Modern Family Evans, Bronwynne C.; Coon, David W.; Belyea, Michael J.
Hispanic journal of behavioral sciences,
11/2015, Letnik:
37, Številka:
4
Journal Article
Recenzirano
This report extends knowledge about the informal caregiving trajectory in Mexican American (MA) families, constituting the second known empirical study of the emerging phenomenon of personal care by ...(MA) sons for their aging mothers, previously reported by our research team. It uses life course perspective (LCP) to compare caregiving patterns over time through case-based comparative-historical methods. “Historical” within-case analysis searches for themes, while “comparative” cross-case analysis allows exploration of themes across multiple cases, enabling examination of eight cases of caregiving MA sons who were currently providing personal care or confronting the imminent need to do so. We used the comparative-historical technique of pattern matching to determine the worth of LCP for exploration of MA family caregiving, test data-derived theoretical propositions, and function as a template for combining multiple methods. Qualitative findings were buttressed in this sub-analysis of a parent study by results from a battery of variable-oriented scales.
Abstract The primary purpose of this study was to examine the synchronous and temporal relations between engagement in activities and the two primary dimensions of affect—namely, positive and ...negative affect—using an intensive time-series design called concomitant time series analysis (CTSA). Twenty-four dementia caregivers completed 56 diary measures (4 times per day for 2 weeks) assessing their experience of positive and negative affect as well as engagement in a variety of activities. Total number of activities was significantly correlated with positive affect ( r = .40), but not negative affect ( r = -.12). Obtained pleasure from activities was significantly correlated with both positive ( r = .42) and negative affect ( r = - .17). These results may help further develop behavioral models of depression by suggesting that behavioral or self-reinforcing activities are associated primarily (or more saliently) with one's experience of positive affect. Future research examining the effect of behavioral interventions on both positive and negative affect is suggested, as is the examination of factors that may be more strongly associated with negative affect.
Family caregivers of older adults with significant cognitive and/or physical impairment are at increased risk for both psychiatric and physical morbidity. This article examines the research ...literature dedicated to the development of effective interventions to reduce distress and enhance well-being for these caregivers. Using a recent empirically based treatment (EBT) review of the literature as a backdrop, 3 overarching types of interventions were described as effective: psychoeducational skill building, psychotherapy (cognitive-behavioral in focus), and multicomponent (using a combination of at least 2 approaches such as education, family meetings, and skill building). Suggestions are made to facilitate future caregiver intervention research and translation of EBTs into the community including the need to expand rigorous research with caregivers of older adults facing problems other than dementia, including older patients with psychiatric problems; develop and test interventions designed for transitions into and out of the caregiving roles, as well as interventions designed to improve physical health outcomes and promote health behaviors; create linkages between interventions at multiple levels of delivery; extend caregiver intervention work with underrepresented ethnic and racial populations; and investigate the cost-effectiveness of caregiver interventions.
Background
Previous research suggests that hypertension shape cognitive health outcomes in older Blacks (Whitfield 2008). However, few studies have explored the relation between objective and ...subjective blood pressure (BP) measures and cognitive decline. This study examined whether systolic, diastolic, and self‐reported BP were associated with changes in cognition.
Method
Data are drawn from the Baltimore Study of Black Aging—Patterns of Cognitive Aging. At baseline, 602 Black participants (48‐95 years) were enrolled. At follow‐up, approximately 3 years later, 450 participants were re‐interviewed. Cognition included 5 domains: working memory, processing speed, verbal memory, vocabulary, and inductive reasoning. Using an oscillometer automated device (A&D model UA‐ 767), three readings of orthostatic BP were collected and mean systolic (SBP; range = 82‐230.3 mmHg) and diastolic BP (DBP; range = 51‐136.7 mmHg) values were calculated for each participant. BP was treated as a continuous variable. Participants were also asked “Have you ever been told by a doctor or nurse that you have high blood pressure? (yes/no response)” Data were analyzed using multiple linear regression, controlling for sociodemographic and health conditions.
Result
Majority of the sample was female (25.4% male) and had at least a high school education (57.1%). Systolic BP was inversely associated with inductive reasoning at follow‐up (b = ‐0.208, p = 0.023; see Table 1), but was not related to any other cognitive domains, after adjusting for age, sex, education, depressive symptoms, comorbidities, diastolic BP, and baseline cognition. Diastolic BP and self‐reported hypertensive status were both unrelated to changes in each of the five cognitive domains (all models, p> 0.05).
Conclusion
The present study adds to our understanding of cognitive aging among older Black Americans. Results support previous research, pointing to an independent effect of BP on domain‐specific cognitive changes (Buford 2016), but also extend the literature by highlighting a more pronounced negative effect of systolic BP. These findings suggest that the pathway to cognitive dysfunction is contributed to by BP. Several key mechanisms – including increased risk for stroke and “vascular dementia” (age‐ and hypertension‐related cerebral vasculature changes) – may explain the influence of hypertension on cognitive decline that warrant further study in Black Americans.
Background
A recent report estimates Latinos in the U.S. living with Alzheimer’s Disease (AD) could reach as high as 3.5 million by 2060 and are 1.5 times more likely to develop AD than non‐Latino ...Whites. Consequently, Latino caregivers of people with Alzheimer’s Disease or other related dementias (ADRD) face significant risks to their physical and mental well‐being. Due to the immense increase of ADRD in Latinos, it is important for research to highlight the ways in which caregivers can learn mindfulness based skills to support challenges they may face.
