Caregivers often prioritize the needs of the care recipient and neglect their own health needs. It is imperative to understand the factors related to their self-care practices and engagement in ...self-care activities. The present study examined the extent to which dementia caregivers engaged in self-care activities, how this varied depending on caregiver characteristics, and whether self-care engagement mediated the relationship between social support and caregiver outcomes. The study utilized baseline data from a diverse sample of dementia caregivers (N = 243) who participated in a randomized trial evaluating a psychosocial technology-based caregiver intervention. Results showed that the dementia caregivers engaged in low levels of self-care activities and that their engagement varied based on the caregivers' background characteristics (age, gender, race/ethnicity, relationship to the care recipient, and employment status). Less caregiver involvement (e.g., less ADL/IADL help provided and more caregiver preparedness) and more social support predicted higher self-care activity engagement. Self-care activity engagement served as a mediator, such that more social support predicted more self-care activities, which, in turn, were associated with more positive perceptions of caregiving and less caregiver burden and depression. The findings suggest a need for interventions that promote self-care engagement among dementia caregivers and underscore the importance of social support and caregiver preparedness to caregivers' well-being.
Abstract
Background and Objectives
Elder mistreatment affects at least 1 in 10 older adults. Financial abuse, or exploitation, of older adults is among the most commonly reported forms of abuse. Few ...validated measures exist to measure this construct. We aim to present a new psychometrically validated measure of financial abuse of older adults.
Research Design and Methods
Classical test theory and item response theory (IRT) methodologies were used to examine a five-item measure of financial abuse of older adults, administered as part of the New York State Elder Mistreatment Survey.
Results
Factor analysis revealed a single factor best fits the data, which we labeled as financial abuse. Moreover, IRT analyses revealed that these items discriminated well between abused and nonabused persons and provided information at high levels of the latent trait θ, as is expected in cases of abuse.
Discussion and Implications
The Five-Item Victimization of Exploitation Scale has acceptable psychometric properties and has been used successfully in large-scale survey research. We recommend this measure as an indicator of financial abuse in elder abuse, or mistreatment prevalence research studies.
This study evaluated the effectiveness of a technology-based psychoeducational intervention for family caregivers of dementia patients. An additional objective was to determine if the intervention ...could be implemented by a community-based social service agency.
Forty-six caregivers were randomly assigned to either a technology-based intervention or an information-only control condition.
Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidenced high depression at baseline experienced a significant decline in depression.
This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers.
Objectives: Exposure to suffering of a relative or friend increases the risk for psychological and physical morbidity. However, little is known about the mechanisms that account for this effect. We ...test a theoretical model that identifies intrusive thoughts as a mediator of the relation between perceived physical and psychological suffering of the care recipient and caregiver depression. We also assess the role of compassion as a moderator of the relation between perceived suffering and intrusive thoughts.
Methods: Hispanic and African American caregivers (N = 108) of persons with dementia were assessed three times within a one-year period. Using multilevel modeling, we assessed the mediating role of intrusive thoughts in the relation between perceived physical and psychological suffering and CG depression, and we tested moderated mediation to assess the role of caregiver compassion in the relation between perceived suffering and intrusive thoughts.
Results: The effects of perceived physical suffering on depression were completely mediated through intrusive thoughts, and compassion moderated the relation between physical suffering and intrusive thoughts. Caregivers who had greater compassion reported more intrusive thoughts even when perceived physical suffering of the CR was low. For perceived psychological suffering, the effects of suffering on depression were partially mediated through intrusive thoughts.
Discussion: Understanding the role of intrusive thoughts and compassion in familial relationships provides new insights into mechanisms driving caregiver well-being and presents new opportunities for intervention.
Today's elders may be healthier than their age cohorts from previous generations, but they often have multiple chronic diseases. Healthcare technology applications hold great promise for allowing ...older adults to manage their own health and age in place at home. But only 47 percent of older adults use the Internet, especially those in that percentage having lower levels of education and income. Barriers against technology adoption that need addressing are cost, accessibility, training, usability, technical support, and privacy and data management. There needs to be greater interaction between designers and users to foster more widespread technology use.
