Showing papers in "Gerontologist in 1995"
TL;DR: Across studies, psychiatric morbidity in caregivers was linked to patient problem behaviors, income, self-rated health, perceived stress, and life satisfaction, and physical morbidity was associated with patient Problem behaviors and cognitive impairment, and with caregiver depression, anxiety, and perceived social support.
Abstract: The dementia caregiving literature is reviewed with the goals of (a) assessing the prevalence and magnitude of psychiatric and physical morbidity effects among caregivers, (b) identifying individual and contextual correlates of reported health effects and their underlying causes, and (c) examining the policy relevance of observed findings. Virtually all studies report elevated levels of depressive symptomatology among caregivers, and those using diagnostic interviews report high rates of clinical depression and anxiety. The evidence is more equivocal and generally weaker for the association between caregiving and physical morbidity, such as self-rated health, number of illnesses, symptomatology, health care utilization, preventive health behaviors, and cardiovascular functioning. Across studies, psychiatric morbidity in caregivers was linked to patient problem behaviors, income, self-rated health, perceived stress, and life satisfaction. Physical morbidity was associated with patient problem behaviors and cognitive impairment, and with caregiver depression, anxiety, and perceived social support. Possible causes of reported effects and policy implications are discussed.
1,781 citations
TL;DR: The process of testing the reliability of the MDS items in 13 nursing homes in five states demonstrates that MDS data gathered in a research effort attain reliabilities that make such data useful.
Abstract: The MDS is a core set of items, definitions, and response categories used to assess all of the nation's 1.5 million nursing home residents who reside in facilities participating in the Medicare or Medicaid programs. Further, the Health Care Financing Administration (HCFA) has proposed a rule that would require facilities to computerize MDS data and submit it to state and federal agencies, paving the way for a national database. This article describes the process of testing the reliability of the MDS items in 13 nursing homes in five states. The results demonstrate that MDS data gathered in a research effort attain reliabilities that make such data useful. MDS items met a standard for excellent reliability (i.e., intraclass correlation of .7 or higher) in key areas of functional status, such as cognition, ADLs, continence, and diagnoses. Sixty-three percent of the items achieved reliability coefficients of .6 or higher. Eighty-nine percent of the items in the MDS achieved .4 or higher.
760 citations
TL;DR: It is suggested that enhancing long-term social support can have a significant impact on depression in caregivers.
Abstract: Caregivers of Alzheimer's disease patients often suffer from depression. Using a longitudinal treatment/control study, we examined the effects of a comprehensive support program on depression in spouse-caregivers. This psychosocial intervention program treats the primary caregiver and family members over the entire course of the disease through individual and family counseling, the continuous availability of ad hoc counseling, and support group participation. In the first year after intake, the control group became increasingly more depressed, whereas the treatment group remained stable. By the eighth month, treated caregivers were significantly less depressed than those in the control group. These results suggest that enhancing long-term social support can have a significant impact on depression in caregivers.
390 citations
TL;DR: Factor analysis and cross-validation of measures of affection, repayment, family harmony, respect, obligation, and sacrifice revealed two important factors--behaviorally oriented and emotionally oriented filial piety.
Abstract: Using survey data on 1,227 adult and pre-adult children in Korea, we identified some specific measures and dimensions of filial piety, a traditional East Asian value to respect and care for parents. Factor analysis and cross-validation of measures of affection, repayment, family harmony, respect, obligation, and sacrifice revealed two important factors--behaviorally oriented and emotionally oriented filial piety. These findings suggest that filial piety is two-dimensional, and that multiple indicators should be used to separately assess the behavioral and emotional components of modern-day filial piety.
226 citations
TL;DR: This study uses data from the 1988 National Children's Health Supplement to the National Health Interview Survey to examine the health and school adjustment of children raised solely by grandparents.
Abstract: This study uses data from the 1988 National Children's Health Supplement (N = 17,110) to the National Health Interview Survey to examine the health and school adjustment of children raised solely by grandparents. We find that these children fare quite well relative to children in families with one biological parent present, a category which includes both single-parent and blended families. Furthermore, children raised solely by grandparents are not significantly different, except for academic performance, from children raised in traditional families where two biological parents are present.
180 citations
TL;DR: Investigating gender differences in caregiving tasks, role strains, and resources to account for gender variations in burden suggests that these differences may partially explain the greater negative impact experienced by nonspousal, female caregivers.
