182 Hispanics of Puerto Rican descent. Exploratory factor analysis was used to establish the multidimensionality of each construct. Consistent with earlier studies, three dimensions of acculturation and familism were identified. Each dimension offamilism was then regressed on a set of explanatory variables that included three dimensions of acculturation. For two dimensions offamilism (familial obligations and support from relatives), acculturation was positively related to familism; for the other dimension (family as referents), the relationship was nonsignificant. In explaining variance in attitudinal familism, the results suggest that acculturation may be better represented as a single, second-orderfactor In interpreting the findings in the context of previous research, however; it is useful to treat acculturation as a multidimensional construct.

Utilization of Respite Services: A Comparison of Users, Seekers, and Nonseekers

Four hundred fifty-eight family caregivers of Alzheimer's patients in Michigan were interviewed to identify factors associated with respite use. Of these caregivers, 176 were using respite (users), 128 had inquired about the service but had not yet used it (seekers), and 154 had neither used nor inquired about respite services (nonseekers). Separate logistic regression models were evaluated to identify users versus nonusers ( n = 458) and seekers versus nonseekers ( n = 282). Need for assistance with activities of daily living, availability of other caregivers, concern with cost, and adherence by the respite programto an established service schedule contributed significantly to the model distinguishing service users from nonusers. Caregiver burden, the presence of other caregivers, and the availability of transportation services made significant, unique contributions to the model distinguishing seekers from nonseekers.

The Effects of Respite on Caregivers of Alzheimer's Patients: One-Year Evaluation of the Michigan Model Respite Programs

The impact of respite care on informal caregiversforparticipants in the Michigan Model Respite Programs was evaluated Using a nonequivalent control group design, 72 caregivers were assessed prior to program participation and again 6 months later on three dimensions: subjective, or felt, burden; objective burden; and morale. Caregivers who had used respite had a significantly lower level of subjective burden and significantly higher morale compared to controls. No differences between groups of caregivers were observed for objective burden. The findings are discussed within the context of recent research that has generally failed to document the effectiveness of respite programs for family caregivers.

Differences in the Perceived Need for Assistive Services by Culturally Diverse Caregivers of-Persons With Dementia

Various explanations have been advanced to explain why older members of ethnic minority groups in the United States tend to use proportionally fewer assistive social and medical services than nonminorities. One possibility is that culturally based differences in attitudes toward need for particular services affect the likelihood of use. Data were analyzed from 2,947 Black, His panic, and White caregiving dyads participating in the Demonstration Grants to States program. Hierarchical logistic regression models were estimated separately for three discretionary ser vices (adult day care, in-home respite, and meal services) and one nondiscretionary service (home health care). Hypothesized outcomes were observed in all of the service models tested

Aging and religious participation in late life

The aim of the study is to evaluate the relationship between two dimensions of religiosity and the process of aging. Secondary analysis of longitudinal data from the Florida Retirement Study was used to assess the trajectories of religious development over time. We analyzed data from six interview waves with 1,000 older adults aged 72 or over. A baseline model of growth processes only indicated significant variation and mean decline in religious attendance, but no significant variation nor mean change in religious beliefs over time. A final model including a set of 17 covariates was estimated, and the model fit statistics indicated very good fit for this latent growth curve model. The decline in mean religious attendance across time did not accompany a mean increase in religious beliefs as expected. There were numerous individual differences in the trajectory of decline for religious attendance, as well as in the initial levels of attendance and religious beliefs.

Performance of the 10-item Center for Epidemiologic Studies Depression scale for caregiving research

OBJECTIVES

The Center for Epidemiologic Studies Depression (CESD) scale has been useful in a broad spectrum of health research on patient and population outcomes. A brief version is used when depressive symptoms are not the primary focus. Rasch (item response) analysis previously demonstrated potential problems with positively worded items. We tested the 10-item CESD (CESD-10) scale and considered an 8-item version with both psychometric and Rasch analyses.

METHODS

This was a special sample of 2067 caregivers from three existing US databases. We describe item response patterns and internal constancy in addition to Rasch scale results.

RESULTS

There were few problems with missing data, and internal consistency was high (alpha = 0.86-0.88) for both CESD versions. Rasch analysis indicated that one of the positive items ("hopeful about future") could be dropped.

