Background. The participation of informal caregivers in the care of nursing home (NH) residents has the potential to positively impact care, especially for cognitively impaired residents whose own ...ability to advocate for their care is often limited. This study examined relationships between the level of informal caregiver involvement (ICI) in the NH and the degree to which residents' common medical conditions were detected by facility staff. Methods. One hundred pairs of cognitively impaired residents and their primary informal caregivers were enrolled from three facilities in the Baltimore, Maryland area. Data collection involved interviews with informal caregivers and facility staff, as well as a medical evaluation and chart review of residents. A measure of illness detection was created by comparing a medical examination of the resident with chart review information. ICI was measured via staff rating and informal caregiver self-report. Results. Correlations between illness detection and ICI were significant, with r = −.46 (p <.001) and r = −.39 (p <.001), for staff rating and self-reports, respectively. In regression models taking into account resident characteristics (age, race, gender, comorbidities, payment status, duration of stay, and cognitive impairment) and facility differences, higher ICI and being female predicted higher rates of illness detection. Conclusions. Though the cross-sectional nature of the study prevents the analysis of causal relationships, the involvement level of informal caregivers in the NH care of cognitively impaired residents was statistically related to higher rates of illness detection. Ramifications for the role of informal caregivers in long-term care are discussed.
Purpose: Barriers to family involvement in the nursing home with the potential for change through intervention are examined, including transportation, caregiver health, relationships with staff, and ...resident characteristics. Design and Methods: Data were collected for 93 family caregiver–resident pairs by means of telephone interviews and chart review. Regression modeling was used to identify relationships between involvement (caregiver visit frequency) and the changeable barriers after the known variables of distance, kinship, payment source, length of stay, and cognitive function were taken into account. Results: Lower visit frequency was found for caregivers reporting problems with transportation, poor relationships with staff, and a smaller network of supportive family and friends. Higher caregiver anxiety was related to higher visit frequency. Implications: Several barriers to family involvement are shown to be as or more influential than ones identified in previous research, thus providing empirical support for interventions currently used as well as suggesting new areas for intervention.
OBJECTIVE: The authors examined the longitudinal changes in posttraumatic stress disorder (PTSD) symptom levels and prevalence rates over a 4-year time period among American former prisoners of war ...(POWs) from World War II and the Korean War. Retrospective symptom reports by World War II POWs dating back to shortly after repatriation were examined for 1) additional evidence of changing PTSD symptom levels and 2) evidence of PTSD cases with a long-delayed onset. METHOD: PTSD prevalence rates and symptom levels were measured by the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. For the longitudinal portion of the study, participants were 177 community-dwelling World War II and Korean POWs. For the retrospective portion, participants were 244 community-dwelling World War II POWs. RESULTS: PTSD prevalence rates and symptom levels increased significantly over the 4-year measurement interval. Retrospective symptom reports indicated that symptoms were highest shortly after the war, declined for several decades, and increased within the past two decades. Long-delayed onset of PTSD symptoms was rare. Demographic and psychosocial variables were used to characterize participants whose symptoms increased over 4 years and differentiate participants who reported a long-delayed symptom onset. CONCLUSIONS: Both longitudinal and retrospective data support a PTSD symptom pattern of immediate onset and gradual decline, followed by increasing PTSD symptom levels among older survivors of remote trauma.
Recent clinical observations suggest that posttraumatic stress disorder (PTSD) symptom levels may be increasing among older survivors of remote trauma, perhaps in response to age-related factors. ...These issues were investigated in a longitudinal study of community-dwelling former POWs from WWII and the Korean Conflict. PTSD symptom levels and the age-related variables of life events, health changes, social support, and death acceptance were measured. The current study incorporated data collected approximately four years previously on this sample by Engdahl, Eberly, and Blake (1996), including PTSD symptom levels, negative affectivity, and retrospective reports by WWII POWs indicating the time periods since 1946 in which they felt "seriously troubled" by PTSD symptoms. Change in PTSD symptom levels over the four year interval was assessed. Change in PTSD symptom levels also was assessed via the retrospective reports of the respondents dating back to 1946. The retrospective reports of being "seriously troubled" by PTSD symptoms at various time points since 1946 also were coded into seven symptom course trajectories, which were then evaluated for evidence of the phenomenon of long-delayed onset of PTSD. The relations of current symptom levels and symptom level change to the age-related variables also were examined. The personality factor negative affectivity was controlled for in the latter analysis, to rule out the possibility that a long-standing personality trait, and not age-related socioenvironmental factors, could account for PTSD symptom level change over time. The results indicated that symptom levels had increased significantly over the interval between the current and initial study. Retrospective symptom level reports indicated that symptom levels were highest shortly after the war, declined for several decades, and began to increase within the past two decades. Symptom course trajectory data did not provide evidence for a pattern of long-delayed onset of PTSD symptoms. The age-related variables of social support, death acceptance, and health changes, but not negative life events, were related to current PTSD symptom levels and change in symptom levels. Negative affectivity was not predictive of change in symptom levels. Clinical implications are discussed.
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