Method
U.S. Latina caregivers of people with ADRD (n = 18) were analyzed from the CarePRO‐VS program. CarePRO‐VS is a multicomponent skill‐focused intervention conducted in Spanish that manages stress, tension and frustration associated with caregiving. This pilot project was conducted over ten weeks via telephone and Zoom including: (1) screening to determine eligibility, (2) pre‐ and post‐ intervention assessments conducted within approximately two weeks of the intervention, (3) individual “coach calls” and (4) the five‐week CarePRO‐VS program.
Result
By week five, 60% of caregivers used mindful breathing 3 or more times a day. In comparison to week one, only 18.8% of caregivers used mindful breathing 3 or more times a day. As an example of a frequent user, coach call notes showed that one participant in particular self‐reported use of the relaxing techniques every week with an average of 3‐4 times a day. Mindful breathing helped her destress, stay positive, and focus on the present moment. Body scans helped her bring awareness to how she felt during stressful situations involving her father, the care recipient. She also extended the use of mindful breathing to situations beyond caregiving. At five weeks, she used mindful breathing with her father to ease his anxiety.
Conclusion
These Latina caregivers implemented a new strategy that shows promising results and future research can expand on aspects of mindfulness as an equitable and accessible strategy to increase relaxation for caregivers and care recipients. To date, there are few published studies incorporating mindfulness techniques that also included Latino caregivers of people with ADRD in the U.S.
The authors evaluated the efficacy of desipramine-alone, vs. cognitive/behavioral therapy-alone (CBT) vs. a combination of the two, for the treatment of depression in older adult outpatients. ...Patients (N=102) meeting criteria for major depressive disorder were randomly assigned to one of these three treatments for 16 to 20 therapy sessions. All treatments resulted in substantial improvement. In general, the CBT-Alone and Combined groups had similar levels of improvement. In most analyses, the Combined group showed greater improvement than the Desipramine-Alone group, whereas the CBT-Alone group showed only marginally better improvement. The combined therapies were most effective in patients who were more severely depressed, particularly when desipramine was at or above recommended stable dosage levels. The results indicate that psychotherapy can be an effective treatment for older adult outpatients with moderate levels of depression.
A growing literature suggests relationships between erectile dysfunction medications (EDM) and riskier sexual behavior among men who have sex with men (MSM). Questions remain concerning EDM use and ...related HIV/sexually transmitted infections (STI) risk among older MSM, particularly those 40 years and over, for whom EDM may be medically warranted.
This exploratory pilot study explores the relationship between EDM and risky sexual behavior in a convenience sample of MSM using EDM and attending historic sex‐on‐premises venues.
We examined anonymous surveys from 139 MSM. Bivariate relationships were examined. We then fit a multiple logistic regression model to determine predictors of engaging in unprotected anal intercourse (UAI) at last EDM, using variables identified as being significantly related to UAI in the bivariate analyses. Potential predictors entered the model in a stepwise fashion.
The primary outcome measure was engaging in UAI at last EDM use.
MSM participating in the study ranged from 27 to 77 years and averaged 52.0 years (standard deviation = 10.73 years). These participants were primarily older MSM; fewer were younger MSM (12.12%), under age 40. Participants reporting UAI at last EDM use (N = 41) were significantly younger (P < 0.01). Men visiting bars within the last 6 months reported less UAI (P < 0.01). Both variables were independent predictors of UAI in the logistic regression model (P < 0.01).
Similar to reports from younger MSM, our findings suggest older MSM using EDM and reporting UAI are also recreational drug users. We include recommendations for urologists and other sexual medicine physicians treating MSM who may be at elevated risk for HIV/STI infection because of joint EDM and club drug use. Goltz HH, Coon DW, Catania JA, and Latini DM. A pilot study of HIV/STI risk among men having sex with men using erectile dysfunction medications: Challenges and opportunities for sexual medicine physicians. J Sex Med 2012;9:3189–3197.
La familia drives elder care in Mexican–American (MA) families, but nursing home placement can result from day-to-day caregiving demands that increase caregiver difficulty with activities of daily ...living (ADLs). Using life course perspective, this article describes the initial data wave of 31 MA caregivers from a descriptive, longitudinal, mixed-methods study of 110 MA caregivers and care recipients over 15 months in their caregiving trajectories. Fifteen of 31 caregivers consistently indicated “no help needed” on the Katz ADL, whereas all but one reported “help needed” during semistructured interviews with cultural brokers. In addition to the discrepancy between results on the Katz ADL and interviews, findings include consideration of nursing home placement by moderately acculturated caregivers and minimization of their illnesses by caregivers. Additional methods of MA caregiver assessment may be needed due to the questionable accuracy of the Katz ADL; additional research should explore minimization and acculturation in MA caregivers.
A modified version of the Revised Memory and Behavior Problems Checklist (RMBPC;
L. Teri et al., 1992
) was administered across 6 different sites to 1,229 family caregivers of community-dwelling ...adults with dementia. The total sample was divided randomly into 2 subsamples. Principal components analyses on occurrence responses and reaction ratings from the first subsample resulted in a 3-factor solution that closely resembled the originally proposed dimensions (memory-related problems, disruptive behaviors, and depression). Confirmatory factor analyses on data from the second subsample indicated adequate fit for the 3-factor model. Correlations with other caregiver and care-recipient measures supported the convergent and discriminant validity of the RMBPC measures. In addition, female caregivers and White caregivers reported more problems, on average, than male caregivers and African American caregivers, respectively.
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