The use of the internet as a source of health information and link to healthcare services has raised concerns about the ability of consumers, especially vulnerable populations such as older adults, ...to access these applications. This study examined the influence of training on the ability of adults (aged 45+ years) to use the Medicare.gov website to solve problems related to health management. The influence of computer experience and cognitive abilities on performance was also examined.
Seventy-one participants, aged 47-92, were randomized into a Multimedia training, Unimodal training, or Cold Start condition and completed three healthcare management problems. MEASUREMENT AND ANALYSES: Computer/internet experience was measured via questionnaire, and cognitive abilities were assessed using standard neuropsychological tests. Performance metrics included measures of navigation, accuracy and efficiency. Data were analyzed using analysis of variance, χ(2) and regression techniques.
The data indicate that there was no difference among the three conditions on measures of accuracy, efficiency, or navigation. However, results of the regression analyses showed that, overall, people who received training performed better on the tasks, as evidenced by greater accuracy and efficiency. Performance was also significantly influenced by prior computer experience and cognitive abilities. Participants with more computer experience and higher cognitive abilities performed better.
The findings indicate that training, experience, and abilities are important when using complex health websites. However, training alone is not sufficient. The complexity of web content needs to be considered to ensure successful use of these websites by those with lower abilities.
The unique features of technological applications may improve the treatment of people at risk of suicide. In this article, we present feasibility and acceptability data as well as two case studies ...demonstrating the use of WellPATH, a tablet app that aims to help suicidal patients during emotionally-charged situations outside of therapy sessions. The WellPATH app was part of a 12-week psychotherapy intervention (CRISP - Cognitive Reappraisal Intervention for Suicide Prevention) for middle-aged and older adults after their discharge from a suicide-related hospitalization.
The use of WellPATH includes three stages: preparation and practice, incorporation, and actual use.
Feasibility was measured by the overall use of WellPATH during 12 weeks, and acceptability was measured with the three items of the Client Satisfaction Questionnaire.
Twelve study participants were administered WellPATH as part of CRISP. The results provide preliminary evidence of feasibility and acceptability of WellPATH. Study participants and therapists reported high satisfaction with WellPATH and provided feedback for future research and development. The patients in the case studies reported a reduction in negative emotions and an increase in emotion regulation (i.e., cognitive reappraisal ability) after using techniques on the WellPATH app.
Our preliminary findings suggest that use of technology applications such as the WellPATH app is feasible and accepted among middle-aged and older adults at high suicide risk. Further research with an adequately powered sample is needed to further evaluate WellPATH's feasibility and accessibility, and test its efficacy with this high-risk population.
Placing a relative with dementia into a long-term care facility is common among caregivers. Placement transition and factors that affect caregiver health and well-being after placement of the patient ...are not well described.
To assess the impact of placing a relative with dementia in a long-term care facility on caregivers' health and well-being.
Prospective study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites. A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period. Data collected before and after placement were analyzed to identify factors associated with placement, the nature of contact between caregivers and their institutionalized relatives after placement, and the relation of both of these factors to health outcomes among dementia caregivers.
Caregiver depression (symptoms on the Center for Epidemiological Studies-Depression CES-D scale; range, 0-60) and anxiety (State Trait Inventory; range, 10-40) and use of prescription medications for depression and anxiety.
Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers. Overall CES-D scores for depression did not change from before to after placement (median IQR, 15.0 8-24.5 and 15.0 7.7-28; P =.64). Overall anxiety scores on the State Trait Inventory also did not change significantly (median IQR, 22.0 19-27 before vs 21.1 18-27 after; P =.21). These effects were most pronounced among caregivers who were married to the patient (P =.02 for depression), visited more frequently (P =.01 for depression and P<.001 for anxiety), and were less satisfied with the help they received from others (P =.003 for depression and P<.001 for anxiety). The use of antidepressants did not change significantly before (21.1%) to after (17.9%) placement (P =.16). The use of anxiolytics before to after placement increased from 14.6% to 19% (P =.02), and nearly half of caregivers (48.3%) were at risk for clinical depression following placement of their relative.
The transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals.
Caring for a family member with dementia is extremely stressful, contributes to psychiatric and physical illness among caregivers, and increases the risk for caregiver death. Finding better ways to ...support family caregivers is a major public health challenge.
To test the effects of a structured multicomponent intervention on quality of life and clinical depression in caregivers and on rates of institutional placement of care recipients in 3 diverse racial or ethnic groups.
Randomized, controlled trial.
In-home caregivers in 5 U.S. cities.
212 Hispanic or Latino, 219 white or Caucasian, and 211 black or African-American caregivers and their care recipients with Alzheimer disease or related disorders.
Caregivers within each racial or ethnic group were randomly assigned to an intervention or to a control group. The intervention addressed caregiver depression, burden, self-care, and social support and care recipient problem behaviors through 12 in-home and telephone sessions over 6 months. Caregivers in the control group received 2 brief "check-in" telephone calls during the 6-month intervention.
The primary outcome was a quality-of-life indicator comprising measures of 6-month caregiver depression, burden, self-care, and social support and care recipient problem behaviors. Secondary outcomes were caregiver clinical depression and institutional placement of the care recipient at 6 months.
Hispanic or Latino and white or Caucasian caregivers in the intervention group experienced significantly greater improvement in quality of life than those in the control group (P < 0.001 and P = 0.037, respectively). Black or African-American spouse caregivers also improved significantly more (P = 0.003). Prevalence of clinical depression was lower among caregivers in the intervention group (12.6% vs. 22.7%; P = 0.001). There were no statistically significant differences in institutionalization at 6 months.
The study used only a single 6-month follow-up assessment, combined heterogeneous cultures and ethnicities into a single group, and excluded some ethnic groups.
A structured multicomponent intervention adapted to individual risk profiles can increase the quality of life of ethnically diverse dementia caregivers. ClinicalTrials.gov identifier: NCT00177489.
Post-exertional malaise (PEM) is often considered a cardinal symptom of Chronic Fatigue Syndrome (CFS). There is no gold standard diagnostic method for CFS, however, and the Centers for Disease ...Control (CDC) Fukuda case definition does not require PEM. Research has identified differences in symptom burden between patients according to PEM, but whether it is associated with psychological distress has not been investigated.
The CDC CFS Inventory, Fatigue Symptom Inventory, Profile of Mood States, Center for Epidemiologic Studies Depression Scale, Perceived Stress Scale, and subscales of the Sickness Impact Profile were administered to 261 patients diagnosed with the Fukuda criteria. PEM status (loPEM/hiPEM) was determined via self-reported post-exertional fatigue severity. Analyses of covariance (ANCOVA), controlling for age and gender, assessed cross-sectional group differences, and cross-sectional linear regressions using the continuous PEM severity predictor paralleled these analyses.
hiPEM patients reported greater symptom intensity, frequency, and interference than loPEM counterparts (p's < .001). hiPEM patients also reported greater social disruption, depressive symptoms, and mood disturbance (p's ≤ .011). Groups did not differ in recent negative life experiences, perceived stress, or demographic variables. The results of regression analyses mirrored those of ANCOVAs.
This study replicates the association between PEM and symptom burden and additionally associates PEM with psychological distress; psychological distress could, however, be a consequence of symptom burden. Differences between hiPEM and loPEM CFS patients highlight the heterogeneity of diagnoses resulting from the Fukuda criteria. It is also possible that PEM identifies particularly distressed patients for whom psychological intervention would be most beneficial.
•Patients high in PEM endorse greater symptom burden than those low in PEM.•Patients high in PEM endorse greater psychological adversity than those low in PEM.•Results suggest the Fukuda case definition does not define a heterogeneous group.•PEM may identify patients who would most benefit from psychological intervention.
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