Abstract: This study investigated gender differences in caregiving tasks, role strains, and resources to account for gender variations in burden among a probability sample of employed, nonspousal caregivers (N = 413). Females were more likely to assist with care provision tasks, to report work role strains, and to experience higher levels of burden than males. After controlling for known sociodemographic dissimilarities in predicting burden, the effect of gender decreased at each step when caregiver tasks, work role strains, and resources were entered into the regression equation. Results suggest that these differences may partially explain the greater negative impact experienced by nonspousal, female caregivers.
179 citations
TL;DR: It is argued that ageism is a set of oppressive social relations directed at and constructed in images of the aged body, and that the work of feminist and postmodern theorists must avoid essentialism, be sensitive to historical and geographical variations in the form of ageism, focus on the contested nature of theaged body and associated identities, and reject attempts at universalizing scholarship.
Abstract: I argue that ageism is a set of oppressive social relations directed at and constructed in images of the aged body. Drawing from feminist and postmodern theorists I suggest that we must avoid essentialism, be sensitive to historical and geographical variations in the form of ageism, focus on the contested nature of the aged body and associated identities, and reject attempts at universalizing scholarship. I suggest that our work focus on five sites of struggle around ageist identities: the labor force, the household, popular culture, the state, and the built environment, each of which is involved in the construction and reconstruction of the aged body.
167 citations
TL;DR: Data on a comprehensive range of social support measures provided by a nationwide sample of elderly people suggests that social class differences emerge when measures of contact with friends, support provided to others, and satisfaction with support are examined, but significant differences fail to emerge.
Abstract: The purpose of this study is to test for social class differences in social support among older adults. Data on a comprehensive range of social support measures provided by a nationwide sample of elderly people suggests that social class differences emerge when measures of contact with friends, support provided to others, and satisfaction with support are examined. However, significant differences fail to emerge with indicators of contact with family, support received from others, and negative interaction.
166 citations
TL;DR: Severity was significantly associated with health and well-being for spouses, offspring, and in-laws, regardless of the amount of caregiving, demonstrating the potential cascading effect of the illness through the family.
Abstract: Examined is the impact of dementia on the physical and mental health of all family members caring for an ill parent/spouse. The sample included 97 spouses of patients diagnosed with either Alzheimer's disease or vascular dementia, 186 offspring, and 97 offspring spouses or "in-laws." Multiple regression tested the association between severity of the illness and family member health and well-being. Severity was significantly associated with health and well-being for spouses, offspring, and in-laws, regardless of the amount of caregiving, demonstrating the potential cascading effect of the illness through the family. Use of services displayed no direct association with spouse health and well-being, but service utilization interacted with illness severity. The relationship between severity of illness and spouse health was lower under conditions of high service utilization than under conditions of low service utilization.
135 citations
TL;DR: Correlation coefficients indicate that statistically significant interrater reliability between the three categories of nursing personnel and the dentist was established, suggesting that nursing staff can be taught to evaluate the oral health of residents.
Abstract: This article presents data from the development and testing of an instrument to evaluate the oral health of nursing home residents by nursing personnel (RNs, LVNs, and CNAs). After the instrument was developed, nursing staff were taught to do a brief oral health status examination (BOHSE). Using the instrument, a dentist examined 100 residents; the examination was repeated on the same residents by each category of nurse examiners. Correlation coefficients indicate that statistically significant interrater reliability between the three categories of nursing personnel and the dentist was established, suggesting that nursing staff can be taught to evaluate the oral health of residents. Replication of the study in multiple sites is recommended.
133 citations
TL;DR: Daughters experienced higher levels of emotional strain than did sons and perceived interference between caregiving and the caregiver's personal and social life predicted emotional strain for both sons and daughters.
Abstract: This research examines the impact of various factors on perceived emotional strain of adult son and daughter caregivers of frail elderly parents. Daughters experienced higher levels of emotional strain than did sons. Perceived interference between caregiving and the caregiver's personal and social life predicted emotional strain for both sons and daughters. For daughters the most important predictors of emotional strain were interference with work and quality of relationship with the parent. For sons the most important predictors were behavioral problems of the parent and few informal helpers.
TL;DR: A pattern of deficits in color discrimination, stereoacuity, contrast sensitivity, and backward masking that differs from that seen in healthy elderly individuals is found.