CONCLUSIONS

We partly confirmed prior work that suggested dropping positive items for the CESD-10. Among caregivers, item-level problems and scaling problems seem minimal. At present, there is not a strong rationale for dropping the CESD-10 positive items: the one poorly performing positive item might be explained by the special caregiver sample.

Caregiving demand and difficulty in older adult spousal caregivers after coronary artery bypass surgery

The purpose of this study was to describe the caregiving demands and difficulties for older adult spousal caregivers of coronary artery bypass (CAB) surgery patients. Caregiving demands and difficulties were measured by the Caregiving Burden Scale. The sample size was 35 caregivers of CAB surgery patients who were, on average, 60 years old and 19 days since hospital discharge. Descriptive analysis revealed that the top four most demanding caregiving activities perceived by spousal caregivers were providing transportation, additional household tasks, providing emotional support, and two tied for fourth: monitoring symptoms and additional tasks outside the home. The top four most difficult caregiving tasks were additional household tasks, providing transportation, and two tied for third: additional tasks outside home and managing behavior problems. Also, caregivers reported experiencing more demands than difficulties. Examining the demanding and difficult caregiving tasks provides information from which to develop and test tailored interventions for caregivers of this population.

Effects of the TCARE® intervention on caregiver burden and depressive symptoms: preliminary findings from a randomized controlled study

OBJECTIVES

We examined the effects of a manualized care management protocol specifically designed for care managers working with caregivers, the Tailored Caregiver Assessment and Referral® (TCARE®) protocol, on caregiver identity discrepancy, burden, and depressive symptoms.

METHODS

Preliminary data from a longitudinal, randomized, controlled intervention study with 266 family caregivers served by 52 care managers in 4 states were analyzed using repeated measures random effects regression procedures. Caregivers in the intervention and control groups were repeatedly assessed for up to 9 months on caregiver identity discrepancy, 3 areas of caregiving burden-objective, relationship, and stress burdens; depression; and intention for nursing home placement.

RESULTS

We found significant group by time interaction effects for caregiver identity discrepancy, relationship burden, stress burden, depression, and intention for nursing home placement. Caregivers in the intervention group experienced significant improvement on these measures, whereas caregivers in the control group worsened on these measures over time.

DISCUSSION

The preliminary findings provide strong support for effectiveness of the TCARE® protocol on improving caregiver well-being and mental health outcomes.

The impact of TCARE® on service recommendation, use, and caregiver well-being

PURPOSE OF THE STUDY

Findings are reported from a study that examined the effects of the Tailored Caregiver Assessment and Referral (TCARE®) protocol, a care management process designed to help family caregivers, on care planning and caregiver outcomes.

DESIGN AND METHODS

A longitudinal, randomized controlled trial was conducted with 97 caregivers enrolled in a demonstration project in Georgia. Data included on care plans pertaining to service recommendations, compliance, and use were reviewed. Caregiver identity discrepancy, objective burden, relationship burden, stress burden, and depressive symptoms were assessed up to 4 times during a 9-month observation period. Chi-square tests, independent samples t tests, random effects regression growth curve analysis, and random intercept regression analysis were conducted.

RESULTS

A greater variety of services were recommended to and used by caregivers in the intervention group than in the control group. Caregivers in the intervention group had lower caregiver identity discrepancy, stress burden, and depressive symptoms over time than caregivers in the control group.

IMPLICATIONS

Study findings provide initial support for the merits of the TCARE® protocol as a process that can be used to effectively target services to individual caregivers' needs.

Impact of a psychoeducational program on three types of caregiver burden among spouses

PURPOSE

The purpose of this study was to investigate the extent to which a psychoeducational intervention called "Powerful Tools for Caregivers" (PTC) influences burden of spouse caregivers. Specifically, this study examined whether spouse caregivers who attended PTC exhibited reductions in stress burden, relationship burden, and objective burden compared to a comparison group.

DESIGN AND METHODS

The 6 -week intervention used a self-efficacy framework to train caregivers to focus on self-care, communicate effectively, and manage emotions. This quasi-experimental study included 115 participants from the PTC group and 95 participants from a comparison group. Assessments were completed before and after the intervention for the PTC group and within a 6 -week time period for the comparison group.

