Effects of caregiving on physical health have received less theoretical and empirical attention than effects on psychological health. This meta-analysis integrates results from 176 studies on correlates of caregiver physical health. Caregiver depressive symptoms had stronger associations with physical health than did objective stressors. Higher levels of care recipient behavior problems were more consistently related to poor caregiver health than were care receiver impairment and intensity of caregiving. Higher age, lower socioeconomic status, and lower levels of informal support were related to poorer health. Predictors of physical health are not identical to predictors of psychological health. Associations of caregiving stressors with health were stronger among older samples, dementia caregivers, and men. In sum, negative effects of caregiving on physical health are most likely to be found in psychologically distressed caregivers facing dementia-related stressors.

Correlates of Physical Health of Informal Caregivers: A Meta-Analysis

This meta-analysis integrates results from 229 studies on gender differences in caregiver psychological and physical health, caregiving stressors, and social resources. Contrary to common perceptions, gender differences in caregiving variables were small to very small. Women had higher levels of burden and depression, and lower levels of subjective well-being and physical health. They reported that their care recipient had more behavioral problems; they provided more caregiving hours, helped with more caregiving tasks, and assisted with more personal care. Women and men did not differ in the use of informal and formal support. Statistically controlling for gender differences in stressors and resources reduced the size of gender differences in depression and physical health to levels that have been observed in noncaregiving samples. The results support stress-and-coping theories on gender differences in caregiving.

Gender Differences in Caregiver Stressors, Social Resources, and Health: An Updated Meta-Analysis

Purpose: The goals of this review are to synthesize what is known about caregiving among diverse groups and to identify gaps in knowledge to guide future research on caregiving. The review focuses on conceptual and theoretical approaches, sampling strategies, measurement techniques, and similarities and differences found among groups and across studies. Design and Methods: A narrative approach was used to review 59 articles published between 1980 and 2000, with particular attention to race, ethnicity, and/or culture. Primary sources of relevant articles included electronic databases, other review articles, and reference lists. Results: Caregiving experiences and outcomes varied across racial and ethnic groups. However, the use of nontheoretical approaches, nonprobability samples, and inconsistent measures among studies has limited understanding of caregiving among diverse populations. Implications: It is important that conceptualization and theorizing broaden with increasing numbers of studies that include diverse groups. Future caregiving research needs to give more attention to such issues as acculturation, assimilation, and cultural values, beliefs, and norms, while also improving theoretical and methodological rigor.

Issues of Race, Ethnicity, and Culture in Caregiving Research A 20-Year Review (1980–2000)

https://escholarship.mcgill.ca/downloads/zp38wf40w

The psychological and physical health of family members caring for an elderly person with dementia.

THINKING Young children understand the relation between objects and events in a functional manner, such that the first object is seen to go with or to operate on the second object. Complementarity criteria are an integral component of their thinking. Older children and young adults, by contrast, tend to use similarity criteria. In old age, however, the use of complementarity criteria has been found to increase once again (Reese & Rodeheaver, 1985). The reversal to complementarity in old age is thought to be caused by environmental factors rather than being attributable to changes in competence. Young children as well as the elderly are rarely required to state their thoughts in a specifically prescribed way, and complementary categorization therefore seems more natural, since such categorization groups occur naturally in time and space. Older adults do not neces-

The encyclopedia of aging

A study of 127 informal caregivers of Alzheimer's disease patients in Florida's Tampa Bay area was undertaken to determine the correlates of the five components of burden, as measured by the Cost of Care Index, a multidimensional measure of caregiving burden. Significant relationships between predictor variables and burden components suggest that global scores and measures of burden do not identify specific problem areas relative to the various components of burden.

Components of Burden: Interventive Implications

The reliability of the Functional Assessment Inventory (FAI) was evaluated using a sample of VA domiciliary and nursing home patients. The interobserver and interrater reliability coefficients of the summary rating scales, based on a single assessment, tended to be higher than their test-retest reliability coefficients, based on two independent assessments separated by a modal four-week interval. Validity coefficients, using the OARS instrument ratings as criteria, also based on two independent assessments several weeks apart, were, on the average, as high as the test-retest reliability coefficients. More specifically, the mental health, physical health, and activities of daily living rating scales, along with the objectively scored Short Portable Mental Status Questionnaire and Short Psychiatric Evaluation Schedule, tended to yield relatively similar scores with repeated measurement, while the social resources and economic resources scales were somewhat less stable, a discrepancy possibly explained by the homogeneous nature of the social and economic status of most of the patients (institutionalized veterans). Thus the reliability and validity of the FAI are satisfactory, but the stability of some of its scales requires further investigation.

An Evaluation of the Reliability and Validity of the Functional Assessment Inventory

Systematic multidimensional assessment techniques such as the Functional Assessment Inventory (FAI) are increasingly used with the elderly for outcome measurement, prediction of service needs, and accurate description for comparative purposes. The FAI is a structured interview followed by a rating process which compares patient status against standard descriptive phrases. Patients are assessed in five areas: mental health, physical health, social resources, economic resources, and activities of daily living (ADL). The validity of the FAI was tested by comparing ratings of patient health obtained by a single investigator using only the instrument with ratings obtained by consensus from an interdisciplinary home care team providing long-term care for the patients studied. An excellent level of agreement (weighted kappas from .583 to .780) was found in all areas studied. A single significant difference in ADL rating with a high correlation coefficient (r = .85) was interpreted as due to a difference between the single rater and the team in the definition of ADL. The ease of obtaining summary ratings from clinical personnel suggests that further exploration of this rapid quantification of patient health is warranted.

Validation of the Functional Assessment Inventory Against a Multidisciplinary Home Care Team

A model is presented describing decision processes of a living system at the level of the individual, together with its interpersonal relationship context (organism, subsystems, and suprasystem). The beginning point was the 1977 system dynamics model of Wegman, which was itself characterized by quantitative cross-level hypotheses concerning both physiological and psychological levels of functioning within the individual personality system

The extension process was accomplished by synthesizing concepts from many different theories in personality and social psychology into equations linking two multiple-loop feedback systems to form a suprasystem. Each individual model was found to have several distinct operational modes, and the dyadic model had a number of interesting combinations of these modes which correlated with clinical descriptions of steady-state behavior and subjective experience in human marital dyads. For example, under certain conditions an individual operating in an unstable mode could achieve personal system stability within a dyadic relationship. In some cases, two unstable individuals could form a stable system

The process of extending the original model supports the utility of a synthetic approach to the construction of quantitative theories concerning small social systems. This process also suggests new approaches to planning future empirical research on small social systems using methods more appropriate to the study of complex, dynamic systems.

Systems simulation. Computer simulation of Freud's counterwill theory: Extension to elementary social behavior†

In January of 1987, Suncoast Gerontology Center at the University of South Florida in Tampa, signed a contract with the Department of Health and Rehabilitative Services (HRS) to establish and develop a statewide Registry for patients with Alzheimer's disease and other memory disorders.The realization of the Registry's goals depends on the support and cooperation of all the participating programs. Suncoast Gerontology Center has the responsibility to demonstrate the utility of the data collection by stimulating new research and by enhancing communication and collaboration with service and research institutions throughout Florida.Preliminary results will be presented in this article regarding the sociodemographic characteristics of Registry patients. Also, an attempt will be made to identify risk factors associated with Alzheimer's disease for this group.

Donald M. Keller

Papers

Components of Burden: Interventive Implications

An Evaluation of the Reliability and Validity of the Functional Assessment Inventory

Validation of the Functional Assessment Inventory Against a Multidisciplinary Home Care Team

Systems simulation. Computer simulation of Freud's counterwill theory: Extension to elementary social behavior†

The first year operating experience of the Florida Dementia Registry