Abstract: In order to assess vision in Alzheimer's disease (AD) and related disorders, gerontologists must use tests that make minimal cognitive demands on the subject. Using such tests, we have found a pattern of deficits in color discrimination, stereoacuity, contrast sensitivity, and backward masking that differs from that seen in healthy elderly individuals. Impaired vision predicts deficient performance of subjects with AD on numerous tests of cognition, underscoring the importance of understanding visual changes in this population.
TL;DR: When added to traditional models predicting subsequent mortality, nursing home placement, hospital resource consumption, and changes in functional status, the four markers of physical activity and exercise have numerous statistically and substantively significant associations, all of which involve better health outcomes.
Abstract: The antecedents and consequences of four markers of physical activity and exercise are examined for the 6,780 baseline self-respondents to the Longitudinal Study on Aging. These dichotomous markers reflect having a level of physical activity greater than one's peers (45.8%), getting as much exercise as needed (58.9%), having a regular exercise routine (28.4%), and walking a mile or more at least once a week (29.9%). The major factors associated with engaging in these behaviors are having fewer lower body limitations, better perceived health, more non-kin social supports, not worrying about one's health, and having a sense of control over one's health. When added to traditional models predicting subsequent (over the next 6 to 8 years) mortality, nursing home placement, hospital resource consumption, and changes in functional status, the four markers of physical activity and exercise have numerous statistically and substantively significant associations, all of which involve better health outcomes.
TL;DR: The size of the total caregiver network and the unpaid network did not differ by race, but the likelihood of there being a non-immediate family member among unpaid caregivers was higher among disabled older blacks.
Abstract: This study investigated whether there are race differences in the structure of informal caregiving networks. Data on 3,793 functionally impaired persons age 65 and over from the 1989 National Long-Term Care Survey were analyzed. The size of the total caregiver network and the unpaid network did not differ by race, but the likelihood of there being a non-immediate family member among unpaid caregivers was higher among disabled older blacks. These findings raise questions about whether race differences in nursing home utilization and paid long-term care services, documented in other studies, can be explained by differences in caregiving arrangements.
TL;DR: Using data from Americans' Changing Lives: Wave 1, 1986, this study examined the long-term effects on the personal functioning of older women and men following the death of an adult child or a spouse.
Abstract: Using data from Americans' Changing Lives: Wave 1, 1986, this study examined the long-term effects on the personal functioning of older women and men following the death of an adult child or a spouse. Guided by Weiss's (1993) theoretical framework, 41 bereaved parents and 143 bereaved spouses were compared to 407 nonbereaved adults on measures of perceived health, self-efficacy, depression, life satisfaction, and future orientation. Analyses revealed bereavement and gender effects and a consistent influence of the sociodemographic characteristics of education, income, and duration of bereavement on functioning.
TL;DR: Those with 8 or fewer years of education were found to be less active than those with 9 or more, despite having controlled for educational differences in income, health compared to one year ago, functional status, body mass, and chronic disease.
Abstract: This study utilized a nationally representative sample of older adults to investigate the association of race and education with five different measures of self-reported physical activity. Rates of physical activity were low among white Americans and even lower among African Americans. However, a majority of the racial variation in activity was accounted for by racial differences in educational attainment. Those with 8 or fewer years of education were found to be less active than those with 9 or more, despite having controlled for educational differences in income, health compared to one year ago, functional status, body mass, and chronic disease. Discussion focuses on self-efficacy and social and cultural contexts.
TL;DR: Both hours and type of care by the primary caregiver were independent of size, scope, and composition of the secondary helper network, which suggests that efforts to alter the secondary caregiver network may have limited effects on thePrimary caregiver.
Abstract: The informal care networks of 242 impaired older people were examined in terms of the primary caregiver and secondary helpers. Most primary caregivers had at least one secondary helper; 88% identified helpers who provided hands-on help, 19% reported that helpers contributed financially, and 44% had helpers involved in care decisions. The size of the network was larger for direct care compared to financial or decision-making assistance. Almost half of primary caregivers reported that their spouse helped. It was expected that after controlling for characteristics of the primary caregiver and of the older person, that characteristics of the secondary caregiver network would influence the amount and type of primary caregiver assistance and formal care used by the older person. However, both hours and type of care by the primary caregiver were independent of size, scope, and composition of the secondary helper network. This independence suggests that efforts to alter the secondary caregiver network may have limited effects on the primary caregiver.
TL;DR: Using a continuity theory perspective (Atchley, 1989), propositions are generated which may facilitate reminiscence research across the life span and are used as a foundation for the creation of seven propositions.