RESULTS

Analyses using structural equation modeling showed that participants in the PTC group reported significantly lower levels of stress and objective burden than the comparison group. There were no group differences in relationship burden.

IMPLICATIONS

The findings indicate that PTC can be an effective resource for reducing psychological distress and objective burden among spouses caring for disabled partners.

Testing a Model of Physical and Psychological Recovery After a Cardiac Event

Little is known about the specific sources and types of support that assist patients in alleviating stress and achieving positive recovery outcomes after a cardiac event. The purpose of this study is to examine the effects of illness-related stress, emotional and tangible support from a significant other, and informational support from a health care provider on physical and psychological recovery outcomes in cardiac patients 8 weeks after their cardiac event. The sample consists of 220 cardiac patients. Data analysis uses structural equation modeling. Final fit indices were as follows: χ2 ( df = 110) = 156.169, comparative fit index = .963, Tucker—Lewis index = .949, and root mean square error of approximation = .044 suggesting an acceptable model. Illness-related stress has direct effects on depression, physical recovery, and activity levels. Partner emotional support has a direct effect on depression. The findings provide direction for developing social support interventions aimed at improving recovery outcomes.

The Impact of Social Embarrassment on Caregiving Distress in a Multicultural Sample of Caregivers

The purpose of this study was to gauge the impact of social embarrassment on caregivers of Alzheimer's patients. Two hypotheses were tested: First, social embarrassment adds a unique component of distress to caregivers of Alzheimer's patients, controlling for other factors known to cause depression; second, the negativity of the embarrassment varies according to the caregiver's race/ethnicity. Using data from the Alzheimer's Disease Demonstration Grants to States program ( N = 1,183), the caregiver's perceived depression was regressed on culturally situated variables and a set of covariates that included characteristics of both caregiver and care receiver. Results indicate that social embarrassment exerts a substantial effect on caregiver depression, but the effect does not vary meaningfully across cultural groups. In addition to social embarrassment, the health of the caregiver, the certainty of the Alzheimer's diagnosis, and the caregiver's perceived duty to care all uniquely contribute to the caregiver's level of depression.

A profile of home care workers from the 2000 census: how it changes what we know

PURPOSE

The goal of our study was to identify a representative sample of direct care aides to generate an accurate profile of the long-term-care workforce, with a special focus on home care workers.

DESIGN AND METHODS

Data were taken from the 5% Public Use Microdata Sample (PUMS) of the 2000 Census.

RESULTS

Variable coding in the 2000 Census data allowed for a more detailed identification of long-term-care workers than was available in previous studies. On the basis of this new sample, the estimated size of the home care workforce is much larger than that in previous estimates, and it is more heterogeneous. In addition, our analyses revealed more self-employed workers, higher salaries than previously reported, and greater ethnic diversity, with Hispanics or Latinos comprising a significant proportion of the home care workforce.

IMPLICATIONS

Numerous state and federal programs are currently underway to increase the capacity of the long-term-care workforce. A more comprehensive understanding of the characteristics of the long-term-care workforce will facilitate more effective development of programs designed to enhance recruitment and retention of these workers to meet the increasing demands of future years.

Longitudinal Analysis of the Reciprocal Effects of Self-Assessed Global Health and Depressive Symptoms

This study examined whether a reciprocal relationship exists between measures of self-assessed global health and depressive symptoms, net of covariates that included chronic illness, functional disability, education, income, gender, race, and age. Analyses of five waves of data from the Rand version of the Health and Retirement Survey (N=7,475), using an autoregressive, cross-lagged panel design, indicated that self-assessed overall health had a modest but statistically significant and consistent effect on depressive symptoms. In contrast, the level of depressive symptoms had a statistically nonsignificant effect on self-assessed health. There has been growing interest in identifying the factors that inform self-assessments of overall health. The present findings indicate that self-assessed global health is not simply a manifestation of depressed affect.

Assessment of active music participation as an indication of subsequent music making engagement for persons with midstage dementia

Persons with midstage dementia and in special care (N = 45) were assessed in groups by a music therapy practitioner to determine the level of engagement in a 15-minute protocol that included a five-minute segment for each of three music activity types--rhythm playing, exercising with music, and singing. Activity staff with little to no formal music training who were employed by the facility were taught to use the protocol to conduct eight subsequent activity sessions for small groups from which activity engagement data were collected for each subject. Results indicated the protocol was accessible and successful for indigenous activity staff, initial assessments were strong predictors of subsequent engagement, and participation levels were stable over time and across each of the three activities.

Evaluating a practice-oriented service model to increase the use of respite services among minorities and rural caregivers

PURPOSE

The goal of this study was to evaluate the practice-oriented model of service use (Yeatts, Crow, & Folts, 1992) relative to the more widely used behavioral model ( Andersen, 1968) in its ability to explain the use of respite services by caregivers of Alzheimer's patients. Unlike the behavioral model, which focuses primarily on characteristics of the service user, the practice-oriented model focuses primarily on characteristics of the service.

DESIGN AND METHODS

Interview data from 1,158 caregivers participating in the Alzheimer's Disease Demonstration Grants to States program ( Montgomery, Kosloski, Karner, & Schaefer, 2002) were analyzed. Separate regression models were estimated for adult day care and in-home respite, using the full information maximum likelihood procedure described by Arbuckle (1996), and ordinary least squares regression with listwise deletion of missing data.

RESULTS

The findings indicate that the factors related to respite use tapped by the practice-oriented model add significantly to explanatory models of service use over models that use only the factors typically represented by the behavioral model. Additional analyses, including a set of interactions with ethnicity, indicated that this improvement occurs primarily for White and Hispanic caregivers, and less so for African Americans.

IMPLICATIONS

The findings are discussed in terms of their implications for enhancing the timely use of respite services and directions for future research.

Factors related to client satisfaction with community-based respite services

The goal of this study was to identify factors related to client satisfaction with respite services. Data were analyzed from interviews with 1183 family caregivers participating in the AoA Demonstration Grants to States program. Two groups of potential explanatory variables were examined: (1) characteristics of client families, and (2) caregivers' perceptions of service delivery. Separate regression models were estimated for users of in-home respite and adult day care. Factors related to satisfaction with in-home respite included elder's ADL, ethnicity, caregivers' expectations for what the respite worker would and would not do, access to services, and the amount of red tape. Factors related to satisfaction with adult day care included the caregiver's age and health, ethnicity, caregivers' expectations for what the respite worker would and would not do, access to services, and the amount of red tape. Differences be- tween the models are discussed in the context of how providers can improve client satisfaction with respite services.

Profiles of respite use

Profiles of long-term respite use are reported for a diverse sample of 4,369 families from seven states who participated in the Alzheimer's Disease Demonstration Grant to States program. Data from service records spanning a period of seven years were analyzed using hierarchical linear modeling techniques. Respite use was examined in both day care and in-home settings using three different measures of use. Client characteristics related to use include the caregiver's gender and relationship to the elder, and the ethnicity, income, functional level, and problem behaviors of the elder. Provider characteristics linked with different patterns of use include level of service, fee structure, and level of capitation. Implications for service delivery are discussed.

The role of cultural factors on clients' attitudes toward caregiving, perceptions of service delivery, and service utilization

The purpose of the present study was to gain a better understanding of the role of culture in the use of respite services. Culture was defined in three different ways: (1) ethnicity (African-American, Hispanic/Latino, or White); (2) relationship of the caregiver to the care receiver (spouse, adult-child, or other); and (3) geographic location (urban or rural). All three of these classifications were significantly related to the use of respite services, even after controlling for elders' income. Two sets of potential intervening variables that might explain the effects of culture on respite use were investigated: caregivers' attitudes and beliefs, and clients' evaluation of aspects of service delivery. When these variables were controlled, the main effects for relationship of the caregiver to the care receiver and geographic location on respite use were no longer significant. The effect of ethnicity on respite use persisted in the presence of these controls, but was greatly diminished. The results suggest specific avenues by which respite providers can increase appropriate service use among caregivers of dementia patients.

Initial findings from the evaluation of the Alzheimer's Disease Demonstration Grants to States Program

This article describes the initial development and implementation of the Alzheimer's Disease Demonstration Grants to States (ADDGS) program in 15 states. In addition to describing the services delivered and the client populations served, key elements of program development are discussed. Development strategies common to the programs that most successfully used the demonstration as a catalyst for developing services that are likely to continue are identified. Successful community programs were characterized by community commitment fostered by forging new partnerships and expanding public awareness. Success was also linked to the creation of new resources an d flexibility in implementation of the federal program.

Weighing the Success of a National Alzheimer's Disease Service Demonstration

As the need for long-term care services within the United States has grown dramatically, Congress has consistently deflected the primary responsibility for such care to state governments, local organizations, and, ultimately, the family. This paper examines the impact of the Alzheimer's Disease Demonstration Grants to States (ADDGS) program, a small federally funded initiative within the context of this trend. Although the demonstration can be deemed a huge success relative to the goals of creating new services for an underserved target population, questions are raised about the merits of the program relative to the exploding need for an effective network of long-term care services.

Keeping the beat: use of rhythmic music during exercise activities for the elderly with dementia

Involving people with dementia in group exercise activities often presents a challenge. The effects of a recorded instrumental musical accompaniment was evaluated on participation in a series of 14 exercise activities with a group of nursing home residents with dementia. All exercise sessions, specifically designed by physical therapists for older adults, were lead by an activity aide and consisted of a series of seated exercises. Direct observations of resident behavior were conducted over a 25-week period in a reversal experimental design. Results showed increased levels of participation during the experimental condition observations where rhythmic music accompanied the exercise activities. The music intervention was most successful on those generally most willing to participate in social activities.

Eddies in the stream: the prevalence of uncertain plans for retirement

OBJECTIVE

This study examined an assumption of retirement theory that typifies older workers as preretirees who are planfully engaged in paths toward retirement.

METHODS

Using survey responses among workers in the 1992 and 1994 waves of the Health and Retirement Study, we described the prevalence of nonsubstantive answers to questions about the expected form and timing of retirement (e.g., "don't know," "haven't thought about it"). We tested explanations for this uncertainty as an artifact of the survey process, but also as an outcome of the opportunity structure for retirement planning.

RESULTS

Survey procedure did generate some of these noncommittal responses. Depending on question type, approximately 10% to 40% of workers did not state when or how they would retire, and such responses were less prevalent across age and time. In addition, categorical uncertainty about form and timing was theoretically predictable in a framework that supposed that workers less subject to a socially attended life--at work or away--would be more undecided about the future.

DISCUSSION

Uncertainty is an authentic, meaningful stance toward retirement that theory and research design should not ignore. Just as actual transitions to retirement can be ambiguous or blurred, the expectation of retirement, as well, can be untidy.

The role of job-related rewards in retirement planning

The authors used data from the first wave of the Health and Retirement Study ( F. Juster and R. Suzman 1995) to evaluate whether certain job-related gratifications might reduce retirement planning. Three definitions of retirement planning were evaluated and then regressed separately on a set of variables that included 3 types of job-related satisfactions (intrinsic gratification, positive social relations, and ascendance in the workplace) and 7 covariates: education, age, sex, health, marital status, race, and pension eligibility. Findings indicated that jobs high in ascendance were related to an increase in certain types of retirement planning, but jobs high in intrinsic rewards and positive social relations were related to less planning, regardless of how planning was defined. The findings suggest that information about work-related rewards may be useful in targeting individuals who might benefit from retirement planning programs, in developing planning programs to help workers realize more complex retirement plans, and in assisting employers who hope to retain older workers.

Profiling plans for retirement

Actual decision making for retirement is largely inaccessible to investigation, yet research can focus on plans as a window into the preretirement process. This article proposes a construct that profiles five generic types of retirement plans, including plans to retire completely, change jobs, never retire, and uncertainty about retirement. The heuristic value of the construct lies in its recognition of the heterogeneity of retirement intentions. The five plan types were operationalized among workers aged 51-61 in the 1992 Health and Retirement Study. Convergent validity was demonstrated by comparisons to analogous survey questions. Construct validity was shown by predictable relationships between intentions and elements of workers' opportunity structure. The retirement-plans construct can serve as the foundation for a taxonomy of specific retirement plans (e.g., about timing, employment), to organize research on stability and change in retirement intentions, and characterize the path dependence of eventual retirement behavior.

The impact of respite use on nursing home placement

The results of experimental studies of the effects of respite care have been difficult to interpret because researchers have lacked experimental control over who actually received the treatment. Data from one such study are reanalyzed, focusing on the linear relationship between amount of respite use and probability of nursing home placement at the end of the treatment period. The results indicate a significant negative relationship between amount of respite use and nursing home placement.

A longitudinal analysis of nursing home placement for dependent elders cared for by spouses vs adult children

Five-wave panel data from 531 informal caregivers and frail elders were analyzed using an event history framework to identify how changes in the caregiving situation are related to nursing home placement. The results indicate that the predictors of placement differ substantially for elders cared for by spouses vs those cared for by adult children. In addition, the findings suggest dramatically different descriptions of the caregiving role over time for the two groups of caregivers. There were differences not only in the conditions under which caregiving ends, but also apparent differences in when caregiving begins and how it is perceived by the caregiver. Differences in the probability of placement of elders cared for by spouses vs adult children are interpreted within the framework of these contextual differences in the caregiving role.

Investigating patterns of service use by families providing care for dependent elders

The behavioral model developed by Andersen in 1968 was used to investigate patterns of support service use by families caring for dependent elders. It was hypothesized that differences in background or predisposing factors that serve to define caregivers (e.g., spouse vs. adult-child) would interact with need factors to influence the use of "discretionary" support services (e.g., adult day care), but not influence the use of "nondiscretionary" services (e.g., hospitalization). Information was obtained on the use of eight different support services from a sample of 503 caregiving dyads. Caregivers were either spouses or adult children of the dependent elder. The results supported the hypotheses derived from the behavioral model and indicate that, among caregiving families, it is important to consider not only the type of service, but who is assessing the need for that service.

Caregiver burden and generic well-being: opposite sides of the same coin?

Caregiver burden is one of the most commonly used variables in caregiving research, both as a predictor and as an outcome. It has been suggested that caregiver burden can be measured in terms of discrete dimensions of well-being and that burden and well-being represent opposite sides of the same coin. The goal of this study was to explore this issue further by comparing commonly used dimensions of burden with parallel dimensions of well-being, both as outcome variables and as predictors of other outcomes, in a sample of caregivers. The findings suggest that burden may tap a unique domain of caregiving outcomes that is not represented by more objective indicators of these effects. Dismissing burden as an unnecessary or redundant construct seems premature.

Foster care for older adults: issues and evaluations

"Adult foster care" is a label that has been applied to very diverse programs. Although adult foster care appears to be a potentially important element in the continuum of care for older adults, its assumptions and characteristic features have not been clearly explicated. In this paper, common assumptions underlying adult foster care are suggested, representative adult foster care programs are examined, and persisting issues discussed. The results suggest that, as yet, there is no consensus among practitioners as to what are reasonable goals for adult foster care, who should participate in such programs, and what constitutes evidence of program success. Until these issues are resolved, adult foster care is likely to remain an underutilized form of long term care for older adults.

Determinants of VA utilization. The 1983 survey of aging veterans

By the end of the decade, fully one half of American males aged 65 years and over will be veterans. In anticipation of the increased demand for medical services, the Veterans Administration recently commissioned a survey of the needs of aging veterans. From a national probability sample, approximately 34,500 households were screened to yield interviews with 3,013 veterans aged 55 years and over. Using multivariate regression analyses, the present study employed this data set for two purposes: 1) to identify covariates of past and present service utilization in the VA system, and 2) to identify the conditions under which veterans will declare an intention to use VA services in the future. Independent variables included medical diagnoses, ADLs, demographic and background characteristics, convenience and proximity to VA facilities, alternative forms of insurance coverage, VA eligibility, and attitudes about the quality of VA care. The results suggest markedly different predictors for current use versus likelihood of future use; however, income was related to both current and intended future utilization. The implications of these findings for policy development and utilization projections are discussed.

Isolating age, period, and cohort effects in developmental research. A critical review

Separating age, period, and cohort effects in developmental research is complicated by their linear dependence. Differing approaches have been advanced to address this problem. These approaches generally presume that age, period, and cohort are conceptually discrete entities; that is, they are confounded statistically, but not logically. This article outlines the dilemma, reviews solutions that have been advanced, and critically examines the assumptions on which these solutions are based.