Abstract: The goal of this article is to provide theoretical underpinnings for reminiscence by reviewing and evaluating previous research, and integrating it within a theoretical framework. Using a continuity theory perspective (Atchley, 1989), propositions are generated which may facilitate reminiscence research across the life span. Three global functions of reminiscence are derived from continuity theory (private, social, and cognitive functions) and are used as a foundation for the creation of seven propositions.
TL;DR: Results indicate that well-being is influenced by social activity, whereas solitary and physical activity have minimal impact and suggests that elders with arthritis need not remove themselves from the pursuit of activity and should be encouraged to develop new interests when physical functioning fails.
Abstract: This study tests the hypotheses that (a) severity of arthritis is inversely associated with frequency of activity participation, and (b) arthritis sufferers who maintain higher levels of participation, particularly in activities which are social in nature, are less likely to experience a decline in well-being. Three activity types are considered: social, physical, and solitary. Results indicate that well-being is influenced by social activity, whereas solitary and physical activity have minimal impact. This suggests that elders with arthritis need not remove themselves from the pursuit of activity and should be encouraged to develop new interests when physical functioning fails. The study also demonstrates the utility of considering activity as multidimensional.
TL;DR: Elderly nursing home residents with an elevated risk of hospitalization for residents with one of several different primary diagnoses and a rise in risk as ADL dependence increases are identified.
Abstract: Little national data have been available to guide the design of programs aimed at reducing the hospitalization of nursing home residents. This article uses the 1987 National Medical Expenditure Survey to identify elderly nursing home residents with an elevated risk of hospitalization and the reasons for and outcomes of residents' hospital stays. Study findings include an elevated risk of hospitalization for residents with one of several different primary diagnoses and a rise in risk as ADL dependence increases. An infection was the main medical reason for roughly 27% of hospital stays. The results suggest possible target groups for two types of programs aimed at reducing hospitalization.
TL;DR: A conceptual framework for organizing discussions of quality of life for elderly persons with disabilities is outlined, relevant empirical research is reviewed, and a framework for understanding the different dimensions and interpretations of this concept is developed.
Abstract: Two major forces are changing the shape of health care for the frail elderly with disabling conditions: increasing emphasis on quality of life and growing reliance on an interprofessional team-based approach to care. This article outlines a conceptual framework for organizing discussions of quality of life for elderly persons with disabilities, reviews relevant empirical research, and develops a framework for understanding the different dimensions and interpretations of this concept--particularly as it is used in communication among health care providers, and between them and their elderly patients and families. New models of health care to enhance the focus on life quality and collaborative team practice are summarized. Proposed is the development of an "empowering and reflective ethic" to achieve more effective communication about quality of life in geriatric clinical practice.
TL;DR: The present descriptive study documents the growth and development of the first seven replications of the On Lok model operating under dual capitation payments as sites in the Program of All-inclusive Care for the Elderly (PACE).
Abstract: As of mid-1994 there were nine replications of the On Lok model operating under dual capitation payments as sites in the Program of All-inclusive Care for the Elderly (PACE) A tenth site had begun operating under capitation, but was unable to remain viable The present descriptive study documents the growth and development of the first seven of these sites, all that had been operating under capitation during 1992 Comparisons among these sites and with On Lok are presented in the areas of organizational structure, client characteristics, approaches to case management, service delivery options, and financing There is considerable variability in the implementation of the PACE model Combined Medicare and Medicaid capitation monthly payments range from $2,147 to $5,973 These seven PACE sites (excluding On Lok) served a total of 888 current clients at the end of 1992, after a cumulative 136 months of experience under capitation The very slow enrollment rates may imply that the target clients are less enthusiastic about this model than are its architects The client selection process may suggest niche-marketing or skimming, but not the full representation of the nursing home population in their states Given both the slow enrollment and the niche-marketing (the benevolent term) or skimming (the pejorative term) that has occurred, caution about the long-term viability of the PACE model may be warranted
TL;DR: 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, and results indicate a significant negative relationship.
Abstract: 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.
TL;DR: The role of caregiving daughters' marital status is examined as it relates to their sharing households with disabled elderly parents, with separated/divorced daughters the most likely to mention finances.
Abstract: The role of caregiving daughters' marital status is examined as it relates to their sharing households with disabled elderly parents. Married daughters fared best in well-being, income, and social support. Never-married women were the most likely to have never moved out of the parental home. Separated/divorced caregivers, more than the married and widowed, had moved into the parent's home rather than the reverse and widowed daughters had lived in re-formed joint households longest. The main reason for re-forming shared households was disability of the parent. Among other reasons were death or withdrawal of previous caregiver and financial problems, with separated/divorced daughters the most likely to mention finances.
TL;DR: Asian Pacific Islander (API) elderly represent the fastest growing group of ethnic elderly in the United States, yet their social and health needs remain little understood in the field of ethnogerontology.
Abstract: Asian Pacific Islander (API) elderly represent the fastest growing group of ethnic elderly in the United States, yet their social and health needs remain little understood in the field of ethnogerontology. Existing literature generally portrays API elderly as in equal or better health compared to whites. However, aggregate API data cloud the bimodal distribution in socioeconomic and health status. We review existing literature on API elderly, and examine selected national data to illustrate the effects of a bimodal distribution on our understanding of API elderly socioeconomic and health status. Implications for research and policy are discussed.
TL;DR: Using a modified version of the behavioral model, hierarchical methods are used to sequentially introduce the predisposing and enabling characteristics, disease history, disabilities and functional limitations, perceived health, and health services utilization both at and after baseline.
Abstract: Mortality risks over an 8-year period are assessed among the 7,527 older adults interviewed as part of the Longitudinal Study on Aging. Using a modified version of the behavioral model, hierarchical methods are used to sequentially introduce the predisposing and enabling characteristics, disease history, disabilities and functional limitations, perceived health, and health services utilization both at and after baseline. Based on their partial r statistics (shown in parentheses), the proportional hazard analyses identify the mean annual number of hospital episodes after baseline (.13), age (.07), female gender (-.05), non-kin social supports (-.03), body mass (-.03), and having a history of diabetes (.03) as the six most salient predictors. These six variables account for 80% of the overall model fit.
TL;DR: Examination of the relationship between resident characteristics and time participating in activities in nursing homes found measures of resource use, cognitive abilities, depression, sense of initiative/involvement, activity repertoire, location preferences, and gender all to be significant in explaining the amount of activity time.
Abstract: Nursing homes are mandated by the Omnibus Budget Reconciliation Act (OBRA) to provide activity programs (US Congress, 1987) Little information exists, however, as to residents' participation in activity programs Using data from a Health Care Financing Administration project, the present study examines the relationship between resident characteristics and time participating in activities Among 2,672 nursing home residents we found measures of resource use, cognitive abilities, depression, sense of initiative/involvement, activity repertoire, location preferences, and gender all to be significant in explaining the amount of activity time
TL;DR: Using The Longitudinal Study of Aging, the independent effects of nine self-reported medical conditions on the likelihood of developing specific instrumental activities of daily living disabilities at three points in time are determined.
Abstract: Using The Longitudinal Study of Aging, we determined the independent effects of nine self-reported medical conditions on the likelihood of developing specific instrumental activities of daily living (IADLs) disabilities at three points in time. We controlled for demographic factors and self-reported health status. The various medical conditions differentially affect each specific IADL disability, and each IADL disability has its own set of predictors which, in general, do not vary over time. The differential effects of thse predictors need to be taken into consideration by researchers, clinicians, and policymakers when studying disability and when implementing and evaluating programs to reduce disability.
TL;DR: For most elders, even the cost of a complete substitution of informal care for formal services, plus living expenses, was less costly than nursing home care.
Abstract: This article describes the total cost of care, including both informal caregiving and formal services for a cohort of disabled elderly living in the community. The cost of informal caregiving hours was calculated using a market value approach. The total annual cost of caring was estimated to be $9,600. Increased disability was associated with increased costs. High-cost elders were more likely to be severely disabled, live with their caregiver, and become institutionalized. For most elders, even the cost of a complete substitution of informal care for formal services, plus living expenses, was less costly than nursing home care.
TL;DR: A modified version of Holtzman, Beck, and Kerber's (1979) four-factor model proved to be the "best" comparative fit based upon a consensus of fit indices.
Abstract: The Aging Semantic Differential (ASD), which is used to measure attitudes and quantify bias and negative stereotypes toward older people, is a 32-item scale published more than 20 years ago (Rosencranz & McNevin, 1969). Several factor analytic studies failed to replicate the original three-factor structure. Confirmatory factor analyses (CFA) using 100 third-year medical students compared six-factor models derived from the gerontological literature. A modified version of Holtzman, Beck, and Kerber's (1979) four-factor model proved to be the "best" comparative fit based upon a consensus of